Post colonoscopy colorectal cancer is arguable one of the 'hardest' quality measures in colonoscopy. Until now, it has been difficult to identify cases often presenting several years after their colonoscopy and sometimes to a different institution. From September, NHS endoscopy units will have access to a bespoke online resource identifying cases of PCCRC. From September, this online tool will be used to audit the 1400 PCCRC cases which we see in the NHS every year. Roland Valori explains the idea behind the audit.
In this podcast we discuss Serrated Polyps with Prof Neil Shepherd. There is much more to these lesions than Size and Number! Did you know that there appears to be two distinct syndromes and it's the Site of the lesions which distinguishes the two? That is just the start. It gets weirder !
We cover a huge amount of ground and headings include (in chronological order):
Serrated polyps - one or two distinct syndromes?
Can you tell histologically?
How does the Serrated Polyposis Syndrome fit ?
What matters the most when deciding on the significance of a serrated polyp?
Dysplasia inside a serrated polyp? - Well it's complicated !
The heterogeneity of serrated lesions is also problematic
Could AI help the Pathologist in the future?
How can we identify patients with serrated polyposis syndrome ?
Can we explain finding both serrated and adenomatous polyps in serrate polyposis syndrome?
Why should I refer patient with serrated polyposis syndrome to geneticists?
Can we tell which cancer has developed from a serrated precursor?
What is the link between serrated polyps and colitis?
The weird issue of stromal changes below serrated polyps
'Mixed polyp' or 'collision polyp'?
How can we as endoscopist help the pathologist?
Do you believe in DISCARD?
What remains the remit of the pathologist to diagnose?
There have been some recent developments shedding welcome light on the issue of cancer in colitis. We take a closer look at the papers and have a chat with Lauranne Derikx about her research. To my surprise, I find that my long lamented 'cancer field theory' is very much alive !
Fed up with the ‘adenoma detection rate’ ? Secretly suspecting that finding more 3mm polyps can’t mean life and death for your patients? You are not alone and I am just as fed up as you are. I've ambushed Nick Burr demanding answers !
Karminski MF. Quality Indicators for Colonoscopy and the Risk of Interval Cancer. NEJM 2010;362:1795-803
Eide T. Risk of CRC in adenoma bearing individuals. Intern J Cancer 1986;38;173–6
Stryker S. Natural history of untreated colonic polyps. Gastroenterology 1987;93:1009–13
Pickhart PJ. Assessment of volumetric growth rates of small colorectal polyps with CT colonography: a longitudinal study of natural history. Lancet Oncol. 2013;14(8):711–20
Kuntz KM. A Systematic Comparison of Microsimulation Models of Colorectal Cancer: The Role of Assumptions about Adenoma Progression. Medical Decision making 2011;31(4):530-9 https://doi.org/10.1177/0272989X11408730
Djinbachian R. Rates of Incomplete Resection of 1- to 20-mm Colorectal Polyps: A Systematic Review and Meta-Analysis. Gastroenterology 2020;159(3):904-14 https://doi.org/10.1053/j.gastro.2020.05.018