What Is the Prevalence of Sessile Serrated Lesions Anyway?

COMMENT

Everyone agrees that SSL detection is important. The authors suggest this literature study will be useful in creating an SSL detection target for colonoscopy. However, the apparent prevalence of SSLs is increasing across colonoscopy studies with time, likely due to improving colonoscopy technology and better colonoscopist and pathologist awareness. The best prospective studies using expert colonoscopy and pathology indicate that the prevalence of SSLs at screening colonoscopy is at least 8% to 9%.

Creating a national or international SSL detection target is complicated by the lack of a uniform histologic definition for SSL, wide variability among pathologist differentiation of SSL from HP, and the impractical nature of any target that utilizes endoscopist size assessment or colon location in its definition. In my opinion, the best approach is to measure SSL detection by colonoscopists within each institution and thereby establish a local minimum acceptable detection target for SSLs (based on the mean level of SSL detection) and an aspirational target (based on the highest SSL detector in the group).