1. Personalised surveillance for serrated polyposis syndrome
- Author
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Liseth Rivero, Manon C.W. Spaander, Francisco Rodríguez-Moranta, Maria Pellise, Niels van Lelyveld, Willemijn de Klaver, Joep E. G. IJspeert, Sabela Carballal, Barbara A. J. Bastiaansen, Evelien Dekker, Jan J. Koornstra, Monique E. van Leerdam, Xavier Bessa, Gerhard Jung, Tanya M. Bisseling, Arne Bleijenberg, Iris D. Nagetaal, Francesc Balaguer, Luis Bujanda, Yasmijn van Herwaarden, Graduate School, AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and Quality of Life, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Gastroenterology and Hepatology, AGEM - Digestive immunity, APH - Quality of Care, and Gastroenterology & Hepatology
- Subjects
Male ,HYPERPLASTIC POLYPOSIS ,medicine.medical_specialty ,COLONOSCOPY ,Colon ,Colorectal cancer ,Colonoscopy ,Medical Overuse ,Colonic polyps ,COLORECTAL-CANCER ,Cohort Studies ,All institutes and research themes of the Radboud University Medical Center ,Risk Factors ,Internal medicine ,Tumours of the digestive tract Radboud Institute for Molecular Life Sciences [Radboudumc 14] ,Prevalence ,medicine ,Clinical endpoint ,Humans ,Cumulative incidence ,Prospective Studies ,Polyposis ,Aged ,Netherlands ,RISK ,medicine.diagnostic_test ,business.industry ,Incidence ,Incidence (epidemiology) ,Gastroenterology ,Middle Aged ,medicine.disease ,Serrated polyposis ,Miscellaneous ,Increased risk ,Adenomatous Polyposis Coli ,Spain ,Population Surveillance ,Female ,Colorectal Neoplasms ,business ,Follow-Up Studies ,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%, pConclusionRisk 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.
- Published
- 2020