Risk of Developing Adenomas and Carcinomas in the Ileal Pouch in Patients With Familial Adenomatous Polyposis
Risk of Developing Adenomas and Carcinomas in the Ileal Pouch in Patients With Familial Adenomatous Polyposis
复制标题
DOI：
10.1016/j.cgh.2008.06.011
复制
发表时间：
2008-11-01
影响因子：
12.6
通讯作者：
Vasen, Hans F. A.
中科院分区：
文献类型：
--
作者：
Friederich, Pieter;De Jong, Andrea E.;Vasen, Hans F. A.
背景和目标：目前，超过一半的家族性腺瘤性息肉病（FAP）患者采用直肠结肠切除术和回肠袋-肛门吻合术（IPAA）治疗。最初，人们认为这种手术可以消除患直肠癌的风险。然而，越来越多的研究报告的发展腺瘤和癌的邮袋。本研究的目的是评估一大群荷兰FAP患者中发生育儿袋腺瘤和癌的长期风险。方法：从荷兰息肉病登记处共选择了254例接受IPAA的FAP患者。对监测结果和病理报告进行分析。对一个亚组的患者进行色素内镜监测。结果：212例（84%）患者的随访信息完整。这些患者（56%为男性）共接受了761次内窥镜检查。平均随访7.9年（范围：0.4-20.3年）。在10年随访中，在囊袋中发展腺瘤的累积风险为45%。25例患者（11.8%）发展为晚期病理腺瘤，4例（1.9%）发展为癌。在10年随访时，发生贮袋癌的累积风险为1%。一个非常高的患病率（75.7%）腺瘤被发现在一个亚组的患者进行了检查与色素内镜。结论：这项研究表明，虽然在IPAA后发生腺瘤的风险很高，但恶性变性的风险似乎很低。色素内镜的使用提高了小腺瘤的检出率。
Background & Aims: At present, more than half of patients with familial adenomatous polyposis (FAP) are treated with a proctocolectomy and an ileal pouch-anal anastomosis (IPAA). Originally it was thought that this procedure would eliminate the risk of developing rectal cancer. However, an increasing number of studies reported development of adenoma and carcinoma in the pouch. The aim of this study was to evaluate the long-term risk of developing adenomas and carcinomas in the pouch in a large cohort of Dutch FAP patients. Methods: A total of 254 patients with FAP who underwent an IPAA were selected from the Dutch Polyposis Registry. The results of the surveillance examinations and the pathology reports were analyzed. Surveillance with chromoendoscopy was offered to a subgroup of patients. Results: Full information on follow-up was available in 212 (84%) patients. These patients (56% male) underwent a total of 761 endoscopies. The mean follow-up was 7.9 years (range, 0.4-20.3 years). The cumulative risk of developing an adenoma in the pouch at 10-year follow-up was 45%. Twenty-five patients (11.8%) developed an adenoma with advanced pathology, and 4 (1.9%) developed a carcinoma. The cumulative risk of developing a pouch carcinoma at 10-year follow-up was 1%. A very high prevalence (75.7%) of adenomas was found in a subgroup of patients who were examined with chromoendoscopy. Conclusions: This study demonstrated that although the risk of developing adenomas in the pouch after an IPAA is high, the risk of malignant degeneration appears to be low. The use of chromoendoscopy improves the detection of small adenomas.