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Rates of synchronous advanced neoplasia and colorectal cancer in patients with colonic serrated lesions

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Abstract

Background and aims

Serrated lesions (SL) have been associated with significant risks of developing colorectal cancer (CRC). Data on synchronous findings after SL detection during colonoscopy is limited. Study aim was to evaluate the rate of synchronous advanced neoplasia (S-AN) and synchronous CRC (S-CRC) in colonoscopies where SLs were detected.

Methods

We conducted a retrospective study of screening aged patients 45–74year with colorectal SL (sessile serrated polyp [SSP] or traditional serrated adenoma [TSA]) detected during an elective colonoscopy. Primary outcome was risk of S-AN in patients with SL. Secondary outcomes included risk of S-AN or S-CRC stratified by SL characteristics.

Results

The study included 1262 patients with 1649 SLs (1214 with SSPs and 48 with TSAs). 47.2% were female and 22.9% of exams were screening colonoscopies, 48.2% surveillance, 28.9% diagnostic. The overall rates of S-AN and S-CRC were 15.1% and 1.3%, respectively. Presence of SSPs ≥ 10 mm was associated with higher rates of S-AN, (18.1 vs. 12.2%, Odds-Ratio [OR] = 1.61 [95% Confidence Interval [CI] 1.17–2.23], p = 0.004). SSP dysplasia was predictive of S-AN, (30.3 vs 14.1%, OR = 2.68 [95%CI 1.24–5.78], p = 0.012) but not S-CRC. SSP number (≥ 3) and location (proximal) were not predictors of S-AN or S-CRC.

Conclusion

Patients with SLs are at high-risk of S-AN and S-CRC. Findings of SSPs ≥ 10 mm and SSP dysplasia are associated with high-risk of S-AN. Endoscopists should exercise heightened vigilance for synchronous findings when SLs are detected, especially SSPs ≥ 10 mm or when bowel preparation is suboptimal. Studies contrasting synchronous risk of other polyp types are needed to confirm these results.

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Acknowledgements

The authors would like to thank the American College of Gastroenterology for funding the study (ACG Medical Resident Clinical Research award). The authors also thank Maureen Fontaine, MSc, research coordinator, and Ekaterina Lebedeva, MSc, research assistant, for their help in the conduction of the study.

Funding

Roupen Djinbachian was supported by a resident clinical research award from the American College of Gastroenterology for the conduction of this study.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Montreal University Hospital Center (CHUM) and Montreal University Hospital Research Center (CRCHUM), Montreal, Canada

    Roupen Djinbachian, Michel Boivin, Mickael Bouin & Daniel von Renteln

  2. Faculty of Medicine, University of Montreal, Montreal, Canada

    Marie-Lyssa Lafontaine, Talia Dufault & Edgard Medawar

Authors
  1. Roupen Djinbachian
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  2. Marie-Lyssa Lafontaine
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  3. Talia Dufault
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  4. Edgard Medawar
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  5. Michel Boivin
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  6. Mickael Bouin
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  7. Daniel von Renteln
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Contributions

RD: Study concept and design; acquisition of data; drafting of the manuscript; analysis and interpretation of data; critical revision of the manuscript for important intellectual content. M-LL: Acquisition of data; critical revision of the manuscript for important intellectual content. TD: Acquisition of data; critical revision of the manuscript for important intellectual content. EM: Acquisition of data; critical revision of the manuscript for important intellectual content. MB: Critical revision of the manuscript for important intellectual content. MB: Critical revision of the manuscript for important intellectual content. DvR: Study concept and design; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content.

Corresponding author

Correspondence to Daniel von Renteln.

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Disclosures

Daniel von Renteln is supported by a “Fonds de Recherche du Québec Santé” (FRQS) career development award and has received research funding from ERBE, Ventage, Pendopharm, and Pentax and is a consultant for Boston Scientific and Pendopharm. Daniel von Renteln has no other personal or financial conflicts of interest relevant to this paper to declare. Marie-Lyssa Lafontaine, Talia Dufault, Edgard Medawar, Michel Boivin, Mickael Bouin have no conflicts of interest relevant to this paper to declare.

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Djinbachian, R., Lafontaine, ML., Dufault, T. et al. Rates of synchronous advanced neoplasia and colorectal cancer in patients with colonic serrated lesions. Surg Endosc 37, 5150–5157 (2023). https://doi.org/10.1007/s00464-023-09974-z

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