Endoscopic red flags for the detection of high-risk serrated polyps: an observational study

E. J. A. Rondagh; A. A. M. Masclee; M. W. E. Bouwens; B. Winkens; R. G. Riedl; A. P. de Bruïne; R. de Ridder; T. Kaltenbach; R. M. Soetikno; S. Sanduleanu

doi:10.1055/s-0030-1256770

Endoscopy, Inhaltsverzeichnis

Endoscopy 2011; 43(12): 1052-1058
DOI: 10.1055/s-0030-1256770

Original article

Endoscopic red flags for the detection of high-risk serrated polyps: an observational study

E. J. A. Rondagh

¹Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, The Netherlands

²NUTRIM, School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, The Netherlands

,

A. A. M. Masclee

¹Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, The Netherlands

²NUTRIM, School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, The Netherlands

,

M. W. E. Bouwens

¹Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, The Netherlands

²NUTRIM, School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, The Netherlands

,

B. Winkens

³Department of Methodology and Statistics, Maastricht University Medical Center, The Netherlands

,

R. G. Riedl

,

A. P. de Bruïne

⁴Department of Pathology, Maastricht University Medical Center, The Netherlands

,

R. de Ridder

¹Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, The Netherlands

,

T. Kaltenbach

⁵Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA

,

R. M. Soetikno

⁵Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA

,

S. Sanduleanu

¹Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, The Netherlands

⁶GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, The Netherlands

› Institutsangaben

Abstract

Background and study aims: In routine practice, colonoscopy may fail to prevent colorectal cancer (CRC), especially in the proximal colon. A better endoscopic recognition of serrated polyps is important, as this pathway may explain some of the post-colonoscopy cancers. In this study, the endoscopic characteristics of serrated polyps were examined.

Patient and methods: This was a cross-sectional, single-center study of all consecutive patients referred for elective colonoscopy during 1 year. The endoscopists were familiarized with the detection and treatment of nonpolypoid colorectal lesions. Serrated polyps were classified into high risk serrated polyps, defined as dysplastic or large ( ≥ 6 mm) proximal nondysplastic serrated polyps, and low risk serrated polyps including the remaining nondysplastic serrated polyps. Advanced colorectal neoplasms were defined as multiple (at least three), ≥ 10 mm in size, high grade dysplastic adenomas or CRC.

Results: A total of 2309 patients were included (46.1 % men, mean age 58.4 years), of whom 2.5 % (57) had at least one high risk serrated polyp and 13.9 % (322) had at least one advanced neoplasm. Overall, serrated polyps were more often nonpolypoid than adenomas (16.2 % vs. 11.1 %; P = 0.002). In total, 65 high risk serrated polyps were found, of which 43.1 % (28) displayed a nonpolypoid endoscopic appearance. Patients with advanced neoplasms were more likely to have synchronous high risk serrated polyps than patients without advanced neoplasms: OR 3.66 (95 % CI 2.03 – 6.61, P < 0.001).

Conclusions: High risk serrated polyps are frequently nonpolypoid and are associated with synchronous advanced colorectal neoplasms. Advanced colorectal neoplasms may therefore be considered red flags for the presence of high risk serrated polyps. Detection, diagnosis, and treatment of high risk serrated lesions may be important targets to improve the quality of colonoscopic cancer prevention.

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Referenzen

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