Upper Gastrointestinal Screening of Polyp Load in Children With Familial Adenomatous Polyposis: Is It Required?
Thomas Middleton1, Ian Sugarman2
1From the Sheffield Children's Hospital.
Insights
Young patients with familial adenomatous polyposis (FAP) develop upper gastrointestinal (GI) polyps early. Early upper GI screening alongside colonoscopy is recommended for pediatric and young adult FAP patients.
Area of Science:
- Gastroenterology
- Pediatric Oncology
- Genetics
Background:
- Familial adenomatous polyposis (FAP) patients are prone to upper gastrointestinal (GI) polyps with malignant potential.
- Current international guidelines recommend initiating upper GI screening in FAP patients in their twenties.
- Early development of upper GI polyps in FAP patients suggests current screening recommendations may be delayed.
Purpose of the Study:
- To evaluate the incidence and characteristics of upper GI polyps in pediatric and young adult FAP patients.
- To determine if upper GI polyps in this demographic occur earlier than current screening guidelines suggest.
- To advocate for earlier upper GI screening in FAP patients.
Main Methods:
- A prospective study was conducted over 12 years, recording all upper GI endoscopies in FAP patients aged 9-17.
- Data collected included polyp location, histology, and treatment.
- 48 esophagogastroduodenoscopies were performed on 28 patients.
Main Results:
- 79% of patients (22/28) had gastric or duodenal polyps; 36% (10/28) had gastric adenomas.
- 29% (8/28) had a very high number of polyps.
- All 21 patients with duodenal polyps had adenomas; no malignancies were observed, but some required intervention.
Conclusions:
- Young FAP patients develop upper GI polyps earlier than previously thought.
- Current upper GI screening guidelines for FAP may need revision to include earlier initiation.
- Screening of the upper GI tract should commence concurrently with colonoscopy for pediatric and young adult FAP patients.
Objectives And Study:
Patients with familial adenomatous polyposis (FAP) have a propensity to form not only large bowel polyps but also upper gastrointestinal (GI) polyps with malignant potential. International guidance suggests that upper GI screening need not begin until patients are at least into their twenties. It is our experience that patients develop upper GI polyps long before this point which have the potential for malignant change.
Methods:
A prospective record of all upper GI endoscopies in children (aged 9 to 17) with FAP was kept across a 12-year period by 1 surgeon in our center. For each scope performed, we recorded the location, histology, and treatment of upper GI polyps.
Results:
Twent-eight patients aged 9 to 17 underwent a total of 48 esophagogastroduodenoscopies across a 12-year period. Thirty-eight esophagogastroduodenoscopies (79%) identified at least 1 gastric or duodenal polyp in 22 (79%) patients; 10 (36%) patients had gastric adenomas. Eight (29%) patients showed very high numbers of polyps. All 21 patients who had duodenal polyps had adenomas. None had yet developed malignancy, but 1 patient required extensive polyp excision and one is awaiting endoscopic mucosal resection.
Conclusion:
Our results demonstrate that young people with FAP are at the risk of developing upper GI polyps long before current guidance suggests screening the upper GI tract. We advocate for screening of the upper GI tract to start along with colonoscopy and happen at the same sitting for pediatric and young adult patients with FAP.
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