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Sessile Serrated Polyps with Synchronous Conventional Adenomas Increase Risk of Future Advanced Neoplasia

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Abstract

Background

Surveillance colonoscopy guidelines following adenomas or sessile serrated adenomas/polyps (SSPs) are based on pathology features known to be associated with risk of future colorectal cancer. A synchronous conventional adenoma may increase the malignant potential of SSP, but current guidelines do not address this combination of pathologies.

Aims

The aim was to assess the risk of advanced neoplasia after SSP with or without synchronous adenoma compared to that following a conventional adenoma.

Methods

An audit was conducted on colonoscopies performed between 2000 and 2014 as part of a surveillance program. Index colonoscopy findings were classified as: low-risk SSP and high-risk SSP (size ≥ 10 mm or with cytological dysplasia) with and without synchronous adenoma; high-risk adenoma and low-risk adenoma. Risk of advanced neoplasia was determined at subsequent surveillance colonoscopies.

Results

In total, 2157 patients had adenoma or SSP found at index colonoscopy—low-risk adenoma (40%), high-risk adenoma (54%) and SSP (4%). Synchronous adenomas were seen with 47% of SSP. The median follow-up was 50.3 months (interquartile range 28.1–79.3). Compared to an index finding of low-risk adenoma, index findings of high-risk adenoma, as well as SSP with synchronous adenoma, were independent predictors of future advanced neoplasia (high-risk adenoma: hazard ratio (HR) = 2.04 (95% CI 1.70–2.45); high-risk SSP + adenoma HR = 3.20 (95% CI 1.31–7.82); low-risk SSP + adenoma: HR = 2.20 (95% CI 1.03–4.68)).

Conclusions

Synchronous adenoma increases the risk of advanced neoplasia for SSP equivalent to that seen following high-risk adenoma. Guidelines for surveillance should take into account concurrent pathologies with SSP.

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Acknowledgments

Author RM was supported by a grant funded by the financial support of Cancer Council SA’s Beat Cancer Project on behalf of its donors and the State Government of South Australia through the Department of Health together with the support of the Flinders Medical Centre Foundation, its donors and partners. The authors would like to acknowledge the assistance of Tony Thomas (TT) for reviewing some of the pathologies.

Funding

Author RM was supported by a grant funded by the financial support of Cancer Council SA’s Beat Cancer Project.

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Authors and Affiliations

  1. Bowel Health Service, Flinders Medical Centre, Bedford Park, SA, 5042, Australia

    Erin Symonds

  2. Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, SA, Australia

    Erin Symonds, Graeme Young & Peter Bampton

  3. Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, SA, Australia

    Shahzaib Anwar, Michelle Coats, Kalindra Simpson, Robert Fraser & Charles Cock

  4. Flinders Centre for Epidemiology and Biostatistics, College of Medicine & Public Health, Flinders University, Bedford Park, SA, Australia

    Rosie Meng

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  1. Erin Symonds
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  2. Shahzaib Anwar
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  3. Graeme Young
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  4. Rosie Meng
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  5. Michelle Coats
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  6. Kalindra Simpson
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  7. Peter Bampton
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  8. Robert Fraser
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  9. Charles Cock
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Correspondence to Erin Symonds.

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The authors declare that they have no conflict of interest.

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Symonds, E., Anwar, S., Young, G. et al. Sessile Serrated Polyps with Synchronous Conventional Adenomas Increase Risk of Future Advanced Neoplasia. Dig Dis Sci 64, 1680–1685 (2019). https://doi.org/10.1007/s10620-019-5454-8

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  • DOI: https://doi.org/10.1007/s10620-019-5454-8

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