Serrated polyp detection rates beyond adenoma detection rate for postcolonoscopy colorectal cancer: findings from the SCREESCO trial
In brief
High serrated-polyp detection linked to 0.06% five-year cancer incidence, versus 0.16%
In this screening trial, five-year postcolonoscopy colorectal cancer incidence was 0.06% for endoscopists with high proximal serrated-polyp detection, compared with 0.16% for those with low detection. The association persisted among endoscopists with high adenoma detection rates, suggesting serrated-polyp detection adds information, but just 37 cancers occurred, so the finding needs confirmation.
- Journal
- Endoscopy (Q1)
- Published
- 16 October 2026
- Study design
- Non-randomized / quasi-experimental trial
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Masau Sekiguchi, Marcus Westerberg, Anna Andreasson, Soran R Bozorg, Anna M Forsberg
- PMID
- 42887539
- DOI
- 10.1055/a-2955-8529
Why clinicians should know about it
- Picked for Gastroenterology (paper of the day, 19 October 2026): Serrated polyp detection rates and postcolonoscopy CRC
Abstract
BACKGROUND: The association between serrated polyp detection rates, including proximal serrated polyp detection rate (PSPDR), and postcolonoscopy colorectal cancer (PCCRC) remains unestablished. We investigated PCCRC incidence and characteristics, and explored associations of PSPDR and adenoma detection rate (ADR) with PCCRC in colonoscopy- and fecal immunochemical test (FIT)-based screening within the Screening of Swedish Colons (SCREESCO) trial. METHODS: Data from participants who underwent colonoscopy in the colonoscopy and FIT arms were analyzed. PCCRC, defined as colorectal cancer (CRC) diagnosed >6 months after a colonoscopy that did not detect CRC, was identified through linkage with cancer registries. Associations between PSPDR and PCCRC incidence were assessed using Cox models. RESULTS: Of 9982 and 5875 individuals in the colonoscopy and FIT arms, PCCRC was identified in 20 and 17 individuals, with 3-year PCCRC rates of 5.9% (3/51) and 3.5% (4/115), respectively. Compared with screening-detected CRC, PCCRC more often involved right-sided location and advanced stage. The 5-year cumulative incidence of PCCRC was 0.16% (95%CI 0.10%-0.27%) and 0.06% (95%CI 0.02%-0.15%) when colonoscopies were performed by endoscopists with low vs. high PSPDR (<10% vs. ≥10%), respectively. Among endoscopists with high ADR, 5-year PCCRC incidence was 0.13% (95%CI 0.04%-0.32%) vs. 0.06% (95%CI 0.02%-0.16%) for those with low vs. high PSPDR, respectively. Within this group, PCCRC incidence over 8 years decreased as PSPDR increased (hazard ratio per percentage-point increase, 0.90; 95%CI 0.82-1.00; P = 0.04). CONCLUSIONS: Despite the limited number of PCCRC events, this study suggests that PSPDR provides complementary information beyond ADR for identifying colonoscopies with higher PCCRC incidence.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.