gastrointestinal disorders
Familial Adenomatous Polyposis
Treatment of Familial Adenomatous Polyposis
Colectomy Endoscopic surveillance of remainder of gastrointestinal tract Perhaps nonsteroidal anti-inflammatory drug (NSAIDs) Colectomy should be done soon after diagnosis. Total proctocolectomy eliminates the risk of colon and rectal cancer. The most commonly used reconstruction options are ileal pouch-anal anastomosis (IPAA) and permanent ileostomy. If subtotal colectomy (removal of most of the colon, leaving the rectum) with ileorectal anastomosis is done, the rectal remnant must be inspected frequently; new polyps must be excised or fulgurated. NSAIDs may inhibit new polyp formation. If new ones appear too rapidly or prolifically to remove, excision of the rectum is needed. recommend doing upper endoscopy including duodenoscopy starting at age 25 to 30 years and repeating surveillance every 6 months to 4 years depending on the stage of duodenal polyposis. The Spigelman classification is used to determine the degree of polyposis based on four variables (number of polyps, polyp size, histology, and dysplasia) and the calculated score provides a recommended surveillance interval ( Treatment reference ). Annual screening of the thyroid with ultrasound also is recommended. 1.Saurin JC, Gutknecht C, Napoleon B, et al: Surveillance of duodenal adenomas in familial adenomatous polyposis reveals high cumulative risk of advanced disease.J Clin Oncol22(3):493–498, 2004. doi: 10.1200/JCO.2004.06.028 