Akromegali Hastalarında Kolonoskopi Bulguları ve Kolon Polipi Sıklığı

Amaç: Akromegali hastalarında kolon polipi prevelansı artmıştır. Kolon poliplerinin malign potansiyele sahip olabilmeleri ve saptanan poliplerin eksizyonunun kolon kanseri insidansını azaltması nedeni ile akromegali hastalarında kolonoskopi taramalarının hasta izleminin bir parçası olması önerilmektedir. Çalışmada akromegali hastalarında kolon patolojilerini ve kolon polipi sıklığını ve ilişkili oldukları faktörleri araştırmayı amaçladık. Gereç ve Yöntemler: Total kolonoskopileri yapılmış 70 akromegali hastasının kayıtları retrospektif olarak incelendi. Kolonoskopi raporları incelenerek saptanan divertikül ve polip gibi patolojik bulgular, poliplerin yerleşim yerleri ve patoloji sonuçları incelendi. Kolon polipi olan ve olmayan hastaların verileri karşılaştırıldı.Bulgular: Hastaların medyan yaşları 49 yıldı ve 42’si %60 kadındı. Hastaların %62,8’inde n=44 kolonoskopi sonuçları normal olarak raporlanmıştı. Hastaların %21,4’ünde n=15 toplam 20 adet polip, %10’unda n=7 divertikül saptandı. Polipler en sık transvers kolonda %35, n=7 ve ikinci sıklıkta rektumda %25, n=5 lokalizeydi. Saptanan poliplerin %50’si n=10 hiperplastik polip, %45’i n=9 adenomatöz polip ve %5’i n=1 lipom idi. İki kez kolonoskopi yapılan hastaların n=32 %18,5’inde n=6 ikinci kolonoskopilerinde polip saptanmıştır. Sonuç: Çalışmamız akromegali hastalarında yeni kolon polipi saptama ihtimalinin az olmadığını ve ilk kolonoskopi sonrası aktif kolonoskopi takiplerinin devamının uygun olduğunu göstermiştir

Anahtar Kelimeler:

Akromegali, Kolonoskopi, Kolon polipi, Kolon divertikülü

Colonoscopy Findings and Colon Polyp Frequency in Patients with Acromegaly

Objective: The prevalence of colon polyps is increased in acromegaly patients. Colon polyps may have malignant potential and excision reduces the colon cancer incidence. Screening with colonoscopy should therefore be included in the follow-up in acromegaly. In this study, we investigated colon pathologies, the frequency of colon polyps and related factors in acromegaly patients.Material and Methods: The retrospective records of 70 acromegaly patients who underwent colonoscopy were reviewed. Colonoscopy reports were examined and findings such as diverticulosis and polyps, polyp location and pathology results were evaluated. The data of the patients with and without colon polyps were compared.Results: The median age of the patients was 49 years and 42 60% were female. Colonoscopy results were normal in 62.8% n=44 . A total of 20 polyps were detected in 21.4% n=15 and diverticulosis was found in 10% n=7 . Polyps were most commonly localized in the transverse colon 35%, n = 7 and secondly in the rectum 25%, n=5 . Of these polyps, 50% n=10 were hyperplastic, 45% n=9 were adenomatous and 5% n=1 were lipomas. Polyps were detected during the second colonoscopy n=32 in 18.5% n=6 of the patients. Conclusion: Our study showed that the probability of detecting new colon polyps in acromegaly patients is not low and that repeated colonoscopic follow-up is appropriate

Keywords:

Acromegaly, Colonoscopy, Colon polyps, Colon diverticulum,

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1. Melmed S. Medical progress: Acromegaly. N Engl J Med 2006; 355:2558-73.
2. Rokkas T, Pistiolas D, Sechopoulos P, Margantinis G, Koukoulis G. Risk of colorectal neoplasm in patients with acromegaly: A meta-analysis. World J Gastroenterol 2008; 14:3484-89.
3. Baldys-Waligorska A, Krzentowska A, Golkowski F, Sokolowski G, Hubalewska-Dydejczyk A. The prevalence of benign and malignant neoplasms in acromegalic patients. Endokrynol Pol 2010; 61:29-34.
4. Atkin WS, Morson BC, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med 1992; 326:658-62.
5. Katznelson L, Laws ER, Jr., Melmed S, Molitch ME, Murad MH, Utz A, Wass JA, Endocrine S. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2014; 99:3933-51.
6. Mechanick JI, Bergman DA, Braithwaite SS, Palumbo PJ, American Association of Clinical Endocrinologists Ad Hoc Task Force for Standardized Production of Clinical Practice G. American Association of Clinical Endocrinologists protocol for standardized production of clinical practice guidelines. Endocr Pract 2004; 10:353- 61.
7. Giustina A, Chanson P, Bronstein MD, Klibanski A, Lamberts S, Casanueva FF, Trainer P, Ghigo E, Ho K, Melmed S, Acromegaly Consensus G. A consensus on criteria for cure of acromegaly. J Clin Endocrinol Metab 2010; 95:3141-8.
8. Delhougne B, Deneux C, Abs R, Chanson P, Fierens H, Laurent-Puig P, Duysburgh I, Stevenaert A, Tabarin A, Delwaide J, Schaison G, Belaiche J, Beckers A. The prevalence of colonic polyps in acromegaly: A colonoscopic and pathological study in 103 patients. J Clin Endocrinol Metab 1995; 80:3223-6.
9. Koksal AR, Ergun M, Boga S, Alkim H, Bayram M, Altuntas Y, Ozguven Yilmaz B, Alkim C. Increased prevalence of colorectal polyp in acromegaly patients: A case-control study. Diagn Ther Endosc 2014; 2014:152049.
10. Petrossians P, Daly AF, Natchev E, Maione L, Blijdorp K, Sahnoun-Fathallah M, Auriemma R, Diallo AM, Hulting AL, Ferone D, Hana V, Jr., Filipponi S, Sievers C, Nogueira C, Fajardo-Montanana C, Carvalho D, Hana V, Stalla GK, Jaffrain-Rea ML, Delemer B, Colao A, Brue T, Neggers S, Zacharieva S, Chanson P, Beckers A. Acromegaly at diagnosis in 3173 patients from the Liege Acromegaly Survey (LAS) Database. Endocr Relat Cancer 2017; 24:505-18.
11. Gonzalez B, Vargas G, Mendoza V, Nava M, Rojas M, Mercado M. The prevalence of colonic polyps in patients with acromegaly: A case-control, nested in a cohort colonoscopic study. Endocr Pract 2017; 23:594-9.
12. Iliaz R, Dogansen SC, Tanrikulu S, Yalin GY, Cavus B, Gulluoglu M, Akyuz F, Yarman S. Predictors of colonic pathologies in active acromegaly: Single tertiary center experience. Wien Klin Wochenschr 2018; 130:511-6.
13. Bogazzi F, Cosci C, Sardella C, Costa A, Manetti L, Gasperi M, Rossi G, Bartalena L, Martino E. Identification of acromegalic patients at risk of developing colonic adenomas. J Clin Endocrinol Metab 2006; 91:1351-6.