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Table 7. Recommended Screening Intervals by Spigelman Stage

Spigelman Stage  NCCN (2014) [92] Groves et al. (2002) [79] 
0 (no polyps)Endoscopy every 4 yEndoscopy every 5 y
IEndoscopy every 2–3 yEndoscopy every 5 y
IIEndoscopy every 1–3 yEndoscopy every 3 y
IIIEndoscopy every 6–12 moEndoscopy every 1–2 y
CP + ET (+/- GA)
IVSurgical referralSurgical resection
Complete mucosectomy or duodenectomy or Whipple procedure if duodenal papilla is involved
Expert endoscopic surveillance every 3–6 moEndoscopy every 1–2 y
CP + ET (+/- GA)

CP = chemoprevention; ET = endoscopic therapy; GA = general anesthetic; NCCN = National Comprehensive Cancer Network.
Refer to the Interventions for FAP section in the Major Genetic Syndromes section of this summary for more information about chemoprevention.
See below for additional information about the use of surgical resection in Spigelman stage IV disease.


  1. Groves CJ, Saunders BP, Spigelman AD, et al.: Duodenal cancer in patients with familial adenomatous polyposis (FAP): results of a 10 year prospective study. Gut 50 (5): 636-41, 2002.  [PUBMED Abstract]

  2. National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology: Genetic/Familial High-Risk Assessment: Colorectal. Version 2.2014. Rockledge, PA: National Comprehensive Cancer Network, 2014. Available online with free registration. Last accessed June 17, 2014.