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

Over the world, fecal occult blood testing (FOBT) is used as a colorectal cancer (CRC) screening method for middle age and older age, but there are problems such as sensitivity/specificity issues, low participation rates in primary and secondary screenings, and that the incidence/mortality rates of CRC are still high. Fusobacterium nucleatum (Fn) has been reported to be frequently detected in the feces of CRC patients in recent years, and it has been reported that screening sensitivity can be increased by combining it with Fn PCR testing. However, due to the cost and technical complexity of PCR, it has not yet been widely used in clinical practice. In this study, we developed a simple method using ELISA to measure antibodies against FadA expressed by Fn and evaluated its usefulness.

Aims & Methods

We evaluated FOBT, Fn PCR quantification, and Fn (ELISA) in 41 individuals diagnosed with CRC from April 2020 to December 2022 and 41 healthy volunteers without CRC. Subgroup analysis was also performed in CRC patients at each stage.

Results

The correlation coefficient between Fn PCR quantification and Fn (ELISA) was good at r=0.722, p<0.001. FOBT alone had a sensitivity of 61% and a specificity of 100%. In Fn ELISA, when cut off#1 was set to maximize the AUC in ROC, the sensitivity and specificity were 76% and 78%, respectively, and when combined with FOBT, the sensitivity was 90% and the specificity was 78%. In screening, high specificity is required, so we set cut off#2 Fn ELISA to achieve a specificity of 93% and performed analysis. When combined with FOBT, the sensitivity was 73% and the specificity was 93%. When targeting advanced cancer of stage II or higher, the sensitivity by combining FOBT and Fn ELISA was 100% at cut off#1 and 79% at cut off#2, while for early cancer, the sensitivity was 76% at cut off#1 and 59% at cut off#2, both of which were better than the sensitivity of FOBT alone.

Conclusion

By combining Fn measurement using ELISA with FOBT, it was possible to increase the diagnostic sensitivity and reduce false negatives compared to FOBT alone. There are challenges such as setting appropriate cut-off values for use in screening, but measuring Fn in addition to FOBT may improve screening accuracy and increase the participation rate in secondary screening, and in the future, we would like to evaluate its effectiveness even in populations with low prior probability of screening participation.

Introduction

Cold snare polypectomy (CSP) for polyps 10-14 mm is unsatisfactory, with higher rates of unclear/positive histologic margins compared to small polyps,¹ which is similar for CSP with submucosal injection.² Therefore, hot snare polypectomy (HSP) or endoscopic mucosal resection (EMR) has been widely performed for polyps measuring ≥10 mm.³ However, these procedures often cause adverse events such as delayed bleeding and perforation due to deep thermal injury related to the use of electrocautery.⁴ A recent large-scale study reported a low incidence (0.9%) of invasive cancer in 10-19 mm colorectal polyps.⁵ Therefore, the development of less invasive therapeutic options for this size category is demanding.
Thus, we have developed HSP with low power pure-cut current (LPPC-HSP), a polypectomy technique with low power, low voltage, and no coagulation current (UMIN Clinical Trials Registry; UMIN000037678). This method uses pure-cut current and reduces the power of electrocautery, expecting less deep thermal damage compared with conventional HSP with blend or coagulation current, resulting in a lower risk of perforation and bleeding. This study aimed to evaluate the efficacy and safety of LPPC-HSP for colorectal polyps 10 to 14 mm, compared with conventional EMR.

Aims & Methods

In this multicenter, retrospective, observational study, records of patients who underwent EMR or LPPC-HSP for nonpedunculated colorectal polyps 10 to 14 mm at two Japanese institutions between January 2021 and March 2022 were evaluated consecutively. EMR was performed with blend cut current (Endocut Q; effect 3, time interval 2, time duration 2), while LPPC-HSP with a low power pure-cut current (Autocut; effect 1, 10 W in VIO300D or Autocut; effect 0.4 [Pmax 13 W] in VIO3). We analyzed the treatment outcomes of the two techniques using propensity score matching to reduce selection bias. The following variables expected to affect treatment outcomes were selected: age, sex, polyp size, morphology, lesion location, endoscopists (experienced endoscopists or gastrointestinal fellows), and antithrombotic agents. R0 resection was defined as en bloc resection with histologically tumor-free margins.

Results

We retrospectively enrolled 203 EMR (168 patients, 203 lesions) and 208 LPPC-HSP (169 patients, 208 lesions) cases. After propensity score matching, the baseline characteristics between the groups were comparable, with 131 pairs. The en bloc and R0 resection rates were not significantly different between EMR and LPPC-HSP groups (93.9% vs. 96.9%, P=0.38; 90.8% vs. 91.6%, P=1.00). The vertical margin was negative in all lesions except one in the EMR group. Immediate bleeding requiring hemostasis was observed in 10.7% of cases in the EMR group versus 2.3% in the LPPC-HSP group (P=0.010). The rates of delayed bleeding and perforation didn’t differ between the groups (0% vs. 0.8%, P=1.00; 0% vs. 0%).

Table 1. Baseline characteristics and treatment outcomes after propensity score matching
Baseline characteristics	EMR n=131	LPPC-HSP n=131	P value	standardized difference		Treatment outcomes	EMR n=131	LPPC-HSP n=131	P value
Age, years (interquartile range)	72 (67-76)	72 (68-78)	0.29	0.105		En bloc resection (%)	123 (93.9)	127 (96.9)	0.38
Male sex (%)	91 (70)	96 (73)	0.59	0.085		R0 resection (%)	119 (90.8)	120 (91.6)	1.00
Lesion size, mm (interquartile range)	10 (10-12)	10 (10-12)	0.93	0.017		Immediate bleeding (%)	14 (10.7)	3 (2.3)	0.01
Location right colon/left colon/rectum (%)	61 (47) / 53 (41) / 17 (13)	63 (48) / 53 (41) / 15 (12)	0.95	0.049		Delayed bleeding (%)	0 (0)	1 (0.8)	1.00
Morphology 0-Is/0-IIa (%)	89 (68) / 42 (32)	87 (66) / 44 (34)	0.90	0.033		Perforation (%)	0 (0)	0 (0)	N/A
Antithrombotic agents (%)	24 (18)	35 (27)	0.14	0.202
Gastrointestinal fellows performed (%)	42 (32)	44 (34)	0.90	0.033

Conclusion

LPPC-HSP showed treatment outcomes comparable to conventional EMR, with fewer adverse events. These results suggest that this technique is a safe and effective treatment for nonpedunculated colorectal polyps 10 to 14 mm.

References

1. Hirose R, Yoshida N, Murakami T, et al. Histopathological analysis of cold snare polypectomy and its indication for colorectal polyps 10-14 mm in diameter. Dig Endosc 2017;29:594-601.
2. Yabuuchi Y, Imai K, Hotta K, et al. Efficacy and safety of cold-snare endoscopic mucosal resection for colorectal adenomas 10 to 14 mm in size: a prospective observational study. Gastrointest Endosc 2020;92:1239-1246.
3. Ferlitsch M, Moss A, Hassan C, et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017;49:270-297.
4. Oka S, Tanaka S, Kanao H, et al. Current status in the occurrence of postoperative bleeding, perforation and residual/local recurrence during colonoscopic treatment in Japan. Dig Endosc 2010;22:376-380.
5. Parsa N, Ponugoti P, Broadley H, et al. Risk of cancer in 10 - 19 mm endoscopically detected colorectal lesions. Endoscopy 2019;51:452-457.

Disclosure

Authors declare no Conflict of Interests for this study.

Introduction

Sessile serrated lesions (SSLs), alongside adenomas, play a significant role in the development of colorectal cancer (CRC). Recent studies suggest that the adenoma detection rate (ADR) alone may not be sufficient for predicting post-colonoscopy CRC. Consequently, the ASGE/ACG Quality Task Force has recently recommended the sessile serrated lesion detection rate (SSLDR) as a new priority indicator for colonoscopy quality. Reviewing the variability of SSLDR in the control groups of previous randomized controlled trials (RCTs) may help identify factors that influence study outcomes.

Aims & Methods

A systematic review was conducted using PubMed, Embase, and the Cochrane Library databases to collect data from control groups of RCTs that assessed methods for increasing polyp detection with high-definition white-light colonoscopy (up to March 14, 2025). Random-effects meta-analysis pooled SSLDRs and their 95% confidence intervals (CIs). Heterogeneity was assessed with the I² statistic. Univariable and multivariable meta-regressions were performed to examine associations between SSLDR and study settings (publication year, sample size, number of centers, study design, and geographic origin), demographics (mean age, male proportion), and technical parameters (type of intervention, proportion of screening colonoscopy, ADR, and withdrawal time). This study was registered in PROSPERO (ID: CRD420251012475).

Results

A total of 23,461 patients from 48 studies were included in the analysis. SSLDR in the control arms ranged from 0.3% to 21.5%, with a pooled value of 4.4% (95% CI: 3.3%-5.8%; I² = 93%). Univariable meta-regression analysis identified patient age (OR 1.112; 95% CI: 1.043-1.186) and gender (OR 1.038; 95% CI: 1.003 to 1.074), geographic origin (OR 2.848; 95% CI: 1.585-5.116 for Europe and OR 4.044; 95% CI: 2.205-7.416 for North America), and ADR in the control arms (OR 1.054; 95% CI: 1.031-1.077) as significant predictors of SSLDR, with sample size (OR 0.999; 95% CI: 0.998-1.000) showing a negative correlation. Other factors, such as publication year, number of study centers (single or multiple), study design (parallel or tandem), type of intervention (imaging or mechanical), proportion of screening colonoscopy, and withdrawal time, had no significant effect. In multivariable meta-regression, RCTs conducted in Europe (OR 2.179; 95% CI: 1.242-3.820) and North America (OR 2.664; 95% CI: 1.550-4.580), as well as ADR in control arms (OR 1.035; 95% CI: 1.006-1.065), remained significant predictors of SSLDR, while sample size (OR 0.998; 95% CI: 0.997-0.999) and proportion of screening colonoscopy (OR 0.991; 95% CI: 0.983-0.998) were negatively correlated with SSLDR.

Conclusion

A high level of variability in SSLDR was found in the control groups of RCTs. Standardization of methodological and technical parameters is essential to improve the generalizability and reproducibility of findings from RCTs and enhance SSL detection in colonoscopy.

Introduction

Colorectal cancer (CRC) is a global health problem with high incidence and mortality rates. Although the incidence has decreased with the use of screening tests, the mortality rate is approximately 1,6 – 2,0 % per year. Recent studies have shown a steady increase in the incidence of early onset (<50 years) CRC compared to that of patients >50 years of age. Early-onset CRC cancer is reported to have a more progressive course and may have a genetic and epigenetic background. In this study, we aimed to investigate the disease characteristics and risk factors for colorectal cancer in patients <50 years old and compare with patients over 50 years of age.

Aims & Methods

Patients younger than 50 years, diagnosed with colorectal adenocarcinoma and followed in our hospitals' gastroenterology, oncology, or general surgery departments between January/2009 and June/2022 were included in this retrospective study. A total of 6102 patients’ files were examined. Among these, 1166 were under the age of 50, whilst 4936 were 50 years and older. Patients younger than 18 years, who had a previous history of CRC, a known familial CRC syndrome, who had synchronous tumors at the time of diagnosis or had in situ CRC were not included in the study. After applying the exclusion criteria, 989 patients were included in the under-50 age group. The comparison group consisted of 1009 patients randomly selected from a group of 4000 patients aged 50 years or older. Patients were divided into Group A (<50 years) and Group B (≥ 50 years) according to the age at diagnosis. Patients’ demographic characteristics, body mass index, history of cigarette smoking and alcohol use, presenting symptoms, history of H. pylori infection, co-morbidities and medications were recorded from the files. Tumour characteristics, localization, size, TNM stage, and treatment methods were also analyzed and the relationship with each other was examined comparatively.

Results

The results of 1998 patients included in the study are shown in Table 1. TNM stages and the duration of symptoms before the diagnosis were similar between the groups but the rate of stage 1 disease was higher in group B. The rates of metastatic disease and rectal cancer were higher in Group A, but statistically non-significant. Abdominal pain was significantly more frequent in Group A, while anemia was significantly more common in Group B. Patients in Group A had higher rates of IBD, family history of CRC, mucinous adenocarcinoma, poorly differentiated tumor, higher histological grade and higher microsatellite instability (MSI-H). Although perineural and lymphatic invasion rates were similar, vascular invasion was higher in group B.

Table1. Comparison of Patients in Group A and Group B

Variables	Group A (n)	Group B (n)	p value
Body Mass Index ≥30 kg/m2	110	198	p<0.01
Family history of CRC	137	130	p<0.05
History of Inflammatory Bowel Disease	16	7	p<0.01
Tumor grade-1	104	151	p<0.01
Mucinous adenocarcinoma	131	90	p<0.01
Poor differentiation	165	96	p<0.01
High histologic grade	116	65	p<0.01
Presence of vascular invasion	277	412	p<0.01
MSI-H	58	29	p<0.01

Conclusion

Our study revealed that Early-onset CRC is more frequently diagnosed at the metastatic stage, is characterized by a more common presence of mucinous cells, poorly differentiated histology, and microsatellite instability.

Introduction

The Mediterranean Diet (MedDiet) has proven to be highly beneficial to human health thanks to its balanced combination of anti-inflammatory and antioxidants nutrients. Several studies^1,2,3 have highlighted the inverse relationship between MedDiet, visceral adiposity, and chronic conditions, namely cardiovascular disease, diabetes, and cancer. The Chrono Med Diet Score (CMDS)⁴ is a recently validated, easy-to-use adherence questionnaire to the MedDiet that, differently from previously validated scores⁵, considers food, lifestyle habits and time of food consumption. Here, we evaluated the CMDS ability to predict the increased risk of gastrointestinal (GI) cancer (colorectal, liver, and stomach) development in a cohort of metabolic subjects.

Aims & Methods

We enrolled 261 patients who accessed our outpatients’ clinic to assess fatty liver disease and Metabolic Syndrome and followed them for a period of 3.2 years. At first evaluation, CMDS was calculated for each patient. Fatty Liver Index (FLI) was calculated as= (e 0.953 × loge (triglycerides) + 0.139 × BMI + 0.718 × loge (GGT) + 0.053 × WC − 15.745)/(1 + e 0.953 × loge (TG) + 0.139 × BMI + 0.718 × loge (GGT) + 0.053 × WC − 15.745) × 100. ROC curves were used to identify the capability of each score to predict cancer development. T-test comparisons for CMDS values were performed for cancer (prostate, bladder, ovarian, and endometrium) and GI cancer diagnosis. P-values lower than 0.05 were considered significant. Chi-square test was used to calculate the associated Odds Ratio (OR) with 95% confidence interval (CI).

Results

A total of 47 out of 261 patients developed cancer. CMDS showed a significant discriminative power (AUC 0.7428) to predict cancer development with a cut-off of 11 (77% sensitivity, 70% specificity, p-value <0.001), while in the 26 subjects with a diagnosis of GI cancer (AUC 0.7961) the cut-off was 13 (67% sensitivity, 85% specificity). Among subjects with CMDS ≤13, those who developed GI cancer showed significantly altered metabolic markers, namely waist circumference, triglycerides, fasting glucose, HDL cholesterol, and FLI compared to patients who did not develop cancer during the follow-up period (see Table). Values of CMDS ≤13 significantly increased the risk of GI cancer with an OR of 3.41 (95% CI: 1.99-6.12). Intriguingly, CMDS was significantly lower (7.1±0.4) in subjects who were diagnosed with gastrointestinal cancer, compared to patients that developed non – gastrointestinal cancer (9.5±0.7).

	NO CANCER - CMDS ≤13 (n=77)	CANCER - CMDS ≤13 (n=19)	p-value
	mean±SEM	mean±SEM
Waist Circumference (cm)	101.7±1.9	108.3±2.9	0.0016**
HDL Cholesterol (mg/dl)	53.4±3.8	38.7±3.9	0.0031**
Triglycerides (mg/dl)	107.3±4.1	148.1±11.3	0.0322*
Fasting Glucose (mg/dl)	100.7±4.4	118.1±4.1	0.0177*
Fatty Liver Index	38.2±6.1	69.4±5.7	0.0021**

Conclusion

In our cohort, adherence to the MedDiet is strongly associated to an increased risk of cancer development in metabolic subjects. This association is even stronger in patients who developed GI cancer, as demonstrated by the significant correlation between the CMDS and specific parameters of dysmetabolism, such as visceral adiposity, dyslipidemia, and liver fibrosis. Taken together, our data indicates not only that the risk of GI cancer can be identified using the CMDS as a non-invasive reference method, but also emphasize that dietary and lifestyle changes, promoting a higher adherence to the MedDiet, are significantly recommended for people affected by dysmetabolic conditions.

References

1. Bamia, C.; Lagiou, P.; Buckland, G.; Grioni, S.; Agnoli, C.; Taylor, A.J.; Dahm, C.C.; Overvad, K.; Olsen, A.; Tjønneland, A., et al. Mediterranean diet and colorectal cancer risk: results from a European cohort. European Journal of Epidemiology 2013, 28, 317-328, doi:10.1007/s10654-013-9795-x
2. Mentella, M.C.; Scaldaferri, F.; Ricci, C.; Gasbarrini, A.; Miggiano, G.A.D. Cancer and Mediterranean Diet: A Review. Nutrients 2019, 11, 2059. https://doi.org/10.3390/nu11092059
3. Crudele, L.; Piccinin, E.; Moschetta, A. Visceral Adiposity and Cancer: Role in Pathogenesis and Prognosis. Nutrients 2021, 13, 2101. https://doi.org/10.3390/nu13062101
4. De Matteis, C.; Crudele, L.; Battaglia, S.; Loconte, T.; Rotondo, A.; Ferrulli, R.; Gadaleta, R.M.; Piazzolla, G.; Suppressa, P.; Sabbà, C.; Cariello, M.; Moschetta, A. Identification of a Novel Score for Adherence to the Mediterranean Diet That Is Inversely Associated with Visceral Adiposity and Cardiovascular Risk: The Chrono Med Diet Score (CMDS). Nutrients 2023, 15, 1910. https://doi.org/10.3390/nu15081910.
5. Panagiotakos, D.B.; Pitsavos, C.; Arvaniti, F.; Stefanadis, C. Adherence to the Mediterranean food pattern predicts the prevalence of hypertension, hypercholesterolemia, diabetes and obesity, among healthy adults; the accuracy of the MedDietScore. Prev. Med. 2007, 44, 335–340. https://doi.org/10.1016/j.ypmed.2006.12.009.

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.