High incidence of advanced colorectal neoplasia during endoscopic surveillance in serrated polyposis syndrome.
Endoscopy
; 51(2): 142-151, 2019 02.
Article
em En
| MEDLINE
| ID: mdl-30068004
ABSTRACT
BACKGROUND:
Serrated polyposis syndrome (SPS) has been associated with an increased risk of colorectal cancer (CRC). Accordingly, intensive surveillance with annual colonoscopy is advised. The aim of this multicenter study was to describe the risk of advanced lesions in SPS patients undergoing surveillance, and to identify risk factors that could guide the prevention strategy.METHODS:
From March 2013 to April 2015, 296 patients who fulfilled criteria I and/or III for SPS were retrospectively recruited at 18 centers. We selected patients in whom successful clearing colonoscopy had been performed and who underwent subsequent endoscopic surveillance. Advanced neoplasia was defined as CRC, advanced adenoma, or advanced serrated lesion that were ≥â10âmm and/or with dysplasia. Cumulative incidence of advanced neoplasia was calculated and independent predictors of advanced neoplasia development were identified.RESULTS:
In 152 SPS patients a total of 315 surveillance colonoscopies were performed (median 2, range 1â-â7). The 3-year cumulative incidence of CRC and advanced neoplasia were 3.1â% (95â% confidence interval [CI] 0â-â6.9) and 42.0â% (95â%CI 32.4â-â51.7), respectively. Fulfilling both Iâ+âIII criteria and the presence of advanced serrated lesions at baseline colonoscopy were independent predictors of advanced neoplasia development (odds ratio [OR] 1.85, 95â%CI 1.03â-â3.33, P â=â0.04 and OR 2.62, 95â%CI 1.18â-â5.81, P â=â0.02, respectively). During follow-up, nine patients (5.9â%) were referred for surgery for invasive CRC (nâ=â4, 2.6â%) or because of polyp burden (nâ=â5, 3.3â%). After total colectomy, 17.9â% patients developed advanced neoplasia in the retained rectum.CONCLUSIONS:
Patients with SPS have a substantial risk of developing advanced neoplasia under endoscopic surveillance, whereas CRC incidence is low. Personalized endoscopic surveillance based on polyp burden and advanced serrated histology could help to optimize prevention in patients with SPS.
Texto completo:
1
Coleções:
01-internacional
Temas:
Epidemiologia
/
Incidencia
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Geral
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Tipos_de_cancer
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Colon_e_reto
Base de dados:
MEDLINE
Assunto principal:
Neoplasias Colorretais
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Colonoscopia
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Polipose Adenomatosa do Colo
Tipo de estudo:
Etiology_studies
/
Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
Limite:
Female
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Humans
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Male
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Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
Endoscopy
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Espanha