Individualized surveillance protocol safe for patients with serrated polyposis syndrome
A personalized surveillance strategy according to risk stratification appears to be safe in the management of patients with serrated polyposis syndrome (SPS), reducing colonoscopy burden without risking an increased colorectal cancer (CRC) incidence, a recent study has shown.
Researchers followed 271 SPS patients for a median of 3.6 years, with each patient surveilled using a protocol appointing either a 1- or 2-year interval based on the findings at the previous endoscopy.
Specifically, a surveillance interval of 1 year was recommended in case of removal of ≥1 advanced serrated polyps or adenomas, removal of ≥5 relevant polyps (sessile serrated lesion of any size and/or adenoma of any size and/or hyperplastic polyp ≥5 mm), or requirement of surgery during the last surveillance/clearing phase. In all other cases, a 2-year surveillance interval was recommended. The primary endpoint was 5-year cumulative incidence of CRC and advanced neoplasia (AN) during surveillance.
Two patients developed CRC during surveillance, yielding a cumulative 5-year incidence of 1.3 percent. The 5-year AN incidence was 44 percent, being lower in the subgroup of patients with SPS type III (26 percent) than in the subgroups of those diagnosed with type I (53 percent) or type I and III (59 percent; p<0.001 for all).
Most patients received a surveillance interval recommendation of 2 years. Notably, this group of patients did not have an increased risk of AN relative to those who received a 1-year recommendation (15.6 percent vs 24.4 percent; odds ratio, 0.57; p=0.08).
The findings indicate that the surveillance protocol could potentially reduce colonoscopy burden in the SPS population, the researchers said. Additional efforts are needed to further reduce the burden, especially for patients only fulfilling the World Health Organization criterion III.