Editor,—We compliment Vasen et al(Gut 1997;40:716–19) on their attempt to quantify the benefit of surveillance of the duodenum in patients with familial adenomatous polyposis (FAP). We should like to make the following points:

The St Marks’s study1 is not strictly comparable to the Scandinavian study in that in the former results are based on the use of a side-viewing endoscope to focus particularly on the high risk periampullary area, whereas the Scandinavian study used forward viewing endoscopes only.

Vasen et al state that pancreaticoduodenectomy has substantial morbidity and mortality; this statement contradicts another within the body of the text referring to the decline in mortality from this operation over the past decade. It would be fair to say that the operation has the potential for substantial morbidity and mortality. However, this potential has not been fulfilled, especially …