SNFGE SNFGE
 
Thématique :
- Colo-proctologie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Frédéric CORDET
Coup de coeur :
 
 
The American Journal of Gastroenterology
  2018/12  
 
  2018 Dec;113(12):1828-1835.  
  doi: 10.1038/s41395-018-0393-0.  
 
  Smoking and Other Risk Factors in Individuals With Synchronous Conventional High-Risk Adenomas and Clinically Significant Serrated Polyps  
 
  Anderson JC, Calderwood AH, Christensen BC, Robinson CM, Amos CI, Butterly L  
  https://www.ncbi.nlm.nih.gov/pubmed/30385834  
 
 

Abstract

BACKGROUND AND AIMS:

Serrated polyps (SPs) and conventional high-risk adenomas (HRAs) derive from two distinct biological pathways but can also occur synchronously. Adults with synchronous SPs and adenomas have been shown to be a high-risk group and may have a unique risk factor profile that differs from adults with conventional HRAs alone. We used the population-based New Hampshire Colonoscopy Registry (NHCR) to examine the risk profile of individuals with synchronous conventional HRAs and SPs.

METHODS:

Our study population included 20,281 first time screening colonoscopies from asymptomatic NHCR participants 40 years or older between 2004-15. Exams were categorized by findings: (1) normal, (2) HRA only (adenomas ≥ 1 cm, villous, high grade dysplasia, multiple adenomas ( > 2) and adenocarcinoma), (3) clinically significant SP (CSSP) only (any hyperplastic polyp ≥ 1 cm, sessile serrated adenomas/polyps or traditional serrated adenomas), and (4) synchronous HRA + CSSP. Risk factors examined included exposure of interest, smoking (never, past, and current/pack years), as well as age, sex, alcohol, education, and family history of colorectal cancer (CRC). Multivariable unconditional logistic regression tested the relation of risk factors with having synchronous HRA + CSSP versus having a normal exam or HRA alone.

RESULTS:

Among NHCR participants with 18,354 screening colonoscopies (with complete smoking, sex, bowel preparation data, and adequate preparation) there were 16,495 normal; 1309 HRA alone; 461 CSSP alone, and 89 synchronous HRA + CSSP. Current smoking was associated with an almost threefold increased risk for HRA or CSSP, and an eightfold risk for synchronous HRA + CSSP (aOR = 8.66; 95% CI: 4.73-15.86) compared to normal exams. Adults with synchronous HRA + CSSP were threefold more likely to be current smokers than those with HRA alone (aOR = 3.27; 95% CI:1.74-6.16).

CONCLUSIONS:

Our data suggest that current smokers may be at a higher risk for synchronous CSSP + HRA even when compared to having HRA alone.

 

 
Question posée
 
Le tabac comme facteur de risque de l’association de polypes festonnées et adénomateux à haut risque.
 
Question posée
 
Etude portant sur 20281 coloscopies de dépistage réalisées sur 10 ans dans le New Hampshire, parmi lesquelles 89 patients étaient porteurs d’adénomes à haut risque et de polypes festonnées de façon synchrone. Le tabac ressort de façon significative comme facteur de risque de cette association en comparaison à des porteurs d’adénomes seuls. Une surveillance rapprochée pourrait être proposée chez les patients fumeurs qui semblent donc plus à risque de lésions synchrones adénomateuses et festonnées et donc de CCR. A noter aussi dans cette étude une confirmation du sur-risque lié à un BMI élevé de développer des adénomes à haut-risque et des polypes festonnés, seuls ou synchrones.
 
Commentaires

Etude intéressante vu le nombre important de coloscopies étudiées, qui pose la question d’adapter la surveillance par coloscopies des patients fumeurs (et en surpoids…).

 
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