Surveillance Guidelines Should Be Updated to Recognize the Importance of Serrated Polyps

University of California, San Francisco, San Francisco, California
Gastroenterology (Impact Factor: 13.93). 09/2010; 139(5):1444-7. DOI: 10.1053/j.gastro.2010.09.024
Source: PubMed
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    ABSTRACT: Introduction In recent years we assisted to a real “boom” of colorectal polyps, mainly due to the diffusion of screening procedures and of colonoscopy. This new “Polyp Epidemic” raises a series of problems and challenges. It became clear that many syndromes are defined by the number, histological type and location of polyps, together with extraintestinal manifestations and, in most cases, specific molecular changes. This paper discusses some of the above mentioned points, focusing on the relative role of endoscopists and pathologists. The objective is to reach an operative classification of the most common polyps observed in daily practice which might be of help for the identification of inherited syndromes. Methods and results Six main histological types of polyps are defined and underlined: Adenoma, hyperplastic/serrated, hamartoma, ganglioneuroma, mixed, inflammatory. The importance of a brief description, in pathology reports, of each type of polyps is fundamental for a correct diagnosis. Each of the defined polyps is associated with inherited syndromes whose genetic basis has recently been elucidated. Relevant information should be given, and separated from additional (and not strictly necessary) information. Recommendations A correct polyp analysis is a valuable element for identifying specific inherited syndromes. Polyps represent a precious tool for planning screening and follow-up in a given individual. In addition, these lesions focus the interest of clinicians toward syndrome which were considered as rare diseases; indeed, the explosion of molecular biology and the diffusion of colonoscopy revealed that these conditions are frequent and amenable of treatment.
    Pathology - Research and Practice 10/2014; 210(10). DOI:10.1016/j.prp.2014.06.004 · 1.56 Impact Factor
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    ABSTRACT: The following recommendations for post-polypectomy endoscopic surveillance should be applied only after a high quality baseline colonoscopy with complete removal of all detected neoplastic lesions.1 In the low risk group (patients with 1 - 2 tubular adenomas < 10 mm with low grade dysplasia), the ESGE recommends participation in existing national screening programmes 10 years after the index colonoscopy. If no screening programme is available, repetition of colonoscopy 10 years after the index colonoscopy is recommended (strong recommendation, moderate quality evidence). 2 In the high risk group (patients with adenomas with villous histology or high grade dysplasia or ≥10 mm in size, or ≥ 3 adenomas), the ESGE recommends surveillance colonoscopy 3 years after the index colonoscopy (strong recommendation, moderate quality evidence). Patients with 10 or more adenomas should be referred for genetic counselling (strong recommendation, moderate quality evidence). 3 In the high risk group, if no high risk adenomas are detected at the first surveillance examination, the ESGE suggests a 5-year interval before a second surveillance colonoscopy (weak recommendation, low quality evidence). If high risk adenomas are detected at first or subsequent surveillance examinations, a 3-year repetition of surveillance colonoscopy is recommended (strong recommendation, low quality evidence).4 The ESGE recommends that patients with serrated polyps < 10 mm in size with no dysplasia should be classified as low risk (weak recommendation, low quality evidence). The ESGE suggests that patients with large serrated polyps (≥ 10 mm) or those with dysplasia should be classified as high risk (weak recommendation, low quality evidence).5 The ESGE recommends that the endoscopist is responsible for providing a written recommendation for the post-polypectomy surveillance schedule (strong recommendation, low quality evidence).
    Endoscopy 10/2013; 45(10):842-51. DOI:10.1055/s-0033-1344548 · 5.20 Impact Factor
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    ABSTRACT: Narrow band imaging (NBI) endoscopy is an optical image enhancing technology that allows a detailed inspection of vascular and mucosal patterns, providing the ability to predict histology during real-time endoscopy. By combining NBI with magnification endoscopy (NBI-ME), the accurate assessment of lesions in the gastrointestinal tract can be achieved, as well as the early detection of neoplasia by emphasizing neovascularization. Promising results of the method in the diagnosis of premalignant and malignant lesions of gastrointestinal tract have been reported in clinical studies. The usefulness of NBI-ME as an adjunct to endoscopic therapy in clinical practice, the potential to improve diagnostic accuracy, surveillance strategies and cost-saving strategies based on this method are summarized in this review. Various classification systems of mucosal and vascular patterns used to differentiate preneoplastic and neoplastic lesions have been reviewed. We concluded that the clinical applicability of NBI-ME has increased, but standardization of endoscopic criteria and classification systems, validation in randomized multicenter trials and training programs to improve the diagnostic performance are all needed before the widespread acceptance of the method in routine practice. However, published data regarding the usefulness of NBI endoscopy are relevant in order to recommend the method as a reliable tool in diagnostic and therapy, even for less experienced endoscopists.