Discussion FAP is a hereditary condition characterized by the development of polyps both in the colon as well as in extra-colonic locations. Polyps in the stomach and small intestine

develop in about 90% of patients. The gastric polyps primarily consist of fundic gland hyperplasia, however occasionally gastric adenomas are found. Notably, gastric cancer is only rarely Inhibitors,research,lifescience,medical reported as a complication of FAP in the United States. Small intestinal neoplasia is however not rare in FAP and principally occurs in the periampullary region of the duodenum. Duodenal adenomatous polyps, which selleck screening library typically appear later than the colonic lesions may be multiple but tend not to carpet the small intestine. The ampulla of Vater is a particular target for neoplastic development. With time, carcinoma develops in up Inhibitors,research,lifescience,medical to 5% to 10% of these patients, therefore duodenal surveillance is required. This was a key point in deciding Inhibitors,research,lifescience,medical to proceed with a jejunal flap in our patient because it allowed for close surveillance of the duodenum. The standard Roux-en-Y reconstruction performed after a gastrectomy makes visualizing the duodenum very difficult. Total

gastrectomy with isoperistaltic jejunal interposition in the setting of gastric polyposis in FAP has not previously been reported in the literature. Jejunal interposition is frequently used to treat dumping syndrome following gastrectomy or gastric bypass (1,2). The Henley jejunal interposition is preferred to Roux-en-Y gastric bypass due to the lower risk for the development of Roux stasis/post gastrectomy syndrome, characterized Inhibitors,research,lifescience,medical by poor emptying (3). The jejunal interposition is also superior in that it allows for easier endoscopic surveillance of the duodenum, a key necessity in FAP patients. Nuclear medicine Tc99m sulfur colloid intestinal Inhibitors,research,lifescience,medical emptying studies following jejunal interposition demonstrate a double exponential curve, consisting MycoClean Mycoplasma Removal Kit of both

slow and fast components compatible with more physiologic emptying (4). Notably, gastrectomy in the setting of gastric polyposis in patients with FAP is not routinely performed due to the low risk of malignant transformation of the gastric polyps in this setting. Our patient however had significant symptomatology including nausea, hematemesis and early satiety with no other explanation. Fortunately post-operatively the patient had near complete clinical improvement. Gastric polyps in the setting of FAP usually consist of fundic gland polyposis which has virtually no malignant potential. Adenomatous gastric polyps can also be seen in FAP and have a 40% chance of malignant transformation.