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QUALYFAP STUDY: PRELIMINARY FINDINGS ON THE IMPACT OF ENDOSCOPIC SURVEILLANCE QUALITY ON ADVANCED NEOPLASIA AFTER PROPHYLACTIC (PROCTO)COLECTOMY IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS

Romina Ariadne Vergara Quispe 1, Mariana Ortiz-Reyes 1, Maria Daca Alvarez 1, Oswaldo Ortiz 1, Teresa Ocaña 1, Francesc Balaguer 1, Maria Pellisé Urquiza 1, Liseth Rivero Sánchez 1

Affiliations

1 Hospital Clinic de Barcelona, Barcelona, Spain

Summary

AI Generated

A retrospective study of 61 FAP patients who underwent prophylactic colectomy found that advanced neoplasia development was associated with lower-quality endoscopic surveillance, with non-use of high-definition endoscopes as the only independent risk factor.

Among 61 FAP patients after prophylactic surgery, 11.5% developed advanced neoplasia in the rectal remnant or reservoir, including three cancers and four advanced adenomas.
Patients with advanced neoplasia had significantly lower-quality surveillance procedures: high-definition endoscope use 42.9% versus 94.4%, retroflexion 14.2% versus 68.5%, adequate bowel preparation 42.8% versus 87%, and dedicated program use 28.5% versus 79.6%.
Non-use of high-definition endoscopes was the only independent variable associated with advanced neoplasia in multivariable analysis.
The authors conclude that these findings highlight the need to establish specific quality indicators for endoscopic surveillance in this high-risk population.
The study has been expanded to a European multicenter phase currently recruiting patients.

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Abstract

Introduction

Familial adenomatous polyposis (FAP) is a hereditary syndrome caused by a pathogenic variant in the APC gene, responsible for 1–2% of colorectal cancers (CRC) and associated with a near 100% lifetime CRC risk. Prophylactic colectomy or proctocolectomy reduces CRC incidence and mortality but does not eliminate the risk of rectal or pouch cancer (2–24%). The ESGE recommends endoscopic surveillance every 1–2 years, taking into account the number, size, and histological features of the polyps. However, these recommendations are mainly based on expert opinions, with limited current evidence available to optimize surveillance guidelines and define endoscopic quality standards.

Aims & Methods

To analyze the quality parameters of endoscopic surveillance and their association with the development of advanced neoplasia in the rectal remnant or reservoir among familial adenomatous polyposis (FAP) patients after prophylactic (procto)colectomy.
A retrospective observational study was conducted including FAP patients who underwent prophylactic colectomy or proctocolectomy and were registered between 1983 and 2022 at the Hospital Clínic de Barcelona. Numerical variables were analyzed using the Mann-Whitney U test, and categorical variables were evaluated with the Chi-square test. Logistic regression was performed to identify independent variables associated with the development of advanced neoplasia.

Results

Of the 85 eligible patients, 61 (64% women; median age, 53 years [range, 39–59]) met the inclusion criteria. Seven patients (11.5%) were diagnosed with advanced neoplasia (AN), of whom six had ileorectal anastomosis and one had ileoanal pouch anastomosis. Of these seven patients, three (43%) developed cancer, while four (57%) presented advanced adenomas in the rectal remnant or reservoir. Patients with AN underwent lower-quality endoscopic procedures compared to those without AN: the use of high-definition endoscopes was 42.9% vs. 94.4% (p=0.002), retroflexion was performed in 14.2% vs. 68.5% (p=0.005), adequate bowel preparation was achieved in 42.8% vs. 87% (p=0.004), procedures were performed in a dedicated endoscopy program in 28.5% vs. 79.6% (p=0.004), and the mean number of polyps removed was 1.1 ± 0.9 vs. 3.4 ± 4.2 (p=0.001), respectively. In the multivariable analysis, the only independent variable associated with the development of advanced neoplasia was the non-use of high-definition endoscopes.

Conclusion

The development of advanced neoplasia is associated with lower quality in endoscopic surveillance parameters among FAP patients who underwent prophylactic (procto)colectomy. These findings highlight the need to establish specific quality indicators to optimize endoscopic surveillance in this high-risk population.
In light of these preliminary findings, the study has been expanded to a European multicenter phase and is currently in the patient recruitment stage.

Conference

UEG Week Berlin 2025

Topics

Colorectal

Submission format

Abstract

Session

Colorectal cancer: Working around genetics and complications (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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