Risk of ileal pouch neoplasms in patients with familial adenomatous polyposis  

作　　者：Masahiro Tajika Yasumasa Niwa Vikram Bhatia Tsutomu Tanaka Makoto Ishihara Kenji Yamao 

机构地区：[1]Department of Endoscopy,Aichi Cancer Center Hospital,Nagoya 464-8681,Japan [2]Department of Medical Hepatology,Institute of Liver and Biliary Sciences,New Delhi 110070,India [3]Department of Gastroenterology,Aichi Cancer Center Hospital,Nagoya 464-8681,Japan

出　　处：《World Journal of Gastroenterology》2013年第40期6774-6783,共10页世界胃肠病学杂志（英文版）

摘　　要：Restorative proctocolectomy is the most common surgical option for patients with familial adenomatous polyposis(FAP). However,adenomas may develop in the ileal pouch mucosa over time,and even carcinoma in the pouch has been reported. We therefore reviewed the prevalence,nature,and treatment of adenomas and carcinoma that develop after proctocolectomy in the ileal pouch mucosa in patients with FAP. In 25 reports that were reviewed,the incidence of adenomas in the ileal pouch varied from 6.7% to 73.9%. Several potential factors that favor the development of pouch polyposis have been investigated,but many remain controversial. Nevertheless,it seems certain that the age of the pouch is important. The risk appears to be 7%to 16% after 5 years,35% to 42% after 10 years,and75% after 15 years. On the other hand,only 21 cases of ileal pouch carcinoma have been recorded in the literature to date. The diagnosis of pouch carcinoma was made between 3 to 20 years(median,10 years) after pouch construction. Although the risk of malignant transformation in ileal pouches is probably low,it is not negligible,and the long-term risk cannot presently be well quantified. Regular endoscopic surveillance,especially using chromoendoscopy,is recommended.Restorative proctocolectomy is the most common surgical option for patients with familial adenomatous polyposis (FAP). However, adenomas may develop in the ileal pouch mucosa over time, and even carcinoma in the pouch has been reported. We therefore reviewed the prevalence, nature, and treatment of adenomas and carcinoma that develop after proctocolectomy in the ileal pouch mucosa in patients with FAP. In 25 reports that were reviewed, the incidence of adenomas in the ileal pouch varied from 6.7% to 73.9%. Several potential factors that favor the development of pouch polyposis have been investigated, but many remain controversial. Nevertheless, it seems certain that the age of the pouch is important. The risk appears to be 7% to 16% after 5 years, 35% to 42% after 10 years, and 75% after 15 years. On the other hand, only 21 cases of ileal pouch carcinoma have been recorded in the literature to date. The diagnosis of pouch carcinoma was made between 3 to 20 years (median, 10 years) after pouch construction. Although the risk of malignant transformation in ileal pouches is probably low, it is not negligible, and the long-term risk cannot presently be well quantified. Regular endoscopic surveillance, especially using chromoendoscopy, is recommended.

关 键 词：Familial adenomatous POLYPOSIS RESTORATIVE PROCTOCOLECTOMY ILEAL POUCH ILEAL pouch-anal ANASTOMOSIS Ileo-rectal ANASTOMOSIS Adenoma Adenocarcinoma POUCH polyp POUCH neoplasm 

分 类 号：R735.3[医药卫生—肿瘤]