This article is from a St. Mark's Polyposis
Newsletter - My thanks go to David for allowing the article
to be reproduced below.
Wolfson Unit for Endoscopy was established in 1996 as
a national centre for flexible endoscopy. It is designed
to combine a stylish and caring environment with modern
high-technology facilities for outpatients and inpatients,
whether NHS or private.
The term medical
screening, or surveillance, frequently appears in the media.
People often associate screening and surveillance programmes
with the prevention of conditions such as cervical cancer
or breast cancer.
What do we actually mean when we say that
a patient is part of a screening programme and how does
this apply to an individual who has Familial Adenomatous
Polyposis (FAP)? Broadly speaking, screening is a method
for detecting disease or body dysfunction before an individual
would normally seek medical advice. FAP is a condition characterised
by the formation of polyps on the lining of the large intestine.
These polyps are important because of their potential to
develop into cancer.
In order to minimise this, two main surgical
options exist: the total removal of the colon and formation
of a pouch (restorative proctocolectomy); or the removal
of the colon without removing the rectum (colectomy with
While the two operations remove a significant
proportion of risk for patients, polyps can still develop
in the rectum, in the duodenum (just beyond the stomach)
and to a lesser extent on the surface of the pouch. Endoscopes
(thin fibre-optic cameras) give us an opportunity to examine,
and in some cases, treat these areas.
Different screening intervals.
They also allow us to suggest the most
appropriate screening intervals. For example a patient with
a small number of polyps in his or her rectum may only require
endoscopic screening once or twice a year, whereas an individual
with a large number of polyps may require more frequent
screening and polyp removal, perhaps on a three monthly
basis until the polyps are under control.
One of the significant advantages of endoscopic
screening is that it allows us to combine surveillance and
treatments. Current treatments include the use of Argon
Plasma Coagulation (APC), which is a laser like machine
ideal for removing small polyps from the lining of bowel.
For certain patients, improved screening techniques have
made it possible for us to attempt treatment of duodenal
polyps using a short-acting general anaesthetic. Despite
these advances in polyp surveillance and treatment, surgery
will still be required in some cases, when endoscopic management
cannot keep up with polyp growth.
Outlined in the table below is a basic
description of the tests carried in endoscopy and the approximate
intervals between the examinations. Screening is not foolproof
every screening technique has an associated miss rate. In
the case of endoscopy this has been estimated at being between
5 and 17 per cent. Most importantly, the success of screening
relies on regular attendance.
Screening techniques and surgical techniques
are constantly improving, and novel drug therapies are currently
under investigation. We hope these will improve the screening,
treatment and quality of life of people with FAP.
All patients with confirmed FAP
aged over 25
Stomach and duodenum
Every 1 - 5 years depending on polyp
Colectomy with ileorectal anastamosis
The rectum and approximately 10cm
of the ileum
Six-monthly on the same day as their
outpatients appointment (more frequently if treatment
Restorative proctocolectomy (pouch)
The pouch and approximately 5cm
of distal ileum
Once a year on the same day as their
Go to top of page