Risks, Benefits, and Effects on Management for Biopsy of the Papilla in Patients With Familial Adenomatous Polyposis

Neal A Mehta; Ravi S Shah; Jiyoon Yoon; Margaret O'Malley; Lisa LaGuardia; Gautam Mankaney; Amit Bhatt; Carol A Burke

doi:10.1016/j.cgh.2020.05.054

Risks, Benefits, and Effects on Management for Biopsy of the Papilla in Patients With Familial Adenomatous Polyposis

Clin Gastroenterol Hepatol. 2021 Apr;19(4):760-767. doi: 10.1016/j.cgh.2020.05.054. Epub 2020 May 31.

Authors

Neal A Mehta¹, Ravi S Shah², Jiyoon Yoon², Margaret O'Malley³, Lisa LaGuardia³, Gautam Mankaney⁴, Amit Bhatt⁴, Carol A Burke⁴

Affiliations

¹ Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: mehtan5@ccf.org.
² Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
³ Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio; Sanford R. Weiss, MD Center for Hereditary Colorectal Neoplasia, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio.
⁴ Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio; Sanford R. Weiss, MD Center for Hereditary Colorectal Neoplasia, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio.

PMID: 32492482
DOI: 10.1016/j.cgh.2020.05.054

Abstract

Background & aims: Ampullary and duodenal cancer are the leading causes of death in patients with familial adenomatous polyposis (FAP) after colectomy has been performed. Risk of duodenal cancer is determined based on Spigelman stage (SS) of duodenal polyposis. Guidelines recommend endoscopic surveillance of the duodenum and visualization of the papilla to stage duodenal polyposis. There is no consensus on whether biopsies should be routinely collected from duodenal papilla and findings included in SS. Additionally, there are no data on the risk of pancreatitis after biopsy collection from papilla of patients with FAP. We studied the incidence of pancreatitis after biopsy of the papilla in patients with FAP and effects of biopsy findings on SS.

Methods: We identified consecutive patients with FAP at a single center from January 2011 through December 2018 with ≥1 endoscopy with biopsy of the papilla. Patients with history of foregut surgery were excluded. We identified 273 patients with FAP who had biopsies collected from papilla over 792 EGDs, with 1-8 independent exams with biopsy per patient. We collected demographic, endoscopic, and histology data from patients and calculated SS with vs without biopsy findings. Post-procedural pancreatitis was defined by 2 of the following: abdominal pain, lipase level 3-fold the upper limit of normal, or radiography findings consistent with pancreatitis within 7 days of esophagogastroduodenoscopy (EGD).

Results: Pancreatitis developed in 2 patients (0.73%): 1 after biopsy of a normal-appearing papilla and 1 after biopsy of an abnormal appearing papilla. Inclusions of biopsy data increased SS in 36 patients (13.2%), with consideration of prophylactic duodenectomy for 3.3%.

Conclusions: Pancreatitis after biopsy of the duodenal papilla is rare. Histology data obtained from biopsy of the papilla in patients with FAP can change SS and affect patient management.

Keywords: Acute Pancreatitis; Gastrointestinal Neoplasia; Hereditary Cancer Syndromes; Prognostic Factor.

MeSH terms

Adenomatous Polyposis Coli* / surgery
Biopsy
Colectomy
Duodenal Neoplasms* / epidemiology
Duodenal Neoplasms* / surgery
Duodenum
Humans