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Low Cancer Risk with Annual Surveillance in Serrated Polyposis

May 13, 2014

Low Cancer Risk with Annual Surveillance in Serrated Polyposis

  1. Douglas K. Rex, MD

No colorectal cancers were detected after a median 3.1 years of colonoscopic surveillance and polypectomy in 50 patients.

  1. Douglas K. Rex, MD

The genetic basis of serrated polyposis syndrome (SPS) is not yet understood, and therefore the World Health Organization definition of serrated polyposis cannot be validated. Several previous studies have suggested a high risk for colorectal cancer when patients with serrated polyposis are first recognized and during colonoscopic follow-up.

The current prospective study involved 50 patients with SPS who underwent annual colonoscopy between 2007 and 2012. All polyps ≥3 mm in size were removed. At a median follow-up time of 3.1 years, no colorectal cancers were detected. The risks for detecting colorectal cancer, advanced adenomas, and large (≥10 mm) serrated polyps after three surveillance colonoscopies were 0%, 9%, and 34%. Twelve patients (24%) were referred for preventive surgery, including nine at the initial colonoscopy and three during surveillance.

Comment

This result is very consistent with my own experience, which is that patients with serrated polyposis can have their endoscopic polyp burden dramatically reduced by aggressive polypectomy and can be followed long term without significant risk for cancer. However, surgical therapy is certainly an important consideration for patients with numerous large, serrated lesions in the proximal colon.

Note to readers: At the time NEJM JW reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

  • Disclosures for Douglas K. Rex, MD at time of publication Consultant / Advisory board Given Imaging; Olympus Corporation America; Exact Sciences; Endo Aid Speaker’s bureau Boston Scientific; Braintree Laboratories; Ferring Pharmaceuticals; Olympus America Grant / Research support CDC; Olympus America; Boston Medical Center Editorial boards World Journal of Gastroenterology; The Journal of Clinical Gastroenterology; Techniques in Gastrointestinal Endoscopy; Gastroenterology & Hepatology; Expert Review of Gastroenterology & Hepatology; Medscape Gastroenterology; World Journal of Gastrointestinal Pharmacology and Therapeutics; Annals of Gastroenterology & Hepatology; World Journal of Gastrointestinal Oncology; Comparative Effectiveness Research; Journal of Anesthesia & Clinical Research; Gastroenterology; World Journal of Gastrointestinal Pathophysiology; Gastroenterology Research and Practice; GI & Hepatology News; Gastroenterology Report; Clinical Epidemiology Reviews; JSM Gastroenterology and Hepatology Leadership positions in professional societies American Society for Gastrointestinal Endoscopy (Councilor); US Multi-Society Task Forces (AGA, ACG, ASGE) (Chair)

Citation(s):

Reader Comments (1)

* * Physician, Gastroenterology, Brisbane

I would disagree with recommendations for surgery as endoscopic therapy is clearly effective.

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