Sessile Serrated Adenomas: How to Detect, Characterize and Resect

Michael, X.; Bourke, Michael J.

doi:10.5009/gnl16523

Cited by 24 publications

(25 citation statements)

References 119 publications

(179 reference statements)

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“…The CRC-AIM model is limited in that, like the CISNET models, it does not account for serrated polyps, the natural history of which differs from the typical adenoma-carcinoma sequence, and may account for up to 30% of CRC. [57,58] Sessile serrated polyps are detected with good sensitivity by mt-sDNA but not FIT. [59,60] Although not explicitly modeled, hyperplastic polyp detection is reflected in the false-positive rate (1-specificity) for colonoscopy.…”

Section: Discussionmentioning

confidence: 99%

Estimating the impact of differential adherence on the comparative effectiveness of stool-based colorectal cancer screening using the CRC-AIM microsimulation model

Piscitello¹,

Saoud

Fendrick

et al. 2020

Preprint

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BackgroundReal-world adherence to colorectal cancer (CRC) screening strategies is imperfect. The CRC-AIM microsimulation model was used to estimate the impact of imperfect adherence on the relative benefits and burdens of guideline-endorsed, stool-based screening strategies.MethodsPredicted outcomes of multi-target stool DNA (mt-sDNA), fecal immunochemical tests (FIT), and high-sensitivity guaiac-based fecal occult blood tests (HSgFOBT) were simulated for 40-year-olds free of diagnosed CRC. For robustness, imperfect adherence was incorporated in multiple ways and with extensive sensitivity analysis. Analysis 1 assumed adherence from 0%-100%, in 10% increments. Analysis 2 longitudinally applied real-world first-round differential adherence rates (base-case imperfect rates=40% annual FIT vs 34% annual HSgFOBT vs 70% triennial mt-sDNA). Analysis 3 randomly assigned individuals to receive 1, 5, or 9 lifetime (9=100% adherence) mt-sDNA tests and 1, 5, or 9 to 26 (26=100% adherence) FIT tests. Outcomes are reported per 1000 individuals compared with no screening.ResultsEach screening strategy decreased CRC incidence and mortality versus no screening. In individuals screened between ages 50-75 and adherence ranging from 10%-100%, the life-years gained (LYG) for triennial mt-sDNA ranged from 133.1-300.0, for annual FIT from 96.3-318.1, and for annual HSgFOBT from 99.8-320.6. At base-case imperfect adherence rates, mt-sDNA resulted in 19.1% more LYG versus FIT, 25.4% more LYG versus HSgFOBT, and generally had preferable efficiency ratios while offering the most LYG. Completion of at least 21 FIT tests is needed to reach approximately the same LYG achieved with 9 mt-sDNA tests.ConclusionsAdherence assumptions affect the conclusions of CRC screening microsimulations that are used to inform CRC screening guidelines. LYG from FIT and HSgFOBT are more sensitive to changes in adherence assumptions than mt-sDNA because they require more tests be completed for equivalent benefit. At imperfect adherence rates, mt-sDNA provides more LYG than FIT or HSgFOBT at an acceptable tradeoff in screening burden.

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Section: Discussionmentioning

confidence: 99%

Estimating the impact of differential adherence on the comparative effectiveness of stool-based colorectal cancer screening using the CRC-AIM microsimulation model

Piscitello¹,

Saoud

Fendrick

et al. 2020

Preprint

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“…12,13 Dysplastic lesions have transition from flat to nodular, sessile or depressed area; type III-V pit pattern and NICE 2. 14 They are more common in the right side of colon where less good preparation can make detection challenging. Detection can be improved by withdrawing slowly, using high definition colonoscope 15 and chromoendoscopy (dye spray) ( Table 1).…”

Section: Sessile Serrated Polyps and Their Endoscopic Detectionmentioning

confidence: 99%

Optimal Endoscopic Treatment and Surveillance of Serrated Polyps

Gupta

East

2020

Gut and Liver

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Serrated polyps are considered precursor lesions that account for 15% to 30% of colorectal cancers, and they are overrepresented as a cause of interval cancers. They are difficult to detect and resect comprehensively; however, recent data suggest that high definition endoscopy, chromoendoscopy (via spray catheter, pump or orally), narrow band imaging, split-dose bowel preparation and a slower withdrawal (>6 minutes) can all improve detection. Cold snare resection is effective and safe for these lesions, including cold snare piecemeal endoscopic mucosal resection, which is likely to become the standard of care for lesions >10 mm in size. Sessile serrated lesions ≥10 mm in size, those exhbiting dysplasia, or traditional serrated adenomas increase the chance of future advanced neoplasia. Thus, a consensus is emerging: a surveillance examination at 3 years should be recommended if these lesions are detected. Serrated lesions likely carry equivalent risk to adenomas, so future guidelines may consider serrated class lesions and adenomas together for risk stratification. Patients with serrated polyposis syndrome should undergo surveillance every 1 to 2 years once the colon is cleared of larger lesions, and their first degree relatives should undergo screening every 5 years starting at age 40.

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“…Similar to previous CISNET models, the current analysis using the CRC-AIM model is limited in that it does not account for serrated polyps which may account for up to 30% of CRC. 22,23 In addition, 100% adherence to CRC screening was assumed; previous results from the CRC-AIM model indicate that changing adherence assumptions to reflect more real-world practice has an impact on predicted outcomes. 24…”

Section: Discussionmentioning

confidence: 99%

Impact of Screening and Follow-up Colonoscopy Adenoma Sensitivity on Colorectal Cancer Screening Outcomes in the CRC-AIM Microsimulation Model

Fisher

Saoud

Lich

et al. 2020

Preprint

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BackgroundReal-world data for patients with positive colorectal cancer (CRC) screening stool-tests demonstrates that adenoma detection rates are lower when endoscopists are blinded to the stool-test results. This suggests adenoma sensitivity may be lower for screening colonoscopy than for follow-up to a known positive stool-based test. Previous CRC microsimulation models assume identical sensitivities between screening and follow-up colonoscopies after positive stool-tests. The Colorectal Cancer and Adenoma Incidence and Mortality Microsimulation Model (CRC-AIM) was used to explore the impact on screening outcomes when assuming different adenoma sensitivity between screening and combined follow-up/surveillance colonoscopies.MethodsModeled screening strategies included colonoscopy every 10 years, triennial multitarget stool DNA (mt-sDNA), or annual fecal immunochemical test (FIT) from 50-75 years. Outcomes were reported per 1,000 individuals without diagnosed CRC at age 40. Base-case adenoma sensitivity values were identical for screening and follow-up/surveillance colonoscopies. Ranges of adenoma sensitivity values for colonoscopy performance were developed using different slopes of odds ratio adjustments and were designated as small, medium, or large impact scenarios.ResultsAs the differences in adenoma sensitivity for screening versus follow-up/surveillance colonoscopies became greater, life-years gained (LYG) and reductions in CRC-related incidence and mortality versus no screening increased for mt-sDNA and FIT and decreased for screening colonoscopy. The LYG relative to screening colonoscopy reached >90% with FIT in the base-case scenario and with mt-sDNA in a “medium impact” scenario.ConclusionsAssuming identical adenoma sensitivities for screening and follow-up/surveillance colonoscopies underestimates the potential benefits of stool-based screening strategies.

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Sessile Serrated Adenomas: How to Detect, Characterize and Resect

Cited by 24 publications

References 119 publications

Estimating the impact of differential adherence on the comparative effectiveness of stool-based colorectal cancer screening using the CRC-AIM microsimulation model

Estimating the impact of differential adherence on the comparative effectiveness of stool-based colorectal cancer screening using the CRC-AIM microsimulation model

Optimal Endoscopic Treatment and Surveillance of Serrated Polyps

Impact of Screening and Follow-up Colonoscopy Adenoma Sensitivity on Colorectal Cancer Screening Outcomes in the CRC-AIM Microsimulation Model

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