Department of Medicine, Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Gastrointest Endosc. 2012 Jun;75(6):1206-10. doi: 10.1016/j.gie.2012.01.033. Epub 2012 Mar 15.
Serrated polyposis syndrome (SPS) is a rare condition of multiple serrated colorectal polyps and cancers. Colorectal cancer risk is increased in SPS.
We determined the prevalence of SPS in a cohort of patients with large (≥ 2 cm) sessile colorectal polyps and the rate at which the diagnosis was made by the clinicians.
Review of patient care database. The 2010 World Health Organization (WHO) criteria were used to identify cases of SPS.
Tertiary academic center.
529 consecutive patients referred for endoscopic resection of a sessile colorectal polyp ≥ 2 cm.
Prevalence of SPS in the cohort and frequency with which the referring physician and the endoscopist recognized SPS.
Of the 529 patients, 20 (4%) met the WHO criteria for SPS. Only 1 of these cases was suspected by a referring physician. Twelve cases (60%) were either diagnosed or suspected by the endoscopist at our center. Compared with all other patients without SPS, those with SPS were more likely to have an index lesion (the lesion that led to referral) that was serrated (60% vs 3.8%), to have a cecal or ascending colon index lesion (70% vs 45%), and to be current smokers (42% vs 15%). Including the first colonoscopy to remove the index lesion and 26 follow-up colonoscopies, the endoscopist at our center removed 183 serrated polyps from the 20 patients with SPS; of those polyps, 68 were >1 cm. Three patients were referred for surgical resection of involved colon. Eighteen of the 20 patients with SPS met the WHO criterion of 5 serrated polyps proximal to the sigmoid, of which 2 are >1 cm. Failure to recognize SPS by the referring physician was at least partly related to unrecognized serrated lesions. Failure to recognize SPS by the endoscopist at our institution was the result of not systematically applying WHO criteria to the polyp findings.
Retrospective study.
SPS was common in a cohort of patients with large sessile colorectal polyps, and it was frequently unrecognized. These data suggest the need for better detection of serrated lesions, better awareness of SPS, and more consistent application of SPS criteria to the polyp findings of individual patients.
锯齿状息肉综合征（SPS）是一种多发性锯齿状结直肠息肉和癌症的罕见病症。SPS 患者的结直肠癌风险增加。
我们确定了一组大型（≥2cm）无蒂结直肠息肉患者中 SPS 的患病率，以及临床医生诊断 SPS 的比率。
回顾患者护理数据库。使用 2010 年世界卫生组织（WHO）标准来确定 SPS 病例。
三级学术中心。
529 例连续患者因内镜切除≥2cm 的无蒂结直肠息肉而被转介。
队列中 SPS 的患病率以及转介医生和内镜医生识别 SPS 的频率。
在 529 例患者中，有 20 例（4%）符合 WHO 锯齿状息肉综合征标准。只有 1 例被转介医生怀疑。在我们中心，12 例（60%）病例被诊断或怀疑为 SPS。与所有其他无 SPS 的患者相比，SPS 患者的索引病变（导致转介的病变）更有可能是锯齿状的（60%比 3.8%），病变位于盲肠或升结肠（70%比 45%），并且更有可能是当前吸烟者（42%比 15%）。包括第一次切除索引病变的结肠镜检查和 26 次随访结肠镜检查，我们中心的内镜医生从 20 例 SPS 患者中切除了 183 个锯齿状息肉；其中 68 个息肉大于 1cm。有 3 例患者因涉及结肠的手术切除而被转介。20 例 SPS 患者中有 18 例符合 WHO 标准，即近端乙状结肠有 5 个锯齿状息肉，其中 2 个大于 1cm。转介医生未识别 SPS 至少部分与未识别的锯齿状病变有关。我们机构的内镜医生未能识别 SPS 是由于未系统地将 WHO 标准应用于息肉发现。
回顾性研究。
在一组大型无蒂结直肠息肉患者中，SPS 很常见，且经常未被识别。这些数据表明，需要更好地检测锯齿状病变，提高对 SPS 的认识，并更一致地将 SPS 标准应用于个体患者的息肉发现。
