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N Z Med J. 2017 Mar 3;130(1451):57-67.

Reducing the polyp burden in serrated polyposis by serial colonoscopy: the impact of nationally coordinated community surveillance.

Author information

1
New Zealand Familial Gastrointestinal Cancer Service, Auckland City Hospital, Auckland.
2
Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA.
3
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
4
Colorectal Oncogenomics Group, Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Australia.
5
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia, Colorectal Oncogenomics Group, Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Australia.
6
Department of Haematology and Oncology, The Queen Elizabeth Hospital, Australia, School of Medicine, University of Adelaide, Australia.
7
Molecular and Cellular Pathology, University of Queensland, Brisbane, Australia, Department of Pathology, University of Melbourne, Melbourne, Australia, Envoi Pathology, Brisbane, Australia.
8
Department of Haematology and Oncology, The Queen Elizabeth Hospital, Australia, School of Medicine, University of Adelaide, Australia, SAHMRI Colorectal Node, Basil Hetzel Institute for Translational Research, Australia.

Abstract

BACKGROUND:

Serrated polyposis syndrome (SPS) is associated with an increased risk of colorectal cancer (CRC) and an evolving management approach. The aims of this study were to assess the polyp burden reduction over time, and the incidence of CRC in serrated polyposis patients undergoing community surveillance.

METHODS:

This is an observational study based on prospectively collected data. A total of 96 SPS patients with no personal history of CRC were prospectively enrolled in a surveillance program under the guidance of a tertiary center. Patients underwent surveillance colonoscopy in multiple centres across New Zealand.

RESULTS:

Patients underwent a median of four colonoscopies with a median interval of 15 months over a median follow-up period of 4.8 years. Five of 96 patients (5%) were referred for surgery, and the remaining 91 were managed by colonoscopy alone. In patients referred for surgery, 92% of the surveillance intervals to the fourth colonoscopy had been ≤12 months compared to 33% (P<0.001) in the colonoscopy only group, and all five (100%) had ≥20 pancolonic polyps after four procedures compared with only 5/91 (5%) in those managed by colonoscopy alone. In patients successfully managed by colonoscopy, 86% had <10 pancolonic polyps, >75% no longer had polyps ≥10mm and >90% no longer had proximal serrated polyps ≥10mm after the fourth colonoscopy. No patients were found to develop CRC during the study time period.

CONCLUSIONS:

Patients with SPS were managed by proactive surveillance colonoscopy in wider hospital settings under tertiary centre guidance, with only 5% requiring surgical management. No CRC was diagnosed in any patient during surveillance.

PMID:
28253245
[Indexed for MEDLINE]

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