Sanchez-Mete L, Mosciatti L, Casadio M, Vittori L, Martayan A, Stigliano V. MUTYH-associated polyposis: Is it time to change upper gastrointestinal surveillance? A single-center case series and a literature overview. World J Gastrointest Oncol 2023; 15(11): 1891-1899 [PMID: 38077639 DOI: 10.4251/wjgo.v15.i11.1891]
Corresponding Author of This Article
Lupe Sanchez-Mete, MD, Doctor, Gastroenterology and Digestive Endoscopy, Regina Elena National Cancer Institute, IRCCS, via Elio Chianesi nr 53, Rome 00144, Italy. lupe.sanchez@ifo.it
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Nov 15, 2023; 15(11): 1891-1899 Published online Nov 15, 2023. doi: 10.4251/wjgo.v15.i11.1891
MUTYH-associated polyposis: Is it time to change upper gastrointestinal surveillance? A single-center case series and a literature overview
Lupe Sanchez-Mete, Lorenzo Mosciatti, Marco Casadio, Luigi Vittori, Aline Martayan, Vittoria Stigliano
Lupe Sanchez-Mete, Lorenzo Mosciatti, Marco Casadio, Aline Martayan, Vittoria Stigliano, Gastroenterology and Digestive Endoscopy, Regina Elena National Cancer Institute, IRCCS, Rome 00144, Italy
Luigi Vittori, Department of Radiological, Oncological and Pathological Sciences, Regina Elena National Cancer Institute, IRCCS, Rome 00144, Italy
Author contributions: Sanchez-Mete L and Mosciatti L contributed to the literature research and wrote the first draft; all authors critically contributed to the analysis of evidence and provided major intellectual input to the paper, and commented on previous versions of the manuscript; and all authors read and approved the final manuscript.
Institutional review board statement: This retrospective review of patient data did not require ethical approval in accordance with local/national guidelines.
Informed consent statement: All the participants signed an informed consent form.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lupe Sanchez-Mete, MD, Doctor, Gastroenterology and Digestive Endoscopy, Regina Elena National Cancer Institute, IRCCS, via Elio Chianesi nr 53, Rome 00144, Italy. lupe.sanchez@ifo.it
Received: February 13, 2023 Peer-review started: February 13, 2023 First decision: April 25, 2023 Revised: May 28, 2023 Accepted: June 13, 2023 Article in press: June 13, 2023 Published online: November 15, 2023
ARTICLE HIGHLIGHTS
Research background
Patients with MUTYH-associated polyposis (MAP) present an increased risk of extra-intestinal manifestations. Among them, a frequent extra-colonic manifestation is duodenal polyposis, which severity is traditionally classified with the Spigelman five-stage system (SS). The occurrence of SS IV duodenal polyposis is reported as the main risk factor for duodenal cancer. However, case reports of duodenal cancers in MAP suggest that they may develop in the absence of advanced benign SS disease, even without coexisting adenomas, and often involve the distal portion of the duodenum, out of the reach of conventional esophagogastroduodenoscopy.
Research motivation
Further studies are needed to define appropriate upper gastrointestinal surveillance programs in MAP patients.
Research objectives
To increase the knowledge regarding MAP and its associated duodenal polyposis, in light of recent literature evidence, we describe a series of MAP patients followed up at the Regina Elena National Cancer Institute of Rome, Italy. In addition, a literature revision on previously reported small bowel (SB) cancers in MAP was carried out.
Research methods
Clinical records of thirty-eight MAP patients followed up at the Regina Elena National Cancer Institute between 2003 and 2021 were considered. A literature revision by a PubMed search was carried out on previously reported SB cancers in MAP, without any limitations in terms of publication date and language.
Research results
In our case series, we identified two (6%) SB adenocarcinomas with no previous history of duodenal polyposis.
Research conclusions
Our observations suggest that the formula for staging duodenal polyposis and predicting risk factors for distal duodenum and jejunal cancer should be adjusted to take in consideration the presence of SS IV disease, rather than focusing only on this feature.
Research perspectives
A revision of upper gastrointestinal/SB surveillance guidelines may be required to better prevent SB cancer in MAP.
