Patients with hyperplastic polyposis syndrome (HPS) receive endoscopic surveillance to prevent malignant progression of polyps.
However, the optimal treatment and surveillance protocol for these patients is unknown.
Dr Evelien Dekker and colleagues from the Netherlands described the clinical and pathological features of a large hyperplastic polyposis syndrome cohort during multiple years of endoscopic surveillance.
Databases were searched for patients with hyperplastic polyposis syndrome, who were analyzed retrospectively.
Endoscopy reports and histopathology reports were collected to evaluate frequency of endoscopic surveillance and to obtain information regarding polyp and the presence of colorectal cancer.
|Cumulative risk of colorectal cancer was 7% at 5 years|
In 77 patients with hyperplastic polyposis syndrome, 1984 polyps were identified during a mean follow-up period of 6 years.
In 35% of patients, colorectal cancer was detected of which 29% at initial endoscopy.
Colorectal cancer was detected during surveillance in 5 patients after a median follow-up time of 1 years, and a median interval of 11 months.
Of these interval colorectal cancers, 4 out of 5 were detected in diminutive serrated polyps.
The research team found that the cumulative risk of colorectal cancer under surveillance was 7% at 5 years.
At multivariate logistic regression, an increasing number of hyperplastic polyps, and serrated adenomas was significantly associated with colorectal cancer presence.
Dr Dekker's team concludes, "Hyperplastic polyposis syndrome patients undergoing endoscopic surveillance have an increased colorectal cancer risk."
"The number of serrated polyps is positively correlated with the presence of colorectal cancer in hyperplastic polyposis syndrome, thus supporting a ‘serrated pathway’ to colorectal cancer."
"To prevent malignant progression, adequate detection and removal of all polyps seems advisable."
"If this is not feasible, surgical resection should be considered."