Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands.
Gastroenterology. 2014 Jul;147(1):88-95. doi: 10.1053/j.gastro.2014.03.015. Epub 2014 Mar 20.
BACKGROUND & AIMS: Patients with serrated polyposis syndrome (SPS) are advised to undergo endoscopic surveillance for early detection of polyps and prevention of colorectal cancer (CRC). The optimal surveillance and treatment regimen is unknown. We performed a prospective study to evaluate a standardized endoscopic treatment protocol in a large cohort of patients with SPS.
We followed a cohort of patients with SPS who received annual endoscopic surveillance at the Academic Medical Centre in Amsterdam, The Netherlands from January 2007 through December 2012. All patients underwent clearing colonoscopy with removal of all polyps ≥3 mm. After clearance, subsequent follow-up colonoscopies were scheduled annually. The primary outcomes measure was the incidence of CRC and polyps. Secondary outcomes were the incidence of complications and the rate of preventive surgery.
Successful endoscopic clearance of all polyps ≥3 mm was achieved in 41 of 50 (82%) patients. During subsequent annual surveillance, with a median follow-up time of 3.1 years (interquartile range, 1.5-4.3 years), CRC was not detected. The cumulative risks of detecting CRC, advanced adenomas, or large (≥10 mm) serrated polyps after 3 surveillance colonoscopies were 0%, 9%, 34%, respectively. Twelve patients (24%) were referred for preventive surgery; 9 at initial colonoscopy and 3 during surveillance. Perforations or severe bleeding did not occur.
Annual surveillance with complete removal of all polyps ≥3 mm with timely referral of selected high-risk patients for prophylactic surgery prevents development of CRC in SPS patients without significant morbidity. Considering the substantial risk of polyp recurrence, close endoscopic surveillance in SPS seems warranted. www.trialregister.nl ID NTR2757.
锯齿状息肉综合征（SPS）患者建议进行内镜监测，以便早期发现息肉并预防结直肠癌（CRC）。目前尚不清楚最佳的监测和治疗方案。我们进行了一项前瞻性研究，以评估荷兰阿姆斯特丹学术医学中心的一个大 SPS 患者队列中标准化内镜治疗方案的效果。
我们对 2007 年 1 月至 2012 年 12 月在荷兰阿姆斯特丹学术医学中心接受年度内镜监测的 SPS 患者队列进行了随访。所有患者均接受了清除性结肠镜检查，并切除了所有≥3mm 的息肉。清除后，每年安排后续结肠镜检查。主要终点是 CRC 和息肉的发生率。次要终点是并发症发生率和预防性手术率。
41 例（82%）患者成功地清除了所有≥3mm 的息肉。在随后的年度监测中，中位随访时间为 3.1 年（四分位距，1.5-4.3 年），未发现 CRC。经过 3 次监测结肠镜检查后，检测 CRC、高级腺瘤或大（≥10mm）锯齿状息肉的累积风险分别为 0%、9%、34%。12 例（24%）患者转介行预防性手术；9 例在初始结肠镜检查时，3 例在监测时。未发生穿孔或严重出血。
每年进行监测，彻底清除所有≥3mm 的息肉，并及时将选定的高危患者转介行预防性手术，可以防止 SPS 患者发生 CRC，且不会显著增加发病率。鉴于息肉复发的风险很大，SPS 患者似乎需要密切的内镜监测。www.trialregister.nl ID NTR2757。
