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Current sessile serrated lesion incidence: implications for future clinical practice.

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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.

Keywords:
colon cancer screeningcolorectal cancersessile serrated lesionsessile serrated polyp

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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.