SFEBES2009 Poster Presentations Pituitary (56 abstracts)
Fifteen years experience of repeated colonoscopic screening of patients with acromegaly shows a high incidence of new colonic neoplasia and allows for effective screening guidelines
D Dworakowska 1 , M Gueorguiev 1 , P Kelly 1 , AB Grossman 1 , JP Monson 1 , GM Besser 1 , SL Chew 1 , S Akker 2 , WM Drake 2 , PD Fairclough 3 & PJ Jenkins 1
1Department of Endocrinology, Barts and The London School of Medicine, London, UK; 2Department of Endocrinology, Barts and The London NHS Trust, London, UK; 3Department of Gastroenterology, Barts and The London NHS Trust, London, UK.
Introduction: Patients with acromegaly have an increased risk of colorectal cancer and pre-malignant adenomatous polyps; however the frequency of colonoscopic screening remains unclear.
Aims: To determine optimum frequency for repeated colonoscopy of acromegalic patients.
Methods: Since 1992, 254 patients (mean age 56.6 years) at our centre have undergone at least one fibre-optic colonoscopic surveillance; 156, 60 and 15 patients have undergone a 2nd, 3rd and 4th colonoscopy, at a mean interval of 4.4, 4.9 and 3.3 years, respectively.
Results: At the 2nd, 3rd and 4th colonoscopy, hyperplastic or adenomatous polyps were recorded in: 2nd – 31 (20%) and 24 (15%) of patients respectively; 3rd – 14 (23%) and 8 (14%); 4th – 3 (20%) and 4 (27%). At the 3rd screen, mean (±S.D.) serum IGF-1 levels (ng/ml) in patients with hyperplastic polyps were 303±121 vs normal colons 212±119 (P<0.05) or adenomas 266±147 (P=ns). The presence of an adenoma or hyperplastic polyp rather than normal colon at the 1st colonoscopy was associated with an increased risk of adenoma or hyperplastic polyp at the 2nd (OR 3.5 and 3.4 respectively, P<0.005) and 3rd (OR 6 and 2.2; P<0.03) surveillance. A polyp at the 2nd screen was associated with increased risk of polyp at the 3rd screen (OR 2.9; P<0.005). Conversely, a normal colon at the 1st screen gave a high chance of normal findings at the 2nd (78%) or 3rd screen (78%), and normal colon at the 2nd was associated with normality at the 3rd screen (81%).
Conclusions: Colonoscopic surveillance of patients with acromegaly shows a high incidence of adenomatous and hyperplastic colonic polyps. Their development appears to be influenced by previous neoplasia and elevated IGF-I levels. It seems appropriate to offer colonoscopy every 5 years in patients with previous adenoma or high IGF-I levels and every 10 years in other patients.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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