Reappraisal of colorectal polyps in acromegaly: study on prevalence, recurrence and risk factors.

OBJECTIVE

Investigation of colorectal polyps’ prevalence and recurrence risk factors in acromegaly.

DESIGN

Retrospective study.

METHODS

171 patients referring to “Federico II” University diagnosed with acromegaly from 2000 to 2022 who underwent at least one colonoscopy.

RESULTS

Colonoscopy was performed at diagnosis in 120 (70.2%) and after a disease duration of 10.2 ± 5.7 years in 51 patients (29.8%). Polyps were found in 37.5% and 37.2%, respectively (p = 0.975). At diagnosis, polyps were found more frequently in older (p = 0.003), diabetic (p = 0.01) patients, with higher number of systemic complications (p < 0.001). Prevalence of polyps at diagnosis was significantly higher in patients with presumed disease onset greater than 6 years (median, p = 0.04). In patients who underwent colonoscopy after the diagnosis, age at diagnosis (p = 0.005), fasting glucose (p < 0.001), HbA1c (p < 0.001), HOMAIR (p = 0.009), and number of systemic complications (p = 0.004) were significantly higher in patients with than those without polyps. Forty-nine patients (34.2%) underwent multiple evaluations with 10-years median of colonoscopy follow-up. Recurrence was present in 38.2% at last evaluation, particularly in patients with uncontrolled acromegaly (p = 0.003), glucose metabolism impairment (p = 0.031), metabolic syndrome (MS, p = 0.004). New onset of polyps at last evaluation was found in 24.2% of patients with first negative colonoscopy, particularly in men (p = 0.006), with uncontrolled acromegaly (p = 0.007), and MS (p = 0.002). Patients with uncontrolled acromegaly had a risk 9.6- and 11.5- fold higher of polyps’ recurrence and new onset, respectively. Overall, six patients (3.5%) had colon cancer.

CONCLUSIONS

Polyps’ recurrence and new onset are more frequent in patients with uncontrolled acromegaly, glucose metabolism impairment, and MS. Colonoscopy follow-up should be tailored, colonoscopy should be performed at diagnosis and periodically thereafter depending on acromegaly and metabolic control.