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Intraoperative small bowel enteroscopy in familial adenomatous and familial juvenile polyposis
M A Rodriguez-Bigas1, R B Penetrante, L Herrera
1Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA.
Insights
Small bowel enteroscopy during surgery can detect polyps in patients with familial adenomatous polyposis and juvenile polyposis. Early detection and biopsy of these gastrointestinal polyps are crucial for preventing cancer development.
Area of Science:
- Gastroenterology
- Surgical Endoscopy
- Gastrointestinal Oncology
Background:
- Familial adenomatous polyposis (FAP) and juvenile polyposis (JP) are conditions characterized by polyps throughout the gastrointestinal tract.
- These hereditary polyposis syndromes increase the risk of colorectal and other gastrointestinal cancers.
Purpose of the Study:
- To evaluate the utility of intraoperative small bowel enteroscopy in identifying and managing polyps in patients with FAP and JP.
- To determine the prevalence and characteristics of small bowel polyps in these patient populations.
Main Methods:
- Seven patients with FAP and two with JP underwent small bowel enteroscopy during exploratory celiotomy.
- Enteroscopy was performed either for colectomy or other abdominal pathologies.
Main Results:
- Polyps were identified in 56% of patients in the jejunum and/or ileum.
- Adenomatous polyps were found in 33% of patients, ranging from 3 mm to 30 mm.
- One patient was diagnosed with an intramucosal carcinoma in a juvenile polyp at age 14.
Conclusions:
- Intraoperative small bowel enteroscopy is recommended for patients with asymptomatic FAP and JP undergoing surgery.
- Patients with known duodenal polyps should undergo enteroscopy during surgery.
- Biopsy or excision of larger polyps is advised due to the potential for malignancy.
Background:
In familial adenomatous polyposis and juvenile polyposis, polyps can occur throughout the gastrointestinal tract.
Methods:
We report seven patients with familial adenomatous polyposis and two patients with juvenile polyposis who underwent small bowel enteroscopy at the time of exploratory celiotomy either for colectomy or other pathology.
Results:
Polyps in the jejunum and/or ileum were noted in five of nine (56%) patients at enteroscopy. In three of nine (33%) patients these polys were adenomatous. Two of these patients had polyps in the jejunum and in the ileum, whereas one patient had jejunal adenomas alone. These polyps were from 3 mm to 30 mm in size. The remaining two patients with polyps had lymphoid hyperplasia in the ileum. All three patients who had adenomas at intraoperative small bowel enteroscopy had duodenal adenomas at esophagogastroduodenoscopy. At the age of 14 years, one patient had an intramucosal carcinoma in a small bowel juvenile polyp.
Conclusion:
Baseline small bowel enteroscopy should be considered at the time of surgical exploration in patients with asymptomatic familial adenomatous polyposis and juvenile polyposis. In patients with duodenal polyps, enteroscopy should be performed at the time of surgery. Biopsy and/or excision of larger polyps should be performed because these polyps may harbor a carcinoma.