Cutting-Edge Advances in Idiopathic Adenomatous Polyposis (IAP)

RATIONALE

CUTTING-EDGE ADVANCES IN IDIOPATHIC ADENOMATOUS POLYPOSIS (IAP) Idiopathic Adenomatous Polyposis (IAP) of the colorectum represents a diagnostic and management challenge that remains largely under-recognized in both clinical guidelines and research frameworks. Traditionally, colorectal polyposis has been dichotomized into syndromic conditions—such as familial adenomatous polyposis (FAP) or MUTYH-associated polyposis (MAP)—and sporadic adenoma formation. Yet, a growing proportion of patients present with an intermediate polyp burden, often ranging between 10 and 100 lesions, without fulfilling classic diagnostic criteria for polyposis syndromes or harboring known pathogenic germline variants. These cases, increasingly encountered due to expanded access to colonoscopy, fall under the imprecise and variably defined category of “ Idiopathic Adenomatous Polyposis.”

This emerging clinical entity is relevant for several reasons. First, its ambiguous nosological status complicates diagnosis, leading to heterogeneity in management. Second, genetic assessment in these individuals often yields inconclusive results, suggesting the presence of unrecognized or oligogenic inheritance patterns that are not yet systematically characterized.

Third, and most crucially, there is a lack of consensus on appropriate surveillance strategies—both in terms of endoscopic follow-up and the use of non-invasive modalities—and on how to counsel first-degree relatives.

A concerted effort is therefore necessary to clarify the clinical definition of Idiopathic Adenomatous Polyposis, explore its underlying genetic architecture, refine surveillance recommendations, and standardize diagnostic algorithms.

This consensus meeting aims to convene leading experts in gastroenterology, genetics, surgery, to address these gaps systematically and collaboratively.

The meeting’s structure is designed to integrate empirical evidence with clinical experience, foster interdisciplinary dialogue, and lay the groundwork for harmonized clinical practice and prospective research initiatives.