Relationship of colonoscopy-detected serrated polyps with synchronous advanced neoplasia in average-risk individuals

• Published in: Gastrointestinal endoscopy Vol. 78; no. 2; pp. 333 - 341.e1
• Main Authors: Álvarez, Cristina, MD, Andreu, Montserrat, MD, Castells, Antoni, MD, Quintero, Enrique, MD, Bujanda, Luis, MD, Cubiella, Joaquín, MD, Salas, Dolores, MD, Lanas, Ángel, MD, Carballo, Fernando, MD, Morillas, Juan Diego, MD, Hernández, Cristina, BSc, Jover, Rodrigo, MD, Sarasqueta, Cristina, MD, Enriquéz-Navascués, José M., MD, Hernández, Vicent, MD, Estévez, Pamela, MD, Macenlle, Ramiro, MD, Sala, Teresa, MD, Balaguer, Francesc, MD, Pellisé, Maria, MD, Moreira, Leticia, MD, Gil, Inés, MD, Peris, Antonio, MD, González-Rubio, Francisca, MD, Ferrández, Ángel, MD, Poves, Carmen, MD, Ponce, Marta, MD, Grau, Jaume, MD, Serradesanferm, Anna, RN, Ono, Akiko, MD, Cruzado, José, MD, Pérez-Riquelme, Francisco, MD, Alonso-Abreu, Inmaculada, MD, Carrillo-Palau, Marta, MD, Santander, Cecilio, MD, Díaz Tasende, José, MD, Herreros, Alberto, MD, Cacho, Guillermo, MD, Barranco, Luis Eugenio, MD, Bessa, Xavier, MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01-08-2013
• Subjects: Adenoma - diagnosis; Adenoma - pathology; Aged; Carcinoma - diagnosis; Carcinoma - pathology; Colonic Neoplasms - diagnosis; Colonic Neoplasms - pathology; Colonic Polyps - diagnosis; Colonic Polyps - pathology; Colonoscopy; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - pathology; Female; Gastroenterology and Hepatology; Humans; Male; Mass Screening; Middle Aged; Neoplasms, Multiple Primary - diagnosis; Neoplasms, Multiple Primary - pathology; Risk Factors; Sex Factors; SSA; traditional serrated adenoma; colorectal cancer; TSA; hyperplastic polyp; HP; LSP; CRC; CIMP; sessile serrated adenoma; large serrated polyp; high degree of microsatellite instability; CpG island methylation phenotype; MSI-H
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2013.03.003

Background Serrated cancers account for 10% to 20% of all colorectal cancers (CRC) and more than 30% of interval cancers. The presence of proximal serrated polyps and large (≥10 mm) serrated polyps (LSP) has been correlated with colorectal neoplasia. Objective To evaluate the prevalence of serrated polyps and their association with synchronous advanced neoplasia in a cohort of average-risk population and to assess the efficacy of one-time colonoscopy and a biennial fecal immunochemical test for reducing CRC-related mortality. This study focused on the sample of 5059 individuals belonging to the colonoscopy arm. Design Multicenter, randomized, controlled trial. Setting The ColonPrev study, a population-based, multicenter, nationwide, randomized, controlled trial. Patients A total of 5059 asymptomatic men and women aged 50 to 69 years. Intervention Colonoscopy. Main Outcome Measurements Prevalence of serrated polyps and their association with synchronous advanced neoplasia. Results Advanced neoplasia was detected in 520 individuals (10.3%) (CRC was detected in 27 [0.5%] and advanced adenomas in 493 [9.7%]). Serrated polyps were found in 1054 individuals (20.8%). A total of 329 individuals (6.5%) had proximal serrated polyps, and 90 (1.8%) had LSPs. Proximal serrated polyps or LSPs were associated with male sex (odds ratio [OR] 2.08, 95% confidence interval [CI], 1.76-4.45 and OR 1.65, 95% CI, 1.31-2.07, respectively). Also, LSPs were associated with advanced neoplasia (OR 2.49, 95% CI, 1.47-4.198), regardless of their proximal (OR 4.15, 95% CI, 1.69-10.15) or distal (OR 2.61, 95% CI, 1.48-4.58) locations. When we analyzed subtypes of serrated polyps, proximal hyperplasic polyps were related to advanced neoplasia (OR 1.61, 95% CI, 1.13-2.28), although no correlation with the location of the advanced neoplasia was observed. Limitations Pathology criteria for the diagnosis of serrated polyps were not centrally reviewed. The morphology of the hyperplasic polyps (protruded or flat) was not recorded. Finally, because of the characteristics of a population-based study carried out in average-risk patients, the proportion of patients with CRC was relatively small. Conclusion LSPs, but not proximal serrated polyps, are associated with the presence of synchronous advanced neoplasia. Further studies are needed to determine the risk of proximal hyperplastic polyps.