Browsing by Subject "Sessile serrated lesion"

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    Frequency of serrated polyposis syndrome recognition by community endoscopists
    (Thieme, 2023-10-06) McWhinney, Connor D.; Lahr, Rachel E.; Rex, Douglas K.; Medicine, School of Medicine
    Background and study aims: Some data indicate serrated polyposis syndrome (SPS) is underdiagnosed. We determined the frequency of SPS diagnosis by community endoscopists prior to referral to a tertiary center. Patients and methods: We performed a retrospective analysis of a prospectively collected database of SPS patients at a tertiary academic hospital. There were 212 patients who were referred to our center for resection of one or more lesions detected at a prior colonoscopy and who had records available that allowed determination of whether SPS was diagnosed before referral. Results: Only 25 of 212 patients (11.8%) had a diagnosis or suspicion of a polyposis syndrome prior to referral, and only 12 patients (5.7%) had a specific SPS diagnosis made prior to referral. Among 187 patients diagnosed at our center, 39 had sufficient serrated lesions removed and documented in outside records to meet SPS criteria prior to referral, but the diagnosis was not made by the referring physician despite adequate numbers of lesions resected. The remaining cases required lesions removed at our center to meet SPS diagnostic criteria. Limitations were a single center, single expert endoscopist. Conclusions: SPS is the most common colorectal polyposis syndrome, but it remains underdiagnosed by community endoscopists. Underdiagnosis may contribute to post-colonoscopy colorectal cancer in patients with SPS.
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    Most large colorectal polyps missed by gastroenterology fellows at colonoscopy are sessile serrated lesions
    (Thieme, 2022-05-13) Vemulapalli, Krishna C.; Lahr, Rachel E.; Rex, Douglas K.; Medicine, School of Medicine
    Background and study aims: Data on adenoma and sessile serrated lesion (SSL) miss rates for gastroenterology fellows during colonoscopy are limited. We aimed to describe the miss rate of fellows based on a second examination by a colonoscopist with a high rate of detection. Patients and methods: Second- and third-year gastroenterology fellows at a single, tertiary center performed initial examinations. A single experienced attending doctor then performed a complete examination of the colon. We recorded the size and pathology of all lesions found at both examinations and calculated the adenoma and SSL miss rates for fellows. Results: Ten trainees performed 100 examinations. Miss rates for conventional adenomas and SSLs were 30.5 % and 85.7 %, respectively. Among pre-cancerous polyps ≥ 10 mm, 10 of 14 lesions missed were SSLs. Conclusions: While conventional adenoma detection skills of gastroenterology fellows are acceptable, SSL detection is poor.