We congratulate the authors (Gut 2004;53:381–6) on gathering this large cohort of patients in this important area in familial adenomatous polyposis (FAP) but would like to express some reservations with regards to the study. Our first concern relates to the means of endoscopic assessment. Standard forward viewing endoscopy was used, whereas in clinical practice side viewing endoscopy is recommended as duodenal polyposis in FAP is more severe in the periampullary region¹ and this is likely to be missed with standard endoscopy. This will therefore underestimate both adenoma staging and frequency. This matter is raised in their discussion where they …