Prevalence and predictive factors of colorectal sessile serrated lesions in younger individuals

Jen-Hao Yeh; Chih-Wen Lin; Po-Jen Hsiao; Daw-Shyong Perng; Jen-Chieh Chen; Kuo-Tung Hung; Chia-Chang Hsu; Chia-Chi Chen; Yu-Peng Liu; Yi-Chia Lee; Jaw-Yuan Wang

doi:10.1055/a-2272-1911

Endoscopy, Table of Contents

CC BY-NC-ND 4.0 · Endoscopy 2024; 56(07): 494-502
DOI: 10.1055/a-2272-1911

Original article

Prevalence and predictive factors of colorectal sessile serrated lesions in younger individuals

Jen-Hao Yeh

¹Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (Ringgold ID: RIN38023)

²Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da DaChang Hospital, I-Shou University, Kaohsiung, Taiwan

,

Chih-Wen Lin

³Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan

,

Po-Jen Hsiao

²Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da DaChang Hospital, I-Shou University, Kaohsiung, Taiwan

,

Daw-Shyong Perng

³Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan

,

Jen-Chieh Chen

⁴Department of Health Examination, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan

,

Kuo-Tung Hung

²Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da DaChang Hospital, I-Shou University, Kaohsiung, Taiwan

,

Chia-Chang Hsu

⁴Department of Health Examination, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan

,

Chia-Chi Chen

⁵Department of Pathology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan

,

Yu-Peng Liu

¹Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (Ringgold ID: RIN38023)

⁶Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (Ringgold ID: RIN38023)

,

Yi-Chia Lee

⁷Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

,

Jaw-Yuan Wang

¹Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (Ringgold ID: RIN38023)

⁸Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

⁹Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan (Ringgold ID: RIN38023)

› Author Affiliations

Abstract

Background Sessile serrated lesions (SSLs) are obscured lesions predominantly in the right-sided colon and associated with interval colorectal cancer; however, their prevalence and risk factors among younger individuals remain unclear.

Methods This retrospective study enrolled individuals who underwent index colonoscopy. The primary outcome was the SSL prevalence in the younger (<50 years) and older (≥50 years) age groups, while the secondary outcomes included clinically significant serrated polyps (CSSPs). Multivariable logistic regression was employed to identify predictors.

Results Of the 9854 eligible individuals, 4712 (47.8%) were categorized into the younger age group. Individuals in the younger age group exhibited lower prevalences of adenomas (22.6% vs. 46.2%; P<0.001) and right-sided adenomas (11.2% vs. 27.2%; P<0.001) compared with their older counterparts. However, both groups exhibited a similar prevalence of SSLs (7.2% vs. 6.5%; P=0.16) and CSSPs (10.3% vs. 10.3%;P=0.96). Multivariable analysis revealed that age 40–49 years (odds ratio [OR] 1.81, 95%CI 1.01–3.23), longer withdrawal time (OR 1.17, 95%CI 1.14–1.20, per minute increment), and endoscopist performance (OR 3.35, 95%CI 2.44–4.58) were independent predictors of SSL detection in the younger age group. No significant correlation was observed between adenoma and SSL detection rates among endoscopists.

Conclusion SSLs are not uncommon among younger individuals. Moreover, diligent effort and expertise are of paramount importance in SSL detection. Future studies should explore the clinical significance of SSLs in individuals of younger age.

Full Text

References

References
1 Arnold M, Sierra MS, Laversanne M. et al. Global patterns and trends in colorectal cancer incidence and mortality. Gut 2017; 66: 683-691
2 Cardoso R, Guo F, Heisser T. et al. Colorectal cancer incidence, mortality, and stage distribution in European countries in the colorectal cancer screening era: an international population-based study. Lancet Oncol 2021; 22: 1002-1013
3 Wong MC, Huang J, Lok V. et al. Differences in incidence and mortality trends of colorectal cancer worldwide based on sex, age, and anatomic location. Clin Gastroenterol Hepatol 2021; 19: 955-966.e961
4 Murcia O, Juárez M, Hernández-Illán E. et al. Serrated colorectal cancer: Molecular classification, prognosis, and response to chemotherapy. World J Gastroenterol 2016; 22: 3516-3530
5 Nakanishi Y, Diaz-Meco MT, Moscat J. Serrated colorectal cancer: the road less travelled?. Trends Cancer 2019; 5: 742-754
6 Meester RG, van Herk MM, Lansdorp-Vogelaar I. et al. Prevalence and clinical features of sessile serrated polyps: a systematic review. Gastroenterology 2020; 159: 105-118.e125
7 Murakami T, Kurosawa T, Fukushima H. et al. Sessile serrated lesions: Clinicopathological characteristics, endoscopic diagnosis, and management. Dig Endosc 2022; 34: 1096-1109
8 Nishizawa T, Yoshida S, Toyoshima A. et al. Endoscopic diagnosis for colorectal sessile serrated lesions. World J Gastroenterol 2021; 27: 1321
9 Burnett-Hartman AN, Newcomb PA, Phipps AI. et al. Colorectal endoscopy, advanced adenomas, and sessile serrated polyps: implications for proximal colon cancer. Am J Gastroenterol 2012; 107: 1213-1219
10 Chang L-C, Shun C-T, Hsu W-F. et al. Fecal immunochemical test detects sessile serrated adenomas and polyps with a low level of sensitivity. Clin Gastroenterol Hepatol 2017; 15: 872-879.e871
11 Zorzi M, Senore C, Da Re F. et al. Detection rate and predictive factors of sessile serrated polyps in an organised colorectal cancer screening programme with immunochemical faecal occult blood test: the EQuIPE study (Evaluating Quality Indicators of the Performance of Endoscopy). Gut 2017; 66: 1233-1240
12 Anderson JC, Hisey W, Mackenzie TA. et al. Clinically significant serrated polyp detection rates and risk for postcolonoscopy colorectal cancer: data from the New Hampshire Colonoscopy Registry. Gastrointest Endosc 2022; 96: 310-317
13 van Toledo DEFWM, IJspeert JEG, Bossuyt PMM. et al. Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer: a population-based study. Lancet Gastroenterol Hepatol 2022; 7: 747-754
14 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
15 Bouwens MWE, Riedl RG, Bosman FT. et al. Large proximal serrated polyps: natural history and colorectal cancer risk in a retrospective series. J Clin Gastroenterol 2013; 47: 734-735
16 Holme Ø, Bretthauer M, Eide TJ. et al. Long-term risk of colorectal cancer in individuals with serrated polyps. Gut 2015; 64: 929-936
17 Liu C, Bettington ML, Walker NI. et al. CpG island methylation in sessile serrated adenomas increases with age, indicating lower risk of malignancy in young patients. Gastroenterology 2018; 155: 1362-1365.e1362
18 Lieu CH, Golemis EA, Serebriiskii IG. et al. Comprehensive genomic landscapes in early and later onset colorectal cancer. Clin Cancer Res 2019; 25: 5852-5858
19 Perea J, Rueda D, Canal A. et al. Age at onset should be a major criterion for subclassification of colorectal cancer. J Mol Diagn 2014; 16: 116-126
20 Lall V, Ismail AGM, Ayonrinde OT. Disparate age and sex distribution of sessile serrated lesions and conventional adenomas in an outpatient colonoscopy population–implications for colorectal cancer screening?. Int J Colorectal Dis 2022; 37: 1569-1579
21 Kim HY, Kim SM, Seo J-H. et al. Age-specific prevalence of serrated lesions and their subtypes by screening colonoscopy: a retrospective study. BMC Gastroenterol 2014; 14: 82
22 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
23 Aronchick CA, Lipshutz WH, Wright SH. et al. A novel tableted purgative for colonoscopic preparation: efficacy and safety comparisons with Colyte and Fleet Phospho-Soda. Gastrointest Endosc 2000; 52: 346-352
24 Yeh JH, Lin CW, Wang WL. et al. Positive fecal immunochemical test strongly predicts adenomas in younger adults with fatty liver and metabolic syndrome. Clin Transl Gastroenterol 2021; 12: e00305
25 Davidson KW, Barry MJ. US Preventive Services Task Force. et al. Screening for colorectal cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2021; 325: 1965-1977
26 Patel SG, May FP, Anderson JC. et al. Updates on age to start and stop colorectal cancer screening: recommendations from the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2022; 162: 285-299
27 Pohl H, Srivastava A, Bensen SP. et al. Incomplete polyp resection during colonoscopy—results of the Complete Adenoma Resection (CARE) study. Gastroenterology 2013; 144: 74-80.e71
28 Kahi CJ, Hewett DG, Norton DL. et al. Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy. Clin Gastroenterol Hepatol 2011; 9: 42-46
29 Payne SR, Church TR, Wandell M. et al. Endoscopic detection of proximal serrated lesions and pathologic identification of sessile serrated adenomas/polyps vary on the basis of center. Clin Gastroenterol Hepatol 2014; 12: 1119-1126
30 Butterly L, Robinson CM, Anderson J. et al. Serrated and adenomatous polyp detection increases with longer withdrawal time: results from the New Hampshire Colonoscopy Registry. Am J Gastroenterol 2014; 109: 417
31 de Wijkerslooth TR, Stoop EM, Bossuyt PM. et al. Differences in proximal serrated polyp detection among endoscopists are associated with variability in withdrawal time. Gastrointest Endosc 2013; 77: 617-623
32 Jennifer T, Lovedeep G, Steven P. et al. Higher adenoma detection, sessile serrated lesion detection and proximal sessile serrated lesion detection are associated with physician specialty and performance on Direct Observation of Procedural Skills. BMJ Open Gastroenterol 2021; 8: e000677
33 Verheyen E, Castaneda D, Gross SA. et al. Increased sessile serrated adenoma detection rate with mechanical new technology devices: a systematic review and meta-analysis. J Clin Gastroenterol 2021; 55: 335-342
34 Wu Z, Yao L, Liu W. et al. Development and validation of a deep learning–based histologic diagnosis system for diagnosing colorectal sessile serrated lesions. Am J Clin Pathol 2023; 160: 394-403
35 Cheng H-C, Chang T-K, Su W-C. et al. Narrative review of the influence of diabetes mellitus and hyperglycemia on colorectal cancer risk and oncological outcomes. Transl Oncol 2021; 14: 101089

Supplementary Material

Supplementary Material