P1258 - Predictors of Duodenal High-Grade Dysplasia in Patients with Familial Adenomatous Polyposis

Daniel Schupack, MD, Shubham Sood, MBBS, Fnu Deepali, MBBS, Nayantara Coelho-Prabhu, MBBS, Lisa Boardman, MD
Mayo Clinic, Rochester, MN

Introduction: Patients with Familial Adenomatous Polyposis (FAP) frequently develop multiple polyps in small intestine, most commonly in the duodenum. Polyps with high-grade dysplasia (HGD) may require management with radical surgical treatment (duodenectomy) to decrease the risk of progression to duodenal cancer. We aimed to study the association of various demographic and endoscopic features of duodenal polyps with the risk of developing duodenal HGD in FAP patients.

Methods: Data was collected retrospectively from electronic health records of 371 patients with FAP who underwent upper gastrointestinal surveillance endoscopies between 1989-2023 at our tertiary care center. Statistical analysis was done using SPSS, with Chi-square and Fischer’s exact test.

Results: High grade dysplasia was detected in 21 patients (5.7%). Of these, 6 patients (28.6%) were found to have HGD at first endoscopy, with the papilla being the most common location for initial detection of HGD (47.6%). On first endoscopy at our institution, there was papillary involvement with adenoma in 104 (28.0%). At the first endoscopy, papillary involvement with adenoma (p=0.002) and a Spigelman score of ≥7 (p< 0.001) were associated with development of HGD. There was trend towards association of HGD with age at first endoscopy, with it being more common in those > 50 years old (p=0.06). HGD was also, unsurprisingly, associated with development of duodenal cancer (p< 0.001). Time from FAP diagnosis to first endoscopy was longer in patients with development of HGD (median 14.6 years vs 3.2 years). The use of chemopreventative agents (NSAIDs) was not associated with higher or lower rate of HGD (p=0.87). Furthermore, no significant association was found between lifestyle factors like tobacco use, alcohol consumption or BMI and HGD. Table 1 shows association of various demographic and endoscopic findings with HGD.

Discussion: We analyzed demographic and endoscopic findings in FAP patients for association with duodenal HGD. The Spigelman classification does not include papillary involvement for risk stratifying patients with FAP. We demonstrated that adenomatous involvement of this structure is associated with risk of developing HGD anywhere in the duodenum. Thus, we suggest that changes to Spigelman classification are needed for appropriate risk stratification of patients with papillary involvement, as closer follow up in such patients could reduce the rates of HGD and eventually duodenal cancer, to improve patient outcomes.



Disclosures:


Daniel Schupack, MD, Shubham Sood, MBBS, Fnu Deepali, MBBS, Nayantara Coelho-Prabhu, MBBS, Lisa Boardman, MD. P1258 - Predictors of Duodenal High-Grade Dysplasia in Patients with Familial Adenomatous Polyposis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.