Gastric Adenomas and their management in Familial Adenomatous Polyposis
Martin I., Roos VH., Anele C., Walton S-J., Cuthill V., Suzuki N., Bastiaansen B., Clark SK., von Roon A., Dekker E., Latchford A.
<jats:p>Background Patients with familial adenomatous polyposis (FAP) are at increased risk of developing gastric adenomas. There is limited understanding of their clinical course and no consensus on management. We reviewed the management of gastric adenomas in patients with FAP from two centres. Patients and methods Patients with FAP and histologically confirmed gastric adenomas were identified between 1997-2018. Patient demographics, adenoma characteristics management/surveillance outcomes were collected. Results One hundred and four (49 female) of 726 patients (14%) were diagnosed with gastric adenomas at a median age of 47 years (range 19-80). The median size of gastric adenoma was 6mm (range 1.5-50mm); 64 (62%) patients had adenomas located distal to the incisura. Five (5%) patients had gastric adenomas demonstrating high grade dysplasia (HGD) on initial diagnosis, distributed equally within the stomach. The risk of HGD was associated with adenoma size (p=0.04). Of adenomas larger than 20mm, 33% contained HGD. Two patients had gastric cancer at initial gastric adenoma diagnosis. Sixty-three (61%) patients underwent endoscopic therapy for gastric adenomas. Complications occurred in three (5%) patients and two (3%) had recurrence, all following piecemeal resection of large (30-50mm) lesions. Three patients were diagnosed with gastric cancer during follow-up, a median of 66 months (range 66-115) after initial diagnosis. Conclusions In this series, we observed gastric adenomas in 14% of patients with FAP. Five per cent contained HGD; risk of HGD correlated with adenoma size. Endoscopic resection was feasible, with few complications and low recurrence rates, but does not completely eliminate the cancer risk. </jats:p>