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Current sessile serrated lesion incidence: implications for future clinical practice
Emma Bone1, Shiristi Kumar1, Simon Richards1,2
1Department of Surgery and Critical Care, University of Otago, Christchurch, New Zealand.
ANZ Journal of Surgery
|September 3, 2024
Summary
Sessile serrated lesions (SSLs) are more common than previously thought, with 18.6% of colonoscopies revealing at least one SSL. This finding suggests historical underestimation of SSL incidence in colorectal cancer development.
Area of Science:
- Gastroenterology
- Colorectal Cancer Research
- Endoscopic Diagnostics
Background:
- Sessile serrated lesions (SSLs) contribute significantly to colorectal cancer pathogenesis, potentially up to 30%.
- Evolving colonoscopy techniques and classification systems may have led to underreporting of SSL incidence.
- Accurate SSL identification is crucial for effective colorectal cancer prevention strategies.
Purpose of the Study:
- To determine the incidence of sessile serrated lesions (SSLs) in patients undergoing colonoscopy in Canterbury, New Zealand.
- To describe the clinical and pathological characteristics of identified SSLs.
- To compare current SSL incidence with historical data and inform diagnostic practices.
Main Methods:
- Retrospective analysis of electronic records for lower endoscopy procedures with polypectomy from January to December 2022.
- Collection of data on histological classification, location, and size of removed polyps.
- Primary outcome: proportion of procedures with at least one SSL, adenoma, or hyperplastic polyp.
Main Results:
- A total of 4346 procedures were analyzed, with 18.6% yielding at least one SSL.
- SSLs constituted 24.0% of all 9166 polyps removed.
- SSLs were predominantly found in the right colon (65.1%) and were typically smaller than 10 mm (84.8%).
Conclusions:
- The study identified a higher incidence of SSLs than previously reported, suggesting historical underestimation.
- Findings question the adequacy of current SSL detection rates as a key performance indicator.
- Results raise concerns about the efficacy of CT colonography as a sole screening tool for colorectal neoplasia.
