Duodenal adenoma surveillance in patients with familial adenomatous polyposis

Table 1 Spigelman classification for duodenal polyposis in patients with familial adenomatous polyposis

Criterion	Points
	1	2	3
Polyp number	1-4	5-20	> 20
Polyp size (mm)	1-4	5-10	> 10
Histology	Tubular	Tubulo-villous	Villous
Dysplasia	Mild	Moderate	Severe
Stage 0: 0 points; stage I: 1-4 points; stage II: 5-6 points; stage III: 7-8 points; stage IV: 9-12 points

Table 2 Recommendations for surveillance and management of duodenal polyposis in familial adenomatous polyposis patients[11,12,28]

Spigelmanstage	Suggested interval (yr) to next duodenoscopy	Conservative therapy	Surgical treatment
0 (0 points)	4 (maximum 5 yr)	No	No
I (1-4 points)	3 (maximum 5 yr)	No	No
II (5-6 points)	2-3	Chemoprevention with or without endoscopic therapy	No
III (7-8 points)	6-12 (maximum 1-2 yr)	Chemoprevention with or without endoscopic therapy1	Acceptable
IV (9-12 ponits)	6-12 (maximum 1-2 yr)	Endoscopic therapy and endoscopic ultrasonography	Duodenectomy with pancreas/pylorus preservation

¹Consider endoscopy general anesthesia.