Background and Aims
Sessile serrated adenomas (SSAs) are precursors of 15% to 30% of colorectal cancers
but are frequently underdiagnosed. We sought to measure the SSA detection rate (SDR)
and predictors of SSA detection after educational training for community gastroenterologists
and pathologists.
Methods
Colonoscopy and pathology data (2010-2014) from 3 medical centers at Kaiser Permanente
Northern California were accessed electronically. Gastroenterologists and pathologists
attended a training session on SSA diagnosis in 2012. Mean SDRs and patient-level
predictors of SSA detection post-training (2013-2014) were investigated.
Results
Mean SDRs increased from .6% in 2010-2012 to 3.7% in 2013-2014. The increase in the
detection of proximal SSAs was accompanied by a decrease in the detection of proximal
hyperplastic polyps (HPs). Among 34,161 colonoscopies performed in 2013 to 2014, SDRs
for screening, fecal immunochemical test positivity, surveillance, and diagnostic
indication were 4.2%, 4.5%, 4.9%, and 3.0%, respectively. SSA detection was lower
among Asians (adjusted odds ratio [aOR], .46; 95% confidence interval [CI], .31-.69)
and Hispanics (aOR, .59; 95% CI, .36-.95) compared with non-Hispanic whites and higher
among patients with synchronous conventional adenoma (aOR, 1.46; 95% CI, 1.15-1.86),
HP (aOR, 1.74; 95% CI, 1.30-2.34), and current smokers (aOR, 1.78; 95% CI, 1.17-2.72).
SDRs varied widely among experienced gastroenterologists, even after training (1.1%-8.1%).
There was a moderately strong correlation between adenoma detection rate (ADR) and
SDR for any SSA (r = .64, P = .0003) and for right-sided SSAs (r = .71, P < .0001).
Conclusions
Educational training significantly increased the detection of SSA, but a wide variation
in SDR remained across gastroenterologists. SSA detection was inversely associated
with Asian and Hispanic race/ethnicity and positively associated with the presence
of conventional adenoma, HP, and current smoking. There was a moderately strong correlation
between ADR and SDR.
Abbreviations:
ADR ((conventional) adenoma detection rate), BMI (body mass index), CRC (colorectal cancer), FIT (fecal immunochemical test), HP (hyperplastic polyp), KPNC (Kaiser Permanente Northern California), R-SDR (right-sided sessile serrated adenoma detection rate), SDR (sessile serrated adenoma detection rate), SSA (sessile serrated adenoma), TSA (traditional serrated adenoma)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 23, 2017
Accepted:
August 6,
2017
Received:
June 11,
2017
Footnotes
DISCLOSURE: The following author received research support for this study from Kaiser Permanente Community Benefit Grant: D. Li. All other authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Li at [email protected]
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© 2018 by the American Society for Gastrointestinal Endoscopy
