Relationship of colonoscopy-detected serrated polyps with synchronous advanced neoplasia in average-risk individuals

Cristina Álvarez, Montserrat Andreu, Antoni Castells, Enrique Quintero, Luis Bujanda, Joaquín Cubiella, Dolores Salas, Ángel Lanas, Fernando Carballo, Juan Diego Morillas, Cristina Hernández, Rodrigo Jover, Cristina Sarasqueta, José M. Enriquéz-Navascués, Vicent Hernández, Pamela Estévez, Ramiro Macenlle, Teresa Sala, Francesc Balaguer, Maria PelliséLeticia Moreira, Inés Gil, Antonio Peris, Francisca González-Rubio, Ángel Ferrández, Carmen Poves, Marta Ponce, Jaume Grau, Anna Serradesanferm, Akiko Ono, José Cruzado, Francisco Pérez-Riquelme, Inmaculada Alonso-Abreu, Marta Carrillo-Palau, Cecilio Santander, José Díaz Tasende, Alberto Herreros, Guillermo Cacho, Luis Eugenio Barranco, Xavier Bessa

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58 Citations (Scopus)


Background: Serrated cancers account for 10% to 20% of all colorectal cancers (CRC) and more than 30% of interval cancers. The presence of proximal serrated polyps and large (≥10 mm) serrated polyps (LSP) has been correlated with colorectal neoplasia. Objective: To evaluate the prevalence of serrated polyps and their association with synchronous advanced neoplasia in a cohort of average-risk population and to assess the efficacy of one-time colonoscopy and a biennial fecal immunochemical test for reducing CRC-related mortality. This study focused on the sample of 5059 individuals belonging to the colonoscopy arm. Design: Multicenter, randomized, controlled trial. Setting: The ColonPrev study, a population-based, multicenter, nationwide, randomized, controlled trial. Patients: A total of 5059 asymptomatic men and women aged 50 to 69 years. Intervention: Colonoscopy. Main Outcome Measurements: Prevalence of serrated polyps and their association with synchronous advanced neoplasia. Results: Advanced neoplasia was detected in 520 individuals (10.3%) (CRC was detected in 27 [0.5%] and advanced adenomas in 493 [9.7%]). Serrated polyps were found in 1054 individuals (20.8%). A total of 329 individuals (6.5%) had proximal serrated polyps, and 90 (1.8%) had LSPs. Proximal serrated polyps or LSPs were associated with male sex (odds ratio [OR] 2.08, 95% confidence interval [CI], 1.76-4.45 and OR 1.65, 95% CI, 1.31-2.07, respectively). Also, LSPs were associated with advanced neoplasia (OR 2.49, 95% CI, 1.47-4.198), regardless of their proximal (OR 4.15, 95% CI, 1.69-10.15) or distal (OR 2.61, 95% CI, 1.48-4.58) locations. When we analyzed subtypes of serrated polyps, proximal hyperplasic polyps were related to advanced neoplasia (OR 1.61, 95% CI, 1.13-2.28), although no correlation with the location of the advanced neoplasia was observed. Limitations: Pathology criteria for the diagnosis of serrated polyps were not centrally reviewed. The morphology of the hyperplasic polyps (protruded or flat) was not recorded. Finally, because of the characteristics of a population-based study carried out in average-risk patients, the proportion of patients with CRC was relatively small. Conclusion: LSPs, but not proximal serrated polyps, are associated with the presence of synchronous advanced neoplasia. Further studies are needed to determine the risk of proximal hyperplastic polyps.
Original languageEnglish
JournalGastrointestinal Endoscopy
Issue number2
Publication statusPublished - 1 Jan 2013


  • CIMP
  • colorectal cancer
  • CpG island methylation phenotype
  • CRC
  • high degree of microsatellite instability
  • HP
  • hyperplastic polyp
  • large serrated polyp
  • LSP
  • MSI-H
  • sessile serrated adenoma
  • SSA
  • traditional serrated adenoma
  • TSA


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