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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Gastric and duodenal polyps in familial adenomatous polyposis patients: Conventional endoscopy vs virtual chromoendoscopy (fujinon intelligent color enhancement) in dysplasia evaluation
Gabriele Lami, Andrea Galli, Giuseppe Macrì, Emanuele Dabizzi, Maria Rosa Biagini, Mirko Tarocchi, Luca Messerini, Rosa Valanzano, Stefano Milani, Simone Polvani
Gabriele Lami, Andrea Galli, Maria Rosa Biagini, Mirko Tarocchi, Stefano Milani, Simone Polvani, Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50139 Florence, Italy
Andrea Galli, Giuseppe Macrì, Maria Rosa Biagini, Mirko Tarocchi, Stefano Milani, Clinical Gastroenterology Unit, Careggi University Hospital, 50134 Florence, Italy
Emanuele Dabizzi, Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Hospital, 20132 Milan, Italy
Luca Messerini, Division of Pathological Anatomy, Department of Experimental and Clinical Medicine, University of Florence, 50139 Florence, Italy
Rosa Valanzano, Surgical Unit, Department of Translational Surgery and Medicine, University of Florence, 50139 Florence, Italy
Author contributions: Lami G, Macrì G, Galli A and Dabizzi E contributed to the study conception, design and supervision; Lami G, Galli A, Macrì G, Dabizzi E and Valenzano R performed the patients recruitment and samples collection; Messerini L supervised the histological examination; Lami G and Biagini MR collected the data and performed the statistical analysis; Milani S reviewed the statistical methods; Lami G, Galli A, Macrì G, Milani S, Dabizzi E, Biagini MR, Messerini L and Polvani S contributed to the interpretation of the data and discussion of the results; Tarocchi M critically revised the manuscript; Lami G, Galli A and Polvani S drafted the manuscript.
Institutional review board statement: The study was reviewed and approved by the AOU Careggi Institutional Review Board.
Informed consent statement: All study participant, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have nothing to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Simone Polvani, PhD, Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, viale Pieraccini 6, 50139 Florence, Italy.
simone.polvani@unifi.it
Telephone: +39-055-2758115
Received: August 26, 2016
Peer-review started: August 27, 2016
First decision: November 19, 2016
Revised: February 22, 2017
Accepted: February 25, 2017
Article in press: February 26, 2017
Published online: April 10, 2017
Processing time: 223 Days and 14.5 Hours
AIM
To test the fujinon intelligent color enhancement (FICE) in identifying dysplastic or adenomatous polyps in familial adenomatous polyposis (FAP) patients.
METHODS
Seventy-six consecutive FAP patients, already treated by colectomy and members of sixty-five families, were enrolled. A FICE system for the upper gastro-intestinal tract with an electronic endoscope system and a standard duodenoscope (for side-viewing examination) were used by two expert examiners. Endoscopic resection was performed with diathermic loop for polyps ≥ 6 mm and with forceps for polyps < 6 mm. Formalin-fixed biopsy specimens were analyzed by two expert gastrointestinal pathologists blinded to size, location and number of FAP-associated fundic gland polyps.
RESULTS
Sixty-nine (90.8%) patients had gastric polyps (34 only in the corpus-fundus, 7 only in the antrum and 28 in the whole stomach) and 52 (68.4%) in duodenum (7 in the bulb, 35 in second/third duodenal portion, 10 both in the bulb and the second portion of duodenum). In the stomach fundus after FICE evaluation, 10 more polyps were removed from 10 patients for suspicious features of dysplasia or adenomas, but they were classified as cystic fundic gland after histology. In the antrum FICE identified more polyps than traditional endoscopy, showing a better tendency to identify adenomas and displastic areas. In the duodenum FICE added a significant advantage in identifying adenomas in the bulb and identified more polyps in the II/III portion.
CONCLUSION
FICE significantly increases adenoma detection rate in FAP patients but does not change any Spigelman stage and thus does not modify patient’s prognosis and treatment strategies.
Core tip: Colon endoscopic surveillance and prophylactic colectomy have strongly reduced mortality due to colorectal carcinoma and have improved survival of familial adenomatous polyposis (FAP) patients, leading to the development of surveillance for extra-colonic cancers. Polyps in the duodenum and stomach are frequent findings in FAP. The timing of endoscopic and histology surveillance is currently a great challenge. Spectral estimation by fujinon intelligent color enhancement (FICE) may identify dysplasia and discriminate between adenomatous and non-adenomatous polyps. Interestingly, application of FICE to FAP patients significantly increases the detection of adenomas but does not yet change the prognosis, surveillance program and treatment strategies.
