Proximal Sessile Serrated Adenomas Are More Prevalent in Caucasians, and Gastroenterologists Are Better Than Nongastroenterologists at Their Detection

Parikh, Malav P.; Muthukuru, Sujit; Jobanputra, Yash; Naha, Kushal; Gupta, Neena; Wadhwa, Vaibhav; López, Rocío; Thota, Prashanthi N.; Sanaka, Madhusudhan R.

doi:10.1155/2017/6710931

Cited by 13 publications

(16 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…45,62,73 Reviews of recently published colonoscopy series studies found that an average 2%-8% of SSLs are detected (akin to prevalence) in average-risk patients undergoing colonoscopy. 8,54,58,62,[73][74][75][76][77][78][79][80][81][82] Among high-detecting endoscopists and centers, however, the reported prevalence values are 13%-20% ( Figure 3A, Supplementary Table 2). 45,54,62,74,78 It is a reasonable assumption that detection of SSLs among high detectors is the best estimate of the true prevalence of these lesions.…”

Section: Prevalence Based On Endoscopic Datamentioning

confidence: 99%

“…69,71 White race is a consistent risk factor for SSLs in US and European studies of average-risk patients, whereas black, Asian, and American Indian/Alaskan Native populations have a lower prevalence. 80,99,100,102,103 In a large US study with data from 1.6 million screening colonoscopies, white men and women were found to have a 2-to 3-fold increase in risk of SSLs compared to black or Asian individuals (Supplementary Figure 1B). 99 Patients with a family history of CRC or a personal history of premalignant serrated polyps also have an increased risk of SSLs.…”

Section: Nonmodifiable Risk Factorsmentioning

confidence: 99%

See 1 more Smart Citation

Terminology, Molecular Features, Epidemiology, and Management of Serrated Colorectal Neoplasia

2019

View full text Add to dashboard Cite

In addition to the adenoma to carcinoma sequence, colorectal carcinogenesis can occur via the serrated pathway. Studies have focused on clarification of categories and molecular features of serrated polyps, as well as endoscopic detection and risk assessment. Guidelines from the World Health Organization propose assigning serrated polyps to categories of hyperplastic polyps, traditional serrated adenomas, and sessile serrated lesions (SSLs). Traditional serrated adenomas and SSLs are precursors to colorectal cancer. The serrated pathway is characterized by mutations in RAS and RAF, disruptions to the Wnt signaling pathway, and widespread methylation of CpG islands. Epidemiology studies of serrated polyps have been hampered by inconsistencies in terminology and reporting, but the prevalence of serrated class polyps is 20%-40% in average-risk individuals; most serrated polyps detected are hyperplastic. SSLs, the most common premalignant serrated subtype, and are found in up to 15% of average-risk patients by highdetecting endoscopists. Variations in rate of endoscopic detection of serrated polyps indicate the need for careful examination, with adequate bowel preparation and sufficient withdrawal times. Risk factors for SSLs include white race, family history of colorectal cancer, smoking, and alcohol intake. Patients with serrated polyps, particularly SSLs and traditional serrated adenomas, have an increased risk of synchronous and metachronous advanced neoplasia. Surveillance guidelines vary among countries, but SSLs and proximal hyperplastic polyps require special attention in assignment of surveillance interval-especially in light of concerns regarding incomplete detection and resection.

show abstract

Section: Prevalence Based On Endoscopic Datamentioning

confidence: 99%

Section: Nonmodifiable Risk Factorsmentioning

confidence: 99%

Terminology, Molecular Features, Epidemiology, and Management of Serrated Colorectal Neoplasia

2019

View full text Add to dashboard Cite

show abstract

“…2,3 However, the racial disparity between African Americans and white Americans in CRC mortality, and prevalence of adenomas and polyps (which are the precursors to CRC) have persisted. 4–7 In addition to race, physician-related factors (e.g., medical specialty) and insurance coverage have also been associated with CRC screening and disease outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…9,10 GEs are more likely than other specialties to remove adenomas and polyps during a colonoscopy. 4,11 Research has also shown that having a GE perform the screening colonoscopy is associated with a lower rate of CRC after a negative colonoscopy. 12,13 Furthermore, CRC patients experience better postoperative outcomes and overall survival when surgery was performed by a CRS than when surgery was performed by a general surgeon.…”

Section: Introductionmentioning

confidence: 99%

Disparities in Utilization of Medical Specialists for Colonoscopy

et al. 2019

View full text Add to dashboard Cite

Purpose: Colonoscopy is the preferred screening modality for colorectal cancer (CRC) prevention. The quality of the procedure varies although medical specialists such as gastroenterologists and colorectal surgeons tend to have better outcomes. We aimed to determine whether there are demographic and clinical differences between those who received a colonoscopy from a specialist versus those who received a colonoscopy from a nonspecialist. Methods: Using the population-based South Carolina Outpatient Ambulatory Surgery Database, we looked retrospectively to obtain patient-level endoscopy records from 2010 to 2014. We used multilevel logistic regression to model whether patients saw a specialist for their colonoscopy. The primary variables were patient race and insurance type, and an interaction by rurality was tested. Results: Of the 392,285 patients included in the analysis, 81% saw a specialist for their colonoscopy. County of residence explained 30% of the variability in the outcome. Non-Hispanic black (OR=0.65; confidence interval [95% CI]: 0.64–0.67) and Hispanic patients (OR=0.75; 95% CI: 0.67–0.84) were significantly less likely than non-Hispanic white patients to see a specialist. Compared with commercial/HMO insurance, all other types were less likely to see a specialist, and even more so for rural patients. The interaction of race by rurality was not significant. Conclusions: Specialists play a key role in CRC screening and can affect later downstream outcomes. This study has shown that ethnic minorities and adults with public or other insurance, particularly in rural areas, are most likely not to see a specialist. These results are consistent with disparities in CRC incidence, mortality, and survival.

show abstract

“…In an evaluation of endoscopist characteristics and their effects on PSPDR, Sarvepalli et al [4] found in multivariate analysis, adjusting for patient and procedural factors, that the only significant factors affecting PSPDR were the length of time since completing training and annual colonoscopy volume-physician specialty-also had no significant effect. In contrast, Parikh et al [7] demonstrated that in the adjusted analysis, gastroenterologists had significantly higher PSPDR compared to non-gastroenterologists for screening colonoscopies. Importantly, prior studies compare cohorts of endoscopists that are more mixed-often combining general surgeons and colorectal surgeons, or all non-gastroenterologists into a single group.…”

mentioning

confidence: 86%