Familial adenomatous polyposis (FAP) with severe upper gastrointestinal disease most commonly involves duodenal adenomas, which are staged using the Spigelman classification. At which Spigelman stage is prophylactic surgical intervention typically recommended?
- A Stage I
- B Stage II
- C Stage IV or V ✓
- D Stage III
Correct answer: C. Stage IV or V
Explanation
The Spigelman classification grades FAP-associated duodenal polyposis from Stage 0–IV (some centres use Stage V) based on polyp number, size, histological grade, and degree of dysplasia. Stage IV (or Stage V in modified classifications) indicates severe disease with high risk of duodenal/periampullary carcinoma, and prophylactic duodenectomy or pancreaticoduodenectomy is recommended. Stages I–III are managed endoscopically with surveillance intervals determined by stage.
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.