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Endoscopy 2016; 48(08): 740-746
DOI: 10.1055/s-0042-105436
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Prevalence, distribution and risk of sessile serrated adenomas/polyps at a center with a high adenoma detection rate and experienced pathologists

Joep E. G. IJspeert
1   Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
,
Koos de Wit
1   Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
,
Manon van der Vlugt
1   Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
2   Bergman Clinics IZA, Amsterdam, The Netherlands
,
Barbara A. J. Bastiaansen
1   Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
2   Bergman Clinics IZA, Amsterdam, The Netherlands
,
Paul Fockens
1   Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
2   Bergman Clinics IZA, Amsterdam, The Netherlands
,
Evelien Dekker
1   Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
2   Bergman Clinics IZA, Amsterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

submitted 06 October 2015

accepted after revision 23 February 2016

Publication Date:
25 April 2016 (online)

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Background and study aims: Sessile serrated adenomas/polyps (SSA/Ps) are the precursors of 15 % – 30 % of colorectal cancers (CRC). We aimed to determine the prevalence and distribution of SSA/Ps and to evaluate the association between SSA/Ps and the risk of synchronous advanced neoplasia at a high quality colonoscopy center.

Methods: Data from all colonoscopies performed within one dedicated colonoscopy center between 2011 and 2015 were prospectively retrieved using an automated reporting system. All lesions were assessed by an experienced gastrointestinal pathologist. Multiple logistic regression was used to evaluate influence of age, gender, and colonoscopy indication on prevalence of SSA/Ps, and to assess the association between SSA/Ps and synchronous advanced neoplasia.

Results: In total 4251 histologically confirmed polyps were resected in 3364 patients; 399 polyps were SSA/Ps (9.4 %). The prevalence of SSA/Ps was 8.2 % overall, increasing to 9.0 % for individuals older than 50 years. SSA/P detection rate varied between 2.5 % and 13.6 % among endoscopists. Increased SSA/P prevalence was associated with colonoscopy indications “familial CRC risk” (odds ratio [OR] 1.52, 95 % confidence interval [95 %CI] 1.05 – 2.22; P = 0.03) and “surveillance” (OR 1.73, 95 %CI 1.20 – 2.49; P < 0.01), when compared with the indication “symptoms.” The presence of synchronous advanced neoplasia was associated with SSA/Ps overall (OR 1.71, 95 %CI 1.25 – 2.34; P = 0.001), as well as with high risk SSA/Ps (defined as ≥ 10 mm and/or with dysplasia) (OR 2.70, 95 %CI 1.56 – 4.67; P < 0.001)

Conclusion: SSA/Ps are more common than previously reported and are associated with the presence of synchronous advanced neoplasia. Endoscopists should be assiduous in identifying SSA/Ps in daily practice and should carefully look for synchronous advanced neoplasia when an SSA/P has been recognized. Results from this study can guide detection standards in general colonoscopy practice adapted to the type of patient that may predominate in an individual department.

 

  • References

  • 1 Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2015. CA Cancer J Clin 2015; 65: 5-29
    CrossrefPubMedSearch in Google Scholar
  • 2 Jass JR. Classification of colorectal cancer based on correlation of clinical, morphological and molecular features. Histopathology 2007; 50: 113-130
    CrossrefPubMedSearch in Google Scholar
  • 3 Toyota M, Ahuja N, Ohe-Toyota M et al. CpG island methylator phenotype in colorectal cancer. Proc Natl Acad Sci USA 1999; 96: 8681-8686
    CrossrefPubMedSearch in Google Scholar
  • 4 Rex DK, Ahnen DJ, Baron J et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol 2012; 107: 1315-1329 ; quiz 1314, 1330
    CrossrefPubMedSearch in Google Scholar
  • 5 Snover DC, Ahnen DJ, Burt RW et al. Serrated polyps of the colon and rectum and serrated polyposis. In: Bosman T, Carneiro F, Hruban R, et al., editors. WHO classification of tumours of the digestive system. Lyon: IARC Press; 2010: 160-165
    Search in Google Scholar
  • 6 Bettington M, Walker N, Clouston A et al. The serrated pathway to colorectal carcinoma: current concepts and challenges. Histopathology 2013; 62: 367-386
    CrossrefPubMedSearch in Google Scholar
  • 7 IJspeert JEG, Vermeulen L, Meijer GA et al. Serrated neoplasia – role in colorectal carcinogenesis and clinical implications. Nat Rev Gastroenterol Hepatol 2015; 12: 401-409
    CrossrefPubMedSearch in Google Scholar
  • 8 IJspeert JEG, Bastiaansen BAJ, van Leerdam ME et al. Development and validation of the WASP classification system for optical diagnosis of adenomas, hyperplastic polyps and sessile serrated adenomas/polyps. Gut 2015; (Epub 2015 Mar 9)
    PubMedSearch in Google Scholar
  • 9 Hassan C, Quintero E, Dumonceau J-M et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2013; 45: 842-851
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 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
    CrossrefPubMedSearch in Google Scholar
  • 11 Hazewinkel Y, López-Cerón M, East JE et al. Endoscopic features of sessile serrated adenomas: validation by international experts using high-resolution white-light endoscopy and narrow-band imaging. Gastrointest Endosc 2013; 77: 916-924
    CrossrefPubMedSearch in Google Scholar
  • 12 Tadepalli US, Feihel D, Miller KM et al. A morphologic analysis of sessile serrated polyps observed during routine colonoscopy (with video). Gastrointest Endosc 2011; 74: 1360-1368
    CrossrefPubMedSearch in Google Scholar
  • 13 Bouwens MWE, van Herwaarden YJ, Winkens B et al. Endoscopic characterization of sessile serrated adenomas/polyps with and without dysplasia. Endoscopy 2014; 46: 225-235
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Ensari A, Bilezikçi B, Carneiro F et al. Serrated polyps of the colon: How reproducible is their classification?. Virchows Arch 2012; 461: 495-504
    CrossrefPubMedSearch in Google Scholar
  • 15 Glatz K, Pritt B, Glatz D et al. A multinational, internet-based assessment of observer variability in the diagnosis of serrated colorectal polyps. Am J Clin Pathol 2007; 127: 938-945
    CrossrefPubMedSearch in Google Scholar
  • 16 Sandmeier D, Seelentag W, Bouzourene H. Serrated polyps of the colorectum: Is sessile serrated adenoma distinguishable from hyperplastic polyp in a daily practice?. Virchows Arch 2007; 450: 613-618
    CrossrefPubMedSearch in Google Scholar
  • 17 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Carr NJ, Mahajan H, Tan KL et al. Serrated and non-serrated polyps of the colorectum: their prevalence in an unselected case series and correlation of BRAF mutation analysis with the diagnosis of sessile serrated adenoma. J Clin Pathol 2009; 62: 516-518
    CrossrefPubMedSearch in Google Scholar
  • 19 Gurudu SR, Heigh RI, de Petris G et al. Sessile serrated adenomas: Demographic, endoscopic and athological characteristics. World J Gastroenterol 2010; 16: 3402-3405
    CrossrefPubMedSearch in Google Scholar
  • 20 Lash RH, Genta RM, Schuler CM. Sessile serrated adenomas: prevalence of dysplasia and carcinoma in 2139 patients. J Clin Pathol 2010; 63: 681-686
    CrossrefPubMedSearch in Google Scholar
  • 21 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
    CrossrefPubMedSearch in Google Scholar
  • 22 Kumbhari V, Behary J, Hui JM. Prevalence of adenomas and sessile serrated adenomas in Chinese compared with Caucasians. J Gastroenterol Hepatol 2013; 28: 608-612
    CrossrefPubMedSearch in Google Scholar
  • 23 Payne SR, Church TR, Wandell M et al. Endoscopic detection of proximal serrated lesions and pathologic identification of sessile serrated adenomas/polyps vary on the basis of center. Clin Gastroenterol Hepatol 2014; 12: 1119-1126
    CrossrefPubMedSearch in Google Scholar
  • 24 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 (Epub 2012 Jan 5)
    CrossrefPubMedSearch in Google Scholar
  • 25 Abdeljawad K, Vemulapalli KC, Kahi CJ et al. Sessile serrated polyp prevalence determined by a colonoscopist with a high lesion detection rate and an experienced pathologist. Gastrointest Endosc 2015; 81: 517-524
    CrossrefPubMedSearch in Google Scholar
  • 26 World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 1997; 310: 2191-2194
    PubMedSearch in Google Scholar
  • 27 Van Doorn SC, van Vliet J, Fockens P et al. A novel colonoscopy reporting system enabling quality assurance. Endoscopy 2014; 46: 181-187
    Thieme ConnectPubMedSearch in Google Scholar
  • 28 Schlemper RJ. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255
    CrossrefPubMedSearch in Google Scholar
  • 29 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174
    CrossrefPubMedSearch in Google Scholar
  • 30 Bettington M, Walker N, Rosty C et al. Clinicopathological and molecular features of sessile serrated adenomas with dysplasia or carcinoma. Gut 2015; (Epub 2015 Oct 15)
    PubMedSearch in Google Scholar
  • 31 Haque TR, Bradshaw PT, Crockett SD. Risk factors for serrated polyps of the colorectum. Dig Dis Sci 2014; 59: 2874-2889
    CrossrefPubMedSearch in Google Scholar
  • 32 Freedman JS, Harari DY, Bamji ND et al. The detection of premalignant colon polyps during colonoscopy is stable throughout the workday. Gastrointest Endosc 2011; 73: 1197-1206
    CrossrefPubMedSearch in Google Scholar
  • 33 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
    CrossrefPubMedSearch in Google Scholar
  • 34 Ng SC, Ching JYL, Chan VCW et al. Association between serrated polyps and the risk of synchronous advanced colorectal neoplasia in average-risk individuals. Aliment Pharmacol Ther 2015; 41: 108-115
    CrossrefPubMedSearch in Google Scholar
  • 35 Rau TT, Agaimy A, Gehoff A et al. Defined morphological criteria allow reliable diagnosis of colorectal serrated polyps and predict polyp genetics. Virchows Arch 2014; 464: 663-672
    CrossrefPubMedSearch in Google Scholar