Sessile serrated lesion prevalence and factors associated with their detection: a post-hoc analysis of a multinational randomized controlled trial from Asia

Abstract

Background Sessile serrated lesions (SSLs) are associated with an increased risk of colorectal cancer. Data on the prevalence of SSLs in Asia are limited. We performed this study to estimate the prevalence of SSLs in Asia and to explore endoscopic factors that are associated with SSL detection.

Methods This is a post-hoc analysis of a multicenter randomized controlled trial from four Asian countries/regions that compared adenoma detection rates using linked-color imaging (LCI) and white-light imaging. Colonoscopies were performed in an average-risk population for screening, diagnostic examination, or polyp surveillance. Patients with SSLs were compared against those without SSLs to evaluate for possible predictors of SSL detection using Firth’s logistic regression.

Results 2898 participants (mean age 64.5 years) were included in the analysis. The estimated prevalence of SSLs was 4.0% (95%CI 3.4%–4.8%), with no sex or age group differences. On multivariable analysis, use of LCI (adjusted odds ratio [aOR] 1.63, 95%CI 1.10–2.41), experienced endoscopists (aOR 1.94, 95%CI 1.25–3.00), use of transparent cap (aOR 1.75, 95%CI 1.09–2.81), and longer withdrawal time (aOR 1.06, 95%CI 1.03–1.10) were independently associated with SSL detection. Synchronous adenoma detection (aOR 1.89, 95%CI 1.20–2.99) was also predictive of SSL detection.

Conclusion The prevalence of SSLs in Asia is 4.0%. Use of LCI or a transparent cap, greater endoscopist experience, and longer withdrawal time were all associated with increased SSL detection.

Publication History

Received: 15 October 2023

Accepted after revision: 18 April 2024

Article published online:
10 June 2024

• References

• 1 East JE, Atkin WS, Bateman AC. et al. British Society of Gastroenterology position statement on serrated polyps in the colon and rectum. Gut 2017; 66: 1181-1196
• 2 Crockett SD, Nagtegaal ID. Terminology, molecular features, epidemiology, and management of serrated colorectal neoplasia. Gastroenterology 2019; 157: 949-966.e4
• 3 Meester RGS, van Herk MMAGC, Lansdorp-Vogelaar I. et al. Prevalence and clinical features of sessile serrated polyps: a systematic review. Gastroenterology 2020; 159: 105-118.e25
• 4 Nagtegaal ID, Odze RD, Klimstra D. et al. The 2019 WHO classification of tumours of the digestive system. Histopathology 2020; 76: 182-188
• 5 Suzuki S, Aniwan S, Chiu HM. et al. Linked-color imaging detects more colorectal adenoma and serrated lesions: an international randomized controlled trial. Clin Gastroenterol Hepatol 2023; 21: 1493-1502.e4
• 6 Li J, Zhang D, Wei Y. et al. Colorectal sessile serrated lesion detection using linked color imaging: a multicenter, parallel randomized controlled trial. Clin Gastroenterol Hepatol 2023; 21: 328-336.e2
• 7 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
• 8 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
• 9 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
• 10 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
• 11 Li D, Woolfrey J, Jiang SF. et al. Diagnosis and predictors of sessile serrated adenoma after educational training in a large, community-based, integrated healthcare setting. Gastrointest Endosc 2018; 87: 755-765.e1
• 12 Crockett SD, Barry EL, Mott LA. et al. Predictors of incident serrated polyps: results from a large multicenter clinical trial. Cancer Epidemiol Biomarkers Prev 2022; 31: 1058-1067
• 13 Li D, Doherty AR, Raju M. et al. Risk stratification for colorectal cancer in individuals with subtypes of serrated polyps. Gut 2022; 71: 2022-2029
• 14 Onyoh EF, Hsu WF, Chang LC. et al. The rise of colorectal cancer in Asia: epidemiology, screening, and management. Curr Gastroenterol Rep 2019; 21: 36
• 15 Aronchick CA, Lipshutz WH, Wright SH. et al. Validation of an instrument to assess colon cleansing. Am J Gastroenterol 1999; 94: 2667
• 16 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
• 17 Firth D. Bias reduction of maximum likelihood estimates. Biometrika 1993; 80: 27-38
• 18 Heinze G, Schemper M. A solution to the problem of separation in logistic regression. Stat Med 2002; 21: 2409-2419
• 19 Zhang J, Yu KF. What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA 1998; 280: 1690-1691
• 20 Harrell Jr FE. Regression modeling strategies: with applications to linear models, logistic and ordinal regression, and survival analysis. New York: Springer; 2001
• 21 Rex DK, Schoenfeld PS, Cohen J. et al. Quality indicators for colonoscopy. Gastrointest Endosc 2015; 81: 31-53
• 22 Lui RN, Kyaw MH, Lam TYT. et al. Prevalence and risk factors for sessile serrated lesions in an average risk colorectal cancer screening population. J Gastroenterol Hepatol 2021; 36: 1656-1662
• 23 Shaukat A, Rector TS, Church TR. et al. Longer withdrawal time is associated with a reduced incidence of interval cancer after screening colonoscopy. Gastroenterology 2015; 149: 952-957
• 24 Zhao S, Yang X, Wang S. et al. Impact of 9-minute withdrawal time on the adenoma detection rate: a multicenter randomized controlled trial. Clin Gastroenterol Hepatol 2022; 20: e168-e181
• 25 Desai M, Rex DK, Bohm ME. et al. Impact of withdrawal time on adenoma detection rate: results from a prospective multicenter trial. Gastrointest Endosc 2023; 97: 537-543.e2
• 26 Zhou MJ, Lebwohl B, Krigel A. Patient and physician factors associated with adenoma and sessile serrated lesion detection rates. Dig Dis Sci 2020; 65: 3123-3131
• 27 Clark BT, Laine L. High-quality bowel preparation is required for detection of sessile serrated polyps. Clin Gastroenterol Hepatol 2016; 14: 1155-1162
• 28 Ng SC, Tsoi KK, Hirai HW. et al. The efficacy of cap-assisted colonoscopy in polyp detection and cecal intubation: a meta-analysis of randomized controlled trials. Am J Gastroenterol 2012; 107: 1165-1173
• 29 Nutalapati V, Kanakadandi V, Desai M. et al. Cap-assisted colonoscopy: a meta-analysis of high-quality randomized controlled trials. Endosc Int Open 2018; 6: E1214-E1223
• 30 Patel HK, Chandrasekar VT, Srinivasan S. et al. Second-generation distal attachment cuff improves adenoma detection rate: meta-analysis of randomized controlled trials. Gastrointest Endosc 2021; 93: 544-553.e7
• 31 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
• 32 Gourevitch RA, Rose S, Crockett SD. et al. Variation in pathologist classification of colorectal adenomas and serrated polyps. Am J Gastroenterol 2018; 113: 431-439
• 33 Keswani RN, Crockett SD, Calderwood AH. AGA clinical practice update on strategies to improve quality of screening and surveillance colonoscopy: expert review. Gastroenterology 2021; 161: 701-711