High incidence of advanced colorectal neoplasia during endoscopic surveillance in serrated polyposis syndrome
Por:
Rodríguez-Alcalde D, Carballal S, Moreira L, Hernández L, Rodríguez-Alonso L, Rodríguez-Moranta F, Gonzalo V, Bujanda L, Bessa X, Poves C, Cubiella J, Castro I, González M, Moya E, Oquiñena S, Clofent J, Quintero E, Esteban P, Piñol V, Fernández FJ, Jover R, Cid L, Saperas E, López-Cerón M, Cuatrecasas M, López-Vicente J, Rivero-Sánchez L, Jung G, Vila-Casadesús M, Sánchez A, Castells A, Pellisé M, Balaguer F and Gastrointestinal Oncology Group of the Spanish Gastroenterological Association
Publicada:
1 feb 2019
Resumen:
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 >= 10 mm 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 1-7). The 3-year cumulative incidence of CRC and advanced neoplasia were 3.1% (95% confidence interval [CI] 0-6.9) and 42.0% (95%CI 32.4-51.7), respectively. Fulfilling both I+III criteria and the presence of advanced serrated lesions at baseline colonoscopy were independent predictors of advanced neoplasia development (odds ratio [OR] 1.85, 95%CI 1.03-3.33, P = 0.04 and OR 2.62, 95%CI 1.18-5.81, P = 0.02, respectively). During follow-up, nine patients (5.9%) were referred for surgery for invasive CRC (n=4, 2.6%) or because of polyp burden (n=5, 3.3%). After total colectomy, 17.9% 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.
Filiaciones:
Rodríguez-Alcalde D:
Digestive Disease Section, Hospital Universitario de Móstoles, Móstoles, Spain
Carballal S:
Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Moreira L:
Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Hernández L:
Digestive Disease Section, Hospital Universitario de Móstoles, Móstoles, Spain
Rodríguez-Alonso L:
Gastroenterology Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
Rodríguez-Moranta F:
Gastroenterology Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
Gonzalo V:
Gastroenterology Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
Bujanda L:
Gastroenterology Department, Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
Bessa X:
Gastroenterology Department, Hospital del Mar, Barcelona, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
Poves C:
Gastroenterology Department, Hospital Clínico San Carlos, Madrid, Spain
Cubiella J:
Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
Castro I:
Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
González M:
Gastroenterology Department, Hospital Puerta de Hierro, Majadahonda, Spain
Moya E:
Gastroenterology Department, Hospital Universitario del Sureste, Arganda del Rey, Spain
Oquiñena S:
Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
Clofent J:
Gastroenterology Department, Hospital de Sagunto, Sagunto, Spain
Quintero E:
Gastroenterology Department, Hospital Universitario de Canarias, La Laguna, Spain
Esteban P:
Gastroenterology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
Piñol V:
Gastroenterology Department, Hospital Josep Trueta, Girona, Spain
Fernández FJ:
Gastroenterology Department, Hospital de Galdakao Usansolo, Galdakao, Spain
:
Gastroenterology Department, Hospital General de Alicante, Alicante, Spain
Cid L:
Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
Saperas E:
Gastroenterology Department, Hospital General de Catalunya, Sant Cugat del Vallès, Spain
López-Cerón M:
Gastroenterology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
Cuatrecasas M:
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Pathology Department, Hospital Clínic de Barcelona, Barcelona, Spain
López-Vicente J:
Digestive Disease Section, Hospital Universitario de Móstoles, Móstoles, Spain
Rivero-Sánchez L:
Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Jung G:
Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Vila-Casadesús M:
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Sánchez A:
Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Castells A:
Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Pellisé M:
Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Balaguer F:
Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Gastrointestinal Oncology Group of the Spanish Gastroenterological Association:
Gastrointestinal Oncology Group of the Spanish Gastroenterological Association, España.
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