Abstract
Upper gastrointestinal surveillance is recommended for patients with familial adenomatous polyposis (FAP) who develop multiple duodenal adenomas as well as colonic adenomas. It is more than three decades since the St. Mark’s Hospital group, London published a scoring system for duodenal polyposis in FAP, the “Spigelman classification” [1]. The classification groups patients into stages from 0 to IV based on the number, size, and pathology (villosity and grade of dysplasia) of polyps, including biopsies from the duodenal ampulla and peri-ampullary area. The relevance of this system for assessing risk was demonstrated in a subsequent study where the risk over a 10-year period of duodenal cancer was only 2 %–3 % in patients with initial scores II and III, but reached 36 % at stage IV [2].
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