Small sessile serrated polyps might not be at a higher risk for future advanced neoplasia than low-risk adenomas or polyp-free groups.

BACKGROUND Polypectomy surveillance colonoscopy is recommended according to the risk stratification of initially removed polyps. This study aimed to evaluate the risk of advanced neoplasia following low-risk SSPs compared with that following LRAs and polyp-free groups. MATERIALS AND METHODS From September 2013 to August 2017, asymptomatic Koreans aged 50-75 years who underwent surveillance colonoscopy post-baseline colonoscopy were enrolled. The 1314 participants who met the study design criteria were stratified into three groups according to the presence of LRAs or low-risk SSPs. The rate of advanced neoplasia was then compared between groups by surveillance colonoscopy. RESULTS A total of 1314 participants were classified according to baseline colonoscopy findings: no polyp (n = 551), LRA (n = 707), and low-risk SSP (n = 56). All participants underwent surveillance colonoscopy after an average of 28.1 ± 8.7 months. The rate of advanced neoplasia at surveillance was not different between groups: no polyp group (13/551, 2.4%), LRA group (27/707, 3.8%), and low-risk SSP group (0/56, 0%). The LRA group exhibited a significantly higher rate of low- and high-risk polyps (47.5, 13.4%) than did the no polyp (35.6, 7.4%, p < .001, p = .001), but no significant differences to the low-risk SSP group (35.7, 7.1%, p = .117, p = .253), respectively. CONCLUSIONS Patients with low-risk SSPs were not at a higher risk of advanced neoplasia than LRA patients, even in the polyp-free group. We suggest that surveillance colonoscopy after the removal of low-risk SSPs is not required more often than for LRAs.

[1]  M. Rugge,et al.  Diagnosis of digestive system tumours , 2020, International journal of cancer.

[2]  C. Hassan,et al.  Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020 , 2020, Endoscopy.

[3]  J. Seo,et al.  Longer Withdrawal Time Is More Important than Excellent Bowel Preparation in Colonoscopy of Adequate Bowel Preparation , 2020, Digestive Diseases and Sciences.

[4]  E. Giovannucci,et al.  Long-term Risk of Colorectal Cancer After Removal of Conventional Adenomas and Serrated Polyps. , 2020, Gastroenterology.

[5]  Christopher D. Jensen,et al.  Long-term Risk of Colorectal Cancer and Related Death After Adenoma Removal in a Large, Community-based Population. , 2020, Gastroenterology.

[6]  J. S. Kim,et al.  Improved Accuracy in Optical Diagnosis of Colorectal Polyps Using Convolutional Neural Networks with Visual Explanations. , 2020, Gastroenterology.

[7]  D. Lieberman,et al.  Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. , 2020, The American journal of gastroenterology.

[8]  J. S. Kim,et al.  Multidirectional Colonoscopy Quality Improvement Increases Adenoma Detection Rate: Results of the Seoul National University Hospital Healthcare System Gangnam Center Colonoscopy Quality Upgrade Project (Gangnam-CUP) , 2019, Digestive Diseases and Sciences.

[9]  P. Bampton,et al.  Sessile Serrated Polyps with Synchronous Conventional Adenomas Increase Risk of Future Advanced Neoplasia , 2019, Digestive Diseases and Sciences.

[10]  A. Jemal,et al.  Annual report to the nation on the status of cancer, part I: National cancer statistics , 2018, Cancer.

[11]  J. Cha,et al.  Guideline Adherence to Colonoscopic Surveillance Intervals after Polypectomy in Korea: Results from a Nationwide Survey , 2018, Gut and liver.

[12]  L. Peirson,et al.  Risk of Advanced Adenoma, Colorectal Cancer, and Colorectal Cancer Mortality in People With Low-Risk Adenomas at Baseline Colonoscopy: A Systematic Review and Meta-Analysis , 2017, The American Journal of Gastroenterology.

[13]  R. Bostick,et al.  Factors Associated With Shorter Colonoscopy Surveillance Intervals for Patients With Low-Risk Colorectal Adenomas and Effects on Outcome. , 2017, Gastroenterology.

[14]  I. Tomlinson,et al.  British Society of Gastroenterology position statement on serrated polyps in the colon and rectum , 2017, Gut.

[15]  J. S. Kim,et al.  Is a split-dose regimen of 2 L polyethylene glycol plus ascorbic acid tolerable for colonoscopy in an early morning visit to a comprehensive medical check-up? , 2017, World journal of gastroenterology.

[16]  F. Bishehsari,et al.  Presence of small sessile serrated polyps increases rate of advanced neoplasia upon surveillance compared with isolated low-risk tubular adenomas. , 2016, Gastrointestinal endoscopy.

[17]  J. S. Kim,et al.  Characteristics and outcomes of endoscopically resected colorectal cancers that arose from sessile serrated adenomas and traditional serrated adenomas , 2016, Intestinal research.

[18]  C. Burke,et al.  Risk of Metachronous Polyps in Individuals With Serrated Polyps , 2015, Diseases of the colon and rectum.

[19]  C. Hassan,et al.  Systematic review with meta‐analysis: the incidence of advanced neoplasia after polypectomy in patients with and without low‐risk adenomas , 2014, Alimentary pharmacology & therapeutics.

[20]  Christopher D. Jensen,et al.  Adenoma detection rate and risk of colorectal cancer and death. , 2014, The New England journal of medicine.

[21]  Charles J. Kahi,et al.  High colonoscopic prevalence of proximal colon serrated polyps in average-risk men and women. , 2012, Gastrointestinal endoscopy.

[22]  Young Sun Kim,et al.  Five-year risk for advanced colorectal neoplasia after initial colonoscopy according to the baseline risk stratification: a prospective study in 2452 asymptomatic Koreans , 2011, Gut.

[23]  M. O'brien,et al.  Variation in the Detection of Serrated Polyps in an Average Risk Colorectal Cancer Screening Cohort , 2010, The American Journal of Gastroenterology.

[24]  F. Lu,et al.  Longitudinal Outcome Study of Sessile Serrated Adenomas of the Colorectum: An Increased Risk for Subsequent Right-sided Colorectal Carcinoma , 2010, The American journal of surgical pathology.

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

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

[27]  Gheorghe Doros,et al.  The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. , 2007, Gastrointestinal endoscopy.

[28]  F. Carey,et al.  The colorectal adenoma–carcinoma sequence , 2002, The British journal of surgery.

[29]  C. Amos,et al.  Risk of Metachronous High-Risk Adenomas and Large Serrated Polyps in Individuals With Serrated Polyps on Index Colonoscopy: Data From the New Hampshire Colonoscopy Registry. , 2018, Gastroenterology.