Endoscopic management of patients with familial adenomatous polyposis after prophylactic colectomy or restorative proctocolectomy – systematic review of the literature

Gavric, Aleksandar; Sanchez, Liseth Rivero; Brunori, Angelo; Bravo, Raquel; Balaguer, Francesc; Pellisé, Maria

doi:10.2478/raon-2024-0029

Figures & Tables

Flowchart of the systematic review according to the Preferred Reporting Items for Systematic Reviews (PRISMA) schema.

Surveillance endoscopy in a 48-year old patient with FAP after colectomy with IRA revealed 18 m LST-G (A). After submucosal injection with gelofusine, indigo carmine and adrenaline, piecemeal endoscopic mucosal resection (pEMR) (B) was performed.

Surveillance endoscopy in a 49-year old patient with FAP after proctocolectomy with IPAA revealed 25 mm LST-G mixed type lesion in the rectal cuff. Lesion was spreading from the anastomosis to the dentate line. Patient had undergone surgery five years earlier and did not show up for endoscopy follow-up since then (A). Lesion was removed with pEMR (B).

Cancer rate after primary ileal pouch anal anastomosis (IPAA)

First author and publication date (ref.)	No of patients	Age at cancer diagnosis (years)	Time to cancer (years)	Interval since last surveillance endoscopy and findings	Endoscopic findings at diagnosis	Location	Staging of cancer and status
Aelvoet et al., 2023⁵⁵	3/111 (2.7%)	/	/	/	/	/	Pouch excision
Pasquer et al., 2021⁵⁸	1/92 (1.1)	30	/	1 month		Pouch body	Endoscopic resection
Ganschow et al., 2018⁶¹	1	/	27	/	/	Pouch body	Resection and reconstruction of a new pouch - alive
Walsh et al., 2016⁶³	1	54	/	Regular annual surveillance	New endoscopy due to anemia and rectal blood loos	Anastomosis	T3N2Mx, resection and ileostomy, alive during last FUP.
Wasmuth et al., 2013⁶⁷	1	/	11	/	/	Rectal cuff	Resection and ileostomy - alive
Boostrom et al., 2013⁶⁶	1	/	23.7	/	/	Pouch body	Transanal resection - alive
Ozdemir et al., 2013³⁸	4	/	Mucosectomy group; median 11.3 years (8.3–22) Without mucosecomy; 8 years	Regular annual surveillance	/	All ATZ	? 3 underwent APR - alive 1 transanal resection – died 4 years later dissemination
Makni et al., 2012⁶⁹	1	26	10	8 months	Polyps, LGD?	Pouch body?	Pouch excision – died 12 months later dissemination
Tonelli et al., 2012⁵¹	2	29 58	10	12 months, normal 6 months, normal	? IIa + IIc polyp	Pouch body Pouch body	Excision with ileostomy, T3N0M0, died 6 months later dissemination/Excision with ileostomy, T2N0M0, alive after 56 month FUP
voon Roon et al., 2011⁷⁰	1	/	13	/	/	Pouch body	Excision of a pouch – died 2 years of disseminated disease
Banasiewicz et al., 2011³³	5	/	/	/	/	Pouch body	/
Ault et al., 2009⁷¹	2	61 50	11 10	6, normal /	Pain and blood per rectum, 3 cm mass/Sacral pain, bleeding ulcer	Pouch body / Pouch body	T2N1Mx, died of AMI prior treatment / Metastatic disease, chemotherapy
Tajika et al., 2009⁸³	2	55 68	8.6 20	9 months, normal No FUP	30×25 mm cancer / Polyposis and 25 × 25 mm polyp	Pouch body/Kock’s pouch body	T4N2M0 – died 1 year later T3N?M? – died (MDS)
Lee et al., 2008⁷¹	1	/	7	/	Ulcerating tumor	Pouch body	T4N1M0, APR ileostomy. Developed metastases 2 years later.
Friederich et al., 2008³²	4	35 37 32 36	14 10.2 16.4 6.2	4.4 years, normal 2.1 years, normal No control (symptoms) 0.6 years, Tubullovilous HGD	/	All pouch body	Dukes C Dukes B Dukes B Dukes B
Linehan et al., 2007⁷²	1	40	10	/	Pelvic pain, discharge	Pouch body (patient had ileostomy but pouch was left in situ)	Excision. At last FUP patient was well.
Ulas et al., 2006⁷⁴	1	/	9	/	/	Anastomosis	Dukes B, APR, metachronous cancer after 1 year
Campos et al., 2005¹⁹	1	/	12	No FUP	Presented with rectal bleeding	Pouch body	T2N0Mx, APR and ileostomy, patient well at 6 years FUP.
Vroueraets et al., 2004⁷⁵	2	48 36	9 10	5 years normal, then 2 and 1 years (both multiple LGD adenomas refused surgery) / Regular FUP every 2 years	Presented after 1 year with rectal bleeding /Normal. Routine biopsies at subsequent FUP revealed adenoca.	Anastomosis Anastomosis	T2N0M0, APR, alive 1 year later / T4N0M0, APR, alive 8 months later
Cherki et al., 2003⁷⁶	1	35	3.5	1.5 years	/	Pouch body	T3N1M1, resection with ileostomy, died 1 month later
Ooi et al., 2003³⁶	2	36 /	2 years 3 months 8 years	/ /	Symptoms of anal bleeding/ /	Anastomosis Anastomosis	T3NOMO, APR, ileostomy, died 2.5 years later dissemination / T2N0M0, transanal excision with ileostomy (refused APR), died 4 years later, dissemination
Brown et al., 2001⁷⁸	1	44	7 years 4 months	Under FUP every 6 months	/	Anastomosis	/
Vuilleumier et al., 2000⁷⁹	1	38	7	No FUP	/	Anastomosis	Resection with ileostomy – died 12 months later dissemination
Palkar et al., 1997¹⁵	1	39	4.7	3 months	?	Pouch body	T4NOM? - alive
Kim et al., 1997¹⁵	1	/	/	/	/	Pouch body?	/
Bassuini et al., 1996⁸⁰	1	31	3	No FUP	/	Pouch body	/
Von Herbay et al., 1996¹⁴	1	33	8			Anastomosis	T1N0M0
Hoehner et al., 1994⁷	1	34	20	/	/	Anastomosis	/

Rate of adenoma development in the neoterminal ileum in patients after ileorectal anastomosis (IRA) and ileal pouch anal anastomosis (IPAA)

First author and publication date (ref.)	Adenomas in the neoterminal ileum – after primary IPAA; n (%)	Cumulative risk for development of neoterminal adenomas	Years since surgery	Risk factor for adenomas in neoterminal ileum	Rate of adenomas in the neoterminal ileum – after primary IRA; n (%)	Years since surgery
Tajika et al., 2019¹⁶	4/24 (16.7)	4.4% at 20 years and 36% at 30 years after primary surgery	23.1 ± 5.8		0/14 (0.0)
Boostrom et al., 2013⁶⁶	4/33 polyps (12.0)
Pommaretet et al., 2013³⁵	9/118 (6.5)			Presence of pouch adenomas (OR, 2.16, P = 0.007)
Booij et al., 2010¹⁸					5/34 (14.7) 2 patients had resection of neo-terminal ileum, one due to LGD and other due to HGD adenoma.
Gleeson et al., 2008³⁰	3/13 (23.1)		Median 6.5 (0–15)		4/16 (25.0)	Median 12 (1–29)
Moussata et al., 2007¹⁷			Mean 17.6 +-7.8(6–35) Mean from colectomy to diagnosis: 16.4+-8.5 (5–30)		10/21 (47.6) of which 2 were advanced adenomas.
Groves et al., 2005³⁴	2/20 (10.0)		6 (1–14)		1/47 (2.0%)	12 (0–39)
Thompson-Fawcett et al., 2001⁷⁷	1/24 (4.2)		Median 7 (1–19)

Patient characteristics and rate of rectal remnant cancer rate in patients after ileorectal anastomosis (IRA)

First author and publication date	Proportion of man; n / (%)	APC mutation Underwent n/(%); Positive in; n/(%)	Follow-up (years/months) since surgery	Years since surgery to cancer diagnosis	Age at surgery	Age at cancer diagnosis	Rectal remnant cancer rate; n/(%)	Cumulative risk for rectal cancer	Rectal cancer mortality
Colletti et al., 2022⁵⁸	57.4%	93.6% /	/	Median of 13 years	/	/	47 / 715 (6.57)	/	14/47 (29.8%) at median follow up of 13 years.
Pasquer et al., 2021⁵⁹	95 (48.2)	/	/	/	/	/	12 / (6.1); 1 was metastatic, 2 were resected endoscopically, 10 surgically	/	/
Maehata et al., 2015²⁰	16 (59.3)	21 (77.8) 14 (66.7)	21.1 (3–35)	/	Median 27 years (9–66)	/	10/27 (37.0); 6/10 cancers were TisN0M0	8% at 10 years; 19% at 20 years; 57% at 30 years	3/27 (11.1)
Koskenvuo et al., 2013²²	59 (42.1)	/	Median 15 years (0–44)	/	Mean 36 years (18–71)	Cumulative risk 2% at 40 years age; 7% at 50; 13% at 60 years age and 16 % at 70 years age.	18/140 (13%)	3% at 5 years; 4% at 10 years; 11% at 20 years; 24% at 30 years after IRA	10/140 (7%); 5-year survival 55%. Cumulative risk for death due to rectal cancer after IRA: 2% at 5 years, 3% at 10 years and 9% at 30 years.
Booij et al., 2010¹⁸	19 (44.2)	/	/	/	Median 16 (7–25)	/	3/34 (8.8)	/	2/34 (5.8)
Sinha et al., 2010²⁶	232 (54.3)	/ 311/427 (72.8)	Median 15 years (7–25)	/	Median 21 years (11–67)	/	48/427 (11.2%)	/	/
Yamaguchi et al., 2009²⁵	35 (59.3)	/	Median 8.9 years	/	Median 30 years (13–65)	/	17/59 (30%)	/	5-year survival 94%; 10-year survival 94%.
Nieuwenhuis et al., 2009²⁷	/	/	/	/	/	/	/	3.7% for group 1; 9.3% for group 2; 8.3% for group 3.%	/
Campos et al., 2008¹⁹	/	/	91.1 (3–557)	/	Mean 45.8 years	Mean 50.6 years	6/36 (16.7)	17.2% at 5 years; 24.1% at 10 years; 43.1% after 15 years	/
Gleeson et al., 2008³⁰	/	/	FUP initiated median 12 (1–29) years after surgery	/	/	40 and 59 years.	2/16 (12.5)	/	/
Bullow et al., 2008²⁴	401 (51.7)	/	Median 7 years (0–13). Patients were operated between 1950–2006		Median 27 (7–75)	/	60/776 (7.7%) (56/576; 10% and 4/200; 2%)	10-year cumulative risk 4.4% [95% CI 2.6–6.2] in pre-pouch era; 10-year cumulative risk 2.5% [95% CI 0–5.5] in pouch era;	/
Moussata et al., 2007¹⁷ They only watched ileal muocas above the IRA	10 (47.6)	21/21 (100.0) 14/21 (66.7)	Mean 8.4 years ± 5 since colectomy	/	/	/	0/21 (0.0)	/	/
Church et al., 2003³⁸	92 / (46.7)	/	Pre-pouch era: 212 months (IQR 148 months); Pouch era: 60 months (IQR 80 months)	/	Median age 23 years (IQR 15.5 years pre-pouch and 17 years pouch)	/	8 (12.9%) in the pre-pouch era and 0 in pouch era.	/	/
Bertario et al., 2000²³	206/371 (55.5)	297/371 (80.1) 200/297 (67.3)	Median 81 months	Median 102 months (1–26 years)	Mean 32 years	/	27/371 (7.3)	10 years – 7.7% 15 years – 13.1 % 20 years – 23.0%	6/371 (1.6)
Jenner et al., 1998²¹	25/55 (45.0)	55/(100.0)	Median 10 (1–31)	/	Mean age 30 (13–62)	Median 41	7/55 (12.7)	/	/

Patient characteristics and rate of adenomas in patients after primary ileal pouch anal anastomosis (IPAA)

First author and publication date	Sex (man); n (%)	APC mutation Underwent; n (%); Positive in; n (%)	Distinguish between pouch body and rectal cuff	Follow-up (months/years)	Time from surgery to first adenomas (years)	Age at surgery (years)	Rate of adenomas (≥ 1 polyp)	Size of adenomas, mm	Histology of adenomas; n (%)	Number of Adenomas
Aelvoet AS et al., 2023⁵⁵	81 (56)	101 (91) 96 (86)	Yes	Median 152 (77–240)	15% at 5 years; 48% at 10 years; 85% at 20 years.	Median 24 (18–32)		Median 5 (3–15)	Tubular adenomas 31 (28%), Tubulovillous 26 (23%), Villous 5 (5%)	Prepouch ileum 4(2–13), Pouch body 20 (5–50), rectal cuff 6 (3–10)
Tajika et al., 2019²⁶	16 (47.1)	/	Yes	Median 21.6 (3.7–8.8)	32 (35.9) of patients showed progression of pouch adenomas during FUP	Median 34.6 (17–52)	24/34 (70.6)	2–40 mm	6 advanced adenomas (25.0)	1–300
Ganschow et al., 2018⁶¹	100 (52.1)	133 (69.3)) ? / 133	No	Median 12.8 (9–17) for patients with pouch adenomas and (2.5–12.2) for patients without pouch adenomas;	32 (35.9) of patients showed progression of pouch adenomas during FUP	27.5 years (10.2–58.5)	90/192 (46.9) at a median of 8.5 years (0.9–25.1) after IPAA. 5 years after IPAA 84.9% patients free of adenoma; 15 years after 40.4% and 20 years after 21.9% patients were free of adenomas.	53/192 (58.9) ≤ 4 mm; 24/192 (26.7) 5 – 10 mm; 13/192 (14.4) ≥ 10 mm	Tubular adenomas in 69/192 (76.7); tubulovillous adenomas in 16/192 (17.8); villous in 5/192 (5.6)	46/192 (51.1) had < 4; 14/192 (15.6) 5–10; 30/192 (33.3) > 10 adenomas
Goldstein et al., 2015⁶³	24 (41.0)		Yes	Mean 11.6 years +-14.6 years	Median adenoma free time interval since surgery; Cuff 10.8 years Pouch 16.9 years	Mean 30.8 years +-10.8 years	35/59 (59.0); - 20 isolated in cuff - 4 isolated in pouch body - 11 in pouch and body	/	All LGD	/
Zahid et al., 2015¹⁹	14 (51.8)		No	Mean 9.2 years	Median; 72 months (18–249)	Median 31 years (14–65)	12/27 (44.0)	/	Only 1 polyp HGD (< 99%)	/
Kennedy et al., 2014⁶⁶	43 (45.0)		Watched only anastomosis	Mean 7.6 (0 – 24)		Mean 15.4 (4–20)	9/95 (9.4)
Pommaretet et al., 2013³⁶		110 / 139 92 / 110 (Cohort included IRA, ileostomy and IPAA patients but did not distinguish between).		/	Median 15 years	25 years (9−61 years)	57/118 (48.3)	> 10 mm:12	94% LGD; 6% HGD	1−4: 22 5−20: 18 > 20: 17
Boostrom et al., 2013⁶⁶	52 (44.5)		Yes	125 months (25–423 months)	12.4 years (15–405 months)	26 years (4–60 years)	30/117 (25.6)	5.9 mm (2 mm to 20 mm)	22 LGD, 8 tubulovillous	/
Wasmuth et al., 2013⁶⁷	34 (55.7)	/	Yes (body and anastomosis)		Cumulative rate of adenomas at 28 years 17% for mucosectomy group and 75% at 15 years in a group without mucosectomy (P < 0.0001)	20 (10–49)	Anastomosis: 4/39 (10.0) vs. 14/22 (64.0) (P < 0.0001) Pouch body: 8/39 vs. 6/22 (P 0.57)
Tonelli et al., 2012⁵¹	/	45 (65%)	No	Median 133 months (12–288 months)	Mean 7 years (1–15 years)	33 years (17–63 years)	25 (36.0)	Mean 3 mm (1–40)	Adenomas, dysplasia not specified	Mean 8 (1–47)
Yan et al., 2012⁶⁸	30 (71.5)	/	Yes	Median 7.2 (2.2–20)		29 (16–65)	At the anastomosis 6/33 (18.2)	/	/	/
Banasiewicz et al., 2011³³	79 (47.9)	/	/	Endoscopies performed 2–19 years since surgery.	Mean 14 months to LGD; Mean 16 months to HGD. Estimated frequency LGD 15 years later 50% and for HGD 17.5 years later 50%.		21/165 (12.7)		LGD - 21/32 (65.6); HGD - 11/32 (34.4)
Gleeson et al., 2008³¹	/	/	Yes	/	FUP began median 6.5 (0–15) after surgery	/	13/13 (100): 10/13 pouch body; 2/13 anastomosis; 3/13 ileum above anastomosis	< 5 mm	/	5–30
Friederich et al., 2008³²	119 (56.0)	/	/	Mean 7.9 (0.4–20.3 years)	Cumulative risk of 16% at 5-years and 42.4% at 10 years for adenoma development. Cumulative risk of 12.8% at 10 years for advanced adenoma development.	Mean 30.0 years (10–62.6 years)	47/212 (35%)	/	/	/
Campos et al., 2008¹⁷	/	/	No	50.8 (5–228)			3/26 (11.5)
Moussata et al., 2007²⁵	12 (57.1)	23/23 (100.0) 22/23 (95.7)	Yes (only polyps in the ileal mucosa of the pouch body are described)	Mean 5.4 +- 2.6 (1–11)	Mean 4.7+-3.3 years (1–14)		17/23 (74.0)	Mean size 5.2 mm +-3.4 mm; 3 polyps were > 10 mm.	LGD 16/17 (94.1); HGD 1/17 (5.9)	/
Groves et al., 2005³⁵	35 (58.3)	/	Between pouch and above anastomosis ileum	6 years (1–17 years)	/	32.5 years (13–66 years)	34/60 (57%) of which 5 were > 10 mm / 11 were advance adenomas	Mean size 5 mm (1–40 mm)	/	Median number 4
Thompson-Fawcett et al., 2001⁷⁷	/	20/33 (60.6) 18/20 (90.0)	Only pouch body	/	/	/	20/33 (60.0) adenomas	1–3 mm	/	Median 10 (1–100) Also lymphoid hyperplasia included

Summary of recommendations from the international guidelines

First author and publication date (ref.)	Endoscopic surveillance – patients with IRA	Indications for secondary proctectomy patients with IRA	Endoscopic surveillance – patients with IPAA
Vasen et al., 2008⁷	Every 3 to 6 months	Multiple large adenomas (> 5 mm) Adenomas with dysplasia	Every 6 to 12 months
Balmaña et al., 2013, ESMO⁸	Every 12 months	No recommendations	Every 12 months
Stoffel et al., 2015, ASCO⁹	Every 6 to 12 months	No recommendations	Every 6 months to 5 years (Intervals should be determined on a case-by-case basis and may be even shorter than 1 year for some individuals)
Sygnal et al., 2015, ACG¹⁰	Every 12 months	No recommendations	Every 12 months
Herzig et al., 2017, ASCRS4	Every 12 months	No recommendations	Every 12 months
Van Leerdam ME et al., 2019, ESGE⁵³	Every 12 to 24 months	No recommendations	Every 12 to 24 months
Yang J et al., 2020, ASGE⁵⁴	6 months after surgery with 6 to 12 months further surveillance interval		12 months after surgery with 12 to 24 months further surveillance interval. 6 months if advance adenoma

Characteristics of included studies

First author and publication date (ref.)	No. of patients	Country	Setting	Study design	Surgery performed (period)	Study population
Aelvoet et al., 2023⁵⁵	144 (111 IPAA, 33 ileostomy)	The Netherlands	Single	Cohort/Retrospective	/	IPAA, ileostomy
Tatsuta et al., 2023⁵⁶	65 (22 IRA, 20 IPAA)	Japan	Single	Cohort/Retrospective	1976–2022	IRA, IPAA
Anele et al., 2022⁵⁷	199 (199 IRA)	United Kingdom	Single	Cohort/Retrospective	1990–2017	IRA
Colletti et al., 2022⁵⁸	715 (715 IRA)	Italy	Multicentre	Retrospective analysis of the Registry	1977–2021	IRA
Pasquer et al., 2021⁵⁹	289 (197 IRA, 92 IPAA)	France	Multicentre	Retrospective analysis of the Registry	1965–2015	IRA, IPAA
Ardoino et al., 2020⁶⁰	925 (585 IRA, 340 IPAA)	Italy	Multicenter	Retrospective analysis of the Registry	1947–2015	IRA, IPAA
Tajika et al., 2019¹⁶	47 (14 IRA, 25 IPAA, 8 ileostomy)	Japan	Single	Cohort/Retrospective	1965–2017	IRA, IPAA and ileostomy
Ganschow et al., 2018⁶¹	192	Germany	Singe	Cohort/Prospective and retrospective analysis of Polyposis Registry	Endoscopy data collected during 2010–2013	IPAA
Kariv et al., 2017⁶²	45	Israel	Single	Cohort/Retrospective	1986–2013	IPAA
Patel et al., 2016⁴²	21 (6 IRA, 5 IPAA, 10 intact colon)	Indianapolis, USA	Single	Cohort/Retrospective	Endoscopies performed between 2004–2016	IRA, IPAA and intact colon
Walsh et al., 2016⁶³	1	Ireland	Single	Case report	1987	IPAA - cancer
Maehata et al., 2015²⁰	27	Japan	Single	Cohort/Retrospective	1990–2004	IRA
Ganschow et al., 2015⁵⁰	100; 50 hand-sewn and 50 stapled anastomoses	Germany	Single	Cohort/Prospective	?	Hand-sewn vs. stapled anastomosis
Goldstein et al., 2015⁶³	59	Israel	Single	Cohort/Retrospective	1986–2013	IPAA
Zahid et al., 2015⁶⁴	27	Australia	Single	Cohort/Retrospective	1984–2011	IPAA
Kennedy et al., 2014⁶⁵	95; 85 hand-sewn and 1 stapled anastomosis	Rochester, Mayo Clinic, USA	Single	Cohort/Retrospective	1987–2011	IPAA
Koskenvuo et al., 2013²²	140	Finland	Single	Cohort/Retrospective	1963–2012	IRA
Pommaret et al., 2013³⁵	118	France	Single	Cohort/Retrospective	/	IPAA and IRA
Boostrom et al., 2013⁶⁶	117	Rochester, Mayo Clinic, USA	Single	Cohort/Retrospective	1972–2007	IPAA
Ozdemir et al., 2013³⁷	260; 86 hand-sewn and 175 stapled anastomoses	Cleveland, USA	Single	Analysis of polyposis registry	1983–2010	Hand-sewn vs. stapled anastomosis
Wasmuth et al., 2013⁶⁷	61; 39 hand-sewn with mucosectomy and 22 without of which 15 were stapled and 7 hand-sewn anastomoses	Norway	Multicenter	Analysis of polyposis registry	1986–2008	IPAA (mucosectomy vs. no-mucosectomy)
Yan et al., 2012⁶⁸	42 (33 IPAA; 6 IRA ?)	China	Single	Cohort/Retrospective	1988–2008	IPAA and IRA
Makni et al., 2012⁶⁹	1	Tunisia	Single	Case report	1996	IPAA - cancer
Tonelli et al., 2012⁵¹	69	Italy	Single	Cohort/Prospective data collection	1984–2008	IPAA
von Roon et al., 2011⁷⁰	140; 44 hand-sewn and 76 stapled anastomoses	UK	Single	Retrospective analysis of St. Mark’s Hospital Polyposis Registry	1978–2007	Hand-sewn vs. stapled anastomosis
Banasiewicz et al., 2011³²	165	Poland	Bicenter	Bicenter/Retrospective analysis	1985–2009 operated, Clinical data from endoscopy FUP between 2004–2009	IPAA
Booij et al., 2010¹⁸	43 (34 IRA)	The Netherlands	Single	Cohort/Retrospective	1977–2005	IRA and IPAA
Sinha et al., 2010²⁶	427	UK	Single	Retrospective analysis of St. Mark’s Hospital Polyposis Registry	1990–2008	IRA
Ault et al., 2009⁷¹	2	Los Angeles, USA	Single	Case series	1990, 1993	IPAA - cancer
Nieuwenhuis et al., 2009²⁷	475	Denmark, Finland, Sweden, Netherlands	Multicenter	Analysis of polyposis registry	/	IRA
Yamaguchi et al., 2009²⁵	59	Japan	Single	Cohort/Retrospective	1962–2007	IRA
Friederich et al., 2008³¹	212; 71 hand-sewn with mucosectomy and 115 stapled anastomoses	The Netherlands	Single	Analysis of National Polyposis Registry	1985–2005	IPAA
Campos et al., 2008¹⁹	36	Brasil	Single	Cohort/Retrospective	1977–2006	IRA and IPAA
Bullow et al., 2008²⁴	776; 576 operated in pre-pouch period and 200 in pouch period starting in 1990	Denmark, Finland, Sweden, Netherlands	Multicenter	Analysis of polyposis registry	1950–2006	IRA
Gleeson et al., 2008³⁰	16	Rochester, Mayo Clinic, USA	Single	Cohort/Retrospective analysis	1964–2003(Analysis of endoscopies between 1992–2006)	IPAA and IRA
Lee et al., 2008⁷²	1	Korea	Single	Case report	1998	IPAA - cancer
Linehan et al., 2007⁷³	1	Ireland	Single	Case report	1997	IPAA - cancer
Valanzano et al., 2007²⁸	25	Italy	Single	Cohort/Prospective	1986–2004	IRA
Moussata et al., 2007¹⁷	21	France	Single	Cohort/Retrospective	/	IPAA and IRA
Ulas et al., 2006⁷⁴	1	Turkey	Single	Case report	1993	IPAA - cancer
Campos et al., 2005¹⁹	1	Brazil	Single	Case report	/	IPAA - cancer
Groves et al., 2005³⁴	60	UK	Single	Retrospective analysis of St. Mark’s Hospital Polyposis Registry	/	IPAA
Vroueraets et al., 2004⁷⁵	2	The Netherlands	Single	Case report	1990, 1991	IPAA – cancer
Ooi et al., 2003³⁶	2	Cleveland, USA	Single	Case report	/	IPAA – cancer
Church et al., 2003³⁸	197; 62 operated in pre-pouch period and 135 in pouch period starting in 1983	Cleveland, USA	Single	Analysis of polyposis registry	1950–1999	IRA
Cherki et al., 2003⁷⁶	1	France	Single	Case report	/	IPAA - cancer
Thompson-Fawcett et al., 2001⁷⁷	33	Canada	Single	Cohort/Prospective	/	IPAA
Church et al., 2001¹⁵	213 (165 IRA)	Cleveland, USA	Single	Analysis of polyposis registry	/	IRA and IPAA
Brown et al., 2001⁷⁸	1	Singapore	Single	Case report	/	IPAA - cancer
Bertario et al., 2000²³	371	Italy	Multicenter	Retrospective analysis of Hereditary tumor registry	1955–1997	IRA
Vuilleumier et al., 2000⁷⁹	1	UK	Single	Case report	1990	IPAA - cancer
Jenner et al., 1998²¹	55	Australia	Single	Analysis of polyposis registry	?–1994	IRA
Bassuini et al., 1996⁸⁰	1	UK	Single	Case report	1991	IPAA - cancer
Hoehner et al., 199⁴⁶	1	Iowa, USA	Single	Case report	/	IPAA - cancer

Endoscopic management of patients with familial adenomatous polyposis after prophylactic colectomy or restorative proctocolectomy – systematic review of the literature

Figures & Tables

FIGURE 1.

FIGURE 2.

FIGURE 3.

Cancer rate after primary ileal pouch anal anastomosis (IPAA)

Rate of adenoma development in the neoterminal ileum in patients after ileorectal anastomosis (IRA) and ileal pouch anal anastomosis (IPAA)

Patient characteristics and rate of rectal remnant cancer rate in patients after ileorectal anastomosis (IRA)

Patient characteristics and rate of adenomas in patients after primary ileal pouch anal anastomosis (IPAA)

Summary of recommendations from the international guidelines

Characteristics of included studies

Paradigm

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