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In Reply To clarify Dr Matuchansky’s first point, the 10-cm section examined began just distal to the duodenal bulb and always included the duodenal papilla and a distance past that area. This is the area of the duodenum commonly examined as part of upper endoscopy, very representative of polyp formation in FAP, and the major area of duodenal adenocarcinoma formation.1 Although areas more distal, including the jejunum itself, are interesting, cancer in those areas is much less common. The study was not meant to be a comprehensive assessment of the distal duodenum and small bowel. The purpose instead was to demonstrate the proof of principle that the drug combination could regress polyps in the duodenum, especially in areas around the duodenal papilla, that are seen on typical endoscopy. Future studies may well want to examine the small bowel more extensively.
Samadder NJ, Neklason DW, Burt RW. Sulindac and Erlotinib for Familial Adenomatous Polyposis—Reply. JAMA. 2016;316(5):545. doi:10.1001/jama.2016.7595