Endoscopic treatment shows therapeutic potential in severe duodenal polyposis

In patients with severe duodenal polyposis, endoscopic treatment safely and effectively prevents cancer, offering a promising alternative to surgery, according to a study.

Researchers assessed the feasibility and safety of endoscopic treatment of duodenal polyposis in patients with familial adenomatous polyposis and evaluated the long-term efficacy of the approach in terms of recurrence and malignant degeneration.

A total of 58 patients (median age 44 years, 50 percent men) participated in the study and were followed for a median of 5.66 years. These patients were grouped into two, according to the endoscopic procedures they received: resection and or destruction (by argon plasma coagulation) of duodenal polyps (group 1) or papillectomy (group 2).

Endoscopic therapy was performed in 37 patients in group 1 and in 19 patients in group 2. The primary outcome of duodenal surgery-free and cancer-free survival rate was 95.8 percent at 5 years and 92.6 percent at 10 years.

Surgery was performed in four patients, and cancer occurred in two. The calculated Spigelman score in the 58 patients dropped from 9.24 points at baseline to 6.35 points at 5 years, then plateauing thereafter. Complications, such as bleeding and perforation, occurred in 20 patients.

Most patients with familial adenomatous polyposis subsequently develop duodenal adenomas with a risk of progression to duodenal cancer. Endoscopic management of duodenal adenomas has been suggested as a less invasive option than surgery. The findings contribute evidence regarding the safety and efficacy of endoscopic treatment in the prevention of cancer in the present population.