FAP Surveillance Post IPAA or IRA

In FAP, annual lower endoscopic screening begins during the early teenage years, with most individuals developing polyposis requiring prophylactic proctocolectomy and reconstructive ileal pouch-anal anastomosis (IPAA) by their early 20s. In cases of attenuated polyposis with relative rectal sparing (≤20 rectal polyps), total abdominal colectomy with ileorectal anastomosis (IRA) may be appropriate. Whether an individual undergoes IPAA or IRA, it is clear that there is a significant risk for metachronous adenomatous polyps in the remaining rectal cuff/anal transition zone (ATZ) or rectum, mandating annual lower gastrointestinal endoscopic screening.