Variation in the Detection of Serrated Polyps in an Average Risk Colorectal Cancer Screening Cohort

Abstract

This study describes the detection of colorectal polyps in an average risk-screening cohort at an urban academic medical center. Detection of proximal SSAs increased during the study period. Detection of adenoma, HP, and SSA differed significantly by endoscopist. Classification of HP and SSA differed significantly by pathologist. Endoscopy and pathology practices should consider educational interventions to improve serrated polyp detection and standardize classification.

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

“…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.…”

“…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).…”

“…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). In this context, the simple clinical score described in our study, might be a useful tool as we assume that a priori estimation of the risk for having LPD SPs may increase the awareness of the endoscopist to detect such lesions, through careful examination of the proximal colon (i.e., longer withdrawal time, twice examination or retroflexion, use of selective dye-based or digital chromoendoscopy, or perhaps, additional tools, such as caps or endocuffs; ref.…”

“…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).…”

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

“…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.…”