Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy.

BACKGROUND & AIMS Colonoscopy may have a greater protective effect for distal colorectal cancer (CRC) than proximal CRC. Serrated polyps are frequently located in the proximal colon, can be missed during colonoscopy, and may progress to CRC. We investigated the prevalence and endoscopist detection rates of proximal serrated polyps in a large cohort of average risk patients undergoing screening colonoscopy. METHODS Screening colonoscopies performed by 15 attending gastroenterologists at 2 academic endoscopy units between 2000 and 2009 were reviewed. Serrated polyps included hyperplastic polyps, sessile serrated adenomas, and traditional serrated adenomas. Endoscopist-level detection rates for adenomas and serrated polyps were calculated. Pearson correlation coefficients were calculated to evaluate the associations of adenoma and proximal serrated polyp detection rates. Logistic regression was used to compare endoscopists' detection rates. RESULTS A total of 11,049 polyps were detected in 6681 colonoscopies (adenomas: 5637, 51%; serrated: 3984, 36%; proximal serrated: 1238, 11%). The proportion of colonoscopies with at least one proximal serrated polyp was 13% (range 1%-18%). Proximal serrated polyp detection rates per colonoscopy ranged from 0.01 to 0.26. Adenoma and proximal serrated polyp detection rates per colonoscopy were strongly correlated (R = 0.76, P = .0005). The odds of detecting at least one proximal serrated polyp for individual endoscopists ranged from 0.05 to 0.67 compared to the highest level detector. Endoscopist (P < .0001), but not patient age (P = .76) or gender (P = .95), was associated with proximal serrated polyp detection. CONCLUSIONS In an average-risk screening cohort, the detection of proximal serrated polyps was highly variable and endoscopist dependent. A significant proportion of proximal serrated polyps may be missed during colonoscopy. High-quality colonoscopy is important for the detection and resection of all polyps with neoplastic potential.

[1]  V. Sharma,et al.  Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. , 2003, Gastrointestinal endoscopy.

[2]  D. Rex,et al.  Variable Detection of Nonadenomatous Polyps by Individual Endoscopists at Colonoscopy and Correlation With Adenoma Detection , 2008, Journal of clinical gastroenterology.

[3]  Douglas K Rex,et al.  Endoscopist Can Be More Powerful than Age and Male Gender in Predicting Adenoma Detection at Colonoscopy , 2007, The American Journal of Gastroenterology.

[4]  P. Bossuyt,et al.  Polyp Miss Rate Determined by Tandem Colonoscopy: A Systematic Review , 2006, The American Journal of Gastroenterology.

[5]  D. Alberts,et al.  Lack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas. Phoenix Colon Cancer Prevention Physicians' Network. , 2000, The New England journal of medicine.

[6]  J. Johanson,et al.  Colonoscopic withdrawal times and adenoma detection during screening colonoscopy , 2007 .

[7]  D. Lieberman,et al.  Colonoscopy practice patterns since introduction of medicare coverage for average-risk screening. , 2004, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[8]  Omer Khalid,et al.  Reinterpretation of histology of proximal colon polyps called hyperplastic in 2001. , 2009, World journal of gastroenterology.

[9]  J. Bond,et al.  Microsatellite instability in interval colon cancers. , 2006, Gastroenterology.

[10]  H. Brenner,et al.  Protection from right- and left-sided colorectal neoplasms after colonoscopy: population-based study. , 2010, Journal of the National Cancer Institute.

[11]  J. Weissfeld,et al.  Lack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas. Polyp Prevention Trial Study Group. , 2000, The New England journal of medicine.

[12]  B. Leggett,et al.  Role of the serrated pathway in colorectal cancer pathogenesis. , 2010, Gastroenterology.

[13]  Dawn Provenzale,et al.  Five-year colon surveillance after screening colonoscopy. , 2007, Gastroenterology.

[14]  Marcin Polkowski,et al.  Quality indicators for colonoscopy and the risk of interval cancer. , 2010, The New England journal of medicine.

[15]  P. Laird,et al.  CpG island methylator phenotype underlies sporadic microsatellite instability and is tightly associated with BRAF mutation in colorectal cancer , 2006, Nature Genetics.

[16]  N. Shepherd,et al.  Observer agreement in the diagnosis of serrated polyps of the large bowel , 2009, Histopathology.

[17]  Bernard Burnand,et al.  Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. , 2005, Gastrointestinal endoscopy.

[18]  M. Tinetti,et al.  Relation between Medicare screening reimbursement and stage at diagnosis for older patients with colon cancer. , 2006, JAMA.

[19]  Tim Byers,et al.  Colorectal cancer in patients under close colonoscopic surveillance. , 2005, Gastroenterology.

[20]  K. Batts,et al.  Serrated polyps of the large intestine: a morphologic and molecular review of an evolving concept. , 2005, American journal of clinical pathology.

[21]  J. Bond,et al.  CIMP Status of Interval Colon Cancers: Another Piece to the Puzzle , 2010, The American Journal of Gastroenterology.

[22]  L. Rabeneck,et al.  Association of Colonoscopy and Death From Colorectal Cancer , 2009, Annals of Internal Medicine.

[23]  Heitham Abdul-Baki,et al.  A randomized single-blind trial of split-dose PEG-electrolyte solution without dietary restriction compared with whole dose PEG-electrolyte solution with dietary restriction for colonoscopy preparation. , 2005, Gastrointestinal endoscopy.

[24]  M. Thun,et al.  A Midpoint Assessment of the American Cancer Society Challenge Goal to Decrease Cancer Incidence by 25% Between 1992 and 2015 , 2007, CA: a cancer journal for clinicians.

[25]  A. Rostom,et al.  A randomized prospective trial comparing different regimens of oral sodium phosphate and polyethylene glycol-based lavage solution in the preparation of patients for colonoscopy. , 2006, Gastrointestinal endoscopy.

[26]  J. Baron,et al.  795 Interval Cancer After Total Colonoscopy: Results from a Pooled Analysis of Eight Studies , 2008 .

[27]  Rozemary Karamatic,et al.  High prevalence of sessile serrated adenomas with BRAF mutations: a prospective study of patients undergoing colonoscopy. , 2006, Gastroenterology.

[28]  N. Matsubara,et al.  BRAF mutation is associated with DNA methylation in serrated polyps and cancers of the colorectum , 2004, Gut.

[29]  Sun Hee Rim,et al.  Colorectal cancer incidence in the United States, 1999‐2004 , 2009, Cancer.

[30]  Charles J Kahi,et al.  Does colonoscopy work? , 2010, Journal of the National Comprehensive Cancer Network : JNCCN.