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Natural history of colonic polyposis in young patients with familial adenomatous polyposis.

Abstract：

BACKGROUND AND AIMS:Proctocolectomy prevents colorectal cancer in familial adenomatous polyposis (FAP). Colorectal polyp progression is one of the indications for surgery. No data exist regarding the natural history of colorectal polyposis in young patients with FAP. This study examined the rate of polyposis progression and factors associated with it. METHODS:Patients with FAP <30 years old who had undergone ≥2 colonoscopies since 2000 were identified. Rate of polyposis progression was calculated by review of polyp counts obtained from baseline and last colonoscopy, accounting for any polyps removed during the observation period. Endoscopic and non-endoscopic factors affecting the rate of polyposis progression were evaluated. Multivariate analysis was performed to identify factors associated with rate of polyposis progression. RESULTS:One hundred sixty-eight patients (52% female; median age, 13.5 years) were included. Median rate of polyposis progression was 25.4 polyps/year (interquartile range, 9.5-69.8). Highest median rate of polyposis progression (89 polyps/year) was associated with mutation in codon 1309. The rate of polyposis progression was independently associated with the location of mutation in the adenomatous polyposis coli gene, the number of polyps at the initial colonoscopy, and exposure to chemoprevention. Of the 39.9% of patients who underwent surgery, an increase in polyp number was the most common indication (53.7%). CONCLUSIONS:The rate of polyposis progression in young patients with FAP varies with a median of about 25 new polyps per year. Progression is associated with distinct factors, which can be used in discussion with patients regarding the need for and timing of prophylactic colorectal surgery.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Sarvepalli S,Burke CA,Monachese M,Leach BH,Laguardia L,O'Malley M,Kalady MF,Church JM

doi

10.1016/j.gie.2018.05.021

subject

Has Abstract

pub_date

2018-10-01 00:00:00

pages

726-733

issue

4

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(18)32753-6

journal_volume

88

pub_type

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