Detection of clinically relevant serrated polyps during screening colonoscopy: results from seven cooperating centers within the German colorectal screening program

Abstract

Background Serrated polyps have been recognized as precursors of colorectal cancer (CRC) via the serrated pathway. Endoscopic detection and histopathological evaluation of serrated polyps are challenging. The aims of this study were to determine detection rates of the recently proposed entity of clinically relevant serrated polyps (crSPs) and to identify factors that influence their detection in a primary colonoscopy screening cohort.

Methods We retrospectively analyzed average-risk screening colonoscopies performed at a tertiary academic hospital and six community-based private practices in Germany between 01/01/2012 and 14/12/2016. Exclusion criteria were age < 50 years, conditions with increased risk for CRC (e. g. inflammatory bowel disease, history of CRC, hereditary cancer syndromes), and incomplete procedures. CrSPs were defined as serrated polyps ≥ 10 mm and/or > 5 mm located proximally to the splenic flexure. Conventional adenomas were defined as adenomas excluding serrated polyps.

Results A total of 4161 colonoscopies from average-risk individuals were included (median age 62 years [interquartile range 56 – 69]; 48.6 % male). CrSPs were detected in 6.9 %, with a mean detection rate of 4.7 % (95 % confidence interval 2.3 % – 7.2 %). Detection rates ranged from 0 % to 16.2 %. In multivariate analysis, simultaneous detection of conventional adenomas and an endoscopist adenoma detection rate of ≥ 25 % were significantly associated with increased detection of crSPs, with odds ratios of 1.43 (95 %CI 1.11 – 1.85; P = 0.01) and 7.35 (95 %CI 4.43 – 12.19; P < 0.001). The individual endoscopist’s detection rate for conventional adenomas and crSPs were significantly correlated (r = 0.54, P = 0.02).

Conclusion Detection rates for crSPs differed between participating endoscopists. However, individual skills to detect polypoid lesions have a relevant bearing on the detection rate of crSPs.

• References

• 1 Torre LA, Bray F, Siegel RL. et al. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65: 87
• 2 East JE, Vieth M, Rex DK. Serrated lesions in colorectal cancer screening: detection, resection, pathology and surveillance. Gut 2015; 64: 991-1000
• 3 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., eds. WHO classification of tumours of the digestive system. Lyon: IARC Press; 2010: 160-165
• 4 Snover DC. Update on the serrated pathway to colorectal carcinoma. Hum Pathol 2011; 42: 1-10
• 5 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
• 6 Terdiman JP, McQuaid KR. Surveillance guidelines should be updated to recognize the importance of serrated polyps. Gastroenterology 2010; 139: 1444-1447
• 7 Crockett SD, Snover DC, Ahned DJ. et al. Sessile serrated adenomas: an evidence-based guide to management. Clin Gastroenterol Hepatol 2015; 13: 11-26
• 8 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
• 9 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
• 10 Schramm C, Kaiser M, Drebber U. et al. Factors associated with reclassification of hyperplastic polyps after pathological reassessment from screening and surveillance colonoscopies. Int J Colorectal Dis 2016; 31: 319-325
• 11 Anderson JC, Lisovsky M, Greene MA. et al. Factors associated with classification of hyperplastic polyps as sessile serrated adenomas/polyps on morphologic review. J Clin Gastroenterol 2017;
• 12 IJspeert JEG, 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
• 13 Hassan C, Quintero E, Dumonceau JM. et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2013; 45: 842-851
• 14 East JE, Atkin WS, Bateman AC. et al. British Society of Gastroenterology position statement on serrated polyps in the colon and rectum. Gut 2017; 66: 1181-1196
• 15 Guideline Program Oncology (German Cancer Society, German Cancer Aid, AWMF): S3 Guideline Colorectal Carcinoma, Long Version 1.1. AWMF Registration number: 021-007OL. 2014 Available from: http://leitlinienprogramm-onkologie.de/Leitlinien.7.0.html
• 16 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
• 17 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
• 18 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
• 19 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
• 20 IJspeert JE, van Doorn SC, van der Brug YM. et al. The proximal serrated polyp detection rate is an easy-to-measure proxy for the detection rate of clinically relevant serrated polyps. Gastrointest Endosc 2015; 82: 870-877
• 21 Kim HY, Kim SM, Seo JH. et al. Age-specific prevalence of serrated lesions and their subtypes by screening colonoscopy: a retrospective study. BMC Gastroenterology 2014; 14: 82
• 22 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
• 23 Kumbhari V, Behary J, Hui JM. Prevalence of adenomas and sessile adenomas in Chinese compared with Caucasians. J Gastroenterol Hepatol 2013; 28: 608-612
• 24 Kahi CJ, Vemulapalli KC, Snover DC. et al. Findings in the distal colorectum are not associated with proximal advanced serrated lesions. Clin Gastroenterol Hepatol 2015; 13: 345-351
• 25 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
• 26 Jover R, Bretthauer M, Dekker E. et al. Rationale and design of the European Polyp Surveillance (EPoS) trials. Endoscopy 2016; 48: 571-578
• 27 Do A, Weinberg J, Kakkar A. et al. Reliability of adenoma detection rate is based on procedural volume. Gastrointest Endosc 2013; 77: 376-380