Investigating Prevalence and Progression of Serrated Polyps: Tampa VA Experience

Abstract

Introduction: Adenomas have historically been considered the sole precursor lesions that lead to colorectal cancer (CRC) via the adenoma-carcinoma sequence. A recently recognized pathway in colorectal carcinogenesis involves “serrated polyps”, which until recently were considered to be innocuous lesions. Serrated polyps are classified into sessile serrated adenomas (SSA), traditional serrated adenomas (TSA) and serrated adenomas (SA). Despite the serrated neoplastic pathway accounting for up to 10-20% of all sporadic colorectal cancers, these polyps remain under diagnosed and poorly understood. We aim to identify the prevalence and potential progression of serrated polyps in our veteran population. Methods: Retrospective analysis was performed on all patients who underwent all cause colonoscopies over a 10-year period from 1/1/2005-12/31/2015. Our primary aim was to analyze the trend in prevalence of serrated polyps. Secondary outcomes were to correlate prevalence of serrated polyps with modifiable lifestyle factors. Low risk adenomas were categorized as tubular adenoma and high-risk adenomas were categorized as tubulo-villous adenomas.Table: Table. Risk factors affecting TA vs. SA and TA vs.TSATable: Table. Risk factors affecting TA vs. SSAFigure: Prevalence of serrated polyps over 10 years.Results: An electronic databank was created after analyzing 14,593 pathology reports from a 10-year period. The individual cases were categorized as SSA, TSA, SA, SSA+high-risk adenoma, SSA+low risk adenoma, SA+high-risk adenoma, SA+low risk adenoma, TSA+high risk adenoma, TSA+low risk adenoma and TA (control). There was a progressive increase in the percentage of serrated polyps per all lesions identified on colonoscopy over the 10-year period. There was no significant correlation between HgA1c, total cholesterol, HLD, LDL and triglycerides between TA vs. TSA and SA. There was a statistical significance between TA vs. SSA in regards to LDL (P<0.03).Figure: Categories of polyps in the study.Conclusion: A database of serrated polyps detected undergoing colonoscopy was generated. Temporal trends in the detection of these lesions and variables that might affect their prevalence were identified and analyzed. Further data is being collected including correlation with Vitamin D and ASA use. Serrated polyps are increasingly being recognized as lesions that can progress into cancer. Therefore, it is imperative that gastroenterologists and pathologists are aware to remove and properly classify these serrated lesions. To our knowledge, this is the first study to date investigating the prevalence of serrated polyps in the veteran population.