Progression to advanced neoplasia is infrequent in post colectomy familial adenomatous polyposis patients under endoscopic surveillance

Background and Study Aims Advanced neoplasia may occur in the remaining colon and distal ileum of familial adenomatous polyposis (FAP) patients who have had a prophylactic colon resection. The role of post operative lower GI endoscopic surveillance and management of advanced neoplasia in FAP patients is not well defined. The aims of this study were to determine the prevalence of post operative neoplasia and to evaluate the safety and effectiveness of lower GI endoscopic surveillance and ablative therapy following prophylactic colon resection. Patients and Methods A retrospective analysis of 42 FAP patients with prior primary colon cancer preventative surgery undergoing lower GI surveillance and ablative therapy from 1992 to 2006. Results All patients had adenomatous disease identified upon initial endoscopy with advanced neoplasia identified in 6/42 (14%). Patients had a median of 4 endoscopic procedures of which 2 (range 0-12) were therapeutic, over a 49 month follow-up period (range 0-168) Thermal ablation with argon plasma coagulation, polypectomy and surgical intervention were required in 55%, 7% and 14% of patients. Ablative therapy complications were due to Nd: YAG laser and snare polypectomy (5%). Progression to advanced neoplasia from baseline pathology occurred despite ablative therapy in 3/42 (7%) patients. We propose a lower GI tract endoscopic surveillance program for post surgical FAP patients. Conclusion Despite prophylactic colon surgery, FAP patients continue to be at risk of neoplasia. The development of advanced neoplasia is infrequent in patients embarking upon endoscopic surveillance. Ablative therapy is effective and safe for the vast majority of FAP patients.