Role of Endoscopy in Familial Adenomatous Polyposis Syndromes

Publication Date: March 10, 2020
Last Updated: March 14, 2022

Recommendations

We recommend 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. (L)
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We recommend genetic counseling and testing in all first-degree relatives of confirmed polyposis syndrome patients. Suspected FAP individuals should be tested at ages 10 to 12 years, whereas suspected AFAP and MAP should be tested at ages 18 to 20 years. (L)
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We recommend screening sigmoidoscopy or colonoscopy in children with or suspected to have FAP starting at ages 10 to 12 years. We recommend follow-up colonoscopy for patients found to have rectosigmoid polyps if sigmoidoscopy was the initial screening test. In patients with negative sigmoidoscopy findings, colonoscopy screening should be offered starting in late teen years. (M)
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We recommend surveillance colonoscopy at 1- to 2-year intervals in FAP. (M)
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We recommend screening colonoscopy in patients with or suspected to have AFAP starting at ages 18 to 20 years. (L)
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We recommend surveillance colonoscopy at 1- to 2-year intervals in AFAP. (L)
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We recommend screening colonoscopy at ages 18 to 20 years in patients with or suspected to have MAP. (L)
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We recommend surveillance colonoscopy at 1- to 2-year intervals in MAP. (L)
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We recommend a pouch endoscopy or ileoscopy in patients with IPAA or ileostomy surgery at 1- to 2-year intervals. (VL)
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We recommend a sigmoidoscopy in patients with IRA surgery at 6-month to 1-year intervals indefinitely. (VL)
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We recommend upper GI surveillance based on the interval advised for the most severely affected organ, whether stomach or duodenum. (L)
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Surveillance examinations should include random biopsy sampling as well as targeted biopsy sampling of any suspicious lesions to assess for dysplasia and accurate duodenal Spigelman stage. Baseline Spigelman score ≥7 is associated with the development of duodenal HGD. (L)
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We recommend endoscopic resection of gastric and duodenal polyps >1 cm, given the risk of developing dysplasia. (L)
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We recommend endoscopic resection of all antral polyps, given the predominance of gastric adenomas in this location. (L)
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We recommend careful examination of the ampulla and periampullary region using a duodenoscope or cap-assisted gastroscope, given the predilection for cancer in this area. (L)
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We recommend biopsy sampling of the ampulla to assess for villous histology or dysplasia for only those with an identifiable mucosal abnormality, with care taken to avoid the pancreatic orifice because of the risk for pancreatitis. (L)
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We recommend the use of chemopreventive agents within the confines of a tertiary hereditary cancer center and/or as part of clinical trials, because data are still emerging regarding its clinical application in hereditary polyposis syndromes. (VL)
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AFAP, attenuated forms of FAP; APC, Adenomatous polyposis coli; FAP, Familial adenomatous polyposis; HHGD, high-grade dysplasia; MAP, MUTYH-associated polyposis; PDT, photodynamic therapy

Recommendation Grading

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Overview

Title

Role of Endoscopy in Familial Adenomatous Polyposis Syndromes

Authoring Organization

Publication Month/Year

March 10, 2020

Last Updated Month/Year

July 24, 2023

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Ambulatory, Outpatient, Radiology services

Intended Users

Epidemiology infection prevention, genetics, nurse, nurse practitioner, physician, physician assistant, radiology technologist

Scope

Diagnosis, Management, Prevention

Diseases/Conditions (MeSH)

D011125 - Adenomatous Polyposis Coli

Keywords

colorectal cancer, endoscopy, dysplasia, gastrointestinal, familial adenomatous polyposis

Source Citation

Yang J, Gurudu SR, Koptiuch C, Agrawal D, Buxbaum JL, Abbas Fehmi SM, Fishman DS, Khashab MA, Jamil LH, Jue TL, Law JK, Lee JK, Naveed M, Qumseya BJ, Sawhney MS, Thosani N, Wani SB, Samadder NJ. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in familial adenomatous polyposis syndromes. Gastrointest Endosc. 2020 May;91(5):963-982.e2. doi:10.1016/j.gie.2020.01.028. Epub 2020 Mar 10. PMID: 32169282.

Methodology

Number of Source Documents
172
Literature Search Start Date
January 1, 2005
Literature Search End Date
May 1, 2018