Controlling Oligopolyposis With Colonoscopy: A Cohort Study.

Abstract

Background: Oligopolyposis is defined as between 10 and 100 polyps in the large intestine. If these are adenomas, at least 15% of affected patients will have a syndrome of hereditary colorectal cancer predisposition. Management is aimed at preventing the development of cancer and options include chemoprevention, colectomy, and colonoscopy, with colectomy generally favored. The role of colonoscopy is relatively unexplored.

Objective: To present the results of colonoscopic control of patients with oligopolyposis.

Design: Retrospective study of a cohort of patients with oligopolyposis separated by genotype and histology.

Settings: Hereditary colorectal cancer center.

Patients: Those with oligopolyposis preferring management with sequential colonoscopy to colectomy, who underwent at least three years of follow-up.

Interventions: Colonoscopy and polypectomy, surgical resection.

Main outcome measures: number of colonoscopies, complications of colonoscopies, length of follow-up, number of polyps at first and last colonoscopy, size of the largest polyp at first and last colonoscopy, incidence and stage of cancer, and timing of the cancer diagnosis.

Results: There were 59 patients; 29 with sessile serrated polyposis, 13 with MUTYH-associated polyposis, 8 with attenuated FAP and 9 with oligopolyposis not otherwise specified. FAP patients were 20 years younger than the other groups. Patients averaged one colonoscopy per year for a mean follow-up between 5 and 11 years. One patient suffered a post polypectomy hemorrhage, but there was no perforation, and no admission. No patient needed surgery to control benign polyposis. Nine patients had cancer, 6 diagnosed and resected prior to the start of the colonoscopic surveillance. Three patients with sessile serrated polyposis developed interval cancers while on surveillance, all stage 1. These were the only patients to need colectomy.

Limitations: Relatively low numbers of FAP and oligopolyposis patients. Lack of specific data on variants.

Conclusions: In compliant patients and experienced hands, endoscopic control of oligopolyposis can be safe and effective. See Video.