Endoscopic scoring indices for assessing disease severity in familial adenomatous polyposis: Systematic review

Anna Lerman Silverman; Hicham Bouchiba; Arthur Aelvoet; John MacDonald; Evelien Dekker; Alexa Zayadi; Jessica Le; Brian Feagan; Vipul Jairath; Christopher Ma; Jewel Samadder

doi:10.1055/a-2330-8037

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(06): E799-E809
DOI: 10.1055/a-2330-8037

Review

Endoscopic scoring indices for assessing disease severity in familial adenomatous polyposis: Systematic review

Authors

Anna Lerman Silverman

¹Gastroenterology and Hepatology, Mayo Clinic Scottsdale, Scottsdale, United States (Ringgold ID: RIN384840)
Hicham Bouchiba

²Department of Gastroenterology and Hepatology, Cancer Center, University of Amsterdam, Amsterdam, Netherlands
Arthur Aelvoet

²Department of Gastroenterology and Hepatology, Cancer Center, University of Amsterdam, Amsterdam, Netherlands
John MacDonald

³Alimentiv, Alimentiv Inc, London, Canada (Ringgold ID: RIN590969)
Evelien Dekker

⁴Gastroenterology & Hepatology, Academic Medical Center, Amsterdam, Netherlands
Alexa Zayadi

³Alimentiv, Alimentiv Inc, London, Canada (Ringgold ID: RIN590969)
Jessica Le

³Alimentiv, Alimentiv Inc, London, Canada (Ringgold ID: RIN590969)
Brian Feagan

³Alimentiv, Alimentiv Inc, London, Canada (Ringgold ID: RIN590969)

⁵Division of Gastroenterology and Department of Epidemiology and Biostatistics, Western University, London, Canada (Ringgold ID: RIN6221)
Vipul Jairath

³Alimentiv, Alimentiv Inc, London, Canada (Ringgold ID: RIN590969)

⁵Division of Gastroenterology and Department of Epidemiology and Biostatistics, Western University, London, Canada (Ringgold ID: RIN6221)
Christopher Ma

³Alimentiv, Alimentiv Inc, London, Canada (Ringgold ID: RIN590969)

⁶Division of Gastroenterology & Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada (Ringgold ID: RIN70401)
Jewel Samadder

¹Gastroenterology and Hepatology, Mayo Clinic Scottsdale, Scottsdale, United States (Ringgold ID: RIN384840)

Abstract

Background and study aims There is limited consensus on the optimal method for measuring disease severity in familial adenomatous polyposis (FAP). We aimed to systematically review the operating properties of existing endoscopic severity indices for FAP.

Methods We searched MEDLINE, EMBASE, and the Cochrane Library from inception to February 2023 to identify randomized controlled trials (RCTs) that utilized endoscopic outcomes or studies that evaluated the operating properties of endoscopic disease severity indices in FAP.

Results A total of 134 studies were included. We evaluated scoring indices and component items of scoring indices, such as polyp count, polyp size, and histology. Partial validation was observed for polyp count and size. The most commonly reported scoring index was the Spigelman classification system, which was used for assessing the severity of duodenal involvement. A single study reported almost perfect interobserver and intra-observer agreement for this system. The InSIGHT polyposis staging system, which was used for assessing colorectal polyp burden, has been partially validated. It showed substantial interobserver reliability; however, the intra-observer reliability was not assessed. Novel criteria for high-risk gastric polyps have been developed and assessed for interobserver reliability. However, these criteria showed a poor level of agreement. Other scoring indices assessing the anal transition zone, duodenal, and colorectal polyps have not undergone validation.

Conclusions There are no fully validated endoscopic disease severity indices for FAP. Development and validation of a reliable and responsive endoscopic disease severity instrument will be informative for clinical care and RCTs of pharmacological therapies for FAP.

Keywords

Endoscopy Upper GI Tract - Precancerous conditions & cancerous lesions (displasia and cancer) stomach - Endoscopy Lower GI Tract - Polyps / adenomas / ... - Colorectal cancer - Endoscopy Small Bowel - Neoplasia

Full Text

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