Endoscopic red flags for the detection of high-risk serrated polyps: an observational study

Rondagh, Eveline J.A.; Masclee, Ad; Bouwens, Mariëlle; Winkens, Björn; Riedl, Robert G.; Bruïne, Adriaan P. de; Ridder, Rogier de; Kaltenbach, Tonya; Soetikno, Roy; Sanduleanu, Silvia

doi:10.1055/s-0030-1256770

Cited by 29 publications

(27 citation statements)

References 29 publications

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“…In the present study, we found that patients with 1 LPD SP significantly more frequently had adenomas and advanced adenomas compared with patients with nondysplastic small distal or no serrated polyps, which is in line with previous data by us (5) and others (31,32). Taken together, these data suggest that older age, prior history of serrated polyps, current smoking, and nondaily/no aspirin use, as well as presence of adenomas, may define a risk phenotype which is associated with synchronous LPD SPs.…”

Section: Discussionsupporting

confidence: 93%

“…This observation is of relevance as it may highlight a subgroup of patients in whom multiplicity of lesions may require personalized surveillance, with regard to the frequency of examination or technique used (i.e., chromoendoscopy, either dye-based or digital-based techniques). In a previous study by our group, we found that presence of (advanced) adenomas during colonoscopic examination might be considered a "red flag" for synchronous serrated polyps (5). The SP risk score proposed in the current study extends these observations, by identifying an a priori risk profile for having 1 LPD SP.…”

Section: Discussionsupporting

confidence: 66%

“…As a strength, all endoscopists were familiarized with the recognition of nonpolypoid colorectal lesions before commencing this study. This was essential, as nearly half of the serrated polyps have a nonpolypoid appearance (5,6). We used a standardized endoscopic reporting system, including quality benchmarking, and applied the WHO histologic classification of serrated polyps.…”

Section: Discussionmentioning

confidence: 99%

“…The serrated neoplastic pathway may contribute to the occurrence of some postcolonoscopy cancers, as some precursor lesions, especially sessile serrated adenomas/polyps (SSA/P), are easily overlooked during colonoscopy (5,6) and are more challenging to remove endoscopically (7). It is generally accepted that large, proximal, or dysplastic (LPD) serrated polyps (SP) purport significant risk for malignant transformation, whereas nondysplastic small distal serrated polyps do not (8)(9)(10)(11).…”

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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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

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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“…Multiple lines of evidence suggest that the serrated pathway to colorectal cancer occurs primarily in the proximal colon. 3 Like others, [25][26][27][28] we found that patients with SPS very commonly had synchronous or metachronous conventional adenomas.…”

Section: Discussionsupporting

confidence: 79%

Failure to recognize serrated polyposis syndrome in a cohort with large sessile colorectal polyps

Vemulapalli¹,

Rex²

2012

Gastrointestinal Endoscopy

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Serrated polyps of the large intestine: current understanding of diagnosis, pathogenesis, and clinical management

et al. 2012

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Approximately 30 % of colorectal carcinomas develop via the serrated neoplasia pathway characterized by widespread DNA methylation and frequent BRAF mutation. Serrated polyps represent a heterogeneous group of polyps which are the precursor lesions to serrated pathway colorectal carcinomas. The histological classification of serrated polyps has evolved over the last two decades to distinguish three separate entities: hyperplastic polyp, sessile serrated adenoma (SSA), and traditional serrated adenoma (TSA). The malignant potential of SSAs and TSAs has been clearly demonstrated. SSAs are more challenging to detect by colonoscopy and are likely to account for some interval carcinomas of the proximal colon. Serrated polyposis syndrome is now widely recognized as conferring a high risk of colorectal carcinoma although its cause remains elusive. The current understanding of the actual malignant potential of each serrated polyp subtype is still limited due to the lack of large-scale prospective studies. Patient management guidelines have been recently updated although high-level evidence to support them is still required.

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Endoscopic red flags for the detection of high-risk serrated polyps: an observational study

Cited by 29 publications

References 29 publications

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

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

Failure to recognize serrated polyposis syndrome in a cohort with large sessile colorectal polyps

Serrated polyps of the large intestine: current understanding of diagnosis, pathogenesis, and clinical management

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