BACKGROUND AND AIMS: Patients with hyperplastic polyposis syndrome (HPS) receive endoscopic surveillance to prevent malignant progression of polyps. However, the optimal treatment and surveillance protocol for these patients is unknown. The aim of this study was to describe the clinical and pathological features of a large HPS cohort during multiple years of endoscopic surveillance. METHODS: Databases were searched for patients with HPS, who were analysed retrospectively. Endoscopy reports and histopathology reports were collected to evaluate frequency of endoscopic surveillance and to obtain information regarding polyp and the presence of colorectal cancer (CRC). RESULTS: In 77 patients with HPS, 1984 polyps were identified during a mean follow-up period of 5.6 years (range: 0.5-26.6). In 27 (35%) patients CRC was detected of which 22 (28.5%) at initial endoscopy. CRC was detected during surveillance in five patients (cumulative incidence: 6.5%) after a median follow-up time of 1.3 years and a median interval of 11 months. Of these interval CRCs, 4/5 were detected in diminutive serrated polyps (range: 4-16 mm). The cumulative risk of CRC under surveillance was 7% at 5 years. At multivariate logistic regression, an increasing number of hyperplastic polyps (OR 1.05, p=0.013) and serrated adenomas (OR 1.09, p=0.048) was significantly associated with CRC presence. CONCLUSIONS: HPS patients undergoing endoscopic surveillance have an increased CRC risk. The number of serrated polyps is positively correlated with the presence of CRC in HPS, thus supporting a 'serrated pathway' to CRC. To prevent malignant progression, adequate detection and removal of all polyps seems advisable. If this is not feasible, surgical resection should be considered.
BACKGROUND AND AIMS: Patients with hyperplastic polyposis syndrome (HPS) receive endoscopic surveillance to prevent malignant progression of polyps. However, the optimal treatment and surveillance protocol for these patients is unknown. The aim of this study was to describe the clinical and pathological features of a large HPS cohort during multiple years of endoscopic surveillance. METHODS: Databases were searched for patients with HPS, who were analysed retrospectively. Endoscopy reports and histopathology reports were collected to evaluate frequency of endoscopic surveillance and to obtain information regarding polyp and the presence of colorectal cancer (CRC). RESULTS: In 77 patients with HPS, 1984 polyps were identified during a mean follow-up period of 5.6 years (range: 0.5-26.6). In 27 (35%) patients CRC was detected of which 22 (28.5%) at initial endoscopy. CRC was detected during surveillance in five patients (cumulative incidence: 6.5%) after a median follow-up time of 1.3 years and a median interval of 11 months. Of these interval CRCs, 4/5 were detected in diminutive serrated polyps (range: 4-16 mm). The cumulative risk of CRC under surveillance was 7% at 5 years. At multivariate logistic regression, an increasing number of hyperplastic polyps (OR 1.05, p=0.013) and serrated adenomas (OR 1.09, p=0.048) was significantly associated with CRC presence. CONCLUSIONS: HPS patients undergoing endoscopic surveillance have an increased CRC risk. The number of serrated polyps is positively correlated with the presence of CRC in HPS, thus supporting a 'serrated pathway' to CRC. To prevent malignant progression, adequate detection and removal of all polyps seems advisable. If this is not feasible, surgical resection should be considered.
Authors: Sapna Syngal; Randall E Brand; James M Church; Francis M Giardiello; Heather L Hampel; Randall W Burt Journal: Am J Gastroenterol Date: 2015-02-03 Impact factor: 10.864
Authors: Danielle M Tholey; Corbett E Shelton; Gloria Francis; Archana Anantharaman; Robert A Frankel; Paurush Shah; Amy Coan; Sarah E Hegarty; Benjamin E Leiby; David M Kastenberg Journal: J Clin Gastroenterol Date: 2015-04 Impact factor: 3.062
Authors: Daniel D Buchanan; Kevin Sweet; Musa Drini; Mark A Jenkins; Aung Ko Win; Michael Gattas; Michael D Walsh; Mark Clendenning; Diane McKeone; Rhiannon Walters; Aedan Roberts; Alasdair Young; Heather Hampel; John L Hopper; Jack Goldblatt; Jill George; Graeme K Suthers; Kerry Phillips; Graeme P Young; Elizabeth Chow; Susan Parry; Sonja Woodall; Kathy Tucker; Amanda Muir; Michael Field; Sian Greening; Steven Gallinger; Jane Green; Michael O Woods; Renee Spaetgens; Albert de la Chapelle; Finlay Macrae; Neal I Walker; Jeremy R Jass; Joanne P Young Journal: Int J Colorectal Dis Date: 2010-03-06 Impact factor: 2.571
Authors: Daniel D Buchanan; Kevin Sweet; Musa Drini; Mark A Jenkins; Aung Ko Win; Dallas R English; Michael D Walsh; Mark Clendenning; Diane M McKeone; Rhiannon J Walters; Aedan Roberts; Sally-Ann Pearson; Erika Pavluk; John L Hopper; Michael R Gattas; Jack Goldblatt; Jill George; Graeme K Suthers; Kerry D Phillips; Sonja Woodall; Julie Arnold; Kathy Tucker; Amanda Muir; Michael Field; Sian Greening; Steven Gallinger; Renee Perrier; John A Baron; John D Potter; Robert Haile; Wendy Frankel; Albert de la Chapelle; Finlay Macrae; Christophe Rosty; Neal I Walker; Susan Parry; Joanne P Young Journal: PLoS One Date: 2010-07-16 Impact factor: 3.240
Authors: Yark Hazewinkel; Johannes B Reitsma; Fokko M Nagengast; Hans F Vasen; Theo A M van Os; Monique E van Leerdam; Jan-Jacob Koornstra; Evelien Dekker Journal: Fam Cancer Date: 2013-12 Impact factor: 2.375