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We read with interest the article by Matsumoto et al reporting their observations on the presence of serrated adenomas in familial adenomatous polyposis (FAP) patients in relation to germline APC mutations (Gut 2002;50:402–4). Their small colonoscopic study identified three FAP patients with serrated adenomas; all had less than 100 polyps and they concluded that serrated adenomas may be characteristic of attenuated FAP.
It is our practice to perform prophylactic colectomy with ileorectal anastomosis or ileoanal pouch formation in patients with FAP in the second or third decade or as soon as possible after a new diagnosis is established. An expert histopathologist performs a meticulous examination of the colectomy specimen, including a formal polyp count. Thereafter any rectal remnant is surveyed six monthly by flexible …
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