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Endoscopy III
PWE-208 High prevalence of hyperplastic polyposis syndrome in the NHS bowel cancer screening programme
  1. S Biswas1,
  2. A J Ellis1,
  3. R Guy2,
  4. R Chetty3,
  5. K Madronal4,
  6. H Savage4,
  7. J E East1
  1. 1Translational Gastroenterology Unit, Oxford University Hospitals NHS Trust, Oxford, UK
  2. 2Colorectal Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
  3. 3Translational Pathology, Oxford University Hospitals NHS Trust, Oxford, UK
  4. 4Bowel Cancer Screening, Oxford University Hospitals NHS Trust, Oxford, UK

Abstract

Introduction Hyperplastic Polyposis Syndrome (HPS) is a rare syndrome (estimated 1:3000, 0.033% general population1) in which multiple hyperplastic polyps can predispose to an increased risk of colorectal cancer of up to 7% at 5 years,2 and a risk for first degree relatives of HPS patients of fivefold compared to the general population.3 Proximal serrated polyps are commonly associated with advanced neoplasia.4 Currently the Bowel Cancer Screening Programme (BCSP) does not offer surveillance for serrated polyps. We aimed to assess how common HPS is in our BCSP population.

Methods We reviewed endoscopic and pathology records for all patients presenting for Bowel Cancer Screening in Oxfordshire between April 2010 (programme start) and January 2012. Three endoscopists performed the procedures. Patients were defined as HPS if they met either of the two main WHO criteria for HPS: either ≥20 hyperplastic polyps throughout the colon, or five hyperplastic polyps in the proximal colon with 2 ≥10 mm. Patients who were 1st degree relatives of HPS patients were not considered.

Results In total 755 patients attended for screening colonoscopy. Five patients met WHO criteria for HPS, of whom three had a synchronous advanced adenoma (see Abstract PWE-208 table 1). The prevalence of HPS in our BCSP population was 0.66% (95% CI 0.24% to 1.52%), a 20-fold increase compared to the estimated rate in the general population.

Abstract PWE-208 Table 1

Characteristics of patients diagnosed with HPS

Conclusion HPS appears to be relatively common in BCSP patients and is often associated with advanced neoplasia. Detection of a large serrated polyp or multiple hyperplastic polyps should alert BCSP colonoscopists to the possibility of HPS where they may wish to augment detection with dye-spray or advanced imaging techniques. BCSP surveillance for large proximal serrated polyps may need to be reviewed to ensure such patients are not overlooked.

Competing interests None declared.

References 1. Lockett MJ, Atkin WS. Gut 2001; 48(Suppl I):A4. 18.

2. Boparai KS, et al. Gut 2010;59:1094–100.

3. Boparai KS, et al. Gut 2010;59:1222–5.

4. Hiraoka S, et al. Gastroenterology 2010;139:1503–10.

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