Singh AD, Bhatt A, Joseph A, et al. - Findings demonstrate that most of the familial adenomatous polyposis (FAP) patients with ampullary adenomas (AAs) did not develop clinically significant progression (CSP) or need resection over 8 years of surveillance. A rare occurrence of ampullary cancer was evident. Endoscopic surveillance of AAs is favored over expedited resection for the majority of patients with FAP.

• Using a hereditary gastrointestinal cancer registry, FAP patients with AAs (n = 143) and ≥2 esophagogastroduodenoscopies were selected.

• A median follow-up of 7.8 years revealed 41 (28.6%) patients experienced CSP for an incidence of 35 per 1,000 patient-years.

• Ampullary cancer occurred in two (1.4%) patients.

• Factors linked with CSP were: male gender, abnormal appearance of papilla at initial AA detection, prior cholecystectomy, and personal history of extracolonic malignancy.

• 24% patients with AAs received intervention specifically for AA and not duodenal polyposis, including endoscopic papillectomy in 23 cases and duodenectomy in 3 at median follow-up of 8.2 years.