Background: In patients with familial adenomatous polyposis (FAP), the duodenum is another high-risk region for malignancy after the large bowel. However, endoscopic and surgical management differs for papillary lesions and adenomas located in other parts of the duodenum. The aim of the study was to present the principles of the endoscopic surveillance of extrapapillary polyps based on a single-center 14-year observational study.Methods: The retrospective analysis was carried out in 2010–24 on a group of 45 people enrolled in endoscopic surveillance of the upper gastrointestinal tract due to FAP. The evaluation was aimed at detecting the malignant transformation of extrapapillary duodenal adenomas, with a radical removal of high-risk lesions. The severity of polyposis in the subsequent years of observation as well as the effectiveness of routine polypectomy on downstaging according to the Spiegelmann score were also assessed.Results: Invasive duodenal cancer was not detected in any case; however, high-grade dysplasia (HGD) was confirmed in five patients. The severity of polyposis and the number of polyps with HGD increased in following examinations, but routine polypectomy performed mainly during the 4th and 5th endoscopies allowed for a transient decrease in the Spiegelman score. Finally, progression of duodenal polyposis was observed in 18 patients, another 4 experienced regression (downstaging) and in 23 cases the stage of severity did not change. In addition, five patients were diagnosed with LST-G lesions, which were removed without recurrence.Conclusions: The patient’s age correlates with the severity of polyposis and the risk of malignancy, but routine endoscopic resections eliminate potentially invasive lesions and contribute to disease regression expressed by the Spiegelmann score. The radical endoscopic therapy of extrapapillary duodenal lesions limits the indications for surgical procedures.
背景：在家族性腺瘤性息肉病（FAP）患者中，十二指肠是继大肠之后的另一恶性肿瘤高风险区域。然而，对于乳头区病变与位于十二指肠其他部位的腺瘤，其内镜及外科处理策略存在差异。本研究旨在基于一项单中心为期14年的观察性研究，阐述十二指肠乳头外息肉的内镜监测原则。 方法：本研究于2010年至2024年间对45例因FAP接受上消化道内镜监测的患者进行回顾性分析。评估重点在于发现乳头外十二指肠腺瘤的恶变，并对高风险病变进行根治性切除。同时，研究还评估了观察期间息肉病的严重程度变化，以及常规息肉切除术在降低Spiegelmann评分方面的有效性。 结果：所有病例均未检出浸润性十二指肠癌，但5例患者确诊为高级别上皮内瘤变（HGD）。在后续检查中，息肉病的严重程度及伴有HGD的息肉数量均有所增加，然而主要在第4次和第5次内镜检查中实施的常规息肉切除术，使得Spiegelmann评分出现暂时性下降。最终，18例患者出现十二指肠息肉病进展，4例出现逆转（降期），23例严重程度分期无变化。此外，5例患者被诊断为侧向发育型肿瘤-颗粒型（LST-G）病变，经切除后无复发。 结论：患者年龄与息肉病严重程度及恶变风险相关，但常规内镜切除术可消除潜在浸润性病变，并有助于实现Spiegelmann评分所体现的疾病逆转。对十二指肠乳头外病变的根治性内镜治疗，可减少外科手术的适应证。
肿瘤(癌症)患者之家