Small Bowel Neoplasia

Clinically significant small-bowel adenomas distal to the duodenum are uncommon in patients with FAP. Adenomas may occur throughout the small bowel but are concentrated for the most part in the proximal jejunum and the distal ileum. Studies using the capsule camera showed ileal polyps in 5% of FAP patients. Malignancy is unusual. In patients with FAP after restorative proctocolectomy, the incidence of neoplasia in the ileal pouch increases. The incidence of adenomas within the ileal pouch ranges between 20 and 62% and depends on duration of follow-up [53-56]. Parc et al. [57] found that the risk of developing adenomas at 5,10, and 15 years was 7, 35, and

75%, respectively. The risk of cancer development in such adenomas has not been established, although three cases of pouch cancer have been reported [58]. Therefore, for all patients with FAP who have undergone restorative proctocolectomy, periodic endo-scopic examination is indicated. Adenomas also occur in the terminal ileum of patients who have an ileostomy or Kock pouch after proctocolectomy without restoration. In addition, the risk of ileostomy carcinoma in these patients appears to be increased compared to the very low incidence of primary small-bowel carcinoma. By 2005, 11 ileostomy carcinomas were reported [59]. Other small bowel lesions include prominent lymphoid polyps that may occur in the terminal ileum of younger patients with FAP and should be differentiated from adenomas by biopsy [60].

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