Efficacy and safety of intensive downstaging polypectomy (IDP) for multiple duodenal adenomas in patients with familial adenomatous polyposis: a prospective cohort study

Author:

Takeuchi Yoji12ORCID,Hamada Kenta13ORCID,Nakahira Hiroko14,Shimamoto Yusaku15,Sakurai Hirohisa16,Tani Yasuhiro1ORCID,Shichijo Satoki1ORCID,Maekawa Akira1,Kanesaka Takashi1ORCID,Yamamoto Sachiko1,Higashino Koji1,Fujisawa Fumie2,Ezoe Yasumasa7,Ishikawa Hideki78,Mutoh Michihiro8,Uedo Noriya1ORCID,Nojima Masanori9,Ishihara Ryu1

Affiliation:

1. Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan

2. Department of Genetic Oncology, Division of Hereditary Tumors, Osaka International Cancer Institute, Osaka, Japan

3. Department of Practical Gastrointestinal Endoscopy, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan

4. Department of Gastroenterology, Japan Community Health Care Organization Hoshigaoka Medical Center, Osaka, Japan

5. Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan

6. Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan

7. Ishikawa Gastroenterological Medical Clinic, Osaka, Japan

8. Department of Molecular-Targeting Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan

9. Center for Translational Research, The Institute of Medical Science Hospital, The University of Tokyo, Tokyo, Japan

Abstract

Background Patients with familial adenomatous polyposis (FAP) risk developing multiple duodenal adenomas (MDAs), leading to duodenal cancer and death. We investigated the efficacy and safety of intensive downstaging polypectomy (IDP) for MDAs integrated with new-generation procedures. Methods This prospective phase II study, conducted at a tertiary cancer center, enrolled patients with FAP who had MDAs. We performed IDP including cold snare/forceps polypectomy (CSP/CFP) and underwater endoscopic mucosal resection (UEMR). The primary end point was the downstaging of Spigelman stage at 1-year follow-up. Results 2424 duodenal polyps in 58 patients with FAP underwent IDP, including 2413 CSPs in 57 patients, seven CFPs in one patient, and four UEMRs in four patients. Only one major adverse event was observed (grade 3 hyperamylasemia) without clinical manifestations. We performed additional UEMR, CSP, and CFP for one, 12, and 22 patients, respectively, during initial follow-up. Overall, 55 patients completed protocol examination; the Spigelman stage was significantly reduced at the 1-year follow-up endoscopy (P < 0.001), with downstaging observed in 39 patients (71 %). Among the 26 patients with Spigelman stage IV at initial examination and protocol completion, 23 (88 %) showed downstaging. There was no major change in Spigelman stages from 1-year follow-up esophagogastroduodenoscopy to a median of 37 months (range 3–56). Conclusions IDP, including new-generation procedures, showed significant downstaging with acceptable adverse events for MDA in patients with FAP, even those with advanced-stage disease. Lesion selection for different resection techniques may be important for suitable and sustainable management of MDA in patients with FAP.

Funder

Japan Agency for Medical Research and Development

Publisher

Georg Thieme Verlag KG

Subject

Gastroenterology

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