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.