High incidence of advanced colorectal neoplasia during endoscopic surveillance in serrated polyposis syndrome

Rodríguez‐Alcalde, Daniel; Carballal, Sabela; Moreira, Letícia; Hernández, Luis; Rodríguez‐Alonso, Lorena; Rodríguez-Moranta, Francisco; Gonzalo, Victoria; Bujanda, Luís; Bessa, Xavier; Povés, Carmen; Cubiella, Joaquín; Castro, Inês; González, Mercedes E.; Moya, Eloisa; Oquiñena, Susana; Clofent, Joan; Quintero, Enrique; Esteban, Pilar; Piñol, Virgı́nia; Fernández, Francisco Javier; Jover, Rodrigo; Cid, Lucía; Saperas, Enric; López-Cerón, María; Cuatrecasas, Míriam; López-Vicente, Jorge; Rivero‐Sánchez, Liseth; Jung, Gerhard; Vila-Casadesús, María; Sánchez, Ariadna; Castells, Antoni; Pellisé, María; Balaguer, Francesc

doi:10.1055/a-0656-5557

Cited by 28 publications

(34 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Serrated polyposis syndrome (SPS) is characterised by the presence of numerous colonic serrated polyps (SPs), and is accompanied by a substantially increased colorectal cancer (CRC) risk 1–4. Hence, close endoscopic surveillance is essential to prevent CRC development 1 2 5.…”

Section: Introductionmentioning

confidence: 99%

“…Although the majority of CRCs in SPS patients occur prior to, or at the time of SPS diagnosis, there also seems to be an increased risk for CRC during surveillance. In three retrospective and one prospective cohorts, the cumulative 5-year incidence of CRC under endoscopic surveillance ranged between 0% and 7.0% 1–4 11. This has led to stringent surveillance recommendations worldwide, most of them recommending either annual colonoscopy or colonoscopy every 1–2 years 12–15.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Personalised surveillance for serrated polyposis syndrome: results from a prospective 5-year international cohort study

Bleijenberg

IJspeert

Herwaarden

et al. 2019

Gut

Self Cite

View full text Add to dashboard Cite

Background and aimsSerrated polyposis syndrome (SPS) is associated with an increased risk of colorectal cancer (CRC). International guidelines recommend surveillance intervals of 1–2 years. However, yearly surveillance likely leads to overtreatment for many. We prospectively assessed a surveillance protocol aiming to safely reduce the burden of colonoscopies.MethodsBetween 2013 and 2018, we enrolled SPS patients from nine Dutch and Spanish hospitals. Patients were surveilled using a protocol appointing either a 1-year or 2-year interval after each surveillance colonoscopy, based on polyp burden. Primary endpoint was the 5-year cumulative incidence of CRC and advanced neoplasia (AN) during surveillance.ResultsWe followed 271 SPS patients for a median of 3.6 years. During surveillance, two patients developed CRC (cumulative 5-year incidence 1.3%[95% CI 0% to 3.2%]). The 5-year AN incidence was 44% (95% CI 37% to 52%), and was lower for patients with SPS type III (26%) than for patients diagnosed with type I (53%) or type I and III (59%, p<0.001). Most patients were recommended a 2-year interval, and those recommended a 2-year interval were not at increased risk of AN: AN incidence after a 2-year recommendation was 15.6% compared with 24.4% after a 1-year recommendation (OR 0.57, p=0.08).ConclusionRisk stratification substantially reduced colonoscopy burden while achieving CRC incidence similar to previous studies. AN incidence is considerable in SPS patients, but extension of surveillance intervals was not associated with increased AN in those identified as low-risk by the protocol. We identified SPS type III patients as low-risk group that might benefit from even less frequent surveillance.Trial registration numberThe study was registered on http://www.trialregister.nl; trial-ID NTR4609.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Personalised surveillance for serrated polyposis syndrome: results from a prospective 5-year international cohort study

Bleijenberg

IJspeert

Herwaarden

et al. 2019

Gut

Self Cite

View full text Add to dashboard Cite

show abstract

“…Polyp clearing was defined as removal of all polyps greater than 3 mm during colonoscopy and/or through a segmental colectomy when needed. 1,7,16 Exclusion criteria were as follows: known inflammatory bowel disease, hereditary CRC syndromes (ie, APC, MUTYH-biallelic, and MMR germline mutations), and total colectomy. To provide a more homogeneous sample, patients who were classified into the WHO criterion II also were excluded because they show a different phenotype and the increased CRC risk in this subgroup has been challenged.…”

Section: Study Population and Proceduresmentioning

confidence: 99%

Panchromoendoscopy Increases Detection of Polyps in Patients With Serrated Polyposis Syndrome

López-Vicente

Rodríguez‐Alcalde

Hernández³

et al. 2019

Clinical Gastroenterology and Hepatology

Self Cite

View full text Add to dashboard Cite

BACKGROUND & AIMS: Serrated polyposis syndrome (SPS), characterized by multiple and/or large proximal serrated lesions, increases the risk of colorectal cancer. Serrated lesions often are missed during colonoscopy but panchromoendoscopy can increase their detection in an average-risk population. We performed a randomized controlled study to determine the efficacy of panchromoendoscopy in detection of polyps in patients with SPS. METHODS: Patients with SPS (n [ 86 patients) underwent tandem high-definition (HD) colonoscopies from February 2015 through July 2016 at 7 centers in Spain. Patients were assigned randomly to groups that received 2 HD white-light endoscopy examinations (HD-WLE group; n [ 43) or HD-WLE followed by 0.4% indigo carmine panchromoendoscopy (HD-CE group; n [ 43). For each procedure, polyps detected were described, removed, and analyzed by histology. The primary outcome was additional polyp detection rate, defined as the number of polyps detected during the second inspection divided by the total number of polyps detected during the first and the second examination. RESULTS: A total of 774 polyps were detected (362 in the HD-WLE group and 412 in the HD-CE group); 54.2% were hyperplastic, 13.8% were adenomas, and 10.9% were sessile serrated polyps. There was a significantly higher additional polyp detection rate in the HD-CE group (0.39; 95% CI, 0.35-0.44) than in the HD-WLE group (0.22; 95% CI, 0.18-0.27) (P < .001). A higher additional rate of serrated lesions proximal to the sigmoid colon were detected in the second inspection with HD-CE (0.40; 95% CI, 0.33-0.47) than with HD-WLE (0.24; 95% CI, 0.19-0.31) (P [ .001). Detection of adenomas and serrated lesions greater than 10 mm did not differ significantly between groups. In a multivariate logistic regression analysis, only use of HD-CE was associated independently with increased polyp detection throughout the colon. CONCLUSIONS: In a randomized controlled trial, we found that panchromoendoscopy increases detection of polyps (mostly of small serrated lesions) and should be considered the standard of care in patients with SPS. Studies are needed to determine the effects of this strategy on the incidence of advanced neoplasia during long-term follow-up evaluation. ClinicalTrials.gov no: NCT03476434.

show abstract

“…Recent evidence suggests that surveillance with colonoscopy should be carried out every 1-2 years (it can be extended to 2 years in most patients based on certain risk factors, i.e. polyp multiplicity or advanced features) (Table 4) [III, C] [58,59]. Although more evidence is needed, screening by colonoscopy every 5 years in FDRs of patients with SPS is commonly recommended, starting at the age of 45 years (or 10 years earlier than the age of diagnosis of the youngest affected family member) [60,61].…”

Section: Serrated Polyposis Syndromementioning

confidence: 99%

Hereditary gastrointestinal cancers: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†

et al. 2019

View full text Add to dashboard Cite

High incidence of advanced colorectal neoplasia during endoscopic surveillance in serrated polyposis syndrome

Abstract: 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.

Cited by 28 publications

References 21 publications

Personalised surveillance for serrated polyposis syndrome: results from a prospective 5-year international cohort study

Personalised surveillance for serrated polyposis syndrome: results from a prospective 5-year international cohort study

Panchromoendoscopy Increases Detection of Polyps in Patients With Serrated Polyposis Syndrome

Hereditary gastrointestinal cancers: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†

Contact Info

Product

Resources

About