Abstract
PURPOSE: Although adenomatous polyps and even adenocarcinomas have been found in the terminal ileum of patients with familial adenomatous polyposis, the prevalence of neoplastic changes in the pouches of patients who have undergone restorative proctocolectomy is unknown. The objective of this study was to determine the frequency of pelvic pouch neoplasia in famial adenomatous polyposis patients after restorative proctocolectomy. METHODS: Patients in a polyposis registry who had undergone restorative proctocolectomy were recruited. Demographic, surgical, pathologic, and endoscopic data were obtained from patient records. Video pouchoscopy was done after two enemas and representative biopsies were taken. RESULTS: Of 102 eligible patients, 26 (17 males and 9 females) participated. Median age at ileal pouch-anal anastomosis was 31 (range, 12–58) years. Median follow-up period was 66 (11–156) months. Adenomas were found in the pouch of 11 (42 percent) patients, in the terminal ileum above the pouch in 1 patient, and in the anal canal of 4 patients. Among patients with pouch polyps, three patients had one lesion, three patients had two lesions, and five patients had more than ten lesions. The incidence of polyps increased steadily with time from restorative proctocolectomy. There was no relation between the incidence of pouch polyposis and the severity of colonic or duodenal disease. CONCLUSIONS: Proctocolectomy and ileal pouch-anal anastomosis is associated with a significant risk of pouch neoplasia in familial adenomatous polyposis patients. The severity of pouch adenomas was not related either to the severity of colonic or duodenal disease. The pelvic pouches of all patients with familial adenomatous polyposis who have undergone restorative proctocolectomy should be examined periodically.
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Groden J, Thliveris A, Samowitz W,et al. Identification and characterization of the familial adenomatous polyposis coli gene. Cell 1991;66:589–600.
Bussey HJ. Familial polyposis coli: family studies, histopathology, differential diagnosis and results of treatment. Baltimore: The Johns Hopkins University Press, 1975.
Church JM. Familial adenomatous polyposis: a review. Perspect Colon Rectal Surg 1995;8:203–25.
Heald RJ. Gardner's syndrome in association with two tumours of the ileum. J R Soc Med 1967;60:914–5.
Hamilton SR, Bussey HJ, Mendelsohn G,et al. Ileal adenomas after colectomy in nine patients with adenomatous polyposis coli/Gardner's syndrome. Gastroenterology 1979;77:1252–7.
Iida M, Yao T, Ohsato K, Itoh H, Watanabe H. Diagnostic value of intraoperative fiberscopy for small-intestinal polyps in familial adenomatosis coli. Endoscopy 1980;12:161–5.
Järvinen H, Nyberg M, Peltokallio P. Upper gastrointestinal tract polyps in familial adenomatosis coli. Gut 1983;24:333–9.
Burt RW, Berenson MM, Lee RG, Tolman KG, Freston JW, Gardner EJ. Upper gastrointestinal polyps in Gardner's syndrome. Gastroenterology 1984;86:295–301.
Nakahara S, Itoh H, Iida M, Iwashita A, Ohsato K. Ileal adenomas in familial polyposis coli: differences before and after colectomy. Dis Colon Rectum 1985;28:875–7.
Tonelli F, Nardi F, Bechi P, Taddei G, Gozzo P, Romagnoli P. Extracolonic polyps in familial polyposis coli and Gardner's syndrome. Dis Colon Rectum 1985;28:664–8.
Johnson CD, White H. Colonic metaplasia with colonictype polyps on an ileostomy stoma in polyposis coli: report of a case. Dis Colon Rectum 1988;31:405–7.
Iida M, Itoh H, Matsui T, Mibu R, Iwashita A, Fujishima M. Ileal adenomas in postcolectomy patients with familial adenomatosis coli/Gardner's syndrome: incidence and endoscopic appearance. Dis Colon Rectum 1989;32:1034–8.
Ross JE, Mara JE. Small bowel polyps and carcinoma in multiple intestinal polyposis. Arch Surg 1974;108:736–8.
Roth JA, Logio T. Carcinoma arising in an ileostomy stoma: an unusual complication of adenomatous polyposis coli. Cancer 1982;49:2180–4.
Primrose JN, Quirke P, Johnston D. Carcinoma of the ileostomy in a patient with familial adenomatous polyposis. Br J Surg 1988;75:384.
Suarez V, Alexander-Williams J, O'Connor HJ,et al. Carcinoma developing in ileostomies after 25 or more years. Gastroenterology 1988;95:205–8.
Gadacz TR, McFadden DW, Gabrielson EW, Ullah A, Berman JJ. Adenocarcinoma of the ileostomy: the latent risk of cancer after colectomy for ulcerative colitis and familial polyposis. Surgery 1990;107:698–703.
Gilson TP, Sollenberger LL. Adenocarcinoma of an ileostomy in a patient with familial adenomatous polyposis: report of a case. Dis Colon Rectum 1992;35:261–5.
Johnson JA III, Talton DS, Poole GV. Adenocarcinoma of a Brooke ileostomy for adenomatous polyposis coli. Am J Gastroenterol 1993;88:1122–4.
Beart RW Jr, Fleming CR, Banks PM. Tubulovillous adenomas in a continent ileostomy after proctocolectomy for familial polyposis. Dig Dis Sci 1982;27:553–6.
Stryker SJ, Carney JA, Dozois RR. Multiple adenomatous polyps arising in a continent reservoir ileostomy. Int J Colorectal Dis 1987;2:43–5.
Shepherd NA, Jass JR, Duval I, Moskowitz RL, Nicholls RJ, Morson BC. Restorative proctocolectomy with ileal reservoir: pathological and histochemical study of mucosal biopsy specimens. J Clin Pathol 1987;40:601–7.
Nugent KP, Spigelman AD, Nicholls RJ, Talbot IC, Neale K, Phillips RK. Pouch adenomas in patients with familial adenomatous polyposis. Br J Surg 1993;80:1620.
Church JM, Oakley JR, Wu JS. Pouch polyposis after ileal pouch-anal anastomosis for familial adenomatous polyposis: report of a case. Dis Colon Rectum 1996;39:584–6.
Tytgat GN, Gopinath N. Recurrent polyps in the ileoanal pouch or rectum in familial adenomatous polyposis. Eur J Cancer 1995;31A:1154–9.
Spigelman AD. Familial adenomatous polyposis and the upper gastrointestinal tract. Semin Colon Rectal Surg 1995;6:26–8.
Thomford NR, Greenberger NJ. Lymphoid polyps of the ileum associated with Gardner's syndrome. Arch Surg 1968;96:289–91.
Shaw EB Jr, Hennigar GR. Intestinal lymphoid polyposis. Am J Clin Pathol 1974;61:417–22.
Shull LN Jr, Fitts CT. Lymphoid polyposis associated with familial polyposis and Gardner's syndrome. Ann Surg 1974;180:319–22.
Ohsato K, Yao T, Watanabe H, Iida M, Itoh H. Small-intestinal involvement in familial polyposis diagnosed by operative intestinal fiberscopy: report of four cases. Dis Colon Rectum 1977;20:414–20.
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Read at the meeting of The American Society of Colon and Rectal Surgeons, Philadelphia, Pennsylvania, June 22 to 26, 1997.
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Wu, J.S., McGannon, E.A. & Church, J.M. Incidence of neoplastic polyps in the ileal pouch of patients with familial adenomatous polyposis after restorative proctocolectomy. Dis Colon Rectum 41, 552–556 (1998). https://doi.org/10.1007/BF02235258
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DOI: https://doi.org/10.1007/BF02235258