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Grant Details

Grant Number: 5R21CA191651-02 Interpret this number
Primary Investigator: Butterly, Lynn
Organization: Dartmouth College
Project Title: Longitudinal Outcomes of Serrated Polyps: a Population Based Study
Fiscal Year: 2017
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Abstract

 DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the second most common cause of cancer deaths, despite being preventable by removing precancerous colon polyps. Therefore, polyp detection rates are a critical measure of endoscopist performance quality. After polyp removal, endoscopists depend on national guidelines to provide evidence- based recommendations for appropriate intervals between colonoscopies. Serrated polyps include hyperplastic polyps (HPs) and sessile serrated polyps (SSPs). Recent evidence indicates that a subset of serrated polyps are important precursors to CRC, highlighting the need for evidence to clarify optimal detection and follow up of serrated lesions. Long-term outcome data to support specific surveillance guidelines in patients with serrated polyps is lacking. Current screening guidelines consider patients with only small HPs in the recto-sigmoid to be at average-risk, and recommend a 10 year return interval. Patients with SSPs are thought to be at higher risk, and shorter return intervals are suggested, based on limited evidence. However, even expert pathologists differ as to whether some polyps are HPs or SSPs, and it remains unclear whether proximally located polyps designated as HPs should be considered SSPs, with accordingly higher risk and shorter surveillance intervals. The New Hampshire Colonoscopy Registry (NHCR), a statewide population-based registry, is uniquely able to provide the long-term outcome data needed to move this developing field forward. Comprehensive data on endoscopist polyp detection rates will identify sources of variation in serrated polyp detection. By 2017, 13,000 NHCR patients will surpass the critical 10 year follow-up interval recommended for patients with normal exams or only small HPs. Increasing numbers of patients will return for repeat exams, and the NHCR database will contain data on risk factors, colonoscopy characteristics and pathology for 145,000 patients, nearly 13,500 with serrated polyps, allowing research into outcomes following all types of serrated polyps. Specific Aims: 1) To investigate variability in serrated polyp detection rates among the approximately 100 endoscopists participating in the NHCR, exploring factors associated with variable detection rates, including patient, endoscopist, procedure, and endoscopy facility characteristics, and 2) To identify factors associated with an increased risk for advanced outcomes - defined as histologically advanced polyps or CRC - at follow- up colonoscopy in patients with baseline serrated polyps. We will investigate the outcomes for serrated polyp subtypes, according to their baseline size, location in the colon, and number of serrated polyps detected, and also analyze the impact of patient risk factors, baseline colonoscopy characteristics, and other findings (such as concurrent conventional adenomas), on future risk of advanced outcomes. This study aims to provide new high-quality population-based evidence needed to refine and strengthen current surveillance guidelines and quality indicators and thereby improve the effectiveness of screening in preventing CRC.

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Publications

Increased risk of metachronous large serrated polyps in individuals with 5- to 9-mm proximal hyperplastic polyps: data from the New Hampshire Colonoscopy Registry.
Authors: Anderson J.C. , Robinson C.M. , Butterly L.F. .
Source: Gastrointestinal endoscopy, 2020 Aug; 92(2), p. 387-393.
EPub date: 2020-04-26.
PMID: 32348745
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Young adults and metachronous neoplasia: risks for future advanced adenomas and large serrated polyps compared with older adults.
Authors: Anderson J.C. , Robinson C.M. , Butterly L.F. .
Source: Gastrointestinal endoscopy, 2020 03; 91(3), p. 669-675.
EPub date: 2019-11-21.
PMID: 31759925
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Risk Factors for Diagnosis of Colorectal Cancer at a Late Stage: a Population-Based Study.
Authors: Andrew A.S. , Parker S. , Anderson J.C. , Rees J.R. , Robinson C. , Riddle B. , Butterly L.F. .
Source: Journal of general internal medicine, 2018 12; 33(12), p. 2100-2105.
EPub date: 2018-10-03.
PMID: 30284171
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Risk of Metachronous High-Risk Adenomas and Large Serrated Polyps in Individuals With Serrated Polyps on Index Colonoscopy: Data From the New Hampshire Colonoscopy Registry.
Authors: Anderson J.C. , Butterly L.F. , Robinson C.M. , Weiss J.E. , Amos C. , Srivastava A. .
Source: Gastroenterology, 2018 01; 154(1), p. 117-127.e2.
EPub date: 2017-09-18.
PMID: 28927878
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Opportunities and Challenges for Environmental Exposure Assessment in Population-Based Studies.
Authors: Patel C.J. , Kerr J. , Thomas D.C. , Mukherjee B. , Ritz B. , Chatterjee N. , Jankowska M. , Madan J. , Karagas M.R. , McAllister K.A. , et al. .
Source: Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2017 09; 26(9), p. 1370-1380.
EPub date: 2017-07-14.
PMID: 28710076
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Providing data for serrated polyp detection rate benchmarks: an analysis of the New Hampshire Colonoscopy Registry.
Authors: Anderson J.C. , Butterly L.F. , Weiss J.E. , Robinson C.M. .
Source: Gastrointestinal endoscopy, 2017 Jun; 85(6), p. 1188-1194.
EPub date: 2017-01-31.
PMID: 28153571
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Hyper-Methylated Loci Persisting from Sessile Serrated Polyps to Serrated Cancers.
Authors: Andrew A.S. , Baron J.A. , Butterly L.F. , Suriawinata A.A. , Tsongalis G.J. , Robinson C.M. , Amos C.I. .
Source: International journal of molecular sciences, 2017-03-02; 18(3), .
EPub date: 2017-03-02.
PMID: 28257124
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Adenoma Detection Rates for Screening Colonoscopies in Smokers and Obese Adults: Data From the New Hampshire Colonoscopy Registry.
Authors: Anderson J.C. , Weiss J.E. , Robinson C.M. , Butterly L.F. .
Source: Journal of clinical gastroenterology, 2017 Nov/Dec; 51(10), p. e95-e100.
PMID: 28059941
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