Small bowel endoscopy in familial adenomatous polyposis and Lynch syndrome

Best Pract Res Clin Gastroenterol. 2012 Jun;26(3):359-68. doi: 10.1016/j.bpg.2012.01.022.

Abstract

Patients with familial adenomatous polyposis (FAP) and patients with Lynch syndrome have an increased risk of developing small intestinal neoplasia. In both conditions, the lifetime risk to develop small bowel cancer is estimated to be around 5%. In FAP, this risk is associated with the degree of duodenal polyposis, classically assessed by the Spigelman classification. For this reason, gastroduodenal surveillance with forward-viewing and side-viewing endoscopy is generally recommended. Studies using video capsule endoscopy and balloon-assisted enteroscopy in FAP patients have revealed that jejunal and ileal polyps occur frequently in FAP, especially in those with extensive duodenal polyposis. Nevertheless, the clinical relevance of small bowel polyps beyond the duodenum appears to be limited. Compared to FAP, little is known about the prevalence and natural history of small bowel neoplasia in Lynch syndrome. Surveillance of the small bowel is not recommended in Lynch syndrome, although recent data using capsule endoscopy provided promising results.

Publication types

  • Review

MeSH terms

  • Adenomatous Polyposis Coli / diagnosis*
  • Adenomatous Polyposis Coli / pathology
  • Capsule Endoscopy
  • Colorectal Neoplasms, Hereditary Nonpolyposis / diagnosis*
  • Colorectal Neoplasms, Hereditary Nonpolyposis / pathology
  • Duodenal Neoplasms / complications
  • Endoscopy, Gastrointestinal / methods*
  • Humans
  • Intestinal Polyps / diagnosis
  • Intestinal Polyps / pathology
  • Intestine, Small*
  • Jejunal Neoplasms / complications