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Original article
Personalised surveillance for serrated polyposis syndrome: results from a prospective 5-year international cohort study
  1. Arne GC Bleijenberg1,
  2. Joep EG IJspeert1,
  3. Yasmijn J van Herwaarden2,
  4. Sabela Carballal3,4,
  5. María Pellisé3,4,
  6. Gerhard Jung3,4,
  7. Tanya M Bisseling2,
  8. Iris D Nagetaal5,
  9. Monique E van Leerdam6,
  10. Niels van Lelyveld7,
  11. Xavier Bessa8,
  12. Francisco Rodríguez-Moranta9,
  13. Barbara Bastiaansen1,
  14. Willemijn de Klaver1,
  15. Liseth Rivero3,4,
  16. Manon CW Spaander10,
  17. Jan Jacob Koornstra11,
  18. Luis Bujanda12,
  19. Francesc Balaguer3,4,
  20. Evelien Dekker1
  1. 1 Gastroenterology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
  2. 2 Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
  3. 3 Gastroenterology Department, Hospital Clinic de Barcelona, Barcelona, Spain
  4. 4 Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
  5. 5 Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
  6. 6 Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands
  7. 7 Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands
  8. 8 Gastroenterology, Institut Hospital del Mar d’Investigacions Mediques, Barcelona, Spain
  9. 9 Gastroenterology Department, Bellvitge University Hospital, Barcelona, Spain
  10. 10 Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
  11. 11 Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
  12. 12 Gastroenterology, Donostia Hospital, San Sebastian, Spain
  1. Correspondence to Dr Evelien Dekker, Department of Gastroenterology and Hepatology C2-115, Academic Medical Center, Amsterdam 1105 AZ, The Netherlands; e.dekker{at}amc.uva.nl

Abstract

Background and aims Serrated 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.

Methods Between 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.

Results We 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).

Conclusion Risk 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 number The study was registered on http://www.trialregister.nl; trial-ID NTR4609.

  • colorectal cancer
  • colonic polyps
  • polyposis

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/gutjnl-2018-318134

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    Footnotes

    • FB and ED contributed equally.

    • Contributors Conception and design: AGCB, JEGIJ and ED. Data acquisition: all authors. Data analysis and interpretation: all authors. Drafting the manuscript: AGCB. Critical revision of the manuscript: all authors. Statistical analyses: AGCB. Supervision: all authors.

    • Funding This work was funded by grants from the Dutch Cancer Society (KWF) and the Instituto de Salud Carlos III (PI16 /00766). This work was co-funded by the European Regional Development Fund (ERDF). CIBEREHD is funded by the Instituto de Salud Carlos III.

    • Disclaimer None of the funding parties has been involved in the collection, analysis and interpretation of the data.

    • Competing interests ED: I have endoscopic equipment on loan of Olympus and Fujifilm, and received a research grant from Fujifilm. I have also received an honorarium for consultancy from Fujifilm, Tillotts and Olympus and a speaker’s fee from Olympus and Roche. FB: I have endoscopic equipment on loan of Fujifilm, and received an honorarium for consultancy from Sysmex and a speaker’s fee from Norgine. MP: I have received a research grant from Fujifilm, consultancy fee from Norgine and speaker’s fee from Olympus, Norgine, Casen Recordati and Janssen.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Correction notice This article has been corrected since it first published online. The open access licence type has been amended.

    • Patient consent for publication Not required.

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