Clinical Trials Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Aug 16, 2025; 17(8): 109176
Published online Aug 16, 2025. doi: 10.4253/wjge.v17.i8.109176
Determinants of high sessile serrated lesion detection: Role of faecal occult blood test and colonoscopy quality indicators
Harry Williams, Natalie R Dierick, Christina Lee, Praka Sundaralingam, Stuart N Kostalas
Harry Williams, Stuart N Kostalas, Rural Clinical School, University of New South Wales, Port Macquarie 2444, New South Wales, Australia
Natalie R Dierick, School of Clinical Medicine, University of New South Wales, Port Macquarie 2444, New South Wales, Australia
Natalie R Dierick, Christina Lee, Praka Sundaralingam, Stuart N Kostalas, Department of Gastroenterology, Port Macquarie Gastroenterology, Port Macquarie 2444, New South Wales, Australia
Natalie R Dierick, Christina Lee, Praka Sundaralingam, Stuart N Kostalas, Gastroenterology Research Group, Port Macquarie Gastroenterology Research Group, Port Macquarie 2444, New South Wales, Australia
Author contributions: Williams H and Kostalas SN carried out the study conceptualization and design and wrote the paper; Williams H, Dierick NR, Lee C, and Kostalas SN analyzed data; Williams H, Dierick NR, Lee C, Sundaralingam P, and Kostalas SN collected data; and all authors thoroughly reviewed and endorsed the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of University of New South Wales Human Research Ethics Advisory Panel, approval No. iRECS0829.
Clinical trial registration statement: No clinical trial registration was performed for this study.
Informed consent statement: Informed verbal consent was obtained from all subjects and/or their legal guardian in accordance with the ethics approved by iRECS. All patients underwent written consent for the colonoscopy procedure.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The data that support the findings of this study are available from Port Macquarie Gastroenterology, but restrictions apply to the availability of this data, which were used under license for the current study, and so are not publicly available. The data however is available upon reasonable request and with permission. Please contact Stuart Kostalas to access the data.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Stuart N Kostalas, Associate Professor, FRACP, Department of Gastroenterology, Port Macquarie Gastroenterology, 22 15 Chancellors Drive, Port Macquarie 2444, New South Wales, Australia. skostalas@gmail.com
Received: May 6, 2025
Revised: May 10, 2025
Accepted: June 27, 2025
Published online: August 16, 2025
Processing time: 105 Days and 23.1 Hours
Abstract
BACKGROUND

Sessile serrated lesions (SSLs) are premalignant polyps implicated in up to 30% of colorectal cancers. Australia reports high SSL detection rates (SSL-DRs), yet with marked variability (3.1%-24%). This substantial variation raises concerns about missed lesions and post-colonoscopy colorectal cancer. This study investigates determinants associated with SSL-DR variation in regional Australia.

AIM

To study how patient, clinical, and colonoscopy factors are associated with SSL detection in a regional Australian practice. We aimed to contribute high-detection data to the literature by analyzing the association of SSL detection with various determinants.

METHODS

This retrospective, cross-sectional analysis examined 1450 colonoscopies performed at Port Macquarie Gastroenterology during 2023. Sigmoidoscopies and repeat procedures were excluded. Multivariate logistic regression analyzed associations between SSL detection and patient demographics, clinical indications, procedural factors, and comorbidities.

RESULTS

The overall SSL-DR was 30.7%. Multivariate analysis identified several independent predictors: Clinical indication, bowel preparation quality, inflammatory bowel disease status, and serrated polyposis syndrome. The faecal occult blood test positive (FOBT) (+) cohort showed the highest predicted SSL detection probability (39.8%), while clinical symptoms showed the lowest (22.3%). After adjustment, SSL detection odds were 2.3 times greater among FOBT (+) patients than those with clinical symptoms (adjusted odds ratio = 2.30, 95% confidence interval: 1.20-4.40, P = 0.004).

CONCLUSION

SSL-DR as a quality indicator requires contextualization regarding clinical indications, bowel preparation quality, and comorbidities. There was a significantly higher prevalence of SSLs in FOBT (+) patients. Despite comprehensive adjustment, this study cannot fully explain the wide SSL-DR variation in Australia, highlighting the need for standardized detection protocols and further research to ensure optimal cancer prevention outcomes.

Keywords: Sessile serrated lesion; Adenoma detection rate; Faecal occult blood test; Polyp detection rate; Dysplasia; Colonoscopy; Prevalence

Core Tip: This study reports an exceptionally high sessile serrated lesion detection rate of 30.7% in regional Australia, with faecal occult blood test positive-positive patients showing the highest rate (42%). Clinical indication, bowel preparation quality, inflammatory bowel disease status, and serrated polyposis syndrome were identified as independent predictors. The marked variability in sessile serrated lesion detection rate across Australia (3.1%-24%) highlights the need for standardized detection protocols and context-specific quality indicators to optimize colorectal cancer prevention.