A proposed staging system and stage-specific interventions for familial adenomatous polyposis

Gastrointestinal Endoscopy
Patrick M LynchGabriela Moeslein

Abstract

It is not possible to accurately count adenomas in many patients with familial adenomatous polyposis (FAP). Nevertheless, polyp counts are critical in evaluating each patient's response to interventions. However, the U.S. Food and Drug Administration no longer recognizes the decrease in polyp burden as a sufficient chemoprevention trial treatment endpoint requiring a measure of "clinical benefit." To develop endpoints for future industry-sponsored chemopreventive trials, the International Society for Gastrointestinal Hereditary Tumors (InSIGHT) developed an FAP staging and intervention classification scheme for lower-GI tract polyposis. Twenty-four colonoscopy or sigmoidoscopy videos were reviewed by 26 clinicians familiar with diagnosis and treatment of FAP. The reviewers independently assigned a stage to a case by using the proposed system and chose a stage-specific intervention for each case. Our endpoint was the degree of concordance among reviewers staging and intervention assessments. The staging and intervention ratings of the 26 reviewers were highly concordant (ρ = 0.710; 95% credible interval, 0.651-0.759). Sixty-two percent of reviewers agreed on the FAP stage, and 90% of scores were within ±1 stage of the mode. Sixt...Continue Reading

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References

Jun 30, 2000·The New England Journal of Medicine·G SteinbachG Kelloff
Jul 21, 2009·Diseases of the Colon and Rectum·Andre da Luz MoreiraCarol A Burke
Mar 5, 2011·Cancer Prevention Research·Frank L MeyskensUNKNOWN C-Change Chemoprevention Clinical Trials and Biomarkers Subcommittee
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Citations

Jun 25, 2016·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·Gabriela Möslein
Apr 21, 2016·Nature Reviews. Gastroenterology & Hepatology·Luigi RicciardielloPatrick M Lynch
Sep 10, 2020·The New England Journal of Medicine·Carol A BurkeAlfred Cohen
Oct 20, 2018·The American Journal of Gastroenterology·Shashank SarvepalliJames M Church
Aug 14, 2019·Scandinavian Journal of Gastroenterology·Hans F A VasenJames C H Hardwick
Nov 26, 2020·Der Internist·I SpierS Aretz
May 23, 2020·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·L KoskenvuoA Lepistö

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