Impact of the quality of endoscopic surveillance on the development of advanced neoplasia after prophylactic (procto)colectomy in patients with familial adenomatous polyposis

Aims To analyze the quality parameters of endoscopic surveillance and their association with the development of advanced neoplasia in the rectal remnant or reservoir among familial adenomatous polyposis (FAP) patients after prophylactic (procto)colectomy.

Methods A retrospective observational study was conducted including FAP patients who underwent prophylactic colectomy or proctocolectomy and were registered between 1983 and 2022 at the Hospital Clínic de Barcelona. Advanced neoplasia was defined as an adenoma≥10 mm, high-grade dysplasia or adenocarcinoma in the rectal remnant or reservoir. Numerical variables were analyzed using the Mann-Whitney U test, and categorical variables were evaluated with the Chi-square test. Logistic regression was performed to identify independent variables associated with the development of advanced neoplasia.

Results Of the 85 eligible patients, 61 (64% women; median age, 53 years [range, 39–59]) met the inclusion criteria. Seven patients (11.5%) were diagnosed with advanced neoplasia, of whom six had ileorectal anastomosis and one had ileoanal pouch anastomosis. Of these seven patients, three (43%) developed cancer, while four (57%) presented advanced adenomas in the rectal remnant or reservoir. Patients with advanced neoplasia(AN) underwent lower-quality endoscopies compared to those without AN: the use of high-definition endoscopes was 42.9% vs. 94.4% (p=0.002), retroflexion was performed in 14.2% vs. 68.5% (p=0.005), adequate bowel preparation was achieved in 42.8% vs. 87% (p=0.004), procedures were performed in a dedicated endoscopy program in 28.5% vs. 79.6% (p=0.004), and the mean number of polyps removed was 1.1±0.9 vs. 3.4±4.2 (p=0.001), respectively. In the multivariable analysis, the only independent variable associated with the development of advanced neoplasia was the non-use of high-definition endoscopes [1] [2] [3] [4] [5].

Conclusions The development of advanced neoplasia is associated with lower quality in endoscopic surveillance parameters among FAP patients who underwent prophylactic (procto)colectomy. These findings highlight the need to establish specific quality indicators to optimize endoscopic surveillance in this high-risk population.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

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