Decision analysis inthemanagementofduodenal adenomatosis infamilial adenomatous polyposis

Background-Patients withfamilial adenomatouspolyposis are notonlyathigh riskof developing adenomasin the colorectum buta substantial numberof patients alsodevelop polypsintheduodenum.Becausetreamentofduodenal polypsisextremely difficult and itis unknownhow many patients ultimately developduodenalcancer, thevalueof surveillance oftheupper digestive tractis uncertain. Aims-(l)Toassessthecumulative riskof duodenal cancer ina largeseries ofpolyposispatients. (2)To develop a decision modelto establish whethersurveillance wouldleadtoincreased life expectancy. Methods-Riskanalysis was performed in155Dutchpolyposis families including 601polyposis patients, and 142Danish families including 376patients. Observation timewas frombirthuntildateof last contact,death, diagnosis ofduodenal cancer,orclosing dateofthestudy. Results-Seven Dutchand fiveDanish patients developed duodenal cancer.The lifetime riskofdeveloping this cancer by theage of70 was 40/0(95%/o confidence interval 1-7%)intheDutchseries and30/o (95%confidence interval 0 60/o) inthe Danishseries. Decision analysis showed thatsurveillance ledtoan increase inlife expectancy byseven months. Conclusions-Surveillance oftheupper digestive tractledtoa moderategainin lifeexpectancy.Futurestudiesshould evaluatewhetherthisincreasein life expectancyoutweighs themorbidity of endoscopic examination and proximal pancreaticoduodenectomy. (Gut1997; 40:716-719)