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Yeh JH, Lin CW, Hsiao PJ, Perng DS, Chen JC, Hung KT, Hsu CC, Chen CC, Liu YP, Lee YC, Wang JY. Prevalence and predictive factors of colorectal sessile serrated lesions in younger individuals. Endoscopy 2024. [PMID: 38378019 DOI: 10.1055/a-2272-1911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
BACKGROUND Sessile serrated lesions (SSLs) are obscured lesions predominantly in the right-sided colon and associated with interval colorectal cancer; however, their prevalence and risk factors among younger individuals remain unclear. METHODS This retrospective study enrolled individuals who underwent index colonoscopy. The primary outcome was the SSL prevalence in the younger (<50 years) and older (≥50 years) age groups, while the secondary outcomes included clinically significant serrated polyps (CSSPs). Multivariable logistic regression was employed to identify predictors. RESULTS Of the 9854 eligible individuals, 4712 (47.8%) were categorized into the younger age group. Individuals in the younger age group exhibited lower prevalences of adenomas (22.6% vs. 46.2%; P<0.001) and right-sided adenomas (11.2% vs. 27.2%; P<0.001) compared with their older counterparts. However, both groups exhibited a similar prevalence of SSLs (7.2% vs. 6.5%; P=0.16) and CSSPs (10.3% vs. 10.3%;P=0.96). Multivariable analysis revealed that age 40-49 years (odds ratio [OR] 1.81, 95%CI 1.01-3.23), longer withdrawal time (OR 1.17, 95%CI 1.14-1.20, per minute increment), and endoscopist performance (OR 3.35, 95%CI 2.44-4.58) were independent predictors of SSL detection in the younger age group. No significant correlation was observed between adenoma and SSL detection rates among endoscopists. CONCLUSION SSLs are not uncommon among younger individuals. Moreover, diligent effort and expertise are of paramount importance in SSL detection. Future studies should explore the clinical significance of SSLs in individuals of younger age.
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Affiliation(s)
- Jen-Hao Yeh
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da DaChang Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chih-Wen Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Po-Jen Hsiao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da DaChang Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Daw-Shyong Perng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Jen-Chieh Chen
- Department of Health Examination, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Kuo-Tung Hung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da DaChang Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chia-Chang Hsu
- Department of Health Examination, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chia-Chi Chen
- Department of Pathology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Peng Liu
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Chia Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jaw-Yuan Wang
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
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Garg R, Burke CA, Aggarwal M, Macaron C, Singh A, Kim MK, Regueiro M, Amit B, Chahal P, Garg S. Sessile serrated polyp detection rates after fecal immunochemical test or multitarget stool DNA test: Systematic review and meta-analysis. Endosc Int Open 2024; 12:E474-E487. [PMID: 38585019 PMCID: PMC10997425 DOI: 10.1055/a-2256-3411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/23/2024] [Indexed: 04/09/2024] Open
Abstract
Background and study aims Published studies report a higher adenoma detection rate (ADR) for FIT-DNA as compared with FIT. Data are less replete about the performance of stool-based tests for sessile serrated polyp (SSP) detection. We performed a meta-analysis to evaluate the performance of FIT and FIT-DNA testing for SSP detection rate (SSPDR) in patients undergoing colonoscopy for follow up of positive noninvasive tests. Methods A comprehensive literature search of multiple databases (until September 2022) was performed to identify studies reporting SSPDR in patients with positive FIT or FIT-DNA tests. The outcome was overall colonoscopy detection of any SSPs and advanced serrated polyps (ASP: SSP ≥ 10 mm and/or dysplasia). Results Included were 482,405 patients (52.4% females) with a mean age of 62.3 ± 4.4 years from 23 studies. The pooled SSPDR for all positive stool-based tests was 5.3% and higher for FIT-DNA (15.0%, 95% confidence interval [CI] 8.3-25.7) versus FIT (4.1%, 95% CI 3.0-5.6; P = 0.0002). The overall pooled ASP detection rate was 1.4% (95% CI 0.81-2.3) and higher for FIT-DNA (3.8 %, 95% CI 1.7-8.6) compared with FIT (0.71%, 95% CI 0.36-1.4; P <0.01). SSPDR with FIT-DNA was also significantly higher than FIT when the FIT cutoff was >10 ug/g and in FIT-positive patients in studies conducted in North America ( P <0.05). Conclusions FIT-DNA outperformed FIT in both SSP and ASP detection including FIT with a lower threshold cutoff of >10 ug/g. Further comparative studies are needed to assess the impact of our findings on colorectal cancer reduction.
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Affiliation(s)
- Rajat Garg
- Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, United States
| | - Carol A. Burke
- Internal Medicine, Cleveland Clinic Foundation, Cleveland, United States
| | - Manik Aggarwal
- Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, United States
| | - Carole Macaron
- Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, United States
| | - Amandeep Singh
- Internal Medicine, Cleveland Clinic Foundation, Cleveland, United States
| | - Michelle K. Kim
- Internal Medicine, Cleveland Clinic Foundation, Cleveland, United States
| | - Miguel Regueiro
- Internal Medicine, Cleveland Clinic Foundation, Cleveland, United States
| | - Bhatt Amit
- Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, United States
| | - Prabhleen Chahal
- Internal Medicine, Cleveland Clinic Foundation, Cleveland, United States
| | - Shashank Garg
- Medicine, University of Arkansas System, Little Rock, United States
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Khuc T, Agarwal A, Li F, Kantsevoy S, Curtin B, Hagan M, Harris M, Maheshwari A, Raina A, Zhou E, Thuluvath P. Accuracy and Inter-observer Agreement Among Endoscopists for Visual Identification of Colorectal Polyps Using Endoscopy Images. Dig Dis Sci 2023; 68:616-622. [PMID: 35947305 DOI: 10.1007/s10620-022-07643-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/06/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND It is essential to accurately distinguish small benign hyperplastic colon polyps (HP) from sessile serrated lesions (SSL) or adenomatous polyps (TA) based on endoscopic appearances. Our objective was to determine the accuracy and inter-observer agreements for the endoscopic diagnosis of small polyps. METHODS High-quality endoscopic images of 30 small HPs, SSLs, and TAs were used randomly to create two-timed PowerPoint slide sets-one with and another one without information on polyp size and location. Seven endoscopists viewed the slides on two separate occasions 90 days apart, identified the polyp type, and graded their confidence level. Overall and polyp-specific accuracies were assessed for the group and individual endoscopists. Chi-square tests and Kappa (κ) statistics were used to compare differences as appropriate. RESULTS When polyp size and location were provided, overall accuracy was 67.1% for TAs, 50.0% for SSLs, and 41.4% for HPs; the corresponding accuracies were 60%, 44.3%, and 34.3% when polyp size and location were withheld (p < .001). Inter-observer agreement was moderate for TAs (κ = 0.50) and fair for SSLs (κ = 0.26) and HPs (κ = 0.29); the corresponding inter-observer agreements were 0.44, 0.31, and 0.17 with polyp size and location withheld. Accuracy was not affected by knowledge of polyp size, location, or confidence level. Endoscopists with ≥ 10 years (vs. < 10 years) of colonoscopy experience had marginally higher (56% vs. 40%, p = 0.05) accuracy for SSL diagnosis. CONCLUSIONS The ability to distinguish between small TAs, SSLs, and HPs on their endoscopic appearance is poor regardless of the endoscopists' knowledge of polyp size and location.
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Affiliation(s)
- Thi Khuc
- Institute for Digestive Health and Liver Disease, Mercy Medical Center, Baltimore, MD, USA.
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Amol Agarwal
- Institute for Digestive Health and Liver Disease, Mercy Medical Center, Baltimore, MD, USA
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Feng Li
- Institute for Digestive Health and Liver Disease, Mercy Medical Center, Baltimore, MD, USA
| | - Sergey Kantsevoy
- Institute for Digestive Health and Liver Disease, Mercy Medical Center, Baltimore, MD, USA
| | - Bryan Curtin
- Institute for Digestive Health and Liver Disease, Mercy Medical Center, Baltimore, MD, USA
| | - Matilda Hagan
- Institute for Digestive Health and Liver Disease, Mercy Medical Center, Baltimore, MD, USA
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mary Harris
- Institute for Digestive Health and Liver Disease, Mercy Medical Center, Baltimore, MD, USA
| | - Anurag Maheshwari
- Institute for Digestive Health and Liver Disease, Mercy Medical Center, Baltimore, MD, USA
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amit Raina
- Institute for Digestive Health and Liver Disease, Mercy Medical Center, Baltimore, MD, USA
| | - Elinor Zhou
- Institute for Digestive Health and Liver Disease, Mercy Medical Center, Baltimore, MD, USA
| | - Paul Thuluvath
- Institute for Digestive Health and Liver Disease, Mercy Medical Center, Baltimore, MD, USA
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
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