Original ResearchFull Report: Clinical—Alimentary TractIncreased Risk of Colorectal Cancer in Patients With Multiple Serrated Polyps and Their First-Degree Relatives
Section snippets
Patients
Patients were selected from the EPIPOLIP project, a multicenter nationwide study that recruited patients from 24 Spanish hospitals to investigate the causes of multiple colonic polyps.16 This project included patients with more than 10 adenomatous or serrated colonic polyps found in single or successive colonoscopies, with the exception of those who had been diagnosed previously with familial adenomatous polyposis, Lynch syndrome, hamartomatous polyposis, inflammatory bowel disease, and those
Clinical Characteristics of SPS and MSP Patients
Of 567 patients included in the EPIPOLIP registry, 53 (9.3%) met the WHO criteria for SPS (SPS group). In 145 additional patients (25.6%), serrated polyps represented more than 50% of the total polyps found (MSP group).
As shown in Table 1, the mean age of patients at diagnosis was higher in the MSP group compared with the SPS group (54.9 vs 48.9 y; P < .001) and they were more frequently male (P = .02). The MSP group had fewer polyps (P < .001), with a median number of polyps larger than 10 mm
Discussion
The primary finding of this study was the identification of a group of patients with MSP who do not meet the WHO criteria for SPS, but who share with them a similar personal and familial risk of CRC. These results identify the need for a specific surveillance strategy for this newly classified CRC risk group and their relatives. Moreover, these results underscore the limitations of the WHO criteria for SPS diagnosis and the need to improve identifying patients with serrated polyps who are at
Acknowledgments
The authors thank San Francisco Edit for editorial assistance.
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2022, Clinical Gastroenterology and HepatologyCitation Excerpt :Recent studies have demonstrated that advanced neoplasia risk in SPS surveillance is markedly reduced in individuals fulfilling only the WHO III criterion and could justify liberalized surveillance recommendations in that population.10,33 Further highlighting the limitations to treatment of SPS based on existing clinical criteria was the finding by Egoavil et al11 that patients with multiple serrated lesions who did not meet the WHO SPS criteria had similar CRC risk to patients diagnosed with SPS. This study underscores the notion that the process of defining the clinical spectrum and diagnostic criteria for SPS is ongoing.
Colorectal Cancer Screening for the Serrated Pathway
2020, Gastrointestinal Endoscopy Clinics of North AmericaCitation Excerpt :In addition to size, the number of serrated polyps may also be a reproducible risk factor for predicting subsequent CRC, similar to conventional adenomas. A recent study on patients with multiple serrated polyps who fell short of current criteria for the serrated polyposis syndrome (SPS) showed increased CRC risk in these individuals as well as in their first-degree relatives.32 In addition to size and histology, there are other potential risks for the development of CRC in adults with the serrated polyps.
Serrated Polyposis Syndrome
2020, Clinical Gastroenterology and HepatologyCitation Excerpt :CRC is commonly reported in the first-degree relatives (FDRs) of patients with SPS. A provocative study from Spain compared the prevalence and standardized incidence ratio (SIR) of CRC in FDRs of patients with SPS and patients who did not meet the WHO criteria for SPS but had more than 10 polyps, at least 50% of which were serrated.9 No difference in CRC in FDRs was observed between the cohorts, reported at 12.2% (SIR, 3.28; 95% CI, 2.16–4.77) and 10.4% (SIR, 2.79; 95% CI, 2.10–3.63), respectively.
Endoscopic surveillance after colonic polyps and colorrectal cancer resection. 2018 update
2019, Gastroenterologia y Hepatologia
This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e29. Learning Objective: Upon completion of this CME activity, successful learners will be able to assess the risk of colorectal cancer (CRC) in patients with multiple serrated colon polyps and the risk of CRC in their first-degree relatives.
Conflicts of interest The authors disclose no conflicts.
Funding This work was supported by the Instituto de Salud Carlos III (PI08/0726, INT-09/208, PI11/2630, INT-12-078, INT13-196, PI14/01386), Fundación de Investigación Biomédica de la Comunidad Valenciana–Instituto de Investigación Sanitaria y Biomédica de Alicante foundation (UGP-13-221, UGP-14-265), and the Asociación Española Contra el Cáncer (Fundación Científica GCB13131592CAST). Carla Guarinos received a predoctoral grant from Conselleria d’Educació de la Generalitat Valenciana (VALi+d. EXP ACIF/2010/018) and Eva Hernández-Illán received a grant from the Instituto de Salud Carlos III (FI12/00233). Asociación para la Investigación en Gastroenterología de la Provincia de Alicante, a private association that promotes research in gastrointestinal diseases in Alicante, also supported the logistic aspects of the study, but declares no conflict of interest.
Authors names in bold designate shared co-first authorship.
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Authors share co-first authorship.