Determinants of high sessile serrated lesion detection: Role of faecal occult blood test and colonoscopy quality indicators

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.