CHALLENGES IN THE MANAGEMENT OF PREVENTING LARGE BOWEL RESECTION IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS: INTENSIVE DOWNSTAGING POLYPECTOMY AND ASPIRIN

Abstract

We have reported two chemoprevention studies on preventing colorectal cancer (CC) without colorectal resection for familial adenomatous polyposis (FAP) using low-dose aspirin and intensive downstaging polypectomy (IDP) of colorectal polyps. Chemoprevention studies using low-dose aspirin, a 2×2 factorial, randomized, double-blind, placebo-controlled, multicenter trials were conducted at 11 centers in Japan. The results showed that low-dose aspirin safely inhibited the growth of colorectal polyps of ＞5.0mm at 8 months in patients with FAP, while mesalazine had little effect. Thus, low-dose aspirin may be a useful cancer chemoprevention drug for CC prevention in patients with FAP. The second study on IDP is a multicenter trial conducted for 5 years to demonstrate the safety of IDP. Although the IDP results confirm its safety and effectiveness in preventing CC, whether IDP prevents CC in the long-term in patients with FAP who did not undergo colorectal resection is unclear. Thus, we are preparing a registry for long-term follow-up. Based on these results, we believe that colorectal resection in patients with FAP can be prevented with appropriate endoscopic intervention and chemoprevention with low-dose aspirin.