SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Gastroenterology
  2016/01  
 
  2016 Apr;150(4):895-902.e5  
  doi: 10.1053/j.gastro.2015.11.046. Epub 2015 Dec 8.  
 
  Increased Risk of Colorectal Cancer Development Among Patients With Serrated Polyps.  
 
  Erichsen R, Baron JA, Hamilton-Dutoit SJ, Snover DC, Torlakovic EE, Pedersen L, Frøslev T, Vyberg M, Hamilton SR, Sørensen HT  
  http://www.ncbi.nlm.nih.gov/pubmed/26677986  
 
 

BACKGROUND & AIMS:

Sessile serrated adenomas/polyps (SSA/Ps) and traditional serrated adenomas (TSAs) are now distinguished from hyperplastic polyps and recognized as precursors to colorectal cancer (CRC). We studied CRC risks associated with serrated polyps.

METHODS:

By using Danish databases (1977-2009), we conducted a nationwide population-based, case-control study nested within individuals who had received colonoscopies (n = 272,342), and identified 2045 CRC cases and 8105 CRC-free individuals (controls). For each case and control, we identified the first colorectal polyp(s) that underwent a biopsy or were excised during or after the initial colonoscopy, and obtained tissue blocks for hyperplastic lesions. Four expert pathologists reviewed these lesions using current terminology for serrated polyps. We used logistic regression to compute odds ratios (ORs) to associate the risk of CRC with polyp type and estimated the absolute risks by multiplying the risk in patients with no polyps by these ORs.

RESULTS:

Seventy-nine cases and 142 controls had SSA/Ps (OR, 3.07; 95% confidence interval [CI], 2.30-4.10). SSA/Ps with cytology markers of dysplasia were associated with a particularly high OR (4.76; 95% CI, 2.59-8.73). Women with SSA/P had a higher risk for CRC than men with SSA/P (OR for women, 5.05; 95% CI, 3.05-8.37 vs OR for men, 2.18; 95% CI, 1.24-3.82); patients with SSA/P proximal to the splenic flexure had the highest risk for CRC (OR, 12.42; 95% CI, 4.88-31.58). The OR for CRC was 4.84 in the 14 cases vs 17 controls with TSAs (95% CI, 2.36-9.93), 2.51 in the 757 cases vs 1698 controls with conventional adenomas (95% CI, 2.25-2.80), and 1.30 in the 55 cases vs 235 controls with hyperplastic polyps (95% CI, 0.96-1.77). The 10-year risk for CRC was 4.4% for patients with SSA/P with dysplasia, 4.5% for patients with TSAs, and 2.3% for patients with conventional adenomas.

CONCLUSION:

Patients with SSA/P or TSA are at increased risk for CRC; their level of risk is similar to or higher than that of patients with conventional adenomas.

 
Question posée
 
Les polypes festonnés sessiles (=sessile serrated adenomas/polyps ou SSA/Ps) et les adénomes festonnés traditionnels (=traditional serrated adenomas ou TSAs) risquent de dégénerer mais la valeur exacte de ce risque est mal connue.
 
Question posée
 
Cette étude nationale danoise montre que le risque de cancer colorectal à 10 ans est 2 fois supérieur pour les polypes festonnés sessiles et pour les adénomes festonnés traditionnels par rapport aux adénomes conventionnels (4,5% vs 2,3%).
 
Commentaires

Le risque élevé de cancer colorectal chez les patients ayant des polypes festonnés impose aux gastroentérologues de bien se familiariser avec la sémiologie endoscopique de ces lésions parfois très difficile à mettre en évidence au cours de la coloscopie.

 
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