New guideline defines role of endoscopy in familial adenomatous polyposis syndromes

Last Updated: 2020-04-17

By Reuters Staff

NEW YORK (Reuters Health) - A new guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides more than a dozen recommendations on using endoscopy in familial adenomatous polyposis (FAP) syndromes.

People with FAP syndromes, including FAP, attenuated forms of FAP (AFAP), and MUTYH-associated polyposis (MAP), have an increased risk of colorectal cancer (CRC). They are advised to receive intensive endoscopic surveillance and/or prophylactic surgery as part of their clinical management.

Dr. Julie Yang of the Albert Einstein College of Medicine, in New York City, and colleagues on the ASGE Standards of Practice Committee reviewed the literature from 2005 to 2018 to provide evidence-based recommendations and clinical guidance in regard to the management of these hereditary colorectal polyposis syndromes. Given that most studies were retrospective, recommendations were based on epidemiologic data and expert opinion.

The recommendations and supporting evidence appear in Gastrointestinal Endoscopy.

The guideline advise genetic counseling and testing in patients with clinical polyposis (defined as 10 or more adenomas found on a single endoscopy and 20 or more adenomas during their lifetime) and in all first-degree relatives of patients with confirmed polyposis syndrome (at ages 10 to 12 for suspected FAP and at ages 18 to 20 for suspected AFAP and MAP).

Screening sigmoidoscopy or colonoscopy is recommended for children with or suspected to have FAP starting at ages 10-12 years, with ongoing surveillance colonoscopy at one- to two-year intervals for those found to have polyps.

Screening of patients with or suspected to have AFAP or MAP can begin later, at ages 18-20 years, with ongoing surveillance colonoscopy at one- to two-year intervals.

Patient should also undergo esophagogastroduodenoscopy (EGD) screening at age 20-25 years (for FAP and AFAP) or 30-35 years (for MAP) or before colectomy, with surveillance intervals and treatments depending on EGD findings.

In general, all gastric antral polyps should be resected, as should gastric and duodenal polyps greater than 1 cm, given the risk of developing dysplasia.

The guideline recommends the use of chemopreventive agents only at tertiary hereditary-cancer centers or as part of clinical trials, "because data are still emerging regarding its clinical application in hereditary polyposis syndromes."

"Future studies with standardized therapeutic endoscopic protocols are needed," the authors note. "The goal of endoscopic management is to downstage disease with close surveillance, thus avoiding symptomatic presentation of malignancy, which portends a poorer prognosis. However, it is not known if decreasing polyp burden, whether endoscopically or through chemoprevention agents, reduces overall risk for cancer."

"Once the polyposis burden is difficult to manage endoscopically, surgical consultation is needed," they add. "A multidisciplinary team approach to the care of this patient population is essential."

Dr. Yang did not respond to a request for comments.

SOURCE: https://bit.ly/3ddgCz0 Gastrointestinal Endoscopy, online March 10, 2020.