Introduction

Sessile serrated lesions (SSLs) are obscured lesions predominantly at right sided colon and associated with interval colorectal cancer. However, the prevalence and risk factors among younger individuals remain unclear.

Aims & Methods

This retrospective study enrolled individuals who underwent index colonoscopy. The primary outcomes were SSL prevalence between younger (<50 years) and older (≥50 years) groups, whereas the secondary outcomes included clinically significant serrated polyps (CSSPs). Multivariable logistic regression was employed to identify predictors. The aim of this study is to investigate the prevalence of SSL of younger age people in the single center cohort. ​Individuals who visited outpatient services were mostly symptomatic, were eligible for screening colonoscopy, or had abnormal fecal/tumor marker test results. Additionally, asymptomatic individuals who underwent health checkups at their own expense or who adhered to national labor law requirements were included. The exclusion criteria were as follows: (1) instances of duplicated cases due to prior colonoscopy examinations, (2) cases with inadequate bowel preparation, (3) history of hospitalization or colonoscopy as part of an emergency room visit, (4) cases of unsuccessful cecal intubation or flexible sigmoidoscopy, and (5) suspicious or confirmed inflammatory bowel disease. Notably, individuals who had previously undergone colonoscopy at other hospitals, as confirmed by their electronic medical records or chart review, were also excluded.

Results

Of the 9854 eligible individuals, 4712 (47.8%) were categorized into the younger age group. Individuals in the younger age group exhibited a lower prevalence of adenomas (22.6% vs. 46.2%, P < 0.001) and right-sided adenomas (11.2% vs. 27.2%, P < 0.001) compared with their older counterparts. However, both groups exhibited a similar prevalence of SSLs (7.2% vs. 6.5%, P = 0.157) and CSSP (10.3% vs. 10.3%, P = 0.956). Multivariable analysis results revealed that age = 40–49 years (odds ratio [OR] = 1.81, 95% confidence interval [CI] = 1.01–3.23), longer withdrawal time (OR = 1.18, 95% CI = 1.15 – 1.21 per minute increment), and endoscopist performance (OR = 3.35, 95% CI = 2.44 – 4.58) were independent predictors of SSL detection in the younger age group. No significant correlation was observed between adenoma and SSL detection rates among endoscopists (P = 0.083).

	Younger age group (< 50-years-old)	Elder age group (≥ 50-years-old)	P value
Cases (%)	4712 (47.8)	5142 (52.1)	Not applicable
Symptomatic cases (%)	1985 (42.1)	2763 (53.7)	< 0.001*
Sex (female, %)	2425 (51.5)	2649 (51.5)	< 0.001*
Family history of CRC (%)	318 (6.7)	164 (3.2)	< 0.001*
Adenoma (%)	1063 (22.6)	2375 (46.2)	< 0.001*
Advanced adenoma (%)	188 (4.0)	728 (14.2)	< 0.001*
SSL (%)	341 (7.2)	335 (6.5)	0.157
CSSP (%)	485 (10.3)	531 (10.3)	0.956
CRC (%)	19 (0.4)	72 (1.4)	< 0.001*

Conclusion

SSLs are not uncommon among younger individuals. Moreover, diligent effort and expertise are of paramount importance in SSL detection. Future studies should explore the clinical significance of SSLs in younger age individuals.

References

1. Murcia O, Juárez M, Hernández-Illán E et al. Serrated colorectal cancer: Molecular classification, prognosis, and response to chemotherapy. World J Gastroenterol 2016; 22: 3516-3530. doi:10.3748/wjg.v22.i13.3516
2. Meester RG, van Herk MM, Lansdorp-Vogelaar I et al. Prevalence and clinical features of sessile serrated polyps: a systematic review. Gastroenterology 2020; 159: 105-118. e125
3. Burnett-Hartman AN, Newcomb PA, Phipps AI et al. Colorectal endoscopy, advanced adenomas, and sessile serrated polyps: implications for proximal colon cancer. The American journal of gastroenterology 2012; 107: 1213-1219. doi:10.1038/ajg.2012.167
4. Zorzi M, Senore C, Da Re F et al. Detection rate and predictive factors of sessile serrated polyps in an organised colorectal cancer screening programme with immunochemical faecal occult blood test: the EQuIPE study (Evaluating Quality Indicators of the Performance of Endoscopy). Gut 2017; 66: 1233-1240
5. Lall V, Ismail AGM, Ayonrinde OT. Disparate age and sex distribution of sessile serrated lesions and conventional adenomas in an outpatient colonoscopy population–implications for colorectal cancer screening? International Journal of Colorectal Disease 2022; 37: 1569-1579
6. Kim HY, Kim SM, Seo J-H et al. Age-specific prevalence of serrated lesions and their subtypes by screening colonoscopy: a retrospective study. BMC Gastroenterology 2014; 14: 82. doi:10.1186/1471-230X-14-82

Disclosure

This study is recently accepted by Endoscopy (2024/02). We hope this research can be considered for the congress with its clinical importance and impact.

Introduction

Sessile serrated lesions with dysplasia (SSLD) are known high-risk polyps due to their potential for rapid progression to colorectal cancer (CRC). As such, timely detection and appropriate treatment are essential. However, due to the fact that SSLDs are relatively rare, evidence regarding their prevalence and characteristics remains limited. This population-based study aims to generate more robust evidence on the prevalence and characteristics of SSLDs.

Aims & Methods

This study analyzed all prospectively collected baseline colonoscopy data from the Dutch CRC screening program between January 2014 and December 2023, linked to the national pathology database (PALGA). The prevalence of sessile serrated lesions (SSL) and SSLD was calculated for two time periods (2014-2018 and 2019-2023), along with the number needed to screen (NNS) and corresponding confidence intervals (CI), stratified by age category (<60, 60-70, >70) and gender. Dysplasia rates (the proportion of SSLD among all SSL diagnoses) were assessed by polyp characteristics- including location, age- and size category- as well as by colonoscopy year to evaluate temporal trends. Multivariate regression using generalized estimating equations (GEE) was performed to examine the influence of age and gender on SSLD prevalence, and to identify polyp-level characteristics associated with dysplasia.

Results

Among 516.193 colonoscopies, 49.953 individuals had at least one SSL, and 5.737 individuals had at least one SSLD. Over the study period, a total 1.033.298 polyps were removed, including 76.771 SSLs and 7.019 SSLDs. Among FIT-positive individuals the overall SSL prevalence 9.68% (9.60-9.76) and the overall SSLD prevalence was 1.11% (1.08-1.14). The NNS for SSLs decreased from 13 in 2014-2018 to 9 in 2019-2023, while the NNS for SSLDs remained stable at 90. At patient level, increasing age was associated with higher SSLD prevalence (OR 1.03 CI95% 1.03-1.04 per year increase). At polyp level, both increasing age and size of SSLs were associated with a higher rate of dysplasia (P<0.001), yet at least 30% of SSLD cases involved polyps <10 mm. Regression analysis combining size and age showed that, compared to SSLs <5mm in individuals aged ≤60 years, the odds of dysplasia were seven times higher in individuals aged >70 years with SSLs ≥25mm (OR 7.01 CI95% 3.81-12.5). Over time, the dysplasia rate among SSLs declined from 17.5% in 2014 to 6.6% in 2023 (table 1).

Table 1: Diagnoses of SSL versus SSL and overall rate of dysplasia over time

	2014	2015	2016	2017	2018	2019	2020	2021	2022	2023
SSLs (n)	1.867	4.467	5.866	7.009	8.202	8.901	6.788	11.148	10.645	11.878
SSLD (n)	326	600	550	857	890	825	521	909	747	785
Rate of dyspl​asia:	17.5%	13.4%	9.4%	12.2%	10.9%	9.3%	7.7%	8.2%	7.0%	6.6%

Conclusion

This national study demonstrated that the prevalence for SSLs increased over time, while the prevalence of SSLD remained stable. Dysplasia in SSLs was associated with older age and larger polyp size. The observed decline in dysplasia rates over time may reflect challenges in SSLD detection, possibly due to limited classification guidelines compared to SSLs. Further research is needed to support improved recognition of SSLDs by both endoscopists and pathologists.

Disclosure

ED: received honoraria for consultancy from Olympus, Fujifilm, Ambu, InterVenn, Norgine and Exact Sciences. Speakers' fees from Olympus, Norgine, IPSEN/Mayoly, FujiFilm, Steris and Pentax. Endoscopic equipment on loan of FujiFilm
All other authors (NR and JIJ, VA) have nothing to disclose.

Introduction

Serrated polyps (in particular sessile serrated lesions and traditional serrated adenomas according to WHO classification) are recognized as premalignant lesions, responsible of a significant proportion of colorectal cancer via the serrated neoplasia pathway.

Aims & Methods

We aimed to study the prevalence and risk factors of serrated polyps, comparing them with adenomas and with patients with negative colonscopies in a colorectal italian screening population. A retrospective case-control study was performed in a secondary-referral center in Rome (San Filippo Neri Hospital). Data were collected on an Excel database and retrieved from pre-endoscopy questionairres, endoscopic and hystologic reports of screening colonscopies, performed from November 2021 to December 2024.

Results

Preliminary analysis was carried out on 700 screening subjects (331 male and 369 female of age between 50 and 74 years). including 274 subjects (39%) with adenomas and 33 subjects with serrated lesions (4,7%). Exclusion criteria were incomplete colonscopies, inadequate bowel preparation (Boston Bowel Preparation Scale < 6) and symptomatic subjects. In the group of subjects with serrated lesions, 23 (69,7 %) had dysplasia. About 70% of adenomas were in the left colon, while the prevalence of serrated lesions was similar in the left and right colon (51,5% and 48,5 % respectevely). People with hyperplastic polyps, although classified as serrated lesions by WHO classification, are generally considered as benign and were therefore not considered in our analysis. For multivariable analysis we considered 12 subjects that had only serrated lesions and 218 subjects that had only adenomas, comparing them to 339 subjects that had no polyps. Independent variable considered were: age, gender, smoking, Body Mass Index, hypertension, dyslipidemia and type 2 diabetes mellitus. From multivariable logistic regression resulted that smoking was significant indipendent risk factor for serrated lesions (OR: 3.646, 95 % CI 0.056-2.532), whilst male sex and smoking were significant indipendent risk factors for adenomas (male sex OR: 1.768, 95 % CI 0.217-0.923; smoking OR: 1.730, 95 % CI 0.196-0.900).

Conclusion

In our study population, the prevalence of colorectal serrated lesions was 4,7%. Risk factors associated with adenomas were male sex and smoking and with serrated lesions was only smoking. However, a larger sample of subjects with serrated polyps is needed to confirm these results.

References

-Lui RN, Kyaw MH, Lam TYT, Ching JYL et al. Prevalence and risk factors for sessile serrated lesions in an average risk colorectal cancer screening population. J Gastroenterol Hepatol. 2021 Jun;36(6):1656-1662. doi: 10.1111/jgh.15368. Epub 2021 Jan 6. PMID: 33617148.
-Zhang R, Ni Y, Guo CL et al. Risk factors for sessile serrated lesions among Chinese patients undergoing colonoscopy. J Gastroenterol Hepatol. 2023 Sep;38(9):1468-1473. doi: 10.1111/jgh.16200. Epub 2023 May 1. PMID: 37128710.

Introduction

Sessile Serrated Lesions (SSLs) show an “ultra flat” morphology, a mucus cap and are predominantly located proximally to the splenic flexure (PSF) (1). Hypothetically, previous knowledge in detection of flat or non-protruding conventional adenoma could be a predictor factor for endoscopic detection of SSLs.

Aims & Methods

Aim: To investigate in a South American Private Hospital, the relationship between Flat Adenomas Detection Rate (FADR) and Sessile Serrate Lesion Detection Rate (SDR)
Methods: This study is a retrospective, single-center analysis carried out at Centro Medico Docente La Trinidad Caracas-Venezuela from total selected colonoscopies performed by the gastroenterologists between 2008 and 2018 in patients 51-80 years old (YO). For this study, Adenoma Detection Rate (ADR) includes the whole morphologic spectrum of colon & rectum traditional adenomas from Paris Classification of Colorectal Lesions (2). We will consider the “General ADR” as “GADR”, including Non-protruding or flat ADR: “FADR” plus Protruding ADR: “PADR”, as well as the last two separately. By using logistic regression generalized estimating equation models, the location in colon & rectum and morphology of all types of adenomas (ADs) were assessed. The relationship between the global number of colonoscopies (GNC), GADR, FADR, PADR and the SDR was investigated calculating a correlation coefficient (CC) weighted by the number of total colonoscopies. In addition, 3 linear regression equation models to estimate the relationship between the 3 different types of ADR and SDR and the probability of occurrence of SDR based on the proportion of colonoscopies with SDR presenting every type of ADR weighted by the number of colonoscopies with SDR were calculated.

Results

Results of the linear regression models used to estimate the relationship between the different types of ADR and SDR and the probability of occurrence based on the number of Centro Medico Docente La Trinidad colonoscopies
Category of ADR	R2	β	P	SDR Correlation coefficient	Probability of occurrence (%)	Colonoscopies in each category of ADR validated for SDR calculation
General ADR	0.9687	0.1632	<0.001	0.9842	94.26	148
Flat ADR	0.759	1.888	0.002	0.8712	92.35	145
Protruding ADR	0.3186	0.1664	0.113	0.5644	37.58	59
R2 : Determination coefficient. This evaluates the strength of the linear relationship between the two variables.
β: Partial regression coefficient. It indicates the average effect that the increase in one unit of the predictor variable has on the dependent variable.
ADR: Adenoma Detection Rate. SDR: Serrated Detection Rate. 157 colonoscopies were valid for the calculation of the SDR

For this study, 8432 colonoscopies were validated for 9 gastroenterologists (G1-G9). For patients between 51 and 80 YO, GADR for all 9 Gastroenterologists was 19.76%. GADR-SDR individually for 9 gastroenterologists (G1-G9) varies from as high as G9 GADR-SDR: 33.21%-4.19% to as low as G1: 12.67%-0.50%. The most frequent location for ADs was PSF: OR 1.95, IC 95% (1.30-2.84), P<0.001. SSLs were mostly located PSF OR 2.18, IC 95% (1.44, 2.92) P<0.001. The morphology of ADs was mainly pedicle OR 1.00 IC 95% P<0.001 and for SSL it was flat by far: OR 6.84 IC 95% (2.08-9.02) P<0.001. The CC demonstrated a good association between GADR and SDR: 0.98 P<0.05; and for FADR: 0.87, P<0.05 but not for PADR: 0.56 P=0.113. The GNC was not associated with the SDR CC: -0.197, P=0.6117. The GADR and FADR show robust strength of the linear relationship with SDR and probability of occurrence, but not for PADR (table)

Conclusion

A sine qua non factor for a good SDR for the gastroenterologist is previous knowledge about “FADR”. To the best of our knowledge, this is the first time that ADR has been divided into “General, Flat and Protruded” in order to investigate the impact of the endoscopic skills on flat colorectal lesions detection for a good SDR.

References

1. Rex DK, Ahnen DJ, Baron JA et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol 2012; 107: 1315-1329; quiz 1314, 1330 [PMID: 22710576 DOI: 10.1038/ ajg.2012.161]
2. Lambert R et al. Superficial Neoplastic Lesions in the Digestive Tract. Endoscopy 2005; 37: 570±578

Introduction

Sessile serrated lesion (SSL), is a precursor lesion in the serrated neoplasia pathway [1]. These lesions are considered a major contributor to the failure of colonoscopy to prevent colorectal cancers (known as “interval cancer” or “post-colonoscopy colorectal cancer”) [2]. Therefore, improved awareness of the clinicopathological and endoscopic characteristics of SSL and their dysplastic components is important.

Aims & Methods

This study aimed to elucidate the clinicopathological and endoscopic features of SSLs with and without dysplasia or carcinoma. We reviewed the data of all colorectal lesions that were pathologically diagnosed as SSLs at Juntendo University Hospital, Tokyo, Japan, between 2011 and 2022. During this period, all suspected SSLs were resected endoscopically or surgically. The histological diagnosis of SSLs was based on the World Health Organization Classification of Tumours of the Digestive System 2019 [3]. We analysed the clinicopathological features of all the patients, including age, sex, tumour location and size, and conventional endoscopic findings.

Results

Table 1.	Clinicopathological and endoscopic characteristics of colorectal lesions studied.
Variable [Lesions / Patients]	ND [1972 (92.5%) / 1276]	LGD [101 (4.7%) / 94]	HGD [39 (1.8%) / 38]	SIC [20 (0.9%) / 20]
Age (years)	62.8 ± 12.1 (23 - 91)	64.8 ± 10.0 (35 - 85)	71.6 ± 8.9 (51 - 86)	72.2 ± 9.7 (47 - 90)
Sex: Male / Female	667 (52.3%) / 609 (47.7%)	41 (43.6%) / 53 (56.4%)	14 (36.8%) / 24 (63.2%)	7 (35.0%) / 13 (65.0%)
Location: Proximal / Distal	1637 (83.0%) / 335 (17.0%)	81 (80.2%) / 20 (19.8%)	33 (84.6%) / 6 (15.4%)	18 (90.0%) / 2 (10.0%)
Size of tumour (mm)	10.8 ± 7.6 (2 - 65)	15.0 ± 9.0 (5 - 42)	14.2 ± 8.4 (6 - 43)	20.2 ± 12.7 (8 - 65)
(Semi)pedunculated morphology	51 (2.6%)	14 (13.9%)	10 (25.6%)	5 (25.0%)
Reddishness	77 (3.9%)	40 (39.6%)	21 (53.8%)	16 (80.0%)
Double elevation	70 (3.5%)	61 (60.4%)	19 (48.7%)	10 (50.0%)
Central depression	44 (2.2%)	6 (5.9%)	2 (5.1%)	6 (30.0%)

The clinicopathological and endoscopic characteristics of the lesions are summarised in Table 1. Out of 2132 SSLs (1368 patients), 1972 (92.5%) had no dysplasia (ND), 101 (4.7%) had low-grade dysplasia (LGD), 39 (1.8%) had high-grade dysplasia (HGD), and 20 (0.9%) had submucosal invasive carcinoma (SIC). Older age is more frequently associated with SSLs and dysplasia/carcinoma. The most frequent location of tumours was the proximal colon. A stepwise increase in the size of the SSL series was identified, along with dysplastic progression from ND to dysplasia to invasive carcinoma. Similarly, larger lesions were associated with higher rates of dysplasia or cancer (≥ 5 mm, 1.2%; 6 - 10 mm, 6.5%; 11-15 mm; 9.5%, 16-20 mm, 12.9%; ≥ 21 mm, 17.3%). However, 66 of the 160 (41.3%) SSLs with dysplasia/carcinoma were ≤ 10 mm in size. Macroscopically, (semi)pedunculated morphology, reddishness, double elevation, and central depression were more frequently observed in SSLs with dysplasia/carcinoma than in those without.

Conclusion

Our findings suggest that SSLs with dysplasia/carcinoma may be more frequently associated with older age, the proximal colon, and larger lesions. However, dysplasia/cancer could coexist in SSLs even if the size was ≤ 10 mm. Additionally, in an SSL series, endoscopic characteristics, including (semi)pedunculated morphology, reddishness, double elevation, and central depression, might be useful for the accurate diagnosis of advanced histology within an SSL. These results may may contribute to improvement in the recognition and complete resection of SSLs with dysplasia or invasive carcinoma, thereby reducing the rates of colorectal cancer.

References

1. O'Brien MJ, Yang S, Mack C, et al. Comparison of microsatellite instability, CpG island methylation phenotype, BRAF and KRAS status in serrated polyps and traditional adenomas indicates separate pathways to distinct colorectal carcinoma end points. Am J Surg Pathol. 2006; 30: 1491–1501.
2. Sawhney MS, Farrar WD, Gudiseva S, et al. Microsatellite instability in interval colon cancers. Gastroenterology. 2006; 131: 1700–1705.
3. Pai RK, Mäkinen MJ, Rosty C. Colorectal serrated lesions and polyps. In: Nagtegaal ID, Arends MJ, Odze RD, Lam AK (eds). WHO Classification of Tumours of the Digestive System, 5^th edn. Lyon: IARC Press, 2019; 163–169.

Introduction

Serrated polyps (SPs) are precursors to 15–20% of colorectal cancers (CRCs). However, there are uncertainties regarding which SPs require surveillance and at what intervals, with recommendations adapted from those for adenomas in the absence of solid evidence.

Aims & Methods

Our aim was to assess which SP risk characteristics relate to a higher risk of metachronous CRC or advanced polyps. We systematically searched PubMed, EMBASE, and Cochrane for cohort, case-control studies, and clinical trials from inception to Dec 31, 2023, for CRC or advanced polyps [advanced adenoma (AA) or advanced SP] incidence at surveillance stratified by baseline SP size, dysplasia, location, and multiplicity. CRC and advanced polyp incidence per 1,000 person-years (p-y) were estimated. We performed a meta-analysis by calculating pooled relative risks (RR) using a random-effects model.

Results

5,903 studies were reviewed and 14 included, with 493,949 patients (mean age 59·5 years, 55% men). Mean follow-up was 4·9 years. CRC incidence per 1,000 p-y was 2·09 (95%CI 1·29–2·90) for advanced SP, 1·52 (0·78–2·25) for SP>10mm, 5·86 (2·16–9·56) for SP with dysplasia, 1·18 (0·77–1·60) for proximal SP, 0·52 (0·08–1·12) for >3SP, 0·50 (0·35–0·66) for non-advanced SP, and 0·44 (0·41–0·46) for normal colonoscopy. Metachronous CRC risk was higher in advanced SP vs non-advanced SP (RR 1·84, 95%CI 1·11–3·04), and vs normal colonoscopy (RR 2·92, 2·26–3·77); in SP>10mm vs <10mm (RR 2·61, 1·43–4·77), and vs normal colonoscopy (RR 3·52, 2·17–5·69); and in SP with dysplasia vs normal colonoscopy (RR 2·71, 2·00–3·67). No increase in CRC or advanced polyp risk was found in patients with proximal vs distal SP, nor in >3SP vs 1–2SP.

Conclusion

CRC risk is significantly higher in patients with baseline advanced SP after 4·9 years of follow-up, with risk magnitudes similar to those described for AA, supporting the current recommendation for 3-year surveillance in patients with advanced SP.

Disclosure

RJ has received research grants from MSD, and has participated as an advisor to MSD, Norgine, Alpha-Sigma, and GISupply. UL has participated in the advisory board (UniversalDx, Lean Medical, Vivante, Kohler Ventures), and as consultant (Medtronic, Clinical Genomics, Guardant Health, Freenome, ChekCap). MDR has no COI since start of 2020 (Advisor for Norgine in 2019). The rest of authors have nothing to disclose.

Introduction

The indications for colonoscopy are well established, with the primary objective being the detection of neoplasia or lesions that carry a high risk for colorectal cancer, even though benign causes are more commonly encountered. In young adults under 50 years of age, common indications include rectal bleeding and diarrhea. In contrast, individuals aged 50 years and older are screened more broadly due to the increased risk of colorectal cancer, although recent trends show a rising incidence of neoplastic lesions in younger adults as well. ​

Aims & Methods

The aim of our study is to compare the indications and outcomes of colonoscopy between individuals younger and older than 50 years, and to identify which indications are most strongly associated with neoplastic findings.
A retrospective, descriptive, and analytical study was conducted over a period of 3.5 years, involving 1,518 patients. Participants were divided into two groups: Group A included patients under 50 years old, while Group B comprised those aged 50 and above. Epidemiological, clinical, and endoscopic data were compared between the two groups. Patients with a known diagnosis of inflammatory bowel disease (IBD) were excluded from the study. Statistical analysis was carried out using SPSS version 21.0.

Results

Among the patients, 65.1% were over 50 years of age, while 34.9% were under 50. The mean age in group A (under 50) was 37.5 ± 9 years, compared to 64.4 ± 9 years in group B (over 50). Females predominated in the younger group (55.3%), whereas males were more prevalent among older patients (56.3%) (p < 0.001). A personal history of colorectal cancer was more frequent in patients over 50 (10.5% vs. 4.4%; p < 0.001).
Colonoscopy indications varied by age group: constipation was the most common indication in group B (29.1% vs. 22%; p = 0.01), whereas diarrhea predominated in group A (33.3% vs. 19.3%; p < 0.001). Pathological findings on colonoscopy were more frequent in older patients (49.1% in group B vs. 32.9% in group A; p < 0.001).
In patients under 50, the most common pathological findings were colitis or ulcerative colitis (47.9% vs. 11.7%; p < 0.001). In contrast, patients over 50 showed a higher prevalence of polyps (61.5% vs. 41.3%; p < 0.001) and rectocolonic neoplasia (16% vs. 5%; p = 0.002).
Among the colonoscopy indications, constipation in patients under 50 was associated with a higher risk of neoplastic lesions (p = 0.007), while in patients over 50, rectal bleeding and constipation were significantly associated with neoplastic lesions (p < 0.001).

Conclusion

The presence of neoplastic lesions was strongly associated with constipation in individuals under 50 years of age, and with both rectal bleeding and constipation in those over 50. Further studies to better define these indications could help improve the appropriateness of colonoscopy, particularly in younger patients.