A 45-year-old patient with familial adenomatous polyposis (FAP) undergoes proctocolectomy with ileal pouch-anal anastomosis (IPAA). Which additional cancer surveillance is STILL required after surgery?

• A No further surveillance needed — colorectal cancer risk is eliminated
• B Annual colonoscopy of the remaining ileostomy
• C Annual pouch endoscopy and upper GI endoscopy for duodenal/periampullary adenomas ✓
• D CT colonography every 5 years

Explanation

After proctocolectomy in FAP, colorectal cancer risk is eliminated but duodenal and periampullary adenomas remain a major risk — duodenal/periampullary adenocarcinoma is the leading cause of cancer death in FAP patients who have undergone colectomy. Annual pouch endoscopy (pouchoscopy) assesses the residual mucosa at the anastomosis and pouch. Upper GI endoscopy (surveillance gastroscopy/duodenoscopy) is essential for duodenal polyp monitoring using the Spigelman classification to guide management.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.