Prognosis of symptomatic duodenal adenomas in familial adenomatous polyposis
P. S. Beckwith, J. A. van Heerden and R. R. Dozois
Department of Surgery, Mayo Clinic, Rochester, MN 55905.
The frequent association between familial adenomatous polyposis and
duodenal tumors is increasingly recognized, yet many patients do not
benefit from adequate diagnosis and follow-up of upper gastrointestinal
polyps. A retrospective review of 14 patients with duodenal tumors
associated with familial adenomatous polyposis was undertaken to assess the
impact of early diagnosis by screening asymptomatic patients. Six of eight
patients presenting with symptoms suggesting duodenal disease had invasive
cancer. Four of these six patients died after surviving a mean of 13 months
after diagnosis. In contrast, none of the six patients diagnosed after
screening with upper gastrointestinal endoscopy has had invasive carcinoma.
Early diagnosis and long-term surveillance of asymptomatic patients with
familial adenomatous polyposis affords the opportunity to diagnose and
treat duodenal tumors at an early stage, thereby, avoiding the dismal
prognosis once invasive cancer has developed.
