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. 2023 Jun;21(6):1637-1645.
doi: 10.1016/j.cgh.2022.09.030. Epub 2022 Oct 12.

Baseline Characteristics and Longitudinal Outcomes of Traditional Serrated Adenomas: A Cohort Study

Mehul Trivedi  1 , Suha Godil  2 , Joshua Demb  3 , Ashley Earles  4 , Ranier Bustamante  5 , Olga V Patterson  6 , Andrew J Gawron  7 , Tonya Kaltenbach  8 , Sumana Mahata  9 , Lin Liu  10 , Samir Gupta  11
Affiliations

Baseline Characteristics and Longitudinal Outcomes of Traditional Serrated Adenomas: A Cohort Study

Mehul Trivedi et al. Clin Gastroenterol Hepatol. 2023 Jun.

Abstract

Background and aims: Traditional serrated adenomas (TSAs) may confer increased risk for colorectal cancer (CRC). Our objective with this study was to examine clinical characteristics and long-term outcomes associated with TSA diagnosis.

Methods: We conducted a retrospective cohort study of U.S. Veterans ≥18 years of age with ≥1 TSA between 1999 and 2018. Baseline characteristics, colonoscopy findings, and diagnosis of incident and fatal CRC were abstracted. Advanced neoplasia was defined by CRC or adenoma with high-grade dysplasia, villous histology, or size ≥1 cm. Follow-up was through CRC diagnosis, death, or end of study (December 31, 2018).

Results: A total of 853 Veterans with a baseline TSA were identified; 74% were ≥60 years of age, 96% were men, 14% were Black, and 73% were non-Hispanic White. About 64% were current or former smokers. Over 2044 total person-years at follow-up, there were 11 incident CRC cases and 1 CRC death. Cumulative CRC incidence was 1.34% (95% confidence interval [CI], 0.67%-2.68%), and cumulative CRC death was 0.12% (95% CI, 0.00%-0.35%). Among the subset of 378 TSA patients with ≥1 surveillance colonoscopy, 65.1% had high-risk neoplasia on follow-up. CRC incidence among TSA patients was significantly higher than in a comparison cohort of patients with normal baseline colonoscopy at baseline (hazard ratio, 3.70; 95% CI, 1.63-8.41) and similar to a comparison cohort with baseline conventional advanced adenoma (hazard ratio, 0.86; 95% CI, 0.45-1.64).

Conclusion: Individuals with TSA have substantial risk for CRC based on their cumulative CRC incidence, as well as significant risk of developing other high-risk neoplasia at follow-up surveillance colonoscopy. These data underscore importance of current recommendations for close colonoscopy surveillance after TSA diagnosis.

Keywords: Colonoscopy; Colorectal Cancer; Conventional Advanced Adenoma; Traditional Serrated Adenoma.

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Conflict of interest statement

Conflicts of Interest

The authors disclose no conflicts.

Figures

Figure 1.
Figure 1.
Study flow.
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