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17-04-2012 | Surgery | Article

Serrated polyposis prognosis ‘rapid and unrelenting’ neoplasia


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MedWire News: Patients with serrated (hyperplastic) polyposis (SP) experience "rapid and unrelenting" colorectal neoplasia after surgery, US researchers report in Gut.

"These findings support the possibility of annual colonoscopic surveillance, consideration for colectomy when SSA/P [sessile serrated adenomas/polyps] or adenomas are encountered, and frequent postoperative endoscopic surveillance of the retained colorectum," say Francis Giardiello (Johns Hopkins University, Baltimore, Maryland) and co-authors.

The team investigated the course of disease in 44 patients who met the World Health Organization (WHO) criteria for SP. This includes five or more serrated polyps proximal to the sigmoid colon including two or more that are 10 mm or larger, or serrated polyps proximal to the sigmoid colon in a patient with a first-degree relative with SP, or more than 20 serrated polyps of any size throughout the colon.

The patients were aged an average of 52.5 years at SP diagnosis, and had undergone their initial colonoscopy for colorectal cancer screening, gastrointestinal bleeding, abdominal pain, anemia, or a change in bowel habit. The patients underwent 146 colonoscopies a median of 1.6 years apart, and were followed up for a median of 2.0 years after each investigation.

All identified polyps were removed at colonoscopy. None of the patients had gastroduodenal polyps but all had developed further sigmoid polyps by the time of surveillance colonoscopy, the researchers report.

Of note, 61% of patients had SSA/P or adenomas at their first colonoscopy, rising to 83% by their final investigation. Recurrent SSA/P or adenoma were detected in 68% of patients at surveillance colonoscopy. Three patients were diagnosed with colorectal cancer.

Eleven patients underwent colorectal surgery. After surgery, seven patients were assessed again, and all had recurrent polyps in the retained colorectum, seven of whom had SSA/P or adenoma.

Giardiello et al say there was no correlation between the development of colorectal neoplasia and age at diagnosis, gender, or initial number of polyps.

Concluding that SP course indicates it is an inherited genetic syndrome, the team recommends: "Based on expert opinion and because of the rapid and relentless natural history of this condition in most patients, clinicians should begin to consider colectomy when SSA/P, traditional serrated adenomas or adenomas are encountered in those meeting WHO criterion III."

By Lynda Williams

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