Endoscopic control of polyp burden and expansion of surveillance intervals in serrated polyposis syndrome

Abstract

Introduction: Serrated polyposis syndrome (SPS) increases colorectal cancer (CRC) risk. We describe the numbers of colonoscopies and polypectomies performed to achieve and maintain low polyp burdens, and the feasibility of expanding surveillance intervals in patients who achieve endoscopic control. Methods: We retrospectively evaluated a prospectively collected database on 115 SPS patients undergoing surveillance at Indiana University Hospital between June 2005 and May 2018. The endoscopist provided surveillance interval recommendations based on polyp burden. Endoscopic control was considered successful if surveillance examinations exhibited fewer polyps and if no or only an occasional polyp ≥1 cm in size was present at follow-up. Initial control was designated the clearing phase and the maintenance phase was surveillance after control was established. Results: In total, 87 patients (75.7%) achieved endoscopic control, with some others in the clearing phase at this writing. Achieving control required a mean of 2.84 colonoscopies (including the baseline) over 20.4 months and a mean total 27.9 polyp resections. After establishing control, 71 patients were recommended to receive ≥24-month follow-up. Of those, 60 patients (69.0% of patients with initial control) continued surveillance at our center. The mean interval between colonoscopies during maintenance was 19.3 months with 6.74 mean polypectomies per procedure on polyps primarily <1 cm. There were no incident cancers or colon surgeries during maintenance.

Terminology, Molecular Features, Epidemiology, and Management of Serrated Colorectal Neoplasia

“…50,51 Close endoscopic surveillance is recommended for patients with confirmed SPS, with annual colonoscopies (or occasionally longer intervals in individuals with lower polyp burden and absence of high-risk features). 52 Endoscopic management can reduce the risk of cancer development in many patients with SPS, so referral to a specialized center or endoscopist should be considered following diagnosis. 53…”

“…161 Annual colonoscopy is generally recommended for patients with confirmed SPS, though longer intervals (eg, 24 months) may be adequate in patients once endoscopic control is achieved. 52…”

Optimal Endoscopic Treatment and Surveillance of Serrated Polyps

“…53,54 Recent data suggests once the colon is cleared, follow-up can be safely deferred to 2 years. 55,56 The risk for patient who are first-degree relatives of patients with SPS also appears elevated between 3-to 5-fold compared to the general population 51,57,58 and screening colonoscopy is recommended for this group, with subsequent colonoscopies determined by polyp burden. Surveillance should then be performed every 5 years if no polyps are found.…”

Serrated polyposis syndrome: time to rethink endoscopic treatment and surveillance

“…In this context, there is a need for evidence that guides our decisions. The study by MacPhail et al 6 in this issue of Gastrointestinal Endoscopy is a retrospective cohort study from a referral center that analyzed a cohort of 115 SPS patients who were treated between 2005 and 2018 by an expert endoscopist. Endoscopic treatment was divided into 2 phases: clearing (defined as treatment required to lower polyp burden to achieve endoscopic control) and maintenance (defined as subsequent procedures to maintain control).…”

“…For instance, in >90% of patients the clearing phase was successful and could be performed in a median of 2 procedures over <12 months. This concept is underlined by the study of MacPhail et al, 6 in which, in a referral center skewed On the basis of the WHO criteria, SPS includes a wide variability of phenotypes. Polyp burden is the main factor to consider if the disease is endoscopically manageable.…”