Familial Adenomatous Polyposis: Management of Upper Gastrointestinal Polyps

Familial adenomatous polyposis (FAP) is known for its association with development of hundreds to thousands of colorectal adenomas and colorectal cancer (CRC). After CRC, the second most common malignancy in FAP is duodenal adenocarcinoma. Over the last several decades, optimized colonoscopic surveillance and timely referral for prophylactic colectomy have reduced morbidity and mortality from CRC in FAP. However, as survival of patients with FAP continues to improve, management of upper gastrointestinal tract neoplasia is critically important. The purpose of this chapter is to discuss the approach to surveillance of gastric, duodenal, and ampullary polyps that arise in individuals with FAP, specifically focusing on clinical features, management, and chemoprevention.