title: Presence of small sessile serrated polyps increases rate of advanced neoplasia upon surveillance compared with isolated low-risk tubular adenomas.
abstract: OBJECTIVE
  The U.S. Multi-Society Task Force (USMSTF) stratifies patients with sessile serrated polyps (SSPs) without cytologic dysplasia of <10 mm in size as at low risk for metachronous advanced neoplasia and recommends management similar to low-risk conventional tubular adenomas. Evidence supporting the recommended surveillance interval for these low-risk SSPs is limited. We aimed to assess rates of metachronous advanced neoplasia based on the presence of an initial low-risk SSP compared with isolated low-risk tubular adenomas.
  
  
  METHODS
  Colonoscopy data were retrieved for 2260 patients found to have an adenoma or SSP on pathology records between 2005 and 2011 at an academic medical center. The 788 patients who met study design criteria were stratified into 4 groups based on the presence of a high- or low-risk adenoma (HRA or LRA) and of a synchronous SSP on initial colonoscopy. The rates of advanced neoplasia at surveillance colonoscopy were then compared between groups.
  
  
  RESULTS
  The rate of advanced neoplasia at surveillance in the LRA inclusive of SSP group (12/66, 18.2%) was greater than in the LRA without any SSP group (29/370, 7.8%; P = .019). The rate of advanced neoplasia at surveillance in patients with isolated low-risk SSP (10/56, 17.9%) remained significantly greater than those with isolated low-risk tubular adenomas (29/370, 7.8%; P = .024). The rate of advanced neoplasia upon surveillance in the LRA inclusive of SSP group (18.2%) was comparable with the rate observed in the index HRA without any SSP group (15.9%) (40/252, P = .709).
  
  
  CONCLUSIONS
  The rate of advanced neoplasia upon surveillance in patients with initial low-risk SSPs is higher than in patients with initial isolated low-risk tubular adenomas and more similar to patients with initial high-risk tubular adenomas. These findings suggest that the rate of metachronous advanced neoplasia in patients with what are considered by USMSTF as "low-risk" SSPs is higher than in those without SSPs. Therefore, a surveillance interval that accounts for the presence of SSPs even in small lesions without cytologic dysplasia should be considered.
authors: Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA.
authors: Joshua
authors: J
authors: Melson
authors: Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA.
authors: Karen
authors: K
authors: Ma
authors: Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA.
authors: Saba
authors: S
authors: Arshad
authors: Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA.
authors: Michael
authors: M
authors: Greenspan
authors: Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA.
authors: Thomas
authors: T
authors: Kaminsky
authors: Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA.
authors: Vinesh
authors: V
authors: Melvani
authors: Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA.
authors: Faraz
authors: F
authors: Bishehsari
authors: Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA.
authors: Brett
authors: B
authors: Mahon
authors: Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA.
authors: Shriram
authors: S
authors: Jakate
mesh_terms: D000046:Academic Medical Centers; D000236:Adenoma / Q000453:epidemiology* / Q000473:pathology; D000368:Aged; D002277:Carcinoma / Q000453:epidemiology* / Q000473:pathology; D003111:Colonic Polyps / Q000453:epidemiology* / Q000473:pathology; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors