A88 EARLY-ONSET GASTRIC POLYPS IN CHILDREN WITH FAMILIAL ADENOMATOUS POLYPOSIS: A CASE SERIES
Bibliographic record
Abstract
Abstract Background Familial adenomatous polyposis (FAP) syndrome is a familial inherited autosomal dominant polyposis syndrome which predisposes affected individuals to a significantly increasing risk of colorectal cancer before the age of 30 years. Studies examining the rates of duodenal and gastric neoplasia in patients with FAP are scarce. Recent reports have shown a concerning rise in gastric cancer in Western FAP patients with certain endoscopic features. Current guidelines suggest screening with gastroscopy beginning at the age of 20 to 25 years. Aims We report a case series of seven pediatric patients with evidence of early-onset upper gastrointestinal adenomatous polyps. Methods A retrospective chart review was performed for all patients diagnosed with FAP between January 2012 and December 2016 in Winnipeg Children’s Hospital which is the only pediatric tertiary-care hospital in Manitoba. A total of seven pediatric patients from 3 different families were enrolled in our case series. The following data were collected: age of diagnosis, gene mutation, time of first screening endoscopy and total number of endoscopies, number of gastric and colonic polyps, pathology results, surgeries and further routine investigations. Descriptive data were then reported on each patient. Results Five of seven patients (71.4%) exhibited maternal inheritance of the APC gene mutation. The mean age of diagnosis was 5.3 years (SE 2.4, range 2–9 years) with male predominance (n=5, 71.4%). Mean age at first colonoscopy was 9.8 years (SE 2.05; range 6.6–11.9) and 9.9 years (SE 1.88; range 6.6–11.9 years) at first gastroscopy. Five (71.4%) patients had evidence of gastric polyps and three (43%) had evidence of duodenal polyps before the age of 14 years. All patients showed an increasing burden of gastric polyposis with age. Tubular adenomas were seen in all patients who developed >50 gastric polyps (n=5), two with low-grade dysplasia diagnosed at the ages of 11 and 15 year. One patient with duodenal polyps showed tubular adenomatous changes at the age of 13.6 years. Capsule endoscopy was performed in all patients and none showed any small bowel polyposis beyond the duodenum. All seven patients had colonic tubular adenomas, two with low-grade dysplasia (at ages of 14 and 15 years) and only one without polyps at the initiation of endoscopic screening. No patients underwent surgery prior to age 15 years. Conclusions The presence of gastric and duodenal polyps in pediatric patients with FAP is not uncommon and may be underestimated. Early screening gastroscopy with gastric and duodenal biopsies should be considered at a younger age than what has currently been recommended. Funding Agencies None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".