Endoscopic surveillance in patients with multiple (10 - 100) colorectal polyps
Valentín F(1), Guarinos C(2), Juárez M(3), Rodríguez-Soler M(2), Serradesanferm A(4), Rodriguez-Moranta F(5), Nicolas-Perez D(6), Bujanda L(7), Herraiz M(8), De-Castro L(9), Fernández-Bañares F(10), Herreros-de-Tejada A(11), Martínez F(12), Aguirre E(13), Ferrández Á(14), Díaz-Tasende J(15), Piñol V(16), Paya A(17), Egoavil C(17), Alenda C(17), Castells A(18), Jover R(3), Cubiella J(1).
(1) Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.
(2) Unidad de Investigación, Hospital General Universitario de Alicante, Alicante, Spain.
(3) Department of Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain.
(4) Unitat d'Avaluació, Suport i Prevenció, Hospital Clínic, Barcelona, Spain.
(5) Department of Gastroenterology, Bellvitge University Hospital, Hospitalet, Spain.
(6) Department of Gastroenterology, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain.
(7) Department of Gastroenterology, Donostia Hospital/Biodonostia Institute, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Basque Country (UPV/EHU), San Sebastián, Spain.
(8) Department of Gastroenterology, Clínica Universitaria de Navarra, Pamplona, Spain.
(9) Department of Gastroenterology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain.
(10) Department of Gastroenterology, Hospital Universitari Mutua de Terrassa, CIBERehd, Terrassa, Spain.
(11) Department of Gastroenterology, IDIPHIM, Hospital Universitario Puerta De Hierro, Majadahonda, Madrid, Spain.
(12) Department of Gastroenterology, Instituto Valenciano de Oncología, Valencia, Spain.
(13) Department of Oncology, Hospital Arnau de Vilanova, Lleida, Spain.
(14) Servicio de Aparato Digestivo, Hospital Clínico Universitario, IIS Aragón, University of Zaragoza, CIBERehd, Zaragoza, Spain.
(15) Department of Gastroenterology, Hospital Universitario 12 de Octubre, Madrid, Spain.
(16) Department of Gastroenterology, Hospital Josep Trueta, Girona, Spain.
(17) Department of Pathology, Hospital General Universitario de Alicante, Alicante, Spain.
(18) Department of Gastroenterology, Hospital Clínic, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, University of Barcelona, Barcelona, Spain.
Date: Jul 10, 2015Digestive Tract Tumours Area High Risk Digestive Tumours Prevention Consultation Unit Digestive [SP]
Background and study aims: Endoscopic surveillance in patients with multiple colorectal polyps aims to reduce colorectal cancer (CRC) incidence and mortality, as well as the need for colorectal surgery. The aim of this study was to determine the risk of developing CRC or the need for surgery during endoscopic surveillance in a cohort of patients with multiple (10 - 100) colorectal polyps.
Patients and methods: This was a multicentrer, longitudinal, observational study in 15 CRC high risk clinics in Spain, carried out between January 2009 and December 2010. Patients who were included in the EPIPOLIP trial and had at least 1 year of follow-up were included in the study. The primary outcome of interest was the incidence of CRC at least 1 year following the initial colonoscopy. The secondary outcome was the need for colorectal surgery.
Results: A total of 265 patients were followed for a median of 3.8 years. Patients underwent a median of 5 colonoscopies, and 17 patients (6.4 %) were diagnosed with CRC. A total of 32 patients (12.1 %) underwent surgery, including 15 (5.7 %) for prophylaxis without a diagnosis of CRC. The corresponding incidence density rates for CRC and colorectal surgery were 1.4 (95 % confidence interval [CI] 0.7 to 2.1) and 2.7 (95 %CI 1.7 to 3.6) per 100 patient-years, respectively. Only the presence of symptoms at first colonoscopy was independently associated with CRC diagnosis (hazard ratio [HR] 7.7, 95 %CI 1.1 to 59.3) and colorectal surgery (HR 4.6, 95 %CI 1.02 to 20.6).
Conclusions: Patients with more than 10 neoplastic polyps required frequent colonoscopies within a short follow-up period. More than 10 % of patients required colorectal surgery within 4 years, more than half for incident CRC.
CITATION Endoscopy. 2015 Jul 10.
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