Surgical versus endoscopic management of colorectal polyps in individuals with hereditary adenomatous polyposis syndromes

The schema above divides patients according to polyp burden; clinical judgment is required to stratify patient management in addition to the number of polyps. Additional evaluations and other preventive measures may be indicated depending on the specific hereditary syndrome. Hereditary adenomatous polyposis syndromes include:

• Familial adenomatous polyposis (FAP) and attenuated FAP (AFAP) due to pathogenic variants in APC.
• Polymerase proofreading-associated polyposis (PPAP) due to pathogenic variants in POLD1 or POLE.
• MUTYH-associated polyposis (MAP).

In contrast, Lynch syndrome is a hereditary nonpolyposis syndrome with increased colorectal cancer risk, but patients usually develop few (<10) early-onset adenomas.