Personalised surveillance for serrated polyposis syndrome: results from a prospective 5-year international cohort study

Abstract

Background and aimsSerrated polyposis syndrome (SPS) is associated with an increased risk of colorectal cancer (CRC). International guidelines recommend surveillance intervals of 1–2 years. However, yearly surveillance likely leads to overtreatment for many. We prospectively assessed a surveillance protocol aiming to safely reduce the burden of colonoscopies.MethodsBetween 2013 and 2018, we enrolled SPS patients from nine Dutch and Spanish hospitals. Patients were surveilled using a protocol appointing either a 1-year or 2-year interval after each surveillance colonoscopy, based on polyp burden. Primary endpoint was the 5-year cumulative incidence of CRC and advanced neoplasia (AN) during surveillance.ResultsWe followed 271 SPS patients for a median of 3.6 years. During surveillance, two patients developed CRC (cumulative 5-year incidence 1.3%[95% CI 0% to 3.2%]). The 5-year AN incidence was 44% (95% CI 37% to 52%), and was lower for patients with SPS type III (26%) than for patients diagnosed with type I (53%) or type I and III (59%, p<0.001). Most patients were recommended a 2-year interval, and those recommended a 2-year interval were not at increased risk of AN: AN incidence after a 2-year recommendation was 15.6% compared with 24.4% after a 1-year recommendation (OR 0.57, p=0.08).ConclusionRisk stratification substantially reduced colonoscopy burden while achieving CRC incidence similar to previous studies. AN incidence is considerable in SPS patients, but extension of surveillance intervals was not associated with increased AN in those identified as low-risk by the protocol. We identified SPS type III patients as low-risk group that might benefit from even less frequent surveillance.Trial registration numberThe study was registered on http://www.trialregister.nl; trial-ID NTR4609.

Serrated polyposis syndrome: time to rethink endoscopic treatment and surveillance

“…As acknowledged by the authors, the study has several limitations: retrospective nature, single center, focus on referral patients, and nonstructured surveillance protocol. With this kept in mind, the results are in line with the observation by Bleijenberg et al 9 Overall, both studies suggest that surveillance should be personalized in SPS patients according to risk factors, and that for most patients the extension of colonoscopy over 2 years is safe and would reduce the burden for patients and endoscopy units. In summary, SPS remains a challenge.…”

“…3,4 Ideally, such risk factors would facilitate personalized risk stratification and reduction of colonoscopy burden for patients at low risk for CRC. A prospective observational study performed in the Netherlands and Spain by Bleijenberg et al 9 on 271 patients with SPS has recently assessed the safety and efficacy of an individualized surveillance protocol (1 vs 2 years) for patients with diagnoses of SPS based on such risk factors (number of polyps, presence of advanced adenomas, or advanced serrated polyps). During a median follow-up period of 3.6 years, the cumulative 5-year incidence of CRC was only 1.3% (CRC developed in only 2 patients).…”

Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG)

“…In a US study following up SPS patients which extended surveillance intervals for SPS patients to 2 years after colon clearance with no lesion ≥10 mm found at surveillance, no cancer developed or surgery was needed 193. A similar multicentre European study that individualised surveillance after colonic clearance to 1 or 2 year follow-up dependent on lesion size (≥10 mm), number and pathology also showed no difference in advanced neoplasia detection with a 2 year surveillance interval once the colon was cleared 194…”

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.…”