Endoscopic and clinical evaluation of treatment and prognosis of Cronkhite–Canada syndrome: a Japanese nationwide survey

• Published in: Journal of gastroenterology 2016-04, Vol.51 (4), p.327-336
• Main Authors: Watanabe, Chikako, Komoto, Shunsuke, Tomita, Kengo, Hokari, Ryota, Tanaka, Masanori, Hirata, Ichiro, Hibi, Toshifumi, Kaunitz, Jonathan D., Miura, Soichiro
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Administration, Oral; Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - therapeutic use; Adult; Aged; Aged, 80 and over; Cancer; Colorectal Surgery; Corticosteroids; Endoscopy, Gastrointestinal - methods; Female; Gastroenterology; Gastrointestinal system; Health aspects; Hepatology; Hospitals; Humans; Intestinal Mucosa - pathology; Intestinal Polyposis - diagnosis; Intestinal Polyposis - pathology; Intestinal Polyposis - therapy; Japan; Male; Medical colleges; Medicine; Medicine & Public Health; Middle Aged; Nutritional Support - methods; Original Article—Alimentary Tract; Original —Alimentary Tract; Prevention; Prognosis; Recurrence; Remission Induction; Retrospective Studies; Surgical Oncology; Surveys; Surveys and Questionnaires; Time Factors
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-015-1107-7

Background First reported in 1955, Cronkhite–Canada syndrome (CCS), a rare syndrome characterized by ectodermal abnormalities and inflammatory changes of the gastrointestinal tract mucosa, has been associated with a poor prognosis and life-threatening malignant complications. In a large population survey, we endeavored to characterize the course and treatment outcome of CCS through clinical and endoscopic assessment, and to explore its optimal treatment and surveillance strategy. Methods A retrospective analysis of 210 patients with CCS was conducted via a questionnaire-based nationwide survey of 983 teaching hospitals located throughout Japan. We assessed clinical features, endoscopic findings, treatments used, and short- and long-term outcomes. Results The average age at diagnosis was 63.5 years. In all cases, upper or lower gastrointestinal tract polyposis was confirmed, accompanied by characteristic ectodermal abnormalities. Of the treatments used, oral corticosteroids (30–49 mg/day) were the most effective treatment for active disease, with adjunctive nutritional support considered beneficial. With corticosteroid treatment, abdominal symptoms were relieved within a few months, whereas polyp regression often required more than 6 months. Maintenance of endoscopic remission with or without steroids for 3 years significantly lowered the development of CCS-related cancer, compared with relapsers or nonresponders, underscoring the importance of sustained endoscopic remission for cancer prevention. Conclusions The prognosis of CCS has greatly improved through the use of improved medical treatment. Although CCS continues to be relentlessly progressive, carrying a high cancer risk, a sufficient dose and duration of corticosteroid therapy accompanied by nutritional support and periodic endoscopic surveillance appears to improve its natural history.