The frequency of sessile serrated adenomas detected during surveillance colonoscopy in patients with a history of colorectal cancer

Introduction and aims

Sessile serrated adenomas (SSAs) are precursor lesions of colorectal cancer (CRC) in 15–30% of cases, but due to their subtle characteristics, their endoscopic detection is a challenge. The present work aimed to determine the frequency of SSAs in patients with a history of CRC who underwent index and surveillance colonoscopies after their cancer diagnosis.

Material and methods

An observational cohort study was conducted on patients diagnosed with CRC who underwent an index colonoscopy and at least two surveillance colonoscopies at the Instituto Nacional de Cancerología in Mexico City, between January 2015 and December 2018. Demographic and clinical variables and endoscopic findings were analyzed. SSA frequency was calculated as the number of patients with one or more SSAs divided by the total number of patients analyzed. Means were compared for the bivariate inferential analysis and the chi-square test and Fisher’s exact test were used for the nominal variable analysis. Logistic regression was carried out to search for factors related to SSA.

Results

Four hundred patients were included; the mean patient age was 58 years and 52% were women. SSA frequency was 5.25%. Thirty-three percent of the SSAs were found in the index colonoscopy and 38% in subsequent colonoscopies. SSAs had a mean size of 5.52 mm, 84% were classified as Paris Is, 45% as KUDO II, and most were located in the ascending or transverse colon (21% and 20%, respectively).

Conclusions

SSAs are rare premalignant lesions, and their endoscopic diagnosis is a challenge. Their identification during the follow-up of patients with a history of CRC is essential for reducing the risk of metachronous progression.