Serrated polyposis syndrome: longer surveillance intervals appear safe for some

  • Bleijenberg AG & al.
  • Gut
  • 13 Apr 2019

  • International Clinical Digest
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Takeaway

  • For patients with serrated polyposis syndrome (SPS), allowing some patients longer colonoscopic surveillance intervals does not correlate with greater advanced neoplasia (AN) risk. 
  • It might be safe to extend the surveillance interval to 2 years with this protocol.
  • Patients fulfilling only WHO criterion III appeared to be at lower risk. 

Why this matters

  • Because of the link between SPS and higher colorectal cancer (CRC) risk, guidelines recommend stringent surveillance every 1-2 years.
  • For most, this interval is closer to 1 year.
  • Risk stratification might allow longer intervals.

Key results

  • Median follow-up, 3.6 years.
  • WHO criteria among patients:
    • 36.5% (99) fulfilled criterion I; 
    • 36.5% (99) criterion III; and 
    • 27% (73) both. 
  • Cumulative 5-year incidences (95% CIs):
    • CRC (2 patients): 1.3% (0%-3.2%).
    • AN (98): 44% (37%-51%).
  • AN risk with criterion III vs I: HR, 0.38 (P<.001 class=""> 
  • AN with 2- vs 1-year interval: OR, 0.57 (P=.08).

Study design

  • Prospective multicenter cohort study (n=271).
  • Participants had SPS, WHO criteria I and/or III.
  • Authors conducted protocolized surveillance colonoscopy every 1 vs 2 years based on previous polyp burden.
  • Outcome: 5-year incidences of CRC, AN (comprising CRC, advanced serrated polyp, advanced adenoma) during surveillance.
  • Funding: European governmental, nonprofit funds.

Limitations

  • Short follow-up.
  • Few cancers.

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