The majority of patients with familial adenomatous polyposis (FAP) develop duodenal adenomas with a risk of progression to duodenal cancer. Endoscopic management of FAP duodenal adenomas has been proposed as a less-invasive option than surgery, but available data still are limited. Our aims were to assess the feasibility and safety of endoscopic treatment in duodenal polyposis and to evaluate its long-term efficacy in terms of recurrence and malignant degeneration. FAP patients with stage IV duodenal polyposis were enrolled in 5 French centers as part of a national cohort and followed up for a median period of 5.66 years (interquartile range, 6.39 y). Primary outcomes were duodenal surgery-free and cancer-free survival. Two groups of patients were identified according to endoscopic procedures: group 1: resection and or destruction (by argon plasma coagulation) of duodenal polyps, and group 2: papillectomy. Fifty-eight patients were enrolled (29 men; median age, 44 y). Endoscopic therapy was performed in 37 patients in group 1 and in 19 patients in group 2. Duodenal cancer-free and surgery-free survival were 95.8% at 5 years and 92.6% at 10 years. Four patients required surgery and 2 patients developed cancers. In the 58 patients, the calculated Spigelman score decreased from 9.24 points at entry to 6.35 at 5 years and then plateaued. Complications (mostly bleeding and perforation) occurred in 20 patients. In this long-term cohort follow-up evaluation, endoscopic treatment of patients with severe duodenal polyposis appears relatively safe and effective as an alternative to surgery for the prevention of cancer.

中文翻译：

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内镜治疗对严重十二指肠息肉病的影响：一项针对家族性腺瘤性息肉病患者的全国研究

大多数家族性腺瘤性息肉病 (FAP) 患者会出现十二指肠腺瘤，并有进展为十二指肠癌的风险。 FAP 十二指肠腺瘤的内镜治疗已被提议作为一种比手术侵入性较小的选择，但可用数据仍然有限。我们的目的是评估内镜治疗十二指肠息肉病的可行性和安全性，并评估其在复发和恶变方面的长期疗效。患有 IV 期十二指肠息肉病的 FAP 患者作为国家队列的一部分在 5 个法国中心入组，随访中位时间为 5.66 年（四分位数间距，6.39 年）。主要结局是十二指肠免手术和无癌生存。根据内窥镜手术分为两组患者：第 1 组：十二指肠息肉切除和/或破坏（通过氩气等离子凝固），第 2 组：乳头切除术。共有 58 名患者入组（29 名男性；中位年龄 44 岁）。第 1 组 37 名患者和第 2 组 19 名患者接受了内镜治疗。十二指肠癌无癌生存率和无手术生存率在 5 年和 10 年分别为 95.8% 和 92.6%。 4 名患者需要手术，2 名患者罹患癌症。在 58 名患者中，计算出的 Spigelman 评分从入组时的 9.24 分下降到 5 年时的 6.35 分，然后趋于稳定。 20 名患者出现并发症（主要是出血和穿孔）。在这项长期队列随访评估中，严重十二指肠息肉病患者的内镜治疗作为预防癌症的手术替代方案似乎相对安全有效。