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DOI: 10.1055/a-1352-4095
Sessile serrated lesion detection rates during average risk screening colonoscopy: A systematic review and meta-analysis of the published literature
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Abstract
Background and study aims Sessile serrated lesion (SSL) detection rate has been variably reported and unlike adenoma detection rate (ADR) is not currently a quality indicator for screening colonoscopy. Composite detection rates of SSL in patients undergoing average risk screening colonoscopy are not available.
Methods Electronic database search (Medline, Embase and Cochrane) was conducted for studies reporting detection rates of serrated polyps (SSL, Hyperplastic polyp, traditional serrated adenoma) among average risk subjects undergoing screening colonoscopy. Primary outcomes were pooled SDR (SSL detection rate) and proximal serrated polyp detection rate (PSPDR). Pooled proportion rates were calculated with 95 %CI with assessment of heterogeneity (I2). Publication bias, regression test and 95 %prediction interval were calculated.
Results A total of 280,370 screening colonoscopies among average risk subjects that were eligible with 48.9 % males and an average age of 58.7 years (± 3.2). The pooled SDR was available from 16 studies: 2.5 % (1.8 %–3.4 %) with significant heterogeneity (I2 = 98.66 %) and the 95 % prediction interval ranging from 0.6 % to 9.89 %. When analysis was restricted to large (n > 1000) and prospective studies (n = 4), SDR was 2 % (1.1 %–3.3 %). Pooled PSPDR was 10 % (8.5 %–11.8 %; 12 studies). There was evidence of publication bias (P < 0.01).
Conclusion Definitions of SSL have been varying over years and there exists significant heterogeneity in prevalence reporting of serrated polyps during screening colonoscopy. Prevalence rate of 2 % for SSL and 10 % for proximal serrated polyps could serve as targets while robust high-quality data is awaited to find a future benchmark showing reduction in colorectal cancer arising from serrated pathway.
Publication History
Received: 06 November 2020
Accepted: 10 December 2020
Article published online:
13 April 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015; 65: 5-29
- 2 Rex DK, Petrini JL, Baron TH. et al. Quality indicators for colonoscopy. Am J Gastroenterol 2006; 101: 873-885
- 3 Kaminski MF, Wieszczy P, Rupinski M. et al. Increased rate of adenoma detection associates with reduced risk of colorectal cancer and death. Gastroenterology 2017; 153: 98-105
- 4 Hassan C, Repici A. Defeating cancer by boosting the adenoma detection rate: the circle of life. Gastroenterology 2017; 153: 8-10
- 5 Rex DK, Ahnen DJ, Baron JA. et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol 2012; 107: 1315-1329; quiz 1314, 1330
- 6 Patai AV, Molnar B, Tulassay Z. et al. Serrated pathway: alternative route to colorectal cancer. World J Gastroenterol 2013; 19: 607-615
- 7 Hawkins NJ, Bariol C, Ward RL. The serrated neoplasia pathway. Pathology 2002; 34: 548-555
- 8 Benedict M, Galvao Neto A, Zhang X. Interval colorectal carcinoma: An unsolved debate. World J Gastroenterol 2015; 21: 12735-12741
- 9 Nishihara R, Wu K, Lochhead P. et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 2013; 369: 1095-1105
- 10 JE IJ, Vermeulen L, Meijer GA. et al. Serrated neoplasia-role in colorectal carcinogenesis and clinical implications. Nat Rev Gastroenterol Hepatol 2015; 12: 401-409
- 11 Yamane L, Scapulatempo-Neto C, Reis RM. et al. Serrated pathway in colorectal carcinogenesis. World J Gastroenterol 2014; 20: 2634-2640
- 12 Ohki D, Tsuji Y, Shinozaki T. et al. Sessile serrated adenoma detection rate is correlated with adenoma detection rate. World J Gastrointest Oncol 2018; 10: 82-90
- 13 Moher D, Shamseer L, Clarke M. et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4: 1
- 14 Wells G, Shea B, O’Connell D. et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2013
- 15 Higgins JP, Altman DG, Gotzsche PC. et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928
- 16 Anderson JC, Butterly LF, Robinson CM. et al. Risk of metachronous high-risk adenomas and large serrated polyps in individuals with serrated polyps on index colonoscopy: data from the New Hampshire Colonoscopy Registry. Gastroenterology 2018; 154: 117-127 e112
- 17 Buda A, De Bona M, Dotti I. et al. Prevalence of different subtypes of serrated polyps and risk of synchronous advanced colorectal neoplasia in average-risk population undergoing first-time colonoscopy. Clin Transl Gastroenterol 2012; 3: e6
- 18 Chang LC, Shun CT, Hsu WF. et al. Fecal Immunochemical test detects sessile serrated adenomas and polyps with a low level of sensitivity. Clin Gastroenterol Hepatol 2017; 15: 872-879 e871
- 19 Hazewinkel Y, de Wijkerslooth TR, Stoop EM. et al. Prevalence of serrated polyps and association with synchronous advanced neoplasia in screening colonoscopy. Endoscopy 2014; 46: 219-224
- 20 Hetzel JT, Huang CS, Coukos JA. et al. Variation in the detection of serrated polyps in an average risk colorectal cancer screening cohort. Am J Gastroenterol 2010; 105: 2656-2664
- 21 JE IJ, Tutein Nolthenius CJ, Kuipers EJ. et al. CT-colonography vs colonoscopy for detection of high-risk sessile serrated polyps. Am J Gastroenterol 2016; 111: 516-522
- 22 JEG IJ, Bevan R, Senore C. et al. Detection rate of serrated polyps and serrated polyposis syndrome in colorectal cancer screening cohorts: a European overview. Gut 2017; 66: 1225-1232
- 23 Ladabaum U, Patel A, Mannalithara A. et al. Predicting advanced neoplasia at colonoscopy in a diverse population with the National Cancer Institute colorectal cancer risk-assessment tool. Cancer 2016; 122: 2663-2670
- 24 Mandaliya R, Baig K, Barnhill M. et al. Significant Variation in the detection rates of proximal serrated polyps among academic gastroenterologists, community gastroenterologists, and colorectal surgeons in a single tertiary care center. Dig Dis Sci 2019; 64: 2614-2621
- 25 Parikh MP, Muthukuru S, Jobanputra Y. et al. Proximal Sessile serrated adenomas are more prevalent in Caucasians, and gastroenterologists are better than nongastroenterologists at their detection. Gastroenterol Res Pract 2017; DOI: 10.1155/2017/6710931.
- 26 Ross WA, Thirumurthi S, Lynch PM. et al. Detection rates of premalignant polyps during screening colonoscopy: time to revise quality standards?. Gastrointest Endosc 2015; 81: 567-574
- 27 Sanaka MR, Gohel T, Podugu A. et al. Adenoma and sessile serrated polyp detection rates: variation by patient sex and colonic segment but not specialty of the endoscopist. Dis Colon Rectum 2014; 57: 1113-1119
- 28 Schachschal G, Sehner S, Choschzick M. et al. Impact of reassessment of colonic hyperplastic polyps by expert GI pathologists. Int J Colorectal Dis 2016; 31: 675-683
- 29 Schramm C, Janhsen K, Hofer JH. et al. Detection of clinically relevant serrated polyps during screening colonoscopy: results from seven cooperating centers within the German colorectal screening program. Endoscopy 2018; 50: 993-1000
- 30 Shaukat A, Gravely AA, Kim AS. et al. Rates of detection of adenoma, sessile serrated adenoma, and advanced adenoma are stable over time and modifiable. Gastroenterology 2019; 156: 816-817
- 31 de Wijkerslooth TR, Stoop EM, Bossuyt PM. et al. Differences in proximal serrated polyp detection among endoscopists are associated with variability in withdrawal time. Gastrointest Endosc 2013; 77: 617-623
- 32 Kahi CJ, Hewett DG, Norton DL. et al. Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy. Clin Gastroenterol Hepatol 2011; 9: 42-46
- 33 Leung WK, Tang V, Lui PC. Detection rates of proximal or large serrated polyps in Chinese patients undergoing screening colonoscopy. J Dig Dis 2012; 13: 466-471
- 34 Schreiner MA, Weiss DG, Lieberman DA. Proximal and large hyperplastic and nondysplastic serrated polyps detected by colonoscopy are associated with neoplasia. Gastroenterology 2010; 139: 1497-1502
- 35 Anderson JC, Butterly LF, Weiss JE. et al. Providing data for serrated polyp detection rate benchmarks: an analysis of the New Hampshire Colonoscopy Registry. Gastrointest Endosc 2017; 85: 1188-1194
- 36 Pereyra L, Gomez EJ, Gonzalez R. et al. Finding sessile serrated adenomas: is it possible to identify them during conventional colonoscopy?. Dig Dis Sci 2014; 59: 3021-3026
- 37 Lieberman DA, Rex DK, Winawer SJ. et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143: 844-857
- 38 Gupta S, Lieberman D, Anderson JC. et al. Recommendations for Follow-up after colonoscopy and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc 2020; 91: 463-485 e465
- 39 Meester RGS, van Herk M, Lansdorp-Vogelaar I. et al. Prevalence and clinical features of sessile serrated polyps: a systematic review. Gastroenterology 2020; 159: 105-118 e125
- 40 Burgess NG, Tutticci NJ, Pellise M. et al. Sessile serrated adenomas/polyps with cytologic dysplasia: a triple threat for interval cancer. Gastrointest Endosc 2014; 80: 307-310
- 41 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative. United Europ Gastroenterol J 2017; 5: 309-334
- 42 Gourevitch RA, Rose S, Crockett SD. et al. Variation in pathologist classification of colorectal adenomas and serrated polyps. Am J Gastroenterol 2018; 113: 431-439
- 43 Gurudu SR, Heigh RI, De Petris G. et al. Sessile serrated adenomas: demographic, endoscopic and pathological characteristics. World J Gastroenterol 2010; 16: 3402-3405
- 44 Spring KJ, Zhao ZZ, Karamatic R. et al. High prevalence of sessile serrated adenomas with BRAF mutations: a prospective study of patients undergoing colonoscopy. Gastroenterology 2006; 131: 1400-1407
- 45 Rondagh EJ, Bouwens MW, Riedl RG. et al. Endoscopic appearance of proximal colorectal neoplasms and potential implications for colonoscopy in cancer prevention. Gastrointest Endosc 2012; 75: 1218-1225
- 46 Zorzi M, Senore C, Da Re F. et al. Detection rate and predictive factors of sessile serrated polyps in an organised colorectal cancer screening programme with immunochemical faecal occult blood test: the EQuIPE study (Evaluating Quality Indicators of the Performance of Endoscopy). Gut 2017; 66: 1233-1240
- 47 Klair JS, Ashat M, Johnson D. et al. Serrated polyp detection rate and advanced adenoma detection rate from a US multicenter cohort. Endoscopy 2019; DOI: 10.1055/a-1031-5672.