Endoscopy 2019; 51(02): 142-151
DOI: 10.1055/a-0656-5557
Original article
© Georg Thieme Verlag KG Stuttgart · New York

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

Daniel Rodríguez-Alcalde*
 1  Digestive Disease Section, Hospital Universitario de Móstoles, Móstoles, Spain
,
Sabela Carballal*
 2  Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain
 3  Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
,
Leticia Moreira
 2  Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain
 3  Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
,
Luis Hernández
 1  Digestive Disease Section, Hospital Universitario de Móstoles, Móstoles, Spain
,
Lorena Rodríguez-Alonso
 4  Gastroenterology Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
,
Francisco Rodríguez-Moranta
 4  Gastroenterology Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
,
Victoria Gonzalo
 5  Gastroenterology Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
,
Luis Bujanda
 6  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
,
Xavier Bessa
 7  Gastroenterology Department, Hospital del Mar, Barcelona, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
,
Carmen Poves
 8  Gastroenterology Department, Hospital Clínico San Carlos, Madrid, Spain
,
Joaquín Cubiella
 9  Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
,
Inés Castro
 9  Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
,
Mariano González
10  Gastroenterology Department, Hospital Puerta de Hierro, Majadahonda, Spain
,
Eloísa Moya
11  Gastroenterology Department, Hospital Universitario del Sureste, Arganda del Rey, Spain
,
Susana Oquiñena
12  Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
,
Joan Clofent
13  Gastroenterology Department, Hospital de Sagunto, Sagunto, Spain
,
Enrique Quintero
14  Gastroenterology Department, Hospital Universitario de Canarias, La Laguna, Spain
,
Pilar Esteban
15  Gastroenterology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
,
Virginia Piñol
16  Gastroenterology Department, Hospital Josep Trueta, Girona, Spain
,
Francisco Javier Fernández
17  Gastroenterology Department, Hospital de Galdakao Usansolo, Galdakao, Spain
,
Rodrigo Jover
18  Gastroenterology Department, Hospital General de Alicante, Alicante, Spain
,
Lucía Cid
19  Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
,
Esteve Saperas
20  Gastroenterology Department, Hospital General de Catalunya, Sant Cugat del Vallès, Spain
,
María López-Cerón
21  Gastroenterology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
,
Miriam Cuatrecasas
 3  Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
22  Pathology Department, Hospital Clínic de Barcelona, Barcelona, Spain
,
Jorge López-Vicente
 1  Digestive Disease Section, Hospital Universitario de Móstoles, Móstoles, Spain
,
Liseth Rivero-Sánchez
 2  Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain
 3  Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
,
Gerhard Jung
 2  Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain
 3  Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
,
María Vila-Casadesús
 3  Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
,
Ariadna Sánchez
 2  Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain
 3  Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
,
Antoni Castells
 2  Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain
 3  Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
,
María Pellisé
 2  Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain
 3  Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
,
Francesc Balaguer
 2  Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain
 3  Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
,
for the Gastrointestinal Oncology Group of the Spanish Gastroenterological Association› Author Affiliations
Further Information

Publication History

submitted 01 February 2018

accepted after revision 11 June 2018

Publication Date:
01 August 2018 (eFirst)

Abstract

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.

* These authors contributed equally to the work


Supplementary Table e3, e4