Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Endoscopy. 2016 Aug;48(8):740-6. doi: 10.1055/s-0042-105436. Epub 2016 Apr 25.
Sessile serrated adenomas/polyps (SSA/Ps) are the precursors of 15 % - 30 % of colorectal cancers (CRC). We aimed to determine the prevalence and distribution of SSA/Ps and to evaluate the association between SSA/Ps and the risk of synchronous advanced neoplasia at a high quality colonoscopy center.
Data from all colonoscopies performed within one dedicated colonoscopy center between 2011 and 2015 were prospectively retrieved using an automated reporting system. All lesions were assessed by an experienced gastrointestinal pathologist. Multiple logistic regression was used to evaluate influence of age, gender, and colonoscopy indication on prevalence of SSA/Ps, and to assess the association between SSA/Ps and synchronous advanced neoplasia.
In total 4251 histologically confirmed polyps were resected in 3364 patients; 399 polyps were SSA/Ps (9.4 %). The prevalence of SSA/Ps was 8.2 % overall, increasing to 9.0 % for individuals older than 50 years. SSA/P detection rate varied between 2.5 % and 13.6 % among endoscopists. Increased SSA/P prevalence was associated with colonoscopy indications "familial CRC risk" (odds ratio [OR] 1.52, 95 % confidence interval [95 %CI] 1.05 - 2.22; P = 0.03) and "surveillance" (OR 1.73, 95 %CI 1.20 - 2.49; P < 0.01), when compared with the indication "symptoms." The presence of synchronous advanced neoplasia was associated with SSA/Ps overall (OR 1.71, 95 %CI 1.25 - 2.34; P = 0.001), as well as with high risk SSA/Ps (defined as ≥ 10 mm and/or with dysplasia) (OR 2.70, 95 %CI 1.56 - 4.67; P < 0.001) CONCLUSION: SSA/Ps are more common than previously reported and are associated with the presence of synchronous advanced neoplasia. Endoscopists should be assiduous in identifying SSA/Ps in daily practice and should carefully look for synchronous advanced neoplasia when an SSA/P has been recognized. RESULTS from this study can guide detection standards in general colonoscopy practice adapted to the type of patient that may predominate in an individual department.
无蒂锯齿状腺瘤/息肉（SSA/Ps）是 15%-30%结直肠癌（CRC）的前体。我们旨在确定 SSA/Ps 的患病率和分布，并评估在高质量结肠镜检查中心 SSA/Ps 与同时性高级别腺瘤的相关性。
使用自动报告系统前瞻性地检索了 2011 年至 2015 年期间在一个专门的结肠镜检查中心进行的所有结肠镜检查的数据。所有病变均由经验丰富的胃肠病病理学家进行评估。多因素逻辑回归用于评估年龄、性别和结肠镜检查指征对 SSA/Ps 患病率的影响，并评估 SSA/Ps 与同时性高级别腺瘤的相关性。
共切除 3364 例患者 4251 个组织学证实的息肉；399 个息肉为 SSA/Ps（9.4%）。SSA/Ps 的总体患病率为 8.2%，50 岁以上人群患病率为 9.0%。SSA/P 的检出率在不同内镜医生之间为 2.5%-13.6%。SSA/P 患病率的增加与“家族性 CRC 风险”（比值比[OR]1.52，95%置信区间[95%CI]1.05-2.22；P=0.03）和“监测”（OR 1.73，95%CI 1.20-2.49；P<0.01）相关，而与“症状”相关的指征相比。同时性高级别腺瘤的存在与 SSA/Ps 总体相关（OR 1.71，95%CI 1.25-2.34；P=0.001），也与高危 SSA/Ps（定义为≥10mm 和/或伴异型增生）相关（OR 2.70，95%CI 1.56-4.67；P<0.001）。
SSA/Ps 比以前报道的更常见，与同时性高级别腺瘤的存在相关。内镜医生在日常实践中应注意识别 SSA/Ps，并在发现 SSA/P 时仔细寻找同时性高级别腺瘤。本研究结果可以为适应个别科室可能占主导地位的患者类型的一般结肠镜检查实践中的检测标准提供指导。
