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Risk for Colorectal Adenomas Among Patients with Pancreatic Intraductal Papillary Mucinous Neoplasms: a Prospective Case-Control Study

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Nikola Panic1,2, Gabriele Capurso3, Fabia Attili1, Giovanna Vitale1, Serena Stigliano3, Gianfranco Delle Fave3, Emanuele Leoncini2, Milutin Bulajic1, Emilio Di Giulio3, Guido Costamagna1, Stefania Boccia2, Alberto Larghi1

1) Digestive Endoscopy Unit;
2) Institute of Public Health, Section of Hygiene, Catholic University;
3) Digestive and Liver Disease Unit, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.244.rsk

Background & Aims: It has been reported that patients with intraductal papillary mucinous neoplasms of the pancreas are at an increased risk of colorectal cancer. The aim of our study was to investigate whether patients with intraductal papillary mucinous neoplasms are at a higher risk of colorectal adenomas with respect to the general population, as this condition represents the precursor of sporadic colorectal cancer.

Methods: A case–control study was conducted at the Catholic University and University Sapienza, Rome, Italy. The cases were patients with intraductal papillary mucinous neoplasms without history of colorectal cancer, who had underwent screening colonoscopy for the first time. The controls were individuals who had underwent first time colonoscopy for screening or evaluation of non-specific abdominal symptoms. Chi-square and Fisher tests were used to compare the distributions of categorical variables.

Results: We enrolled 122 cases and 246 controls. Colorectal polyps were found in 52 cases (42.6%) and 79 controls (32.1%) (p<0.05). In 29 cases (23.8%) and 57 controls (23.2%) histological examination disclosed adenomatous polyps (p=0.90). There was no difference between the groups in relation to the presence of polyps with low-grade (19.7% vs. 19.8%, p=0.98) and high-grade dysplasia (4.9% vs. 4.5%, p=0.85).

Conclusion: Patients with intraductal papillary mucinous neoplasms of the pancreas are not at an increased risk for the development of adenomatous colorectal polyps.

Key words: IPMN – colorectal cancer – colonoscopy – adenomatous polyps.

Abbreviations: BD-IPMN: branch duct intraductal papillary mucinous neoplasm; CRC: colorectal cancer; FAP: familiar adenomatous polyposis; FNA: fine needle aspiration; FOBT: fecal occult blood test; HNPCC: hereditary non-polyposis colorectal cancer; IPMN: intraductal papillary mucinous neoplasm; M-IPMN: mixed intraductal papillary mucinous neoplasm; MD-IPMNs: main duct intraductal papillary mucinous neoplasm; PDAC: pancreatic ductal adenocarcinoma; S-MRCP: magnetic resonance cholangiopancreatography with secretin stimulation.