To Optimally Prevent Colorectal Cancer, We Need to Detect Both Adenomas and Serrated Lesions

To Optimally Prevent Colorectal Cancer, We Need to Detect Both Adenomas and Serrated Lesions

Douglas K. Rex, MD, MASGE, reviewing Anderson JC, et al. Am J Gastroenterol 2023 Jul 7.

Recent studies have found that significant fractions of colonoscopists possess adequate detection of conventional adenomas, as measured by adenoma detection rate (ADR), but low detection of serrated lesions.

Now a third study supports this concept. This most recent study used data from the New Hampshire Colonoscopy Registry to evaluate 26,901 patients who had at least one colonoscopy 6 or more months after an index examination or had a diagnosis of colorectal cancer (CRC).

Patients who underwent endoscopy performed by endoscopists with higher sessile serrated lesion detection rates (SSLDRs) had a lower risk for postcolonoscopy CRC (PCCRC), with the highest quintile of SSL detection having SSLDRs >6%. There was a 14% reduction in PCCRC for each 1% increase in the SSLDR. Those with an SSLDR of ≥6% had a 71% reduction in PCCRC compared with those in the lowest quintile of SSL detection. About one-third of endoscopists had an ADR ≥25% but SSLDR <6%.

When doctors were stratified into groups of (1) ADR <25%, (2) ADR ≥25% and SSLDR <3%, and (3) ADR ≥25% and SSLDR ≥3%, the group of doctors with higher ADRs and higher SSLDRs had the lowest PCCRC rates.

Douglas K. Rex, MD, FASGE


We now have 3 studies supporting the measurement of both serrated detection and adenoma detection to identify which colonoscopists produce the lowest rates of PCCRC.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Anderson JC, Rex DK, Mackenzie TA, Hisey W, Robinson CM, Butterly LF. Higher serrated polyp detection rates are associated with lower risk for post colonoscopy colorectal cancer: data from the New Hampshire Colonoscopy Registry. Am J Gastroenterol 2023 Jul 7. (Epub ahead of print) (

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