Features associated with high-risk sessile serrated polyps at index and follow-up colonoscopy

Shahzaib Anwar, Charles Cock, Joanne Young, Graeme P. Young, Rosie Meng, Kalindra Simpson, Michelle Coats, Junming Huang, Peter Bampton, Robert Fraser, Erin L. Symonds

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Background and Aim: Clinically significant serrated polyps are precursors of colorectal cancers, with features considered high risk including size ≥10 mm, dysplasia, and presence of synchronous conventional adenoma. While these features have been described in cohorts undergoing screening colonoscopy, there is little information regarding the prevalence and patient characteristics associated with high-risk sessile serrated polyps (SSPs) in those undergoing surveillance colonoscopy. Methods: Polyp pathology at the index and first follow-up colonoscopy performed between 2004 and 2019 were examined in patients enrolled in a surveillance program because of an index finding of adenoma and/or SSP. Demographics and pathology features for SSP were compared between the colonoscopies. Results: Of 6297 patients undergoing index colonoscopy, 2035 underwent follow-up colonoscopy after 3.3 years (interquartile range 2.1–4.8 years). The proportion with SSP decreased from 7.6% at index to 5.0% at follow-up (P < 0.001); however, the proportion of SSPs that were considered high risk was not different between the colonoscopies (62.8% vs 62.4%). Female gender was associated with the presence of high-risk SSP at index colonoscopy (odds ratio [OR] 1.62, 95% confidence interval [CI] 1.28–2.06), while age ≥75 years (OR 3.38, 95% CI 1.67–6.81) and previous high-risk SSP (OR 9.40, 95% CI 4.23–20.88) were independently associated with high-risk SSP at follow-up. Conclusions: The prevalence of SSP falls by one-third at first follow-up colonoscopy although the proportion of SSP with high-risk features remains the same. While females were more likely to have a high-risk SSP at the index colonoscopy, those at greatest risk for high-risk SSP at follow-up colonoscopy were age >75 years and an index high-risk SSP.

Original languageEnglish
Pages (from-to)1620-1626
Number of pages7
JournalJournal of Gastroenterology and Hepatology (Australia)
Issue number6
Early online date3 Nov 2020
Publication statusPublished - Jun 2021


  • Colorectal cancer
  • Sessile serrated adenoma
  • Sessile serrated lesion colonoscopy
  • Surveillance


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