Prevalence and Variable Detection of Proximal Colon Serrated Polyps During Screening Colonoscopy

Kahi, Charles J.; Hewett, David G.; Norton, D.; Eckert, George J.; Rex, Douglas K.

doi:10.1016/j.cgh.2010.09.013

Cited by 401 publications

(289 citation statements)

References 32 publications

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“…The international discussions on the significance of these lesions, during the development of the guidelines, stimulated further efforts to clarify appropriate methods of histologic reporting and clinical management [59] and led to related recommendations in the guidelines [21,25]. Since then, recent findings at two academic endoscopy units in North America have indicated that the prevalence of proximal colon serrated lesions in patients undergoing screening colonoscopy in a clinical setting may be higher than previously reported [63] and a significant proportion of proximal serrated lesions may be missed during colonoscopy [64]. Interval cancers have also been associated with proximal location in a population-based screening setting in Europe [65].…”

Section: Author Manuscriptmentioning

confidence: 59%

European guidelines for quality assurance in colorectal cancer screening and diagnosis: Overview and introduction to the full Supplement publication

Karsa¹,

Patnick²,

Segnan³

et al. 2012

Endoscopy

249

187

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Population-based screening for early detection and treatment of colorectal cancer (CRC) and precursor lesions, using evidence-based methods, can be effective in populations with a significant burden of the disease provided the services are of high quality. Multidisciplinary, evidence-based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010.They include 10 chapters and over 250 recommendations, individually graded according to the strength of the recommendation and the supporting evidence. Adoption of the recommendations can improve and maintain the quality and effectiveness of an entire screening process, including identification and invitation of the target population, diagnosis and management of the disease and appropriate surveillance in people with detected lesions. To make the principles, recommendations and standards in the guidelines known to a wider professional and scientific community and to facilitate their use in the scientific literature, the original content is presented in journal format in an open-access Supplement of Endoscopy. The editors have prepared the present overview to inform readers of the comprehensive scope and content of the guidelines. IntroductionAccording to recent estimates by the International Agency for Research on Cancer [1], colorectal cancer (CRC) is the most common cancer in Europe with 432 000 new cases reported annually in men and women combined. It is the second most common cause of cancer deaths in Europe with 212 000 deaths reported in 2008.Worldwide, CRC ranks third in incidence and fourth in mortality with an estimated 1.2 million cases and 0.6 million deaths annually. In the 27 Member States of the European Union (EU), CRC ranks first in incidence and second in mortality, with approximately 334000 new cases and 149000 deaths estimated in 2008.Even in those Member States in the lower range for age-standardized rates of CRC, the burden of disease is significantly greater when compared with many other HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript regions of the world (see reference [1]). CRC is therefore an important health problem across the EU.Screening can be effective in cancer control in populations with a significant burden of CRC, provided the services are of high quality [2]. The aim of CRC screening is to lower the burden of cancer in the population by discovering disease in its early, latent stages [3]. Evidence-based methods permit treatment that is more effective than if disease is diagnosed later when symptoms have occurred. Early treatment of invasive lesions, for example by endoscopic resection of early CRC, can also be less detrimental for quality of life. The endoscopic removal of pre-malignant lesions also reduces the incidence of CRC by avoiding the progression to cancer. Randomized trials in people of average risk invite...

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Section: Author Manuscriptmentioning

confidence: 59%

European guidelines for quality assurance in colorectal cancer screening and diagnosis: Overview and introduction to the full Supplement publication

Karsa¹,

Patnick²,

Segnan³

et al. 2012

Endoscopy

249

187

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“…Some studies indicate that 31% of hyperplastic polyps and 27% of nonadenomatous polyps are missed during colonoscopy (12,13), which is consistent with a high variability in serrated polyp detection among endoscopists (i.e., ranging from 8%-32% for all serrated polyps, and from 1%-18% for proximal serrated polyps; refs. 14,15). Taken together these findings highlight the need for improving detection of these lesions.…”

Section: Introductionmentioning

confidence: 83%

“…It became clear that serrated polyps often have a subtle endoscopic appearance, thereby explaining the operatordependent variation in their detection, ranging from 8% to 32% (14,15). This high variability in detection highlights the need for education and training, for which a systematic approach is needed, that is, by means of videotraining, computer-aided programs, and learning from experts (14,15).…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, data on risk factors for serrated polyps are still controversial, probably due to large variation between endoscopists in serrated polyp detection (14,15), relatively small number of patients with serrated polyps examined (19,20), inclusion of patients with distal serrated polyps only (18,23), or a predominant male population (21).…”

Section: Introductionmentioning

confidence: 99%

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Simple Clinical Risk Score Identifies Patients with Serrated Polyps in Routine Practice

Bouwens

Winkens

Rondagh

et al. 2013

Cancer Prevention Research

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Large, proximal, or dysplastic (LPD) serrated polyps (SP) need accurate endoscopic recognition and removal as these might progress to colorectal cancer. Herewith, we examined the risk factors for having 1 LPD SP. We developed and validated a simple SP risk score as a potential tool for improving their detection. We reviewed clinical, endoscopic, and histologic features of serrated polyps in a study of patients undergoing elective colonoscopy (derivation cohort). A self-administered questionnaire was obtained. We conducted logistic regression analyses to identify independent risk factors for having 1 LPD SP and incorporated significant variables into a clinical score. We subsequently tested the performance of the SP score in a validation cohort. We examined 2,244 patients in the derivation and 2,402 patients in the validation cohort; 6.3% and 8.2% had 1 LPD SP, respectively. Independent risk factors for LPD SPs were age of more than 50 years [OR 2.2; 95% confidence interval (CI), 1.3-3.8; P ¼ 0.004], personal history of serrated polyps (OR 2.6; 95% CI, 1.3-4.9; P ¼ 0.005), current smoking (OR 2.2; 95% CI, 1.4-3.6; P ¼ 0.001), and nondaily/no aspirin use (OR 1.8; 95% CI, 1.1-3.0; P ¼ 0.016). In the validation cohort, a SP score 5 points was associated with a 3.0-fold increased odds for LPD SPs, compared with patients with a score <5 points. In the present study, age of more than 50 years, a personal history of serrated polyps, current smoking, and nondaily/no aspirin use were independent risk factors for having LPD SPs. The SP score might aid the endoscopist in the detection of such lesions. Cancer Prev Res; 6(8); 855-63. Ó2013 AACR.

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“…Finally, reports that advanced imaging techniques such as narrow band imaging or chromoendoscopy can help identify and demarcate lesions may help endoscopists improve their ability to detect and completely remove these lesions ( 17,18 ). Although substantial variability in the detection rates of serrated polyps among endoscopists has been reported ( 19,20 ), Hetzel et al ( 19 ) reported that the rates increased from 2006 to 2008, indicating that recognition of these lesions can be improved.…”

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confidence: 99%

Editorial: Serrated Polyposis: The Last (or Only the Latest?) Frontier of Familial Polyposis?

Lanspa

Ahnen

Lynch

2012

American Journal of Gastroenterology

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Prevalence and Variable Detection of Proximal Colon Serrated Polyps During Screening Colonoscopy

Cited by 401 publications

References 32 publications

European guidelines for quality assurance in colorectal cancer screening and diagnosis: Overview and introduction to the full Supplement publication

European guidelines for quality assurance in colorectal cancer screening and diagnosis: Overview and introduction to the full Supplement publication

Simple Clinical Risk Score Identifies Patients with Serrated Polyps in Routine Practice

Editorial: Serrated Polyposis: The Last (or Only the Latest?) Frontier of Familial Polyposis?

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