Endoscopy 2018; 50(11): 1080-1088
DOI: 10.1055/a-0596-7231
Original article
© Georg Thieme Verlag KG Stuttgart · New York

The clinical significance and synchronous polyp burden of large (≥ 20 mm) sessile serrated polyps in patients without serrated polyposis syndrome

Lobke Desomer
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
,
David J. Tate
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
2   Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia
,
Mahesh Jayanna
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
,
Maria Pellise
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
,
Halim Awadie
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
,
Nicholas G. Burgess
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
2   Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia
,
Duncan McLeod
3   Westmead Clinical School, University of Sydney, Sydney, Australia
,
Hema Mahajan
3   Westmead Clinical School, University of Sydney, Sydney, Australia
,
Eric Y. T. Lee
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
,
Stephen J. Williams
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
,
Michael J. Bourke
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
2   Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia
› Author Affiliations
Further Information

Publication History

submitted 01 October 2017

accepted after revision 28 February 2018

Publication Date:
08 May 2018 (online)

Abstract

Background Sessile serrated polyps (SSPs) are important precursors of colorectal carcinoma and interval cancer. Large SSPs (≥ 20 mm) outside the definition of serrated polyposis syndrome (SPS) have not been studied in comparison with SPS. We aimed to describe the characteristics of patients with large SSPs in this context.

Methods Patients with at least one SSP (≥ 20 mm) were eligible. Data from three consecutive colonoscopies were used to compare clinical and endoscopic characteristics in three patient groups: SPS, a solitary large SSP, and patients with at least two SSPs without fulfilling the criteria for SPS (oligo-SSP). Data on the diagnostic colonoscopy were collected retrospectively, whereas the remaining data was collected prospectively.

Results 67/146 patients (45.9 %) had SPS, 53/146 (36.3 %) had a solitary SSP, and 26/146 (17.8 %) were categorized as oligo-SSP. Personal (16.4 %, 9.4 %, and 11.5 %, respectively) and family (17.9 %, 17.0 %, and 23.1 %, respectively) history of colorectal carcinoma did not differ significantly between groups. Polyp burden was greater in SPS compared with solitary SSP but was not different from oligo-SSP (advanced adenomas: SPS 32.8 % vs. solitary SSP 9.4 % [P = 0.002] vs. oligo-SSP 34.6 % [P = 0.87]; ≥ 10 conventional adenomas: 11.9 % vs. 0 % [P = 0.01] vs. 3.8 % [P = 0.44], respectively). Dysplasia in large SSPs was frequent in all groups (41.1 % overall). SPS was recognized by referring endoscopists in only 9.0 % of cases.

Conclusion Patients with oligo-SSPs have similar synchronous polyp burden and clinical characteristics as patients with SPS and may require similar surveillance. Modification of the criteria for the diagnosis of SPS to include this group seems warranted. Patients with a solitary SSP have a lower risk of synchronous polyps, including advanced adenomas. Larger studies are warranted to determine whether these patients may return to standard surveillance following complete examination and clearance of the colon.

 
  • References

  • 1 Torlakovic E, Skovlund E, Snover DC. et al. Morphologic reappraisal of serrated colorectal polyps. Am J Surg Pathol 2003; 27: 65-81
  • 2 Rex DK, Ahnen DJ, Baron JA. et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol 2012; 107: 1315-1329
  • 3 O’Brien MJ, Zhao Q, Yang S. Colorectal serrated pathway cancers and precursors. Histopathology 2015; 66: 49-65
  • 4 Arain MA, Sawhney M, Sheikh S. et al. CIMP status of interval colon cancers: another piece to the puzzle. Am J Gastroenterol 2010; 105: 1189-1195
  • 5 Schreiner MA, Weiss DG, Lieberman DA. Proximal and large hyperplastic and nondysplastic serrated polyps detected by colonoscopy are associated with neoplasia. Gastroenterology 2010; 139: 1497-1502
  • 6 Burgess NG, Pellise M, Nanda KS. et al. Clinical and endoscopic predictors of cytological dysplasia or cancer in a prospective multicentre study of large sessile serrated adenomas/polyps. Gut 2016; 65: 437-446
  • 7 Burnett-Hartman AN, Newcomb PA, Potter JD. et al. Genomic aberrations occurring in subsets of serrated colorectal lesions but not conventional adenomas. Cancer Res 2013; 73: 2863-2872
  • 8 Bettington M, Walker N, Clouston A. et al. The serrated pathway to colorectal carcinoma: current concepts and challenges. Histopathology 2013; 62: 367-386
  • 9 Leggett B, Whitehall V. Role of the serrated pathway in colorectal cancer pathogenesis. Gastroenterology 2010; 138: 2088-2100
  • 10 Hazewinkel Y, De Wijkerslooth TR, Stoop EM. et al. Prevalence of serrated polyps and association with synchronous advanced neoplasia in screening colonoscopy. Endoscopy 2014; 46: 219-224
  • 11 Li D, Jin C, McCulloch C. et al. Association of large serrated polyps with synchronous advanced colorectal neoplasia. Am J Gastroenterol 2009; 104: 695-702
  • 12 Snover DC. Update on the serrated pathway to colorectal carcinoma. Hum Pathol 2011; 42: 1-10
  • 13 Guarinos C, Sánchez-Fortún C, Rodríguez-Soler M. et al. Clinical subtypes and molecular characteristics of serrated polyposis syndrome. Clin Gastroenterol Hepatol 2013; 11: 705-711
  • 14 Boparai KS, Mathus-Vliegen EMH, Koornstra JJ. et al. Increased colorectal cancer risk during follow-up in patients with hyperplastic polyposis syndrome: a multicentre cohort study. Gut 2010; 59: 1094-1100
  • 15 Hazewinkel Y, Tytgat KMAJ, Van Eeden S. et al. Incidence of colonic neoplasia in patients with serrated polyposis syndrome who undergo annual endoscopic surveillance. Gastroenterology 2014; 147: 88-95
  • 16 Ng SC, Ching JYL, Chan VCW. et al. Association between serrated polyps and the risk of synchronous advanced colorectal neoplasia in average-risk individuals. Aliment Pharmacol Ther 2015; 41: 108-115
  • 17 Hiraoka S, Kato J, Fujiki S. et al. The presence of large serrated polyps increases risk for colorectal cancer. Gastroenterology 2010; 139: 1503-1510
  • 18 Álvarez C, Andreu M, Castells A. et al. Relationship of colonoscopy-detected serrated polyps with synchronous advanced neoplasia in average-risk individuals. Gastrointest Endos 2013; 78: 333-341.e1
  • 19 Nishihara R, Wu K, Lochhead P. et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 2013; 369: 1095-1105
  • 20 Egoavil C, Juárez M, Guarinos C. et al. Increased risk of colorectal cancer in patients with multiple serrated polyps and their first-degree relatives. Gastroenterology 2017; 153: 106-112.e2
  • 21 Anderson MA, Ben-Menachem T, Gan SI. et al. Management of antithrombotic agents for endoscopic procedures. Gastrointest Endosc 2009; 70: 1060-1070
  • 22 Holt BA, Bourke MJ. Wide field endoscopic resection for advanced colonic mucosal neoplasia: current status and future directions. Clin Gastroenterol Hepatol 2012; 10: 969-979
  • 23 Lieberman DA, Rex DK, Winawer SJ. et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143: 844-857
  • 24 Heitman SJ, Ronksley PE, Hilsden RJ. et al. Prevalence of adenomas and colorectal cancer in average risk individuals: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2009; 7: 1272-1278
  • 25 IJspeert JEG, Rana SAQ, Atkinson NSS. et al. Clinical risk factors of colorectal cancer in patients with serrated polyposis syndrome: a multicentre cohort analysis. Gut 2017; 66: 278-284
  • 26 Carballal S, Rodriguez-Alcalde D, Moreira L. et al. Colorectal cancer risk factors in patients with serrated polyposis syndrome: a large multicentre study. Gut 2016; 65: 1829-1837
  • 27 IJspeert JEG, Bevan R, Senore C. et al. Detection rate of serrated polyps and serrated polyposis syndrome in colorectal cancer screening cohorts: a European overview. Gut 2017; 66: 1225-1232
  • 28 Bettington M, Walker N, Rosty C. et al. Clinicopathological and molecular features of sessile serrated adenomas with dysplasia or carcinoma. Gut 2017; 66: 97-106
  • 29 Crockett SD, Snover DC, Ahnen DJ. et al. Sessile serrated adenomas: an evidence-based guide to management. Clin Gastroenterol Hepatol 2015; 13: 11-26.e11
  • 30 Holme Ø, Bretthauer M, Eide TJ. et al. Long-term risk of colorectal cancer in individuals with serrated polyps. Gut 2015; 64: 929-936
  • 31 Bailie L, Loughrey MB, Coleman HG. Lifestyle risk factors for serrated colorectal polyps: a systematic review and meta-analysis. Gastroenterology 2017; 152: 92-104
  • 32 Vemulapalli KC, Rex DK. Failure to recognize serrated polyposis syndrome in a cohort with large sessile colorectal polyps. Gastrointest Endosc 2012; 75: 1206-1210
  • 33 Anderson JC, Butterly LF, Weiss JE. et al. Providing data for serrated polyp detection rate benchmarks: an analysis of the New Hampshire Colonoscopy Registry. Gastrointest Endosc 2017; 85: 1188-1194