SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Réexamen
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Gut
  2017/07  
 
  2017 Jul;66(7):1181-1196.  
  doi: 10.1136/gutjnl-2017-314005.  
 
  British Society of Gastroenterology position statement on serrated polyps in the colon and rectum  
 
  East JE, Atkin WS, Bateman AC, Clark SK, Dolwani S, Ket SN, Leedham SJ, Phull PS, Rutter MD, Shepherd NA, Tomlinson I, Rees CJ  
  https://www.ncbi.nlm.nih.gov/pubmed/28450390  
 
 

Abstract

Serrated polyps have been recognised in the last decade as important premalignant lesions accounting for between 15% and 30% of colorectal cancers. There is therefore a clinical need for guidance on how to manage these lesions; however, the evidence base is limited. A working group was commission by the British Society of Gastroenterology (BSG) Endoscopy section to review the available evidence and develop a position statement to provide clinical guidance until the evidence becomes available to support a formal guideline. The scope of the position statement was wide-ranging and included: evidence that serrated lesions have premalignant potential; detection and resection of serrated lesions; surveillance strategies after detection of serrated lesions; special situations-serrated polyposis syndrome (including surgery) and serrated lesions in colitis; education, audit and benchmarks and research questions. Statements on these issues were proposed where the evidence was deemed sufficient, and re-evaluated modified via a Delphi process until >80% agreement was reached. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool was used to assess the strength of evidence and strength of recommendation for finalised statements. Key recommendation: we suggest that until further evidence on the efficacy or otherwise of surveillance are published, patients with sessile serrated lesions (SSLs) that appear associated with a higher risk of future neoplasia or colorectal cancer (SSLs ≥10 mm or serrated lesions harbouring dysplasia including traditional serrated adenomas) should be offered a one-off colonoscopic surveillance examination at 3 years (weak recommendation, low quality evidence, 90% agreement).

 

 
Question posée
 
Faut-il surveiller (et comment) les lésions festonnées sessiles du colon et du rectum ?
 
Question posée
 
15 recommandations sont émises dans ce papier. L’une des recommandations les plus importantes est de proposer la réalisation d’une coloscopie de contrôle à 3 ans pour les lésions festonnées sessiles de plus de 10mm ou avec présence de dysplasie.
 
Commentaires

Il s’agit des recommandations émanant de la British Society of Gastroenterology qui a repris, avec une méthodologie assez solide, les études majeures publiées sur ces lésions. Le niveau de preuve reste cependant relativement faible, ce qui nécessitera d’évaluer l’impact de ces recommandations au travers d’études prospectives.

 
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