MUTYH-associated polyposis: Is it time to change upper gastrointestinal surveillance? A single-center case series and a literature overview

Table 1 Comparison of international guidelines for small bowel surveillance in familial polyposis

SS	Surveillance interval (yr/mo)
	ESGE[13,14] 2022, 2019	EMG[35] 2008	ESMO[36] 2019	ASGE[5] 2020	NCCN[7] (v. 2.2022)
Duodenum
0	5 yr	5 yr	5 yr	5 yr	3-5 yr
I	5 yr	5 yr	5 yr	5 yr	2-3 yr
II	3 yr	3 yr	3 yr	3 yr	1-2 yr
III	1 yr	1-2 yr	1-2 yr	6-12 mo	6-12 mo
IV	6 mo, consider treatment	Surgical evaluation	6 mo or consider prophylactic surgery	3-6 mo, surgical evaluation	Expert surveillance 3-6 mo
Rest of SB
	ESGE 2019 do not mention SB. ESGE 2022: CE and/or cross-sectional imaging techniques may be considered when an investigation of the mid-distal small bowel is clinically indicated	Not mentioned	Carry out a first endoscopy at 25-30 yr and continue depending on the SS. In FAP, the risk of cancer in the jejunum and ileum is extremely low; therefore, routine surveillance is not recommended	Suggested in SS IV with CE or MRE. Enteroscopy is not recommended routinely but only in positive CE or MRE and pre-duodenal surgery to avoid reconstruction with an SB segment with a high-density adenoma	High evidence supporting SB screening distal to the duodenum is lacking. Consider it, especially if advanced duodenal polyposis

ESGE: European Society of Gastrointestinal endoscopy; EMG: European Mallorca Group; ESMO: European Society of Medical Oncology; ASGE: American Society of Gastrointestinal Endoscopy; NCCN: National Comprehensive Cancer Network; CE: Capsule endoscopy; MRE: Magnetic resonance enteroscopy; SB: Small bowel; SS: Spigelman stage; FAP: Familial adenomatous polyposis.