Authors: Shreya Narayanan MD, Brijesh B. Patel MD, David J. Bromberg MD, Meghana Vellanki MD, Philip Foulis MD, MPH, Prasad Kulkarni MD.
Background: Adenomatous polyps have historically been considered the sole precursor lesions that lead to colorectal cancer (CRC) via the adenoma-carcinoma sequence. It is increasingly recognized that CRC is not a single disease, but rather a heterogeneous disorder with various distinct molecular pathways. A recently recognized emerging pathway in colorectal carcinogenesis involves “serrated polyps”, which until recently were considered to be innocuous lesions. The WHO classification system divides serrated polyps into sessile serrated adenomas (SSA), traditional serrated adenomas (TSA) and serrated adenomas (SA). Despite the serrated neoplastic pathway accounting for up to 10-20% of all sporadic colorectal cancers, these polyps remain under-diagnosed and poorly understood. We sought to identify the prevalence and potential progression of serrated polyps in our veteran population.
Methods: We conducted a retrospective analysis of all patients who underwent all-cause colonoscopies at James A Haley Veterans’ Hospital over a 10-year period from January 1, 2004 through December 31, 2014. Our primary outcome was to analyze the change in prevalence of serrated polyps in the veteran population. Secondary outcomes were to correlate prevalence of serrated polyps with modifiable lifestyle factors, and attempt to correlate if the previous presence of serrated polyps leads to the development of colorectal cancer. Low risk adenomas were categorized as tubular adenoma and high risk adenomas were categorized as tubulo-villous adenomas.
Results: An electronic databank was created using keyword search “polyps,” “colonoscopy.” A retrospective analysis of pathology reports 14593 all cause colonoscopies was conducted over 10-year period. The individual cases were categorized as SSA, TSA, SA, SSA + high risk adenoma, SSA + low risk adenoma, SA + high risk adenoma, SA + low risk adenoma, TSA + high risk adenoma, TSA + low risk adenoma and TA (Control). There was a progressive increase in the percentage of serrated polyps per all lesions identified on colonoscopy over the 10 year period, with the most exponential increase occurring between 2010 through 2014. There was no significant correlation between HgA1c, Total cholesterol, HLD, LDL and Triglycerides between TA vs. TSA and SA. There was a statistical significance between TA vs. SSA in regards to LDL (p<0.03).
Discussion: Serrated polyps are increasingly being recognized as lesions with malignant potential. It is therefore essential that these lesions are properly removed and classified. In this study, a large database of serrated polyps in the veteran population undergoing all-cause colonoscopy was created. Temporal trends in the detection of these lesions and variables that may affect their prevalence were identified and analyzed. To our knowledge, this is the first study to date to investigate the prevalence of serrated polyps in the veteran population.
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