Endoscopy 2018; 50(10): 993-1000
DOI: 10.1055/a-0598-4477
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Detection of clinically relevant serrated polyps during screening colonoscopy: results from seven cooperating centers within the German colorectal screening program

Christoph Schramm
1  Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
,
Katharina Janhsen
2  Department of Gastroenterology and Hepatology, St. Katharinen Hospital, Frechen, Germany
,
Jan-Hinnerk Hofer
3  Magen Darm Zentrum Wiener Platz, Cologne, Germany
,
Hans Toermer
4  GastroPraxis Köln Nord, Cologne, Germany
,
Annette Stelzer
5  Gastroenterologische Schwerpunktpraxis, Mannheim, Germany
,
Frank Stenschke
6  Gastroenterologie Köln West, Cologne, Germany
,
Michael Stollenwerk
7  Praxis Stollenwerk, Cologne, Germany
,
Ingo Scheller
Gastroenterologie Remscheid, Remscheid, Germany
,
Sonja Lang
1  Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
,
Tobias Goeser
1  Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
,
Hans-Michael Steffen
1  Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
› Author Affiliations
Further Information

Publication History

submitted 19 November 2017

accepted after revision 28 February 2018

Publication Date:
04 May 2018 (eFirst)

Abstract

Background Serrated polyps have been recognized as precursors of colorectal cancer (CRC) via the serrated pathway. Endoscopic detection and histopathological evaluation of serrated polyps are challenging. The aims of this study were to determine detection rates of the recently proposed entity of clinically relevant serrated polyps (crSPs) and to identify factors that influence their detection in a primary colonoscopy screening cohort.

Methods We retrospectively analyzed average-risk screening colonoscopies performed at a tertiary academic hospital and six community-based private practices in Germany between 01/01/2012 and 14/12/2016. Exclusion criteria were age < 50 years, conditions with increased risk for CRC (e. g. inflammatory bowel disease, history of CRC, hereditary cancer syndromes), and incomplete procedures. CrSPs were defined as serrated polyps ≥ 10 mm and/or > 5 mm located proximally to the splenic flexure. Conventional adenomas were defined as adenomas excluding serrated polyps.

Results A total of 4161 colonoscopies from average-risk individuals were included (median age 62 years [interquartile range 56 – 69]; 48.6 % male). CrSPs were detected in 6.9 %, with a mean detection rate of 4.7 % (95 % confidence interval 2.3 % – 7.2 %). Detection rates ranged from 0 % to 16.2 %. In multivariate analysis, simultaneous detection of conventional adenomas and an endoscopist adenoma detection rate of ≥ 25 % were significantly associated with increased detection of crSPs, with odds ratios of 1.43 (95 %CI 1.11 – 1.85; P = 0.01) and 7.35 (95 %CI 4.43 – 12.19; P < 0.001). The individual endoscopist’s detection rate for conventional adenomas and crSPs were significantly correlated (r = 0.54, P = 0.02).

Conclusion Detection rates for crSPs differed between participating endoscopists. However, individual skills to detect polypoid lesions have a relevant bearing on the detection rate of crSPs.