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Endoscopic treatment protocol for patients with serrated polyposis syndrome

A study in the latest issue of Gastroenterology evaluates the incidence of colonic neoplasia in patients with serrated polyposis syndrome who undergo annual endoscopic surveillance.

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Patients with serrated polyposis syndrome are advised to undergo endoscopic surveillance for early detection of polyps and prevention of colorectal cancer.

The optimal surveillance and treatment regimen is unknown.

Dr Evelien Dekker and colleagues performed a prospective study to evaluate a standardized endoscopic treatment protocol in a large cohort of patients with SPS.

The research team followed a cohort of patients with serrated polyposis syndrome who received annual endoscopic surveillance at the Academic Medical Center in Amsterdam, The Netherlands from 2007 through 2012.

All patients underwent clearing colonoscopy with removal of all polyps ≥3 mm.

After clearance, subsequent follow-up colonoscopies were scheduled annually.

The research team's primary outcomes measure was the incidence of colorectal cancer and polyps.

Successful endoscopic clearance of all polyps ≥3 mm was achieved in 82% of patients
Gastroenterology

Secondary outcomes were the incidence of complications and the rate of preventive surgery.

Successful endoscopic clearance of all polyps ≥3 mm was achieved in 82% of patients.

During subsequent annual surveillance, with a median follow-up time of 3 years, colorectal cancer was not detected.

The team found that the cumulative risks of detecting colorectal cancer, advanced adenomas, or large (≥10 mm) serrated polyps after 3 surveillance colonoscopies were 0%, 9%, 34%, respectively.

The researchers referred 24% of patients for preventive surgery, with 9 patients at initial colonoscopy, and 3 during surveillance.

Perforations or severe bleeding did not occur.

Dr Dekker and team conclude, "Annual surveillance with complete removal of all polyps ≥3 mm with timely referral of selected high-risk patients for prophylactic surgery prevents development of colorectal cancer in serrated polyposis syndrome patients without significant morbidity."

"Considering the substantial risk of polyp recurrence, close endoscopic surveillance in serrated polyposis syndrome seems warranted."

Gastroenterol 2014: 147(1): 88–95
27 June 2014

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