Ali Aamar, MD, Khalil Aloreidi, MD, Evangelos Tsipotis, MD, Madhavi Reddy, MD, FACG
The Brooklyn Hospital Center, Brooklyn, NY
Introduction: Hyperplasic polyposis syndrome is characterized by multiple serrated polyps in the colon. It is also known Serrated Polyposis Syndrome (SPS). Serrated polyps can be divided into hyperplastic polyps, sessile serrated polyps and traditional serrated adenomas. It is associated with up to 50 % lifetime risk of colorectal cancer. Serrated polyps can be difficult to diagnose due to their flat and sessile nature making it hard to be visualized by the endoscopist. We report a case of a young Caucasian female who presented with hematochezia and she was found to have SPS.
Case Description/Methods: A 29-year-old female presented to the clinic with hematochezia. She did not have any family history of colon cancer in her first-degree relatives. She underwent a diagnostic colonoscopy and multiple polyps were seen. A 1.5 cm flat polyp (Image 1) was seen in the ascending colon that was removed with endoscopic mucosal resection (EMR). Biopsy suggested hyperplastic polyp. A 3.5 cm flat polyp (hyperplastic) was seen in the ascending colon (Image 2) that was removed with EMR and 5 clips were placed to prevent delayed bleeding. A 5 mm flat polyp was seen in the transverse colon and a 1 cm polyp was seen in the descending colon. Patient was rescheduled for colonoscopy in 3 months to remove these polyps. On repeat colonoscopy, a 1 cm polyp (hyperplastic) was seen in the ascending colon at previous EMR site. Repeat EMR was performed to remove the polyp. An 8 mm flat polyp (hyperplastic) was seen in the ascending colon that was removed with cold snare polypectomy. A 6 mm flat polyp (tubular adenoma) was seen at the hepatic flexure that was removed with snare cautery polypectomy. A 6 mm polyp (hyperplastic) was seen in sigmoid colon that was removed with cold biopsy polypectomy.
Discussion: Sessile polyposis syndrome (SPS) is defined as following: (1) At least 5 serrated lesions proximal to sigmoid colon with at least 2 polyps > 1cm in size; (2) One serrated polyp was family history of SPS; (3) > 20 serrated polyps in the entire colon. Based on current studies of SPS, some experts believe that patients should undergo regular endoscopic surveillance to prevent malignant progress of polyps removing only proximally located polyps, while others believe all polyps greater than 5 mm should be removed. First-degree relatives of patients with SPS should be screened starting at age 40 or 10 years earlier than age of presentation of SPS in the family member.
Citation: Ali Aamar, MD, Khalil Aloreidi, MD, Evangelos Tsipotis, MD, Madhavi Reddy, MD, FACG. P0155 - HEMATOCHEZIA IN A YOUNG FEMALE: AN EARLY SIGN OF SERRATED POLYPOSIS SYNDROME. Program No. P0155. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.