source: Clinical gastroenterology and hepatology
Sinha A, Neale K F, Phillips R K, Clark S K
We read with interest the article by Ruys et al, regarding jejunal cancer in familial adenomatous polyposis (FAP) and their suggestion of jejunal surveillance. There have also been recent reports of capsule endoscopy revealing diminutive jejunal polyps in patients with FAP.
In our experience and in the literature, jejunal and ileal adenomas do not result in significant clinical problems in FA except within ileoanal pouches or associated with ileostomies. Small bowel polyps are more common in other inherited polyposis syndromes, particularly Peutz–Jeghers polyposis, where they often cause small bowel obstruction by intussusception. There exists only 1 case report of intussusception due to jejunal polyps occurring in a postcolectomy FAP patient. Jejunal cancer has also been reported very infrequently in FAP, with only 3 cases being identified in the current study. In our series of 591 FAP patients undergoing primary surgery at our institution, only 1 patient developed a confirmed jejunal cancer, at the age of 52 years. These data suggest that clinically significant jejunal polyps are extremely rare in FAP. There is no relevant clinical issue to justify routine surveillance.
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