title: Incidence of colonic neoplasia in patients with serrated polyposis syndrome who undergo annual endoscopic surveillance.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Yark
authors.initials: Y
authors.lastname: Hazewinkel
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Kristien M A J
authors.initials: KM
authors.lastname: Tytgat
authors.affiliation: Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Susanne
authors.initials: S
authors.lastname: van Eeden
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bastiaansen
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Tanis
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Karam S
authors.initials: KS
authors.lastname: Boparai
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Fockens
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: e.dekker@amc.nl.
authors.forename: Evelien
authors.initials: E
authors.lastname: Dekker
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D005260:Female; D006268:Health Facilities; D006801:Humans; D008297:Male; D011127:Polyps / Q000175:diagnosis*
keywords: Cancer Prevention; Colon Cancer; Screening; Serrated Neoplasia Pathway