Epidemiology of overall and early‐onset serrated polyps versus conventional adenomas in a colonoscopy screening cohort

Abstract

Serrated polyps (SPs) are precursors to one‐third of colorectal cancers (CRCs), with histological subtypes: hyperplastic polyps (HPs), sessile serrated lesions (SSLs) and traditional serrated adenomas (TSAs). The incidence of early‐onset CRC before the age of 50 is increasing, with limited understanding of SPs in younger cohorts. Using a large colonoscopy‐based cohort, we characterized epidemiologic profiles of SP subtypes, compared to conventional adenomas, with secondary analysis on early‐onset polyps. Ninety‐four thousand four hundred and twenty‐seven patients underwent screening colonoscopies between 2010 and 2018. Demographic, endoscopic and histopathologic characteristics of each polyp subtype were described. High‐risk polyps included SSLs ≥10 mm/with dysplasia and conventional adenomas ≥10 mm/with tubulovillous/villous histology/high‐grade dysplasia. We examined polyp prevalence with age and compared early‐ (age < 50) and late‐onset polyps (age ≥ 50). Eighteen thousand one hundred and twenty‐five patients had SPs (4357 SSLs, 15 415 HPs, 120 TSAs) and 26 699 had conventional adenomas. High‐risk SSLs were enriched in the ascending colon (44.1% vs 2.6‐35.8% for other locations; P < .003). Early‐ and late‐onset SPs had similar subsite distribution. Early‐onset conventional adenomas were more enriched in the distal colon/rectum (51.8% vs 43.4%, P < .001). Multiple conventional adenomas were more represented in late‐onset groups (40.8% vs 33.8%, P < .001), with no difference in SSLs. The prevalence of conventional adenomas/high‐risk conventional adenomas increased continuously with age, whereas the prevalence of SSLs/high‐risk SSLs was stable from age 40 years onwards. A higher proportion of women were diagnosed with early‐onset than late‐onset SSLs (62.9% vs 57.6%, P = .03). Conventional adenomas, SSLs, early‐ and late‐onset polyps have distinct epidemiology. The findings have implications for improved colonoscopy screening and surveillance and understanding the etiologic heterogeneity of CRC.

Clinicopathologic and endoscopic features of sessile serrated lesions and conventional adenomas: a large inpatient population-based study in China

“…For endoscopic presentation, our results are generally consistent with previous studies ( 3 , 26 ). We found that compared to CAs, SSLs tended to be larger, predominantly located in the proximal colon, mostly as single lesions, mainly with a flat morphology.…”

Comments on “Epidemiology of overall and early‐onset serrated polyps versus conventional adenomas in a colonoscopy screening cohort”

“…Tomonori Aoki 1 Yoku Hayakawa 1 Ryota Niikura 1,2 Nobumi Suzuki 1 Mitsuhiro Fujishiro 1 1 Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan 2…”

“…

We read the recent publication written by Vithayathil et al 1 with great interest, wherein the authors have conducted a large colonoscopybased cohort study to evaluate epidemiologic profiles of the sessile serrated lesions (SSLs), compared them with conventional adenomas, and performed secondary analysis on early-onset polyps. The prevalence of

…”

Microvesicular hyperplastic polyp and sessile serrated lesion of the large intestine: a biological continuum or separate entities?

“…While microvesicular HPs and SSLs occur more commonly in the left and right colon respectively, both lesions can occur anywhere within the large intestine, and therefore, a specific diagnosis of serrated lesion type is not dependent on its anatomical location 1. For example, a study of over 94 000 screening colonoscopies found the following patterns of distribution of HPs and SSLs in individuals aged over 50 years: HP—proximal colon 26.6%, distal colon 51.5%; rectum 38.6%; SSL—proximal colon 84.4%, distal colon 15.2%, rectum 4.4%) 8…”