Published online Apr 10, 2017. doi: 10.5306/wjco.v8.i2.168
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
To test the fujinon intelligent color enhancement (FICE) in identifying dysplastic or adenomatous polyps in familial adenomatous polyposis (FAP) patients.
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.
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.
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.