In the Journals

Low-risk serrated polyposis syndrome comes with lower colonoscopy burden

Personalized surveillance can help reduce the colonoscopy burden among patients with lower risk serrated polyposis syndrome, according to research published in Gut.

Evelien Dekker, PhD, of the department of gastroenterology and hepatology at the University of Amsterdam in the Netherlands, and colleagues wrote that research into serrated polyposis syndrome (SPS) has revealed varied but high rates of colorectal cancer, leading to rigorous surveillance recommendations.

“The prevalence of SPS combined with the stringent surveillance regimens lead to substantial colonoscopy burden,” they wrote. “Annual surveillance seems appropriate for some patients, but extension of surveillance intervals beyond one year might be safe for the majority.”

Researchers performed a 5-year, prospective study comprising 271 patients with SPS from Dutch and Spanish hospitals between 2013 and 2018. Clinicians surveilled patients using protocol that assigned them to undergo either a one or two-year interval after each surveillance colonoscopy based on their polyp burden.

The primary endpoint of the study was 5-year cumulative incidence of CRC and advanced neoplasia during surveillance.

During surveillance, investigators found that two patients developed CRC, resulting in a 5-year cumulative CRC incidence of 1.3% (95% CI, 0%–3.2%).

The 5-year incidence of advanced neoplasia was 44% (95% CI, 37%–53%), but it was lower in patients with SPS type III (26%) compared with patients with type I (53%) or type I and III (59%; P < .001).

The 2-year interval — which was recommended to most patients — did not increase risk for advanced neoplasia. Incidence after a 2-year recommendation was 15.6% compared with 24.4% after a 1-year interval recommendation (OR = 0.57; P = .08).

Dekker and colleagues wrote their findings show that personalized surveillance strategies based on a patient’s risk can be implemented safely without increasing CRC incidence.

“Future studies should aim to reduce the colonoscopy burden in true low-risk patients even further,” they wrote. “Since a two-year recommendation was not associated with increased [advanced neoplasia] incidence, perhaps further extension beyond two years might be safe for these patients as well.” – by Alex Young

Disclosures: Dekker reports having endoscopic equipment on loan of Olympus and Fujifilm, and receiving a research grant from Fujifilm. Dekker also received an honorarium for consultancy from Fujifilm, Tillotts and Olympus and a speaker’s fee from Olympus and Roche. Please see the full report for all other authors’ relevant financial disclosures.

Personalized surveillance can help reduce the colonoscopy burden among patients with lower risk serrated polyposis syndrome, according to research published in Gut.

Evelien Dekker, PhD, of the department of gastroenterology and hepatology at the University of Amsterdam in the Netherlands, and colleagues wrote that research into serrated polyposis syndrome (SPS) has revealed varied but high rates of colorectal cancer, leading to rigorous surveillance recommendations.

“The prevalence of SPS combined with the stringent surveillance regimens lead to substantial colonoscopy burden,” they wrote. “Annual surveillance seems appropriate for some patients, but extension of surveillance intervals beyond one year might be safe for the majority.”

Researchers performed a 5-year, prospective study comprising 271 patients with SPS from Dutch and Spanish hospitals between 2013 and 2018. Clinicians surveilled patients using protocol that assigned them to undergo either a one or two-year interval after each surveillance colonoscopy based on their polyp burden.

The primary endpoint of the study was 5-year cumulative incidence of CRC and advanced neoplasia during surveillance.

During surveillance, investigators found that two patients developed CRC, resulting in a 5-year cumulative CRC incidence of 1.3% (95% CI, 0%–3.2%).

The 5-year incidence of advanced neoplasia was 44% (95% CI, 37%–53%), but it was lower in patients with SPS type III (26%) compared with patients with type I (53%) or type I and III (59%; P < .001).

The 2-year interval — which was recommended to most patients — did not increase risk for advanced neoplasia. Incidence after a 2-year recommendation was 15.6% compared with 24.4% after a 1-year interval recommendation (OR = 0.57; P = .08).

Dekker and colleagues wrote their findings show that personalized surveillance strategies based on a patient’s risk can be implemented safely without increasing CRC incidence.

“Future studies should aim to reduce the colonoscopy burden in true low-risk patients even further,” they wrote. “Since a two-year recommendation was not associated with increased [advanced neoplasia] incidence, perhaps further extension beyond two years might be safe for these patients as well.” – by Alex Young

Disclosures: Dekker reports having endoscopic equipment on loan of Olympus and Fujifilm, and receiving a research grant from Fujifilm. Dekker also received an honorarium for consultancy from Fujifilm, Tillotts and Olympus and a speaker’s fee from Olympus and Roche. Please see the full report for all other authors’ relevant financial disclosures.