Treatment of FAP with Gastric, Duodenal, or Ampullary (Papillary) Adenomas
This protocol addresses familial adenomatous polyposis (FAP) presenting with gastric adenomas, duodenal adenomas, duodenal polyposis, or papillary (ampullary) adenomas. Endoscopic evaluation and intervention form the basis of management, with approach determined by lesion site, size, and histological findings.
Clinical scenario: FAP with gastric adenomas, duodenal adenomas (including duodenal polyposis), or ampullary (papillary) adenomas. Lesion characteristics and Spigelman staging guide the management pathway.
Treatment approach (partial summary)
Endoscopic resection is the primary intervention for qualifying gastric, duodenal, and papillary adenomas in FAP. Endoscopic management is also applied to address advanced duodenal polyposis staging. The full protocol defines the complete selection criteria, resection strategy, and the stepwise algorithm.
Treatment goal
Successful endoscopic downstaging of duodenal polyposis to Spigelman stage 0–III.
References
DOI: 10.1093/bjs/znae263
- All gastric adenomas larger >5 mm should undergo endoscopic resection.
- All non-papillary duodenal lesions >10 mm should undergo endoscopic resection.
- All papillary adenomas should be candidates for endoscopic resection, but especially if harbouring HGD, villous histology, or if >10 mm in size.
- Endoscopic downstaging should be personalized according to endoscopic findings. Ideally, Spigelman stage IV should be downstaged as much as possible. An attempt to downstage Spigelman stage III can be performed.
- Spigelman stages III and IV duodenal polyposis without evidence of invasive tumour should undergo endoscopic treatment, if feasible, rather than surgical resection.
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