title: Reducing the polyp burden in serrated polyposis by serial colonoscopy: the impact of nationally coordinated community surveillance.
abstract: Serrated polyposis syndrome (SPS) is associated with an increased risk of colorectal cancer (CRC) and an evolving management approach. The aims of this study were to assess the polyp burden reduction over time, and the incidence of CRC in serrated polyposis patients undergoing community surveillance.
  
  
  
  This is an observational study based on prospectively collected data. A total of 96 SPS patients with no personal history of CRC were prospectively enrolled in a surveillance program under the guidance of a tertiary center. Patients underwent surveillance colonoscopy in multiple centres across New Zealand.
  
  
  
  Patients underwent a median of four colonoscopies with a median interval of 15 months over a median follow-up period of 4.8 years. Five of 96 patients (5%) were referred for surgery, and the remaining 91 were managed by colonoscopy alone. In patients referred for surgery, 92% of the surveillance intervals to the fourth colonoscopy had been ≤12 months compared to 33% (P<0.001) in the colonoscopy only group, and all five (100%) had ≥20 pancolonic polyps after four procedures compared with only 5/91 (5%) in those managed by colonoscopy alone. In patients successfully managed by colonoscopy, 86% had <10 pancolonic polyps, >75% no longer had polyps ≥10mm and >90% no longer had proximal serrated polyps ≥10mm after the fourth colonoscopy. No patients were found to develop CRC during the study time period.
  
  
  
  Patients with SPS were managed by proactive surveillance colonoscopy in wider hospital settings under tertiary centre guidance, with only 5% requiring surgical management. No CRC was diagnosed in any patient during surveillance.
authors.affiliation: New Zealand Familial Gastrointestinal Cancer Service, Auckland City Hospital, Auckland.
authors.forename: Susan
authors.initials: S
authors.lastname: Parry
authors.affiliation: Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors.forename: Randall W
authors.initials: RW
authors.lastname: Burt
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
authors.forename: Aung Ko
authors.initials: AK
authors.lastname: Win
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
authors.forename: Ye Kyaw
authors.initials: YK
authors.lastname: Aung
authors.affiliation: New Zealand Familial Gastrointestinal Cancer Service, Auckland City Hospital, Auckland.
authors.forename: Sonja
authors.initials: S
authors.lastname: Woodall
authors.affiliation: New Zealand Familial Gastrointestinal Cancer Service, Auckland City Hospital, Auckland.
authors.forename: Julie
authors.initials: J
authors.lastname: Arnold
authors.affiliation: Colorectal Oncogenomics Group, Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Clendenning
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia, Colorectal Oncogenomics Group, Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Australia.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Buchanan
authors.affiliation: Department of Haematology and Oncology, The Queen Elizabeth Hospital, Australia, School of Medicine, University of Adelaide, Australia.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Price
authors.affiliation: Molecular and Cellular Pathology, University of Queensland, Brisbane, Australia, Department of Pathology, University of Melbourne, Melbourne, Australia, Envoi Pathology, Brisbane, Australia.
authors.forename: Christophe
authors.initials: C
authors.lastname: Rosty
authors.affiliation: Department of Haematology and Oncology, The Queen Elizabeth Hospital, Australia, School of Medicine, University of Adelaide, Australia, SAHMRI Colorectal Node, Basil Hetzel Institute for Translational Research, Australia.
authors.forename: Joanne P
authors.initials: JP
authors.lastname: Young
mesh_terms: D000328:Adult; D003111:Colonic Polyps / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D012307:Risk Factors; D013997:Time Factors