Long2term Effects of Sul indac on Familial Adenomatous Pol iposis

Objective 　To evaluate the long2term effect of sulindac in attempting to maintain the regression of colorectal adenomas and changing of pathology of familial adenomatous polyposis ( FAP) patient s. Methods 　FAP patient s who were diagnosed by family history and colonscopy were t reated with sulindac 400mg per day. The patient s received colonoscopy examination regularly to assess number of polyps. Bi2 opsies of remnant polyp s were obtained. The type and dysplasia grade of biopsies were evaluated and compared with baseline. Results 　Eighteen patient s of FAP received sulindac. The average age was (37. 4 ±9. 8) years old. The average period of t reatment was (65. 3 ±31. 6) months. Compared with baseline, the average number of polyp s reduced significantly at last follow2up ( P < 0. 01) . There were totally 200 adenoma biopsies obtained before the t reatment . Among them, 86. 5 % were tubular, while 13. 0 % were tubulovillous adenoma and 0. 5 % was villous adenoma. The dysplasia of grade Ⅰ, Ⅱ and Ⅲ were 40. 0 %, 43. 5 % and 11. 5 %, respectively. Af ter sulindac t reatment, there were totaly 133 adenoma bi2 opsies obtained. 97. 7 % of adenoma biopsies were tubular adenoma, while 2. 3 % were tubulovillous ade2 noma. There was significant difference compared with baseline ( P < 0. 01) . The dysplasia of grade Ⅰ, Ⅱand Ⅲwere 48. 9 %, 48. 1 % and 3. 0 % respectively, which had significant difference with baseline ( P < 0. 01) . However, 1 patient who took sulindac 100 mg/ d by himself developed colonic cancer. Conclu2 sion 　Long2term use of sulindac seems to be effective in maintaining the regression of colorectal adenoma of FAP patient s and reducing dysplasia grade and tubulovillous adenoma of retained colorectal adenoma. These effect s are associated with dosage. However, the effect of sulindac to regress the adenoma seems to be uncompleted. FAP patient s who take sulindac need to receive colonoscopy regularly to find colorec2 tal cancer.