Abstract
Purpose: Studies suggest that colonoscopy may have a greater protective effect for distal colorectal cancer (CRC) than proximal CRC. Serrated polyps are frequently located in the proximal colon, can be missed during colonoscopy, and may progress to CRC via the serrated pathway. The aims of this study were to determine the prevalence of proximal serrated polyps, and compare the proximal serrated polyp detection rates of individual endoscopists in a large cohort of average-risk patients undergoing screening colonoscopy. Methods: Screening colonoscopies performed by 15 attending gastroenterologists at two academic endoscopy units between 2000 and 2009 were reviewed. Individual endoscopist detection rates for adenomas and serrated polyps were calculated. Pearson correlation coefficients were calculated to evaluate the associations of adenoma and proximal serrated polyp detection rates. Logistic regression was used to compare the endoscopists for the detection of at least 1 serrated polyp in the proximal colon. Results: A total of 11,049 polyps were detected in 6681 colonoscopies (adenomas: 5637, 51%; serrated: 3984, 36%; proximal serrated: 1238, 11%). The overall proportion of colonoscopies with at least one proximal serrated polyp was 13% and ranged from 1% to 18% for individual endoscopists. Proximal serrated polyp detection rates per colonoscopy ranged from 0.01 to 0.26. Adenoma and proximal serrated polyp detection rates per colonoscopy were strongly correlated (R=0.76, p=0.0005). The odds of detecting at least one proximal serrated polyp for individual endoscopists ranged from 0.05 to 0.67 compared to the highest level detector. Endoscopist (p<0.0001), but not patient age (p=0.76) or patient gender (p=0.95), was strongly associated with proximal serrated polyp detection. Conclusion: In this average-risk screening cohort, the detection of proximal serrated polyps was highly variable and endoscopist-dependent. A significant proportion of proximal serrated polyps may be missed during colonoscopy. This highlights the importance of a high quality colonoscopy to allow the detection and resection of all polyps with neoplastic potential.
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