High prevalence of serrated polyps in patients undergoing colonoscopy: a prospective study

Notizia del 05/04/2009

Scritto da admin

Authors (first name, last name):

• Andrea Buda1
• Eva Zabeo [1]
• Manuela De Bona [2]
• Renzo Barbazza MD [3]
• Pierluca Piselli [4]
• Angelo Bellumat MD [2]
• Flavio Valiante [2]
• Massimo Pignatelli [5]
• Giacomo C. Sturniolo [1]
• Michele De Boni [2]

Abstract body - Introduction:

A growing body of evidence indicates that serrated polyps (SP) have a substantial risk for subsequent malignancy and the serrated pathway colorectal tumorigenesis is recognized as an alternative to the adenoma-carcinoma sequence. SP include sessile serrated adenomas (SSA), traditional serrated adenomas (TSA). However, the overall impact of SA on colorectal cancer is uncertain because the true prevalence is unknown.

Aims & methods:

Aim of this study was to determine the prevalence, characteristics of SP in a prospective series of patients. Methods. A consecutive series of patients undergoing colonoscopy over 18-month period was studied. Asymptomatic patients with positive FOBT + or subjects at first colonoscopy for different clinical indications were included. Only patients without history of CRC or adenomas, inflammatory bowel disease were enrolled. All colonoscopies were performed with white light conventional endoscopes, the mean withdrawal time 11.4 min and the cecum was reached in 94% of cases. For purposes of the analysis, the junction of the splenic flexure and the descending colon, as determined by the endoscopist, defined the border between the proximal and the distal colon. All retrieved polyps were examined by 2 independent pathologists (RB, MP) and SP classified using the system described by Torlakovich et al.

Results:

Among 2036 patients included (48.9% M, mean age 59.3±6 and 51.1% F, mean age 60.1±4), 707 (34.7%) had polyps. Most were adenomas (68.6%), followed by SA (20.8%, SSA 18%, TSA 2.8% respectively) and hyperplastic polyps (5.4%). SSA were less than 5 mm in 81.5% of cases (p<0.001) and mostly located in the distal colon (88%, p<0.001). TSA were more prevalent in distal colon (77.8%, p<0.001) and the size was less than 5 mm in 78.3% of cases. SP were significantly associated with adenomas (p< 0.001). The presence of at least one SSA but not TSA was associated with malignant polyp (p< 0.001) and colorectal cancer (p< 0.010). The prevalence of SA was significantly higher in the FOBT + group compared to symptomatic consecutive patients (11.8% vs 5.4%, p< 0.0001).

Conclusion:

In our series SP prevalence was higher than previously described, particularly in the asymptomatic screening subgroup with FOBT + (11.8%) and associated with adenomas. SSA were flat, small (< 5mm) and significantly associated with malignant polyp burden and CRC. Because of their potential for malignant transformation, SSA should be identify and completely remove.

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