American Board of Internal Medicine (ABIM) Certification Practice Exam

For patients with familial adenomatous polyposis, how often is upper endoscopy indicated for duodenal cancer surveillance?

1. Every year

2. 1 to 5 years

3. Every 3 to 4 years

4. Every 6 months

The correct answer is: 1 to 5 years

For patients with familial adenomatous polyposis (FAP), the risk of developing duodenal cancer increases significantly over time due to the presence of duodenal adenomas, which can progress to cancer. Guidelines recommend that upper endoscopy be performed regularly as a surveillance measure to monitor for the development of these lesions and to detect any potentially malignant changes early. The recommended interval for upper endoscopy in this population is typically between 1 to 5 years, depending on the number and size of adenomas found during prior examinations. Annual surveillance may be too frequent for many patients, as not all individuals will develop significant lesions within a single year. On the other hand, less frequent surveillance could lead to missed opportunities to detect cancer at a more manageable stage. Surveillance at intervals within this range allows for a balance between thorough monitoring and avoidance of unnecessary procedures, enabling timely intervention if significant changes are noted. Therefore, the correct recommendation for upper endoscopy in individuals with familial adenomatous polyposis is to conduct these examinations every 1 to 5 years.