SCREENING FOR UPPER GASTROINTESTINAL NEOPLASMS IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS AND GARDNERS-SYNDROME

Patients with familial adenomatous polyposis and Gardner's syndrome frequently have adenomas of the stomach and small intestine. Unlike the colonic adenomas, the upper gastrointestinal lesions seldom cause symptoms or become malignant. Many investigators recommend screening and surveillance upper gastrointestinal endoscopies, although there is no evidence of benefit. The degree of benefit is apt to be small, so many patients will have to be studied. This editorial is a plea for a multicenter study to demonstrate efficacy before screening upper gastrointestinal endoscopy is recommended for patients with familial adenomatous polyposis or Gardner's syndrome. Investigators and editors should show restraint in advising endoscopic screening until benefit is shown.