Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Endoscopic Findings and Treatment of Gastric Neoplasms in Familial Adenomatous Polyposis

  • Sato, Chihiro (Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University) ;
  • Takahashi, Kazuya (Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University) ;
  • Sato, Hiroki (Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University) ;
  • Naruse, Takumi (Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University) ;
  • Nakajima, Nao (Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University) ;
  • Takatsuna, Masafumi (Department of Gastroenterology, Nagaoka Red Cross Hospital) ;
  • Mizuno, Ken-ichi (Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University) ;
  • Hashimoto, Satoru (Department of Gastroenterology, Saiseikai Kawaguchi General Hospital) ;
  • Takeuchi, Manabu (Department of Gastroenterology, Nagaoka Red Cross Hospital) ;
  • Yokoyama, Junji (Division of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital) ;
  • Kobayashi, Masaaki (Department of Gastroenterology, Niigata Cancer Center Hospital) ;
  • Terai, Shuji (Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University)
  • Received : 2022.05.29
  • Accepted : 2022.08.23
  • Published : 2022.10.31
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Abstract

Purpose: Gastric neoplasia is a common manifestation of familial adenomatous polyposis (FAP). This study aimed to elucidate the clinical characteristics, endoscopic features including fundic gland polyposis (FGPsis), and treatment outcomes of gastric neoplasms (GNs) in patients with FAP. Materials and Methods: A total of 35 patients diagnosed with FAP, including nine patients from four pedigrees who underwent esophagogastroduodenoscopy (EGD), were investigated regarding patient characteristics, GN morphology, and treatment outcomes. Results: Twenty-one patients (60.0%) had 38 GNs; 33 (86.8%) and 5 (13.2%) were histologically diagnosed with adenocarcinoma and adenoma, respectively. There were no specific patient characteristics related to GNs.Nodule-type GNs were more prevalent in patients with FGP than without (52.2% vs. 0.0%, P=0.002) in the upper body of the stomach. Conversely, depressed-type GNs were fewer in patients with FGPsis than in those without (13.0% vs. 73.3%, P<0.001). Slightly elevated-type GNs were observed in both groups (34.8% vs. 20.0%, P=0.538). Even within pedigrees, the background gastric mucosa and types of GNs varied. In total, 24 GNs were treated with endoscopic submucosal dissection (ESD) and eight with endoscopic mucosal resection (EMR). EMR was selected for GNs with FGPsis because of the technical difficulty of ESD, resulting in a lower en bloc resection rate (62.5% vs. 100%, P=0.014). Conclusions: Our study indicates the necessity of routine EGD surveillance in patients diagnosed with FAP. Notably, the morphology and location of GNs differed between patients with and without FGPsis. Endoscopic treatment and outcomes require more attention in cases of FGPsis.

Keywords

Acknowledgement

The authors thank Dr. Yusuke Tani from the Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, for his valuable comments.

References

  1. Half E, Bercovich D, Rozen P. Familial adenomatous polyposis. Orphanet J Rare Dis 2009;4:22. https://doi.org/10.1186/1750-1172-4-22
  2. Vasen HF, Moslein G, Alonso A, Aretz S, Bernstein I, Bertario L, et al. Guidelines for the clinical management of familial adenomatous polyposis (FAP). Gut 2008;57:704-713. https://doi.org/10.1136/gut.2007.136127
  3. Dinarvand P, Davaro EP, Doan JV, Ising ME, Evans NR, Phillips NJ, et al. Familial adenomatous polyposis syndrome: an update and review of extraintestinal manifestations. Arch Pathol Lab Med 2019;143:1382-1398. https://doi.org/10.5858/arpa.2018-0570-RA
  4. Clark S, Hyer W, Guenther T. Familial adenomatous polyposis. J Pediatr Surg 2007;42:1463-1464. https://doi.org/10.1016/j.jpedsurg.2007.04.043
  5. Martin I, Roos VH, Anele C, Walton SJ, Cuthill V, Suzuki N, et al. Gastric adenomas and their management in familial adenomatous polyposis. Endoscopy 2021;53:795-801. https://doi.org/10.1055/a-1265-2716
  6. Watanabe H, Enjoji M, Yao T, Ohsato K. Gastric lesions in familial adenomatosis coli: their incidence and histologic analysis. Hum Pathol 1978;9:269-283. https://doi.org/10.1016/S0046-8177(78)80085-9
  7. Iwama T, Mishima Y, Utsunomiya J. The impact of familial adenomatous polyposis on the tumorigenesis and mortality at the several organs. Its rational treatment. Ann Surg 1993;217:101-108. https://doi.org/10.1097/00000658-199302000-00002
  8. Nakano K, Kawachi H, Chino A, Kita M, Arai M, Ide D, et al. Phenotypic variations of gastric neoplasms in familial adenomatous polyposis are associated with endoscopic status of atrophic gastritis. Dig Endosc 2020;32:547-556. https://doi.org/10.1111/den.13512
  9. Shibata C, Ogawa H, Miura K, Naitoh T, Yamauchi J, Unno M. Clinical characteristics of gastric cancer in patients with familial adenomatous polyposis. Tohoku J Exp Med 2013;229:143-146. https://doi.org/10.1620/tjem.229.143
  10. Iwama T, Tamura K, Morita T, Hirai T, Hasegawa H, Koizumi K, et al. A clinical overview of familial adenomatous polyposis derived from the database of the Polyposis Registry of Japan. Int J Clin Oncol 2004;9:308-316. https://doi.org/10.1007/s10147-004-0414-4
  11. Nakamura K, Nonaka S, Nakajima T, Yachida T, Abe S, Sakamoto T, et al. Clinical outcomes of gastric polyps and neoplasms in patients with familial adenomatous polyposis. Endosc Int Open 2017;5:E137-E145. https://doi.org/10.1055/s-0042-119809
  12. Bianchi LK, Burke CA, Bennett AE, Lopez R, Hasson H, Church JM. Fundic gland polyp dysplasia is common in familial adenomatous polyposis. Clin Gastroenterol Hepatol 2008;6:180-185. https://doi.org/10.1016/j.cgh.2007.11.018
  13. Kashiwagi H, Spigelman AD. Gastroduodenal lesions in familial adenomatous polyposis. Surg Today 2000;30:675-682. https://doi.org/10.1007/s005950070077
  14. Leone PJ, Mankaney G, Sarvapelli S, Abushamma S, Lopez R, Cruise M, et al. Endoscopic and histologic features associated with gastric cancer in familial adenomatous polyposis. Gastrointest Endosc 2019;89:961-968. https://doi.org/10.1016/j.gie.2018.12.018
  15. Abraham SC, Nobukawa B, Giardiello FM, Hamilton SR, Wu TT. Fundic gland polyps in familial adenomatous polyposis: neoplasms with frequent somatic adenomatous polyposis coli gene alterations. Am J Pathol 2000;157:747-754. https://doi.org/10.1016/S0002-9440(10)64588-9
  16. Nakamura S, Matsumoto T, Kobori Y, Iida M. Impact of Helicobacter pylori infection and mucosal atrophy on gastric lesions in patients with familial adenomatous polyposis. Gut 2002;51:485-489. https://doi.org/10.1136/gut.51.4.485
  17. Hofgartner WT, Thorp M, Ramus MW, Delorefice G, Chey WY, Ryan CK, et al. Gastric adenocarcinoma associated with fundic gland polyps in a patient with attenuated familial adenomatous polyposis. Am J Gastroenterol 1999;94:2275-2281. https://doi.org/10.1111/j.1572-0241.1999.01312.x
  18. Mitsui Y, Miyoshi A, Okamoto K, Muguruma N, Miyoshi J, Tanaka K, et al. Different phenotypes of gastric fundic gland polyposis and cancer in patients with familial adenomatous polyposis depending on Helicobacter pylori infection. Gastric Cancer 2019;22:1294-1300. https://doi.org/10.1007/s10120-019-01005-y
  19. Aihara H, Kumar N, Thompson CC. Diagnosis, surveillance, and treatment strategies for familial adenomatous polyposis: rationale and update. Eur J Gastroenterol Hepatol 2014;26:255-262. https://doi.org/10.1097/MEG.0000000000000010
  20. Kim GH. Proton pump inhibitor-related gastric mucosal changes. Gut Liver 2021;15:646-652. https://doi.org/10.5009/gnl20036
  21. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011;14:101-112. https://doi.org/10.1007/s10120-011-0041-5
  22. Nagtegaal ID, Odze RD, Klimstra D, Paradis V, Rugge M, Schirmacher P, et al. The 2019 WHO classification of tumours of the digestive system. Histopathology 2020;76:182-188. https://doi.org/10.1111/his.13975
  23. Schlemper RJ, Riddell RH, Kato Y, Borchard F, Cooper HS, Dawsey SM, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000;47:251-255. https://doi.org/10.1136/gut.47.2.251
  24. Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis. Endoscopy 2008;1:87-97. https://doi.org/10.1055/s-0028-1098086
  25. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 2021;24:1-21. https://doi.org/10.1007/s10120-020-01042-y
  26. Watari J, Ueyama S, Tomita T, Ikehara H, Hori K, Hara K, et al. What types of early gastric cancer are indicated for endoscopic ultrasonography staging of invasion depth? World J Gastrointest Endosc 2016;8:558-567. https://doi.org/10.4253/wjge.v8.i16.558
  27. Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant 2013;48:452-458. https://doi.org/10.1038/bmt.2012.244
  28. Yang J, Gurudu SR, Koptiuch C, Agrawal D, Buxbaum JL, Abbas Fehmi SM, et al. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in familial adenomatous polyposis syndromes. Gastrointest Endosc 2020;91:963-982.e2. https://doi.org/10.1016/j.gie.2020.01.028
  29. Syngal S, Brand RE, Church JM, Giardiello FM, Hampel HL, Burt RW, et al. ACG clinical guideline: Genetic testing and management of hereditary gastrointestinal cancer syndromes. Am J Gastroenterol 2015;110:223-262. https://doi.org/10.1038/ajg.2014.435
  30. Shimamoto Y, Ishiguro S, Takeuchi Y, Nakatsuka SI, Yunokizaki H, Ezoe Y, et al. Gastric neoplasms in patients with familial adenomatous polyposis: endoscopic and clinicopathologic features. Gastrointest Endosc 2021;94:1030-1042.e2. https://doi.org/10.1016/j.gie.2021.06.010
  31. Wu TT, Kornacki S, Rashid A, Yardley JH, Hamilton SR. Dysplasia and dysregulation of proliferation in foveolar and surface epithelia of fundic gland polyps from patients with familial adenomatous polyposis. Am J Surg Pathol 1998;22:293-298. https://doi.org/10.1097/00000478-199803000-00003
  32. Hackeng WM, Montgomery EA, Giardiello FM, Singhi AD, Debeljak M, Eshleman JR, et al. Morphology and genetics of pyloric gland adenomas in familial adenomatous polyposis. Histopathology 2017;70:549-557. https://doi.org/10.1111/his.13105
  33. Wood LD, Salaria SN, Cruise MW, Giardiello FM, Montgomery EA. Upper GI tract lesions in familial adenomatous polyposis (FAP): enrichment of pyloric gland adenomas and other gastric and duodenal neoplasms. Am J Surg Pathol 2014;38:389-393. https://doi.org/10.1097/PAS.0000000000000146
  34. Choi WT, Brown I, Ushiku T, Yozu M, Setia N, Srivastava A, et al. Gastric pyloric gland adenoma: a multicentre clinicopathological study of 67 cases. Histopathology 2018;72:1007-1014. https://doi.org/10.1111/his.13460
  35. Calavas L, Rivory J, Hervieu V, Saurin JC, Pioche M. Macroscopically visible flat dysplasia in the fundus of 3 patients with familial adenomatous polyposis. Gastrointest Endosc 2017;85:679-680. https://doi.org/10.1016/j.gie.2016.03.1499
  36. Tanabe H, Moriichi K, Takahashi K, Ono Y, Kobayashi Y, Murakami Y, et al. Genetic alteration of colorectal adenoma-carcinoma sequence among gastric adenocarcinoma and dysplastic lesions in a patient with attenuated familial adenomatous polyposis. Mol Genet Genomic Med 2020;8:e1348.
  37. Grady WM, Yu M, Markowitz SD. Epigenetic Alterations in the gastrointestinal tract: current and emerging use for biomarkers of cancer. Gastroenterology 2021;160:690-709. https://doi.org/10.1053/j.gastro.2020.09.058
  38. Monahan KJ, Bradshaw N, Dolwani S, Desouza B, Dunlop MG, East JE, et al. Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/ Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG). Gut 2020;69:411-444. https://doi.org/10.1136/gutjnl-2019-319915
  39. van Leerdam ME, Roos VH, van Hooft JE, Dekker E, Jover R, Kaminski MF, et al. Endoscopic management of polyposis syndromes: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2019;51:877-895. https://doi.org/10.1055/a-0965-0605
  40. Sinha A, Tekkis PP, Gibbons DC, Phillips RK, Clark SK. Risk factors predicting desmoid occurrence in patients with familial adenomatous polyposis: a meta-analysis. Colorectal Dis 2011;13:1222-1229. https://doi.org/10.1111/j.1463-1318.2010.02345.x
  41. Lian J, Chen S, Zhang Y, Qiu F. A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc 2012;76:763-770. https://doi.org/10.1016/j.gie.2012.06.014
  42. Tao M, Zhou X, Hu M, Pan J. Endoscopic submucosal dissection versus endoscopic mucosal resection for patients with early gastric cancer: a meta-analysis. BMJ Open 2019;9:e025803. https://doi.org/10.1136/bmjopen-2018-025803
  43. Negishi R, Koizumi K, Ohata K. Endoscopic submucosal dissection for multiple gastric superficial adenocarcinomas identified in patient with familial adenomatous polyposis. Dig Endosc 2020;32:e57-e58.
  44. Imaeda H, Hosoe N, Kashiwagi K, Ohmori T, Yahagi N, Kanai T, et al. Advanced endoscopic submucosal dissection with traction. World J Gastrointest Endosc 2014;6:286-295. https://doi.org/10.4253/wjge.v6.i7.286
  45. Walton SJ, Frayling IM, Clark SK, Latchford A. Gastric tumours in FAP. Fam Cancer 2017;16:363-369. https://doi.org/10.1007/s10689-017-9966-0
  46. Watanabe K, Nagata N, Nakashima R, Furuhata E, Shimbo T, Kobayakawa M, et al. Predictive findings for Helicobacter pylori-uninfected, -infected and -eradicated gastric mucosa: validation study. World J Gastroenterol 2013;19:4374-4379. https://doi.org/10.3748/wjg.v19.i27.4374