Abstract
Simple SummarySerrated polyposis syndrome is characterized by the development of large and/or multiple serrated polyps throughout the colorectum and is associated with an increased risk of colorectal cancer (CRC). Even though CRC incidence is low under adequate endoscopic follow-up, a substantial risk of advanced neoplasia (AN) has been described. Nevertheless, very few studies have focused on long-term surveillance. The main aim of this study was to evaluate the incidence of AN in a single-centre cohort followed over 10 years. Within endoscopic surveillance we did not find any CRC and we observed that five-year cumulative incidences of AN were much lower than in other studies. However, a significant reduction of these incidences during follow-up was not proven. Individuals at higher risk of AN were those who fulfilled both 2010 WHO criteria I and III. Our results suggest that at least patients at lower risk might benefit from the extension of surveillance intervals.Serrated polyposis syndrome (SPS) implies a slightly elevated risk of colorectal cancer (CRC) during endoscopic follow-up, but its natural course is still not well known. The main objective of this study was to describe the long-term risk of developing advanced neoplasia (AN) in these patients. Until October 2020, individuals who fulfilled 2010 WHO criteria I and/or III for SPS were retrospectively recruited. We selected those under endoscopic surveillance after resection of all lesions >3 mm in a high-quality colonoscopy. We excluded patients with total colectomy at diagnosis and those with any interval between colonoscopies >3.5 years. We defined AN as advanced serrated polyp (≥10 mm and/or with dysplasia), advanced adenoma, or CRC. In 109 patients, 342 colonoscopies were performed (median = 3, median interval = 1.8 years) during a median follow-up after colonic clearance of 5.0 years. Five-year cumulative incidences of AN were 21.6% globally, and 5.6%, 10.8%, and 50.8% in patients who fulfilled criterion I, III, and both, respectively (p < 0.001). No CRC was diagnosed and only 1 (0.9%) patient underwent surgery. In conclusion, cumulative incidences of AN could be lower than previously described, at least in patients who fulfil the 2010 WHO criterion III alone. Therefore, low-risk individuals might benefit from less stringent surveillance.
Highlights
Serrated polyposis syndrome (SPS) is a condition characterized by the development of large and/or multiple serrated polyps (SPs) in the colon and rectum, which implies a higher risk of colorectal cancer (CRC) compared to the average-risk population [1,2,3,4,5,6]
In 2010 the World Health Organization (WHO) defined SPS based on the compliance of at least one of these criteria: (I) the presence of ≥5 SPs proximal to the sigmoid colon, with two or more being ≥10 mm in size; (II) the presence of any number of SPs occurring proximal to the sigmoid colon in a patient with a first-degree relative with SPS; and (III) the presence of more than 20 SPs spread throughout the colon [7]
We have shown that the vast majority of patients can be managed endoscopically once colonic clearance is achieved
Summary
In 2010 the World Health Organization (WHO) defined SPS based on the compliance of at least one of these criteria: (I) the presence of ≥5 SPs proximal to the sigmoid colon, with two or more being ≥10 mm in size; (II) the presence of any number of SPs occurring proximal to the sigmoid colon in a patient with a first-degree relative with SPS; and (III) the presence of more than 20 SPs spread throughout the colon [7]. In the UK in a guaiac faecal occult blood test-based CRC screening program its prevalence was reported between 0.03% and 0.66%, whereas in colonoscopy-based programs it ranged from 0.1 to 0.4% [12,13]. Rivero-Sánchez et al showed that, in a faecal immunochemical test (FIT)-based program, its prevalence rises up to 0.9% after one-year reassessment colonoscopy in patients with proximal SPs [14]
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