Esophagus to Small Intestine
Am J Gastroenterol. 2022;117(8):1246–54
Novel endoscopic polypectomy surveillance technique for fundic gland polyps in familial adenomatous polyposis can improve early detection of dysplasia and gastric cancer
Introduction: Fundic gland polyps (FGPs) are commonly found in patients with familial adenomatous polyposis (FAP) and are considered benign. Biopsies are not routinely performed, and conventional forceps may be time-consuming and/or yield non-representative histology. The purpose of this study was to evaluate the role of a novel endoscopic polypectomy surveillance (EPS), a large volume cold-snare polypectomy technique of random FGPs, in the incidence of dysplasia and gastric cancer (GC) in FAP.
Methods: This is a retrospective longitudinal cohort of patients with FAP referred to a tertiary care center for duodenal adenoma surveillance and who underwent EPS of FGPs between 2001 and 2019. Demographic, endoscopic, and clinicopathologic information was reviewed.
Results: 35 patients with FAP were identified at initial endoscopy by the mean age of 43.4 ± 12.8 years. 113 surveillance endoscopies were performed in total using EPS. Dysplasia of FGPs was present on initial esophagogastroduodenoscopy in 7 patients (20%), and 13 additional patients (46.4%) progressed to low-grade dysplasia. Three patients (15%) who subsequently had progression to GC were found to have signet ring cell cancer within the foci of FGPs through EPS. One patient presented as metastatic GC. Progression from non-dysplastic FGP to low-grade dysplasia occurred over 63 ± 46.3 months with further progression to GC over 34 ± 8.5 months. Endoscopic risk factors for cancer were polyps > 10 mm in size (p < 0.001) and carpeting of polyps (p < 0.001). The 5-year cumulative incidence of developing dysplasia was 35.7%.
Discussion: The authors identified that the incidence of dysplasia and gastric cancer (GC) is higher than previously reported in patients with familial adenomatous polyposis. Their study used a novel endoscopic polypectomy surveillance (EPS) technique and was able to identify GC within the foci of fundic gland polyps (FGPs). Upper endoscopic guidelines should include a more rigorous sampling method for FGPs, such as EPS, to optimize early detection of dysplasia and GC.