Endoscopic management of duodenal lesions in familial adenomatous polyposis: A tertiary referral center experience

BACKGROUND: Familial adenomatous polyposis (FAP) requires lifelong surveillance for duodenal lesions due to increased cancer risk. AIMS: This study evaluated the effectiveness, safety, and long-term impact of endoscopic surveillance and treatment of duodenal and ampullary lesions, focusing on lesion detection, dysplasia grade, Spigelman stage evolution and adverse events. METHODS: This retrospective study analyzed prospectively collected data from 233 genetically confirmed FAP patients undergoing esophagogastroduodenoscopy (EGD) at the National Cancer Institute between 2013 and 2023. Demographics, endoscopic procedures, histology, Spigelman staging, treatment techniques, and outcomes were assessed. RESULTS: A total of 862 EGDs were performed, with 208 duodenal lesions treated. Structured surveillance was associated with increased lesion treatment and reduced high-grade dysplasia rates. Cold snare polypectomy was the most commonly used technique (41.9%). Histology showed low-grade dysplasia in 72.4% of lesions, high-grade dysplasia in 25.9%, and adenocarcinoma in 1.7%. Forty-seven ampullary lesions were identified; most were managed with surveillance (78.7%), while 21.3% underwent papillectomy. CONCLUSIONS: Endoscopic management of duodenal lesions in FAP is safe and effective. Papillectomy for selected ampullary lesions carries low morbidity and low risk of progression. A multidisciplinary approach may reduce progression to advanced Spigelman stages and high-grade dysplasia.