Endoscopic Management for Patients with Serrated Polyposis Syndrome is Feasible and Effective:

Abstract

Background and Study Aims: Serrated polyposis syndrome is a rare condition in which multiple serrated lesions develop all over the colon, which is thought to be associated with an increased risk for the development of cancer. The aim of this study was to investigate the feasibility of endoscopic treatment and standardised surveillance in patients with this increasingly recognised syndrome.

Methods: From September 2010 to November 2013, consecutive patients were included in a prospective study. All patients underwent chromoendoscopy at first presentation and during surveillance. Follow-up examinations were carried out at 3 month intervals until complete clearance was achieved. Afterwards, patients entered a standardised surveillance protocol with a chromoendoscopic colonoscopy annually.

Results: Altogether 100 colonoscopies were carried out in 28 patients, with endoscopic resection of 436 lesions. Total clearance was accomplished in 27 patients (96.0 %) after 2.5 colonoscopies (range 1 – 8). Histology revealed 359 hyperplastic polyps (82.3 %), 37 sessile serrated adenomas (8.5 %), 36 low-grade adenomas (8.3 %), and one patient with advanced colorectal cancer. Twelve patients (42.8 %) had serrated polyps > 10 mm in size. During the surveillance period, 86 additional lesions were detected and resected. The mean follow-up period was 21.5 months (range 2 – 39 months). No interval carcinoma was detected during the surveillance.

Conclusions: The present study indicates that endoscopic management in patients who meet the diagnostic criteria for serrated polyposis syndrome is feasible and safe. In particular, the incidence of colorectal cancer in this cohort was lower in comparison with previous studies.

Zusammenfassung

Hintergrund: Das serratierte Polyposis-Syndrom ist eine seltene Erkrankung mit multiplen serratierten Läsionen im gesamten Kolon. Es gibt Evidenz dafür, dass das Syndrom mit einer erhöhten Rate an kolorektalen Karzinomen einhergeht. Das Ziel dieser Studie war es daher die Praktikabilität und Sicherheit einer standardisierten Nachsorge, bei dieser zunehmend diagnostizierten Erkrankung, zu untersuchen.

Methode: Von September 2010 bis November 2013 wurden konsekutive Patienten in diese prospektive Studie eingeschlossen. Alle Patienten unterzogen sich einer Koloskopie mit chromoendoskopischer Färbung bei der Erstvorstellung und während jeder Nachsorgeuntersuchung. Es erfolgten 3 monatliche Koloskopien bis zur Beseitigung aller Polypen. Anschließend wurden die Patienten in ein standardisiertes Nachsorgeprotokoll mit jährlicher chromoendoskopischer Koloskopie eingeschlossen.

Ergebnisse: In 28 Patienten erfolgte während 100 Koloskopien die Resektion von 436 Läsionen. Die Entfernung aller Polypen konnte in 27 Patienten (96 %) nach 2,5 (1 − 8) Koloskopien erreicht werden. Die Histologie ergab 359 hyperplastische Polypen (82,3 %), 37 sessile serratierte Adenome (8,5 %), 36 (8,3 %) Adenome mit niedriggradiger Dysplasie und ein Patient mit fortgeschrittenem kolorektalem Karzinom. Zwölf Patienten (42,8 %) hatten serratierte Polypen > 10 mm. Während der Nachsorgephase wurden 86 zusätzliche gefunden und reseziert. Die durchschnittliche Nachsorgezeit war 21,5 Monate (2 − 39 Monate). Während der Nachsorge konnten keine Intervallkarzinome nachgewiesen werden.

Schlussfolgerung: Die aktuelle Studie zeigt, dass das endoskopische Management bei Patienten mit serratiertem Polyposis-Syndrom sicher ist. Insbesondere ist aber die Inzidenz kolorektaler Karzinome in dieser Kohorte geringer als in vergleichbaren Studien.

Schlüsselwörter

kolorektales Karzinom - kolorektales Adenom - intraepitheliale Neoplasie

Key words

colorectal carcinoma - colorectal adenoma - intraepithelial neoplasm

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