Low detection rate of advanced neoplasia within 5 years after polypectomy of small serrated adenoma (original) (raw)
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American Journal of Gastroenterology, 2016
The risk of developing metachronous advanced neoplastic lesions (ANLs) during surveillance after resection of sessile serrated adenomas (SSAs) has not been quantifi ed. METHODS: Patients with sporadic SSAs resected between 1 April 2007 and 31 December 2009 who underwent surveillance colonoscopy in our institution were prospectively evaluated. Patients with low-risk adenomas (LRAs), high-risk adenomas (HRAs), and negative index colonoscopy (NIC) during the same period were identifi ed using the pathology database and electronic medical records, and were also included as a comparison cohort. The primary outcome was the comparison of the study groups with regard to incidence of metachronous ANLs during surveillance colonoscopy. RESULTS: A total of 185 patients had SSAs, of whom 75 with 101 resected polyps were fi nally included. The comparison cohort consisted of 564 patients: 140 LRAs (160 polyps), 87 HRAs (478 polyps), and 337 NICs. The overall mean colonoscopy follow-up was for 54.5 months (±s.d. 14). SSA patients with synchronous HRA on index colonoscopy presented a higher incidence rate of metachronous ANL (12.96 per 1,000 person-months) compared with patients with HRA (5.07 per 1,000 person-months), whereas those with synchronous LRA and without synchronous adenoma on index colonoscopy presented a low incidence rate of metachronous ANL (0 and 1.41 per 1,000 personmonths, respectively) similar to LRA (1.47 per 1,000 person-months). Among patients with SSA the 3-and 5-year ANL free-cumulative probability was 64.3 and 32.1% in those with synchronous HRA, 100 and 100% in those with synchronous LRA, and 95.1 and 91.7% if no synchronous adenoma was found. CONCLUSIONS: Among patients with resected sporadic SSAs the risk of developing metachronous ANL is infl uenced by the presence of synchronous HRA on index colonoscopy. Patients with SSAs and synchronous HRA on index colonoscopy require closer surveillance, whereas those with synchronous LRA and those without synchronous adenomas may be followed up in the same way as those with LRAs.
Clinical and Translational Gastroenterology, 2012
OBJECTIVES: A growing body of evidence indicates that patients with sessile serrated adenoma/polyp (SSA/P) and traditional serrated adenoma (TSA) are at risk for subsequent malignancy. Despite increasing knowledge on histological categorization of serrated polyps (SPs) data are lacking on the actual prevalence and the association of each SP subtype with advanced colorectal neoplasia. METHODS: We prospectively determined the prevalence of different SP subtypes and evaluate the association with synchronous advanced neoplasia in asymptomatic average-risk subjects undergoing first-time colonoscopy. All retrieved polyps were examined by two independent pathologists. Serrated lesions were classified into hyperplastic polyps (HP), SSA/P (without and with cytological dysplasia, SSA/P/DIS), and TSA, and were screened for BRAF and K-ras mutations. RESULTS: Among 258 polyps detected in 985 subjects, the proportion of SSA/P and TSA was 8.9% and 1.9% with an overall prevalence of 2.3% and 0.6%, respectively. SSA/Ps were small without significant difference in their location between proximal and distal colon; TSA were predominantly left-sided. BRAF mutation was common in SSA/Ps and K-ras mutation was present in all TSA. Independent predictors of advanced neoplasia were male sex (odds ratio (OR) ¼ 2.0, 95% confidence interval (CI) 1.0-4.0), increasing age (OR ¼ 4.5, 95% CI 1.5-13.4 for 50-69 years and OR ¼ 9.9, 95% CI 3.1-31.5 for 470 years), current smoking (OR ¼ 2.0, 95% CI 1.3-6.8), 43 tubular adenoma (OR ¼ 3.6, 95% CI 1.9-6.4), and SSA/P (OR ¼ 6.0, 95% CI 1.9-19.5). CONCLUSIONS: The substantial prevalence of BRAF-mutated SSA/P and the independent association with synchronous advanced colorectal neoplasia in asymptomatic average-risk subjects support the overall impact of the serrated pathway on colorectal cancer (CRC) risk in general population. The endoscopic characteristics of SSA/P emphasize the need of high-quality colonoscopy as a key factor for an effective CRC screening program.
BMJ Open Gastroenterology, 2020
BackgroundThe audit process may help improve performance indicators for colonoscopy quality but it is unclear whether this is sustained over several years.Methods44138 procedures for 28 endoscopists from 2004 to 2019 were analysed for polyp detection rate and withdrawal time. From 2012, 14 endoscopists were analysed with additional data on polyp histology and number of polyps removed.ResultsPolyp detection increased from 40.7% in 2004 to 62.2% in 2019; removal of polyps>1 cm remained constant (11%). Adenoma detection rate was 25.8% in 2012 and 28.3% in 2019. Sessile serrated polyp (SSP) detection rate increased from 4.5% to 14.7%; most of the increase was in the first 2 years of the histology part of the audit. There was a significant correlation of adenoma detection rate with mean number of adenomas (r=0.72, p=0.004) and a significant correlation of SSP detection with mean number of SSPs (r=0.85, p=0.0001).ConclusionThe audit process appears to encourage a higher rate of polyp d...
Gastrointestinal Endoscopy, 2013
on behalf of the ColonPrev study investigators Barcelona, Spain Background: Serrated cancers account for 10% to 20% of all colorectal cancers (CRC) and more than 30% of interval cancers. The presence of proximal serrated polyps and large (R10 mm) serrated polyps (LSP) has been correlated with colorectal neoplasia. Objective: To evaluate the prevalence of serrated polyps and their association with synchronous advanced neoplasia in a cohort of average-risk population and to assess the efficacy of one-time colonoscopy and a biennial fecal immunochemical test for reducing CRC-related mortality. This study focused on the sample of 5059 individuals belonging to the colonoscopy arm.
Finding Sessile Serrated Adenomas: Is It Possible to Identify Them During Conventional Colonoscopy?
Digestive Diseases and Sciences, 2014
Background and Aim Proximal colorectal cancer may arise from sessile serrated adenomas (SSAs). Recognition of these lesions during colonoscopy can optimize the endoscopic approach. We aimed to identify specific endoscopic features of SSA with conventional colonoscopy. Methods Patients undergoing screening colonoscopies from January 2011 to September 2012, in whom colonic polyps were found, were prospectively included in our study. Polyp morphology, location, polyp pit pattern (Kudo classification), and other previously reported features of SSA were evaluated. Histological examination was conducted independently by two pathologists. Multivariate analysis was performed to identify independent predictors of SSA. Results A total of 272 patients were included, and 440 polyps were evaluated (1.6 polyps per patient). Thirty-four polyps (8 %) were SSA, 135 (31 %) hyperplastic, and 249 (56 %) adenomas. The most prevalent endoscopic features of SSA were right-side location (94 %), type II Kudo pit pattern (91 %), mucus cap (41 %), flat morphology (29 %) and red-colored surface (26 %). Multivariate analysis revealed that flat morphology (p = 0.002, OR = 3.81 CI 1.53-9.09), red-colored surface (p \ 0.001, OR = 12.97 CI 4.43-37.69), right-side location (p \ 0.001, OR = 22.21 CI 5.09-135.94) and mucus cap (p \ 0.001, OR 8.77 CI 3.76-20.44) were independent predictors of SSA. Conclusion We were able to identify specific features of SSA during conventional colonoscopy, which may help to identify, and therefore to optimize the endoscopic approach of these lesions.
Endoscopy International Open
Background: The risk of developing total metachronous advanced neoplasia (TMAN) in patients with index serrated lesions (SL) or adenoma with high-grade dysplasia (HGD) is unknown. We evaluated this risk in patients with either HGD, SL <10 mm or SL ≥10 mm at index colonoscopy, who underwent surveillance colonoscopies. Methods: This retrospective cohort study evaluated all consecutive patients (n = 2477) diagnosed between 2010 and 2019 with colorectal HGD, SL <10 mm or SL ≥10 mm. We excluded patients aged <45 or >75 years or those who had inflammatory bowel disease, hereditary colorectal cancer (CRC) syndromes, previous or synchronous CRC, or no follow-up colonoscopy. Descriptive variables were compared using analysis of variance or Pearson chi-squared tests. Multivariate Cox regressions were used to compare the risk of TMAN between the HGD, SL <10 mm and SL ≥10 mm groups. Results: Overall, 585 patients (mean age 63 years; 55% male; mean follow-up 3.67 years) were inclu...
Clinical Gastroenterology and Hepatology, 2013
BACKGROUND & AIMS: The adenoma detection rate (ADR) is an important quality indicator originally developed for screening colonoscopies. However, it is unclear whether the ADR should be calculated using data from screening and surveillance examinations. The recommended benchmark ADR for screening examinations is 20% (15% for women and 25% for men ‡50 y). There are few data available to compare ADRs from surveillance vs screening colonoscopies. We used a population-based registry to compare ADRs from screening vs surveillance colonoscopies. The serrated polyp detection rate (SDR), a potential new quality indicator, also was examined.
Sessile serrated adenomas: Demographic, endoscopic and pathological characteristics
World Journal of Gastroenterology, 2010
AIM: To study the demographic and endoscopic characteristics of patients with sessile serrated adenoma (SSA) in a single center. METHODS: Patients with SSA were identified by review of the pathology database of Mayo Clinic Arizona from 2005 to 2007. A retrospective chart review was performed to extract data on demographics, polyp characteristics, presence of synchronous adenomatous polyps or cancer, polypectomy methods, and related complications. RESULTS: One hundred and seventy-one (2.9%) of all patients undergoing colonoscopy had a total of 226 SSAs. The mean (SE) size of the SSAs was 8.1 (0.4) mm; 42% of SSAs were ≤ 5 mm, and 69% were ≤ 9 mm. Fifty-one per cent of SSAs were located in the cecum or ascending colon. Approximately half of the patients had synchronous polyps of other histological types, including hyperplastic and adenomatous polyps. Synchronous adenocarcinoma was present in seven (4%) cases. Ninety-seven percent of polyps were removed by colonoscopy. CONCLUSION: Among patients with colon polyps, 2.9% were found to have SSAs. Most of the SSAs were located in the right side and were safely managed by colonoscopy.