Presence of small sessile serrated polyps increases rate of advanced neoplasia upon surveillance compared with isolated low-risk tubular adenomas

Melson, Joshua; Ma, Karen; Arshad, Saba; Greenspan, Michael; Kaminsky, Thomas; Melvani, Vinesh; Bishehsari, Faraz; Mahon, Brett; Jakate, Shriram

doi:10.1016/j.gie.2016.01.064

Cited by 37 publications

(35 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nevertheless, consensus expert panels have recommended the removal of all SLs proximal to the sigmoid and those larger than 5 mm in the rectum and sigmoid in the general population 8 because of their association with advanced neoplasia during surveillance. 22 In addition, previous data have shown invasive carcinoma in diminutive SLs during SPS surveillance suggesting that, in this specific scenario, even small SLs (<10 mm) have to be taken into consideration and removed. 5,7 The role of SSP as a precursor lesion for CRC is more widely accepted.…”

Section: Discussionmentioning

confidence: 99%

Panchromoendoscopy Increases Detection of Polyps in Patients With Serrated Polyposis Syndrome

López-Vicente

Rodríguez‐Alcalde

Hernández³

et al. 2019

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

BACKGROUND & AIMS: Serrated polyposis syndrome (SPS), characterized by multiple and/or large proximal serrated lesions, increases the risk of colorectal cancer. Serrated lesions often are missed during colonoscopy but panchromoendoscopy can increase their detection in an average-risk population. We performed a randomized controlled study to determine the efficacy of panchromoendoscopy in detection of polyps in patients with SPS. METHODS: Patients with SPS (n [ 86 patients) underwent tandem high-definition (HD) colonoscopies from February 2015 through July 2016 at 7 centers in Spain. Patients were assigned randomly to groups that received 2 HD white-light endoscopy examinations (HD-WLE group; n [ 43) or HD-WLE followed by 0.4% indigo carmine panchromoendoscopy (HD-CE group; n [ 43). For each procedure, polyps detected were described, removed, and analyzed by histology. The primary outcome was additional polyp detection rate, defined as the number of polyps detected during the second inspection divided by the total number of polyps detected during the first and the second examination. RESULTS: A total of 774 polyps were detected (362 in the HD-WLE group and 412 in the HD-CE group); 54.2% were hyperplastic, 13.8% were adenomas, and 10.9% were sessile serrated polyps. There was a significantly higher additional polyp detection rate in the HD-CE group (0.39; 95% CI, 0.35-0.44) than in the HD-WLE group (0.22; 95% CI, 0.18-0.27) (P < .001). A higher additional rate of serrated lesions proximal to the sigmoid colon were detected in the second inspection with HD-CE (0.40; 95% CI, 0.33-0.47) than with HD-WLE (0.24; 95% CI, 0.19-0.31) (P [ .001). Detection of adenomas and serrated lesions greater than 10 mm did not differ significantly between groups. In a multivariate logistic regression analysis, only use of HD-CE was associated independently with increased polyp detection throughout the colon. CONCLUSIONS: In a randomized controlled trial, we found that panchromoendoscopy increases detection of polyps (mostly of small serrated lesions) and should be considered the standard of care in patients with SPS. Studies are needed to determine the effects of this strategy on the incidence of advanced neoplasia during long-term follow-up evaluation. ClinicalTrials.gov no: NCT03476434.

show abstract

Section: Discussionmentioning

confidence: 99%

Panchromoendoscopy Increases Detection of Polyps in Patients With Serrated Polyposis Syndrome

López-Vicente

Rodríguez‐Alcalde

Hernández³

et al. 2019

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

show abstract

“… 84 A recent article by Melson et al suggests that the risk of metachronous advanced neoplasia in low-risk SPs is comparable to that of high-risk tubular adenomas. 85 Moreover, small observational studies estimate the risk of metachronous CRC in patients harboring SSPs to be as high as 12.5%. 86 , 87 …”

Section: Overview Of Spsmentioning

confidence: 99%

The clinical impact of serrated colorectal polyps

O’Connell¹,

Crockett²

2017

CLEP

View full text Add to dashboard Cite

Serrated polyps (SPs) of the colorectum pose a novel challenge to practicing gastroenterologists. Previously thought benign and unimportant, there is now compelling evidence that SPs are responsible for a significant percentage of incident colorectal cancer worldwide. In contrast to conventional adenomas, which tend to be slow growing and polypoid, SPs have unique features that undermine current screening and surveillance practices. For example, sessile serrated polyps (SSPs) are flat, predominately right-sided, and thought to have the potential for rapid growth. Moreover, SSPs are subject to wide variations in endoscopic detection and pathologic interpretation. Unfortunately, little is known about the natural history of SPs, and current guidelines are based largely on expert opinion. In this review, we outline the current taxonomy, epidemiology, and management of SPs with an emphasis on the clinical and public health impact of these lesions.

show abstract

“…Unsurprisingly, large and/or proximal SPs appear to be of particular significance. Schreiner et al reported an elevated risk of MACN in patients with proximal SPs on baseline colonoscopy (OR, 3.14; 95% CI, 1.59–6.20), and a recent article by Melson et al suggests that the risk of MACN in low-risk SPs is comparable to that of high-risk conventional adenomas [37,50]. Moreover, a recent population-based study from Denmark reported an increased risk of metachronous CRC in patients harboring SSPs, especially those in the right colon (OR, 12.42; 95% CI, 4.88–31.58) [51].…”

Section: What Do We Know About Serrated Polyps?mentioning

confidence: 99%

The Serrated Polyp Pathway: Is It Time to Alter Surveillance Guidelines?

O’Connell

Hafiz

Crockett

2017

Curr Gastroenterol Rep

View full text Add to dashboard Cite

Purpose of the review In this manuscript, we review current surveillance guidelines for serrated polyps (SPs) and discuss how recent studies inform the selection of appropriate surveillance intervals for patients with SPs. Recent Findings Large and/or proximal SPs, particularly sessile serrated polyps (SSPs), are associated with increased risk of both synchronous and metachronous neoplasia, including advanced adenomas and colorectal cancer (CRC). Persons harboring multiple SSPs or dysplastic SSPs are at the highest risk. Moreover, a high percentage of large and/or proximal SPs are reclassified as SSPs when read by trained gastrointestinal pathologists, even if they were originally reported as hyperplastic polyps. These findings support the adoption of surveillance guidelines that prescribe closer surveillance of large and/or proximal SPs, regardless of subtype. Summary SSPs remain a challenge to reliably identify, resect, and diagnose via histology. The increased risk of future neoplasia in patients with SSPs is likely driven by a combination of underdetection, inadequate removal, misclassification, and biology. Until further evidence emerges, we support guidelines that recommend close surveillance of patients with a history of large and/or proximal SPs and SSPs specifically in order to mitigate the threat of interval CRC.

show abstract

Presence of small sessile serrated polyps increases rate of advanced neoplasia upon surveillance compared with isolated low-risk tubular adenomas

Cited by 37 publications

References 36 publications

Panchromoendoscopy Increases Detection of Polyps in Patients With Serrated Polyposis Syndrome

Panchromoendoscopy Increases Detection of Polyps in Patients With Serrated Polyposis Syndrome

The clinical impact of serrated colorectal polyps

The Serrated Polyp Pathway: Is It Time to Alter Surveillance Guidelines?

Contact Info

Product

Resources

About