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
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancer statistics, 2016.CA Cancer J Clin. 2016; 66: 7-30
- Serrated lesions of the colorectum: review and recommendations from an expert panel.Am J Gastroenterol. 2012; 107 (quiz 1314, 1330): 1315-1329
- Increased risk of colorectal cancer development among patients with serrated polyps.Gastroenterology. 2016; 150: 895-902
- A morphologic analysis of sessile serrated polyps observed during routine colonoscopy (with video).Gastrointest Endosc. 2011; 74: 1360-1368
- Distinct CpG island methylation profiles and BRAF mutation status in serrated and adenomatous colorectal polyps.Int J Cancer. 2008; 123: 2587-2593
- Serrated polyps of the large intestine: a morphologic and molecular review of an evolving concept.Am J Clin Pathol. 2005; 124: 380-391
- Morphologic reappraisal of serrated colorectal polyps.Am J Surg Pathol. 2003; 27: 65-81
- Role of the serrated pathway in colorectal cancer pathogenesis.Gastroenterology. 2010; 138: 2088-2100
- Colorectal endoscopy, advanced adenomas, and sessile serrated polyps: implications for proximal colon cancer.Am J Gastroenterol. 2012; 107: 1213-1219
- Endoscopic detection of proximal serrated lesions and pathologic identification of sessile serrated adenomas/polyps vary on the basis of center.Clin Gastroenterol Hepatol. 2014; 12: 1119-1126
- Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy.Clin Gastroenterol Hepatol. 2011; 9: 42-46
- High colonoscopic prevalence of proximal colon serrated polyps in average-risk men and women.Gastrointest Endosc. 2012; 75: 515-520
- Prevalence, distribution and risk of sessile serrated adenomas/polyps at a center with a high adenoma detection rate and experienced pathologists.Endoscopy. 2016; 48: 740-746
- The proximal serrated polyp detection rate is an easy-to-measure proxy for the detection rate of clinically relevant serrated polyps.Gastrointest Endosc. 2015; 82: 870-877
- Sessile serrated polyp prevalence determined by a colonoscopist with a high lesion detection rate and an experienced pathologist.Gastrointest Endosc. 2015; 81: 517-524
- Differences in detection rates of adenomas and serrated polyps in screening versus surveillance colonoscopies, based on the New Hampshire Colonoscopy Registry.Clin Gastroenterol Hepatol. 2013; 11: 1308-1312
- Providing data for serrated polyp detection rate benchmarks: an analysis of the New Hampshire Colonoscopy Registry.Gastrointest Endosc. 2017; 85: 1188-1194
- Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer.Gastroenterology. 2012; 143: 844-857
Gordon NP. Similarity of the adult Kaiser Permanente membership in Northern California to the insured and general population in northern California: statistics from the 2009 California Health Interview Survey. Internal Division of Research report. Oakland, CA: Kaiser Permanente Division of Research; January 24, 2012. Available at: https://pdfs.semanticscholar.org/9f32/4cdc735ed84604311eeac46a0c024369b283.pdf. Accessed January 24, 2012.
- Current procedural terminology 2011 professional edition. American Medical Association Press, Chicago, IL2010
- Development and validation of an algorithm for classifying colonoscopy indication.Gastrointest Endosc. 2015; 81: 575-582
- Adenoma detection rate and risk of colorectal cancer and death.N Engl J Med. 2014; 370: 1298-1306
- Progress in medical information management. Systematized nomenclature of medicine (SNOMED).JAMA. 1980; 243: 756-762
- Variation of adenoma prevalence by age, sex, race, and colon location in a large population: implications for screening and quality programs.Clin Gastroenterol Hepatol. 2013; 11: 172-180
- Reliability of adenoma detection rate is based on procedural volume.Gastrointest Endosc. 2013; 77: 376-380
- Gender as a risk factor for advanced neoplasia and colorectal cancer: a systematic review and meta-analysis.Clin Gastroenterol Hepatol. 2009; 7: 676-681
- Reproduction, endogenous and exogenous sex hormones, and colon cancer: a review and hypothesis.J Natl Cancer Inst. 1980; 65: 1201-1207
- Estrogen plus progestin use, microsatellite instability, and the risk of colorectal cancer in women.Cancer Res. 2007; 67: 7534-7539
- Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial.JAMA. 2002; 288: 321-333
- Alcohol intake and colorectal cancer: a pooled analysis of 8 cohort studies.Ann Intern Med. 2004; 140: 603-613
- Cigarette smoking and adenomatous polyps: a meta-analysis.Gastroenterology. 2008; 134: 388-395
- Association between body size and colorectal adenoma recurrence.Clin Gastroenterol Hepatol. 2007; 5: 982-990
- Gender-related survival differences associated with EGFR polymorphisms in metastatic colon cancer.Cancer Res. 2008; 68: 3037-3042
- Association of large serrated polyps with synchronous advanced colorectal neoplasia.Am J Gastroenterol. 2009; 104: 695-702
- Modifiable lifestyle factors associated with risk of sessile serrated polyps, conventional adenomas and hyperplastic polyps.Gut. 2016; 0: 1-10
- Differences in epidemiologic risk factors for colorectal adenomas and serrated polyps by lesion severity and anatomical site.Am J Epidemiol. 2013; 177: 625-637
- Adenoma detection rates for screening colonoscopies in smokers and obese adults: data from the New Hampshire Colonoscopy Registry.J Clin Gastroenterol. 2017; https://doi.org/10.1097/MCG.0000000000000795
- Risk of microsatellite-unstable colorectal cancer is associated jointly with smoking and nonsteroidal anti-inflammatory drug use.Cancer Res. 2006; 66: 6877-6883
- Race and prevalence of large bowel polyps among the low-income and uninsured in South Carolina.Dig Dis Sci. 2016; 61: 265-272
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] .
Identification
Copyright
© 2018 by the American Society for Gastrointestinal Endoscopy
