Patients with small and diminutive proximal hyperplastic polyps have higher rates of synchronous advanced neoplasia compared with patients without serrated lesions

Hamoudah, Thayer; Ma, Karen; Esteban, Marcus Juan; Hayat, Waqas; Berger, Daniel; Mahon, Brett; Jakate, Shriram; Melson, Joshua

doi:10.1016/j.gie.2017.12.028

Cited by 17 publications

(15 citation statements)

References 25 publications

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“…29 A more recent report suggested that proximal HPs and SSPs irrespective of size were associated with an increase in synchronous advanced neoplasia in the colon. 30 However, detection of SLs remains a challenge for colonoscopists. These lesions are typically flat with indistinct borders and are located in the proximal colon where the bowel preparation quality may be poor; the surface is usually pale and may be obscured/concealed by stool debris or the mucous cap.…”

Section: Discussionmentioning

confidence: 99%

A prospective RCT comparing combined chromoendoscopy with water exchange (CWE) vs water exchange (WE) vs air insufflation (AI) in adenoma detection in screening colonoscopy

Jia

et al. 2019

UEG Journal

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Background A low adenoma detection rate (ADR) increases risks of interval cancers (ICs). Proximal colon flat polyps, e.g. serrated lesions (SLs), are difficult to find. Missed proximal colon flat lesions likely contribute to IC. Aims We compared chromoendoscopy with water exchange (CWE), water exchange (WE) and air insufflation (AI) in detecting adenomas in screening colonoscopy. Methods After split-dose preparation, 480 veterans were randomized to AI, WE and CWE. Results Primary outcome of proximal ADR (55.6% vs 53.4% vs 52.2%, respectively) were similar in all groups. Adenoma per colonoscopy (APC) and adenoma per positive colonoscopy (APPC) were comparable. Detection rate of proximal colon SLs was significantly higher for CWE and WE than AI (26.3%, 23.6% and 11.3%, respectively, p = 0.002). Limitations: single operator; SLs only surrogate markers of but not IC. Conclusions When an endoscopist achieves high-quality AI examinations with overall ADR twice (61.6%) the recommended standard (30%), use of WE and CWE does not produce further improvement in proximal or overall ADR. Comparable APC and APPC confirm equivalent withdrawal inspection techniques. WE alone is sufficient to significantly improve detection of proximal SLs. The impact of increased detection of proximal SLs by WE on prevention of IC deserves to be studied. This study is registered at ClinicalTrial.gov (NCT#01607255).

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Section: Discussionmentioning

confidence: 99%

A prospective RCT comparing combined chromoendoscopy with water exchange (CWE) vs water exchange (WE) vs air insufflation (AI) in adenoma detection in screening colonoscopy

Jia

et al. 2019

UEG Journal

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“…It should be acknowledged that the prospective cohort design as compared to a controlled trial may be limited with regard to possible confounding factors. However, our analysis is similar to that used in the studies cited above 9,10 as well as other studies examining metachronous risk 22,23 . Furthermore, we adjusted for many known CRC risk factors, decreasing the potential that confounding factors may have influenced the results.…”

Section: Accepted Manuscriptmentioning

confidence: 92%

Association of small versus diminutive adenomas and the risk for metachronous advanced adenomas: data from the New Hampshire Colonoscopy Registry

Anderson

Rex

Robinson³

et al. 2019

Gastrointestinal Endoscopy

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Background and Aims Limited data are available to investigate the impact of index adenoma size on the risk of metachronous advanced adenomas. Our goal was to examine the impact of having small (5-9 mm) versus diminutive (<5 mm) adenomas on the future risk of advanced adenomas within the categories for polyps <1cm currently used in the United States: 1 to 2 and 3 or more tubular adenomas. Methods We included data from individuals participating in the statewide, population-based New Hampshire Colonoscopy Registry (NHCR). Groups were based on index findings: (1) 1 to 2 adenomas <5 mm (both diminutive), (2) 1 to 2 adenomas <1 cm (one or both small), (3) 3 to 10 adenomas <5 mm (all diminutive), (4) 3 to 10 adenomas <1 cm (one or more small), and (5) advanced adenomas (AA). AAs were defined as adenomas >1cm or those with villous elements or high-grade dysplasia and colorectal cancer (CRC). Outcomes were the absolute and adjusted risk of metachronous advanced adenomas. Covariates included age, sex, body mass index, family history of CRC, lifestyle factors, presence of serrated polyps, and time since the index examination. Results After adjusting for the covariates, we observed that having 1 to 2 adenomas with at least one 5 to 9 mm adenoma (adjusted odds ratio [AOR], 1.54; 95% CI, 1.12-2.11), 3 to 10 diminutive adenomas (AOR, 1.75; 95% CI, 1.03-2.95), 3 to 10 adenomas <1 cm (1 or more small) (AOR, 2.14; 95% CI, 1.39-3.29) or advanced adenomas (AOR, 2.77; 95% CI, 2.05-3.74) were associated with an increased risk for metachronous AA as compared with having 1 to 2 diminutive adenomas. A further stratification of Group 2 observed that those with exactly 2 small adenomas had an absolute risk of future AA of 7.6% (11/144) (95% CI, 4.3%-13.2%), higher than the absolute risk in the 1 to 2 diminutive polyp group, and similar to the risk for 3 to 10 adenomas 8.2 (95% CI, 5.4-11.9). Conclusions For individuals with 1 to 2 adenomas <1 cm, having at least 1 small adenoma increased the metachronous risk of AA compared to having only diminutive adenomas. Furthermore, the subset with 2 small adenomas had a risk of future AA similar to the risk for 3 to 10 adenomas. These data suggest that individuals with at least 1 small adenoma may be at higher risk for future advanced adenomas and thus require closer follow-up than those with only diminutive adenomas. These data may be valuable to guideline committees for the creation of future surveillance recommendations. Background Colorectal cancer (CRC) is the second most common cause of death from cancer in the United States 1 , despite being a preventable disease. The key to prevention lies in delivery of appropriate and timely screening and surveillance colonoscopies, and development of appropriate guideline recommendations for prevention requires evidence to inform those guidelines. Colonoscopy is the most common form of CRC screening in the United States, and surveillance colonoscopies, which are follow-up colonoscopies in individuals found to have

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“…These lesions, that are histologically characterized by a “serrated” (or saw-toothed) appearance of the epithelial glandular crypts within the precursor polyps, have long been considered innocuous [31,32,33,34]. Nevertheless, serrated lesions are among the main causes of the “interval” CRCs and are associated with synchronous and metachronous advanced colorectal neoplasia [35,36].…”

Section: Introductionmentioning

confidence: 99%

The Molecular Hallmarks of the Serrated Pathway in Colorectal Cancer

Palma

D’Argenio

Pol

et al. 2019

Cancers

146

102

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Colorectal cancer (CRC) is a leading cause of cancer death worldwide. It includes different subtypes that differ in their clinical and prognostic features. In the past decade, in addition to the conventional adenoma-carcinoma model, an alternative multistep mechanism of carcinogenesis, namely the “serrated pathway”, has been described. Approximately, 15 to 30% of all CRCs arise from neoplastic serrated polyps, a heterogeneous group of lesions that are histologically classified into three morphologic categories: hyperplastic polyps, sessile serrated adenomas/polyps, and the traditional serrated adenomas/polyps. Serrated polyps are characterized by genetic (BRAF or KRAS mutations) and epigenetic (CpG island methylator phenotype (CIMP)) alterations that cooperate to initiate and drive malignant transformation from normal colon mucosa to polyps, and then to CRC. The high heterogeneity of the serrated lesions renders their diagnostic and pathological interpretation difficult. Hence, novel genetic and epigenetic biomarkers are required for better classification and management of CRCs. To date, several molecular alterations have been associated with the serrated polyp-CRC sequence. In addition, the gut microbiota is emerging as a contributor to/modulator of the serrated pathway. This review summarizes the state of the art of the genetic, epigenetic and microbiota signatures associated with serrated CRCs, together with their clinical implications.

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Patients with small and diminutive proximal hyperplastic polyps have higher rates of synchronous advanced neoplasia compared with patients without serrated lesions

Cited by 17 publications

References 25 publications

A prospective RCT comparing combined chromoendoscopy with water exchange (CWE) vs water exchange (WE) vs air insufflation (AI) in adenoma detection in screening colonoscopy

A prospective RCT comparing combined chromoendoscopy with water exchange (CWE) vs water exchange (WE) vs air insufflation (AI) in adenoma detection in screening colonoscopy

Association of small versus diminutive adenomas and the risk for metachronous advanced adenomas: data from the New Hampshire Colonoscopy Registry

The Molecular Hallmarks of the Serrated Pathway in Colorectal Cancer

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