Incidence of Colonic Neoplasia in Patients with Serrated Polyposis Syndrome Who Undergo Annual Endoscopic Surveillance
Menée sur 50 patients atteints de polypose dentelée et soumis à une surveillance endoscopique annuelle entre 2007 et 2012 (durée médiane de suivi : 3,1 ans), cette étude prospective néerlandaise évalue l'efficacité, du point de vue de l'incidence des polypes et des cancers colorectaux, et les complications associées à un traitement standardisé par coloscopie
Background & Aims : Patients with serrated polyposis syndrome (SPS) are advised to undergo endoscopic surveillance for early detection of polyps and prevention of colorectal cancer (CRC). The optimal surveillance and treatment regimen is however unknown. We performed a prospective study to evaluate a standardized endoscopic treatment protocol in a large cohort of patients with SPS.
Methods : We followed a cohort of patients with SPS who received annual endoscopic surveillance at the Academic Medical Centre in Amsterdam, the Netherlands from January 2007 through December 2012. All patients underwent clearing colonoscopy with removal of all polyps ≥3 mm. After clearance, subsequent follow-up colonoscopies were scheduled annually. The primary outcome measure was the incidence of CRC and polyps. Secondary outcomes were the incidence of complications and the rate of preventive surgery.
Results : Successful endoscopic clearance of all polyps ≥ 3 mm was achieved in 41/50 (82%) patients. During subsequent annual surveillance with a median follow-up time of 3.1 y (inter-quartile range, 1.5–4.3 y), CRC was not detected. The cumulative risks of detecting CRC, advanced adenomas, or large (≥ 10 mm) serrated polyps after 3 surveillance colonoscopies were 0%, 9%, 34%, respectively. Twelve patients (24 %) were referred for preventive surgery; 9 at initial colonoscopy and 3 during surveillance. Perforations or severe bleedings did not occur.
Conclusions : Annual surveillance with complete removal of all polyps ≥3 mm with timely referral of selected high-risk patients for prophylactic surgery prevents the development of CRC in SPS patients without significant morbidity. Considering the substantial risk of polyp recurrence, close endoscopic surveillance in SPS seems warranted. www.trialregister.nl NTR2757
Gastroenterology , résumé, 2013