Small-bowel Diagnosis in Patients with Familial Adenomatous Polyposis: Comparison of Push Enteroscopy, Capsule Endoscopy, Ileoscopy, and Enteroclysis

Background: Conventional upper endoscopy (EGD), EGD with side-view endoscope and ileoscopy are established procedures for endoscopic evaluation of patients with familial adenomatous polyposis (FAP). However, we still have little data on the frequency and relevance of adenomas in those parts of the small bowel which are not accessible to EGD and ileoscopy. Adenomas distal to the duodenum are found more often in FAP patients with known duodenal adenomas. The question is, whether these patients can benefit from additional endoscopic and/or radiographic examinations.

Methods: Between July 2001 and August 2006 we performed comparative small bowel studies with push enteroscopy (PE), capsule endoscopy (CE), ileoscopy (IL) and enteroclysis (EC) in 25 FAP patients known to have duodenal adenomas. The number, size and location of any adenomas detected were documented.

Results: PE: The examination revealed duodenal adenomas (max. size 80 mm) requiring treatment in 9 of the 25 patients examined. In 12 of the 25 patients the PE showed adenomas distal to the ligament of Treitz with a maximum size of 15 mm. CE: In 22 of the 23 examined patients the CE revealed adenomas of the small bowel. Thirteen of these 22 patients also had adenomas in regions not accessible to PE or IL. These adenomas had a maximum size of 10 mm. IL: In 12 of the 25 patients adenomas were found in the region of the ileal pouch. The maximum size of the adenomas was 10 mm. EC: In 19 of the 23 examined patients the EC examination produced a false-negative result. in 8 of these 19 patients the adenomas not detected radiologically measured >or= 10 mm.

Conclusions: FAP patients with duodenal adenomas particularly often have adenomas distal to the duodenum. CE is a safe and convenient method for evaluating the small bowel in these patients. EC is considerably inferior to the endoscopic procedures for evaluation of the small bowel and is therefore not suitable for the diagnosis of adenomas in FAP.