Abstract

BACKGROUND & AIMS: Sessile serrated polyps (SSPs) could account for a substantial proportion of colorectal cancers. We aimed to increase clarity on SSP prevalence and clinical features.METHODS: We performed a systematic review of Medline, Web of Science, Embase, and Cochrane databases for original studies published in English since 2000. We included studies of different populations (United States general or similar), interventions (colonoscopy, autopsy), comparisons (world regions, alternative polyp definitions, adenoma), outcomes (prevalence, clinical features), and study designs (cross-sectional). Random-effects regression was used for meta-analysis where possible.RESULTS: We identified 74 relevant colonoscopy studies. SSP prevalence varied by world region, from 2.6% in Asia (95% CI, 0-5.9%) to 10.5% in Australia (95% CI, 2.8%-18.2%). Prevalence values did not differ significantly between the United States and Europe (P=.51); the pooled prevalence was 4.6% (95% CI, 3.4%-5.8%), and SSPs accounted for 9.4% of polyps with malignant potential (95% CI, 6.6%-12.3%). Mean prevalence was higher when assessed through high-performance exams (9.1%; 95% CI, 4.0%-14.2%, P=.04) and with alternative definition of clinically relevant serrated polyps (12.3%; 95% CI, 9.3%-15.4%; P<.001). Increases in prevalence with age were not statistically significant, and prevalence did not differ significantly by sex. Compared with adenomas, a higher proportion of SSPs were solitary (69.0%; 95% CI, 45.9%-92.1%; P=.08), with diameters of 10 mm or more (19.3%; 95% CI, 12.4%-26.2%; P=.13), and were proximal (71.5%; 95% CI, 63.5%-79.5%; P=.009). Mean ages for detection of SSP without dysplasia, with any or low-grade dysplasia, and with high-grade dysplasia were 60.8 y, 65.6 y, and 70.2 y, respectively. The range for proportion of SSPs with dysplasia was 3.7%-42.9% across studies, possibly reflecting different study populations.CONCLUSIONS: In a systematic review, we found that sessile serrated polyps are relatively uncommon, compared with adenoma. More research is needed on appropriate diagnostic criteria, variations in detection, and long-term risk.

View details for DOI 10.1053/j.gastro.2020.03.025

View details for PubMedID 32199884