title: Serrated polyps and the risk of synchronous colorectal advanced neoplasia: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Serrated polyps of the colon comprise a heterogeneous group of lesions with distinct histological and malignant features. The presence of serrated polyps has been associated with synchronous advanced neoplasia, although the magnitude of this relationship is unclear.
  
  
  METHODS
  Using studies identified from systematic literature search up to February 2014, we performed a systematic review and meta-analysis to estimate the pooled prevalence of serrated polyps and their association with synchronous advanced neoplasia. Random-effects models were used to combine estimates from heterogeneous studies, and odds ratios (ORs) with 95% confidence intervals (CIs) were presented.
  
  
  RESULTS
  Nine studies with 34,084 participants were included. The mean age of subjects was 59.9±6.6 years and 52.5% of the subjects were male. Pooled prevalence of serrated polyps was 15.6% (95% CI, 10.3-22.9%). The pooled OR of advanced neoplasia in individuals with serrated polyps was 2.05 (95% CI, 1.38-3.04). Pooled analysis showed that the presence of proximal serrated polyps (OR=2.77, 95% CI, 1.71-4.46) and large serrated polyps (OR=4.10, 95% CI, 2.69-6.26) was associated with an increased risk of synchronous advanced neoplasia. The pooled OR for advanced neoplasia in individuals with proximal and large serrated polyps was 3.35 (95% CI, 2.51-4.46). Considerable heterogeneity was observed in most analyses.
  
  
  CONCLUSIONS
  Our meta-analysis showed that serrated polyps are associated with a more than twofold increased risk of detection of synchronous advanced neoplasia. Individuals with proximal and large serrated polyps have the highest risk. These individuals deserve surveillance colonoscopy.
authors.affiliation: 1] Institute of Digestive Disease, Department of Medicine and Therapeutics, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong, Shatin, Hong Kong, China [2] Division of Gastroenterology and Hepatology, Ren-Ji Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China.
authors.forename: Qinyan
authors.initials: Q
authors.lastname: Gao
authors.affiliation: 1] Institute of Digestive Disease, Department of Medicine and Therapeutics, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong, Shatin, Hong Kong, China [2] School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Kelvin K F
authors.initials: KK
authors.lastname: Tsoi
authors.affiliation: Institute of Digestive Disease, Department of Medicine and Therapeutics, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Hoyee W
authors.initials: HW
authors.lastname: Hirai
authors.affiliation: School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Martin C S
authors.initials: MC
authors.lastname: Wong
authors.affiliation: Institute of Digestive Disease, Department of Medicine and Therapeutics, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Francis K L
authors.initials: FK
authors.lastname: Chan
authors.affiliation: Institute of Digestive Disease, Department of Medicine and Therapeutics, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Justin C Y
authors.initials: JC
authors.lastname: Wu
authors.affiliation: Department of Surgery, Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: James Y W
authors.initials: JY
authors.lastname: Lau
authors.affiliation: Institute of Digestive Disease, Department of Medicine and Therapeutics, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Joseph J Y
authors.initials: JJ
authors.lastname: Sung
authors.affiliation: Institute of Digestive Disease, Department of Medicine and Therapeutics, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Siew C
authors.initials: SC
authors.lastname: Ng
mesh_terms: D000328:Adult; D000368:Aged; D015982:Bias; D002471:Cell Transformation, Neoplastic; D003111:Colonic Polyps / Q000150:complications* / Q000453:epidemiology / Q000473:pathology*; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000453:epidemiology* / Q000209:etiology; D016017:Odds Ratio; D015995:Prevalence; D012306:Risk