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(Familial Adenomatous Polyposis)

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Personal Screening

Article by Mr David Swain DipHE RN

The Wolfson Unit for Endoscopy

This article is from a St. Mark's Polyposis Newsletter - My thanks go to David for allowing the article to be reproduced below.

The 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.

Personal Screening

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.

Detecting disease

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 ileorectal anastomosis).

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.

Examination
Patient Group
Area Examined
Frequency
OGD
All patients with confirmed FAP aged over 25
Stomach and duodenum
Every 1 - 5 years depending on polyp status
Flexible sigmoidoscopy
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 required)
Pouchoscopy
Restorative proctocolectomy (pouch)
The pouch and approximately 5cm of distal ileum
Once a year on the same day as their outpatients appointment

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