Exploring the Frequency of Colonic Polyps in Patients with Acromegaly: A Perspective from a Referral Center in Mexico

Aims The prevalence of colonic polyps in patients with acromegaly in the Mexican population has not been widely documented. Early detection and surveillance of these precursor lesions are crucial for preventing their progression to malignancy. This observational study was conducted at a referral center for patients with acromegaly in Mexico to provide insights into the prevalence and characteristics of colonic polyps in this population.

Methods We collected clinical, biochemical, endoscopic, and histopathological data from patients diagnosed with acromegaly who were referred for colonoscopy at the National Institute of Medical Sciences and Nutrition (INCMNSZ) between 2015 and 2024.

Results A total of 34 patients diagnosed with acromegaly were included in the study. Of these, 55.9% were female, and the median age was 56 years (IQR 34-62). Seventy-six percent (76.5%) of the patients had active disease at the time of the endoscopic evaluation. The median duration of disease from the onset of acral growth to the time of colonoscopy was 8.5 years (IQR 4.7-14.2). Most patients (82.4%) were asymptomatic for gastrointestinal symptoms. All patients underwent colonoscopy. The median procedure time was 31 minutes (IQR 28-42), and the median withdrawal time was 15 minutes (IQR 10-23). All patients received bowel preparation with polyethylene glycol, with 85.7% receiving the full dose the day before the procedure, while the rest received a split-dose regimen. Fourteen point seven percent (14.7%) of patients had inadequate bowel preparation.The detection rate for polyps and adenomas was 47.1% and 20.6%, respectively. The median number of lesions per patient was 2 (IQR 1-4). The median size of the largest lesion was 5 mm (IQR 3-9). The most common lesion locations were the ascending and transverse colon, each accounting for 20.6%. Histological findings, in decreasing order of frequency, included tubular adenoma (17.6%), hyperplastic polyp (14.7%), chronic colitis (8.8%), villous adenoma with high-grade dysplasia (2.9%), and adenocarcinoma (2.9%).No significant differences were found between patients with and without polypoid lesions, except for a longer median withdrawal time in the former group (21 vs. 15 minutes). Notably, no polyps or adenomas were found in patients who underwent colonoscopy before the age of 30 [1] [2].

Conclusions This study highlights the high frequency of colonic polyps and adenomas in patients with acromegaly, including advanced adenomas and colorectal cancer. These findings underscore the need for early endoscopic surveillance in this population, particularly for patients over 30 years of age. Standardized surveillance protocols should be implemented, and patients should be educated on the importance of adequate bowel preparation to improve colonoscopy quality and polyp detection.

Publication History

Article published online:
27 March 2025

• References

• 1 Dworakowska D, Grossman AB.. Colonic Cancer and Acromegaly. Front Endocrinol 2019; 10: 390
• 2 Sninsky JA, (Lausanne). Shore BM, Lupu GV, Crockett SD. Risk Factors for Colorectal Polyps and Cancer. Gastrointest Endosc Clin N Am 2022; 32 (2): 195-213