Upper GI polyposis and cancer in FAP: diagnosis, surveillance and treatment

Colorectal cancer can be prevented in most patients with FAP by performing (procto)colectomy and lifelong endoscopic surveillance. Subsequently, the challenge is to prevent duodenal and gastric cancer. Duodenal cancer is one of the most common FAP-related causes of death and, in the last decade, the incidence of gastric cancer has increased. Performing frequent endoscopic surveillance with removal of neoplasia is important to prevent cancer especially since cancers in the upper GI tract generally have a poor prognosis. Moreover, the goal is to prevent upper GI surgery as these procedures are associated with substantial morbidity. In this review, we provide the prevalence of upper GI polyposis and cancer, describe endoscopic and histologic features, and discuss strategies for surveillance and treatment.