scholarly journals A118 POLYP SIZE CUT-OFF LEVEL TO IMPLEMENT OPTICAL POLYP DIAGNOSIS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 98-99
Author(s):  
M Taghiakbari ◽  
R Djinbachian ◽  
D von Renteln
Keyword(s):  
Colorectal Polyps ◽  
Optical Diagnosis ◽  
Clinical Implementation ◽  
Polyp Size ◽  
Funding Agencies ◽  
Size Groups ◽  
Surveillance Interval ◽  
High Reduction ◽  
Advanced Adenomas ◽  
Post Hoc

Abstract Background Optical polyp diagnosis can be used for real-time pathology prediction of colorectal polyps ≤10 mm. However, the risk of misdiagnosing a polyp with advanced pathology potentially increases with increasing polyp size. Aims This study aimed to evaluate different size cut-offs for using optical polyp diagnosis and the associated risk of patients undergoing inadequate follow-up or surveillance. Methods In a post-hoc analysis of two prospective studies, the performance of optical diagnosis was evaluated in three polyp size groups: 1–3 mm, 1–5 mm, and 1–10 mm. The primary outcome was the proportion of patients with advanced adenomas and delayed or inappropriate surveillance. Secondary outcomes included percentage of polyps with advanced pathology, agreement between surveillance intervals based on high-confidence optical diagnosis and pathology outcomes, reduction in histopathological examinations, and proportion of patients who could receive an immediate surveillance interval recommendation. Results We included 1525 patients with complete colonoscopies (mean age 62.9 years, 50.2% male). The percentage of patients with advanced adenomas and delayed or inappropriate surveillance was 0.7%, 1.7%, and 1.8% when using optical diagnosis for patients with polyps of 1–3, 1–5, and 1–10 mm, respectively. The percentage of polyps with advanced pathology was 0.5%, 1.4%, and 1.9%, respectively. Surveillance interval agreement between pathology and optical diagnosis was 99%, 98%, and 97.8%, respectively. Total reduction in pathology examinations was 33.9%, 53.5%, and 69.0%, respectively. Conclusions A 3-mm cut-off for clinical implementation of optical polyp diagnosis yielded high surveillance interval agreement with pathology and a high reduction in pathology examinations while minimizing the risk of inappropriate management for polyps with advanced pathology. Funding Agencies None

scholarly journals A79 CLINICAL VALIDATION OF THE SIMPLE CLASSIFICATION FOR OPTICAL DIAGNOSIS OF DIMINUTIVE AND SMALL COLORECTAL POLYPS

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 93-94
Author(s):  
A Alaoui ◽  
K Oumedjbeur ◽  
R Djinbachian ◽  
E Marchand ◽  
P Marques ◽  
...  
Keyword(s):  
Colorectal Polyps ◽  
Adenomatous Polyps ◽  
Prospective Clinical Study ◽  
Study Cohort ◽  
Clinical Validation ◽  
The Novel ◽  
Optical Diagnosis ◽  
Simple Classification ◽  
Funding Agencies ◽  
Surveillance Interval

Abstract Background Image enhanced endoscopy (IEE) allows for real-time optical diagnosis of colorectal polyps in order to replace histopathology. A novel classification system (SIMPLE classification) has recently been developed for optical diagnosis when using the novel Pentax Optivista IEE platform. Aims The aim of this study was to evaluate the SIMPLE classification for optical polyp diagnosis in a prospective clinical study. Methods Patients undergoing screening, diagnostic or surveillance colonoscopies were enrolled in the study. All colorectal polyps 1-10mm found underwent optical polyp diagnosis using the SIMPLE classification with either iScan or Optivista for image-enhanced endoscopy (IEE). Polyps were resected as per standard care and sent for histopathology analysis. Optical diagnosis and surveillance intervals were calculated based on SIMPLE criteria and compared to pathology-based results as reference. Primary outcome was the agreement of the surveillance intervals based on the SIMPLE classification with pathology-based surveillance intervals for 1-5mm colorectal polyps. Secondary outcomes included negative predictive value (NPV) for rectosigmoid adenoma, percentage of pathology avoided, percentage of post-colonoscopy immediate recommendations, and surveillance interval agreement, rectosigmoid NPV for 1-10mm polyps. Results 399 patients (mean age: 62.4, 55.6% female) with 278 diminutive and 364 small polyps were evaluated in the study cohort. For ≤5mm polyps, agreement with pathology-based surveillance intervals was 93.5% [95% CI 91.1–95.9] (shorter: 4.5% [95% CI 2.5–6.5]; longer: 1.8% [95% CI 0.5–3.0]). NPV for rectosigmoid adenomatous polyps (including SSA) was 85.5% [95% CI 77.6–93.4]. Using Optical diagnosis and the SIMPLE classification, pathology analysis could be avoided in 61.5% [95% CI 56.9–66.2] of polyps and post-colonoscopy immediate surveillance interval recommendation could be given in 70.9% [95% CI 66.5–75.4] of patients. For ≤10mm polyps, agreement with pathology-based surveillance intervals was 92.2% [95% CI 89.6–94.9] (shorter: 5.5% [95% CI 3.3–7.8]; longer: 2.3% [95% CI 0.8–3.7]). NPV for rectosigmoid adenomatous polyps (including SSA) was 83.7% [95% CI 75.9–91.5]. Conclusions The first clinical validation study using the SIMPLE classification in combination with Optivista or iScan IEE showed a high (≥90%) surveillance interval agreement compared to pathology. More than 60% of pathology could be avoided, and most patients could be given immediate surveillance intervals when using IEE in combination with the SIMPLE classification. Funding Agencies NonePentax

The location-based resect and discard strategy for diminutive colorectal polyps: a prospective clinical study

Endoscopy ◽  
2021 ◽  
Author(s):  
Mahsa Taghiakbari ◽  
Heiko Pohl ◽  
Roupen Djinbachian ◽  
Alan Barkun ◽  
Paola Marques ◽  
...  
Keyword(s):  
Task Force ◽  
A Priori ◽  
Colonic Polyps ◽  
Colorectal Polyps ◽  
Prospective Clinical Study ◽  
Optical Diagnosis ◽  
Clinical Implementation ◽  
Surveillance Interval ◽  
Task Force Guideline ◽  
Very High

Abstract Background Clinical implementation of the resect-and-discard strategy has been difficult because optical diagnosis is highly operator dependent. This prospective study aimed to evaluate a resect-and-discard strategy that is not operator dependent. Methods The study evaluated a resect-and-discard strategy that uses the anatomical polyp location to classify colonic polyps into non-neoplastic or low risk neoplastic. All rectosigmoid diminutive polyps were considered hyperplastic and all polyps located proximally to the sigmoid colon were considered neoplastic. Surveillance interval assignments based on these a priori assumptions were compared with those based on actual pathology results and on optical diagnosis. The primary outcome was ≥ 90 % agreement with pathology in surveillance interval assignment. Results 1117 patients undergoing complete colonoscopy were included and 482 (43.1 %) had at least one diminutive polyp. Surveillance interval agreement between the location-based strategy and pathological findings using the 2020 US Multi-Society Task Force guideline was 97.0 % (95 % confidence interval [CI] 0.96–0.98), surpassing the ≥ 90 % benchmark. Optical diagnoses using the NICE and Sano classifications reached 89.1 % and 90.01 % agreement, respectively (P < 0.001), and were inferior to the location-based strategy. The location-based resect-and-discard strategy allowed a 69.7 % (95 %CI 0.67–0.72) reduction in pathology examinations compared with 55.3 % (95 %CI 0.52–0.58; NICE and Sano) and 41.9 % (95 %CI 0.39–0.45; WASP) with optical diagnosis. Conclusion The location-based resect-and-discard strategy achieved very high surveillance interval agreement with pathology-based surveillance interval assignment, surpassing the ≥ 90 % benchmark and outperforming optical diagnosis in surveillance interval agreement and the number of pathology examinations avoided.

Optical diagnosis expanded to small polyps: post-hoc analysis of diagnostic performance in a prospective multicenter study

Endoscopy ◽  
2018 ◽  
Vol 51 (03) ◽  
pp. 244-252 ◽  
Author(s):  
Jasper Vleugels ◽  
Yark Hazewinkel ◽  
Marcel Dijkgraaf ◽  
Lianne Koens ◽  
Paul Fockens ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Screening Program ◽  
Narrow Band Imaging ◽  
Optical Diagnosis ◽  
Prospective Multicenter Study ◽  
Post Hoc Analysis ◽  
Confidence Levels ◽  
Surveillance Interval ◽  
Immunochemical Test ◽  
Post Hoc

Abstract Background: Optical diagnosis can replace histopathology of diminutive (1 – 5 mm) polyps if surveillance intervals based on optical diagnosis of polyps have ≥ 90 % agreement with intervals based on polyp histology and if the negative predictive value (NPV) for predicting neoplastic histology in the rectosigmoid is ≥ 90 %. This study aims to assess whether small (6 – 9 mm) polyps can be included in optical diagnosis strategies. Method: This is a post-hoc analysis of a prospective multicenter study in which 27 endoscopists, all performing endoscopies for the Dutch screening program, were trained in optical diagnosis. For 1 year, endoscopists recorded the predicted histology for all lesions detected using narrow-band imaging during 3144 consecutive colonoscopies after a positive fecal immunochemical test, along with confidence levels. Surveillance interval agreement and NPV were calculated for high confidence predictions for polyps of 1 – 9 mm and compared with histopathology. Surveillance interval agreement was calculated using the European Society of Gastrointestinal Endoscopy surveillance guideline. Results: Surveillance interval agreement was 95.4 % (confidence interval [CI] 94.2 % – 96.4 %), and NPV for predicting neoplastic histology in the rectosigmoid 90.0 % (CI 87.3 % – 92.2 %). The reduction in histology (45.9 % vs. 30.5 %) and the proportion of patients who could have received direct surveillance advice (15.6 % vs. 7.3 %) was higher when small polyps were included (P < 0.001). T1 cancer was found in seven small polyps (0.33 %), five of which would have been discarded without histopathology. Conclusion: Including small polyps in the optical diagnosis strategy improves its efficacy while maintaining performance thresholds. However, there is a small risk of missing T1 cancers when small polyps are included in the optical diagnosis strategy.

scholarly journals Clinical validation of the SIMPLE classification for optical diagnosis of colorectal polyps

2021 ◽  
Vol 09 (05) ◽  
pp. E684-E692
Author(s):  
Ahmed Amine Alaoui ◽  
Kussil Oumedjbeur ◽  
Roupen Djinbachian ◽  
Étienne Marchand ◽  
Paola N. Marques ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Colorectal Polyps ◽  
Clinical Validation ◽  
Optical Diagnosis ◽  
Clinical Cohort ◽  
Simple Classification ◽  
Surveillance Interval ◽  
Colonoscopy Surveillance ◽  
Secondary Outcomes ◽  
Diagnosis Classification

Abstract Background and study aims A novel endoscopic optical diagnosis classification system (SIMPLE) has recently been developed. This study aimed to evaluate the SIMPLE classification in a clinical cohort. Patients and methods All diminutive and small colorectal polyps found in a cohort of individuals undergoing screening, diagnostic, or surveillance colonoscopies underwent optical diagnosis using image-enhanced endoscopy (IEE) and the SIMPLE classification. The primary outcome was the agreement of surveillance intervals determined by optical diagnosis compared with pathology-based results for diminutive polyps. Secondary outcomes included the negative predictive value (NPV) for rectosigmoid adenomas, the percentage of pathology exams avoided, and the percentage of immediate surveillance interval recommendations. Analysis of optical diagnosis for polyps ≤ 10 mm was also performed. Results 399 patients (median age 62.6 years; 55.6 % female) were enrolled. For patients with at least one polyp ≤ 5 mm undergoing optical diagnosis, agreement with pathology-based surveillance intervals was 93.5 % (95 % confidence interval [CI] 91.4–95.6). The NPV for rectosigmoid adenomas was 86.7 % (95 %CI 77.5–93.2). When using optical diagnosis, pathology analysis could be avoided in 61.5 % (95 %CI 56.9–66.2) of diminutive polyps, and post-colonoscopy surveillance intervals could be given immediately to 70.9 % (95 %CI 66.5–75.4) of patients. For patients with at least one ≤ 10 mm polyp, agreement with pathology-based surveillance intervals was 92.7 % (95 %CI 89.7–95.1). NPV for rectosigmoid adenomas ≤ 10 mm was 85.1 % (95 %CI CI 76.3–91.6). Conclusions IEE with the SIMPLE classification achieved the quality benchmark for the resect and discard strategy; however, the NPV for rectosigmoid polyps requires improvement.

scholarly journals A119 THE LOCATION-BASED RESECT AND DISCARD STRATEGY FOR DIMINUTIVE COLORECTAL POLYPS: A PROSPECTIVE CLINICAL STUDY

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 99-101
Author(s):  
M Taghiakbari ◽  
H Pohl ◽  
R Djinbachian ◽  
A N Barkun ◽  
P Marques ◽  
...  
Keyword(s):  
Task Force ◽  
A Priori ◽  
Cost Effective ◽  
Colorectal Polyps ◽  
Prospective Clinical Study ◽  
Colon Polyps ◽  
Optical Diagnosis ◽  
Cost Effective Approach ◽  
Surveillance Interval ◽  
Task Force Guideline

Abstract Background Replacing histopathology evaluation of diminutive polyps with optical polyp diagnosis is considered a cost-effective approach. However, the widespread use of optical diagnosis is limited due to concerns about making incorrect optical diagnoses and the requirements of training, credentialing and auditing of performance. Aims This prospective study aimed to evaluate a simplified resect and discard strategy that is not operator dependent. Methods The study evaluated a resect and discard strategy that uses anatomical polyp location to classify colon polyps into non-neoplastic or low-risk neoplastic. All rectosigmoid diminutive polyps were considered hyperplastic and all polyps located proximally to the sigmoid colon were considered neoplastic. Surveillance interval assignments based on these a priori assumptions were compared with those based on actual pathology results and optical diagnosis, respectively. The primary outcome was ≥90% agreement with pathology in surveillance interval assignment. Results Overall, 1117 patients undergoing complete colonoscopy were included and 482 (43.1%) had at least one diminutive polyp. Surveillance interval agreement between the location-based resect and discard strategy and pathological findings using the 2020 US Multi-Society Task Force guideline was 97.0% (95% CI = 0.96 - 0.98), surpassing the ≥90% benchmark. Optical diagnoses using NICE and Sano classifications reached 89.1% and 90.01% agreement, respectively (p &lt;0.0001), and were inferior to the location-based strategy. The location-based resect and discard strategy allowed a 69.7% (95% CI = 0.67 - 0.72) reduction in pathology examinations compared with 55.3% (95% CI = 0.52 - 0.58) (NICE and Sano) and 41.9% (95% CI = 0.39 - 0.45) (WASP) with optical diagnosis. Conclusions The location-based resect and discard strategy achieved very high surveillance interval agreement with pathology-based surveillance interval assignment, surpassing the ≥90% quality benchmark and outperforming optical diagnosis in surveillance interval agreement and the number of pathology examinations avoided. Funding Agencies None

Evaluation of the polyp-based resect and discard strategy: a retrospective study

Endoscopy ◽  
2021 ◽  
Author(s):  
Antoine Duong ◽  
Heiko Pohl ◽  
Roupen Djinbachian ◽  
Annie Deshêtres ◽  
Alan N. Barkun ◽  
...  
Keyword(s):  
Multiple Testing ◽  
Primary Outcome ◽  
Task Force ◽  
Colorectal Polyps ◽  
Surveillance Interval ◽  
Almost All ◽  
A Prospective Study ◽  
Post Hoc ◽  
Standard Colonoscopy

Abstract Background Standard colonoscopy practice requires removal and histological characterization of almost all detected small (< 10 mm) and diminutive (≤ 5 mm) colorectal polyps. This study aimed to test a simplified polyp-based resect and discard (PBRD) strategy that assigns surveillance intervals based only on size and number of small/diminutive polyps, without the need for pathology examination. Methods A post hoc analysis was performed on patients enrolled in a prospective study. The primary outcome was surveillance interval agreement of the PBRD strategy with pathology-based management according to 2020 US Multi-Society Task Force guidelines. Chart analysis also evaluated clinician adherence to pathology-based recommendations. One-sided testing was performed with a null-hypothesis of 90 % agreement with pathology-based surveillance intervals and a two-sided 96.7 % confidence interval (CI) using correction for multiple testing. Results 452 patients were included in the study. Surveillance intervals assigned using the PBRD strategy were correct in 97.8 % (96.7 %CI 96.3–99.3 %) of patients compared with pathology-based management. The PBRD strategy reduced pathology examinations by 58.7 % while providing 87.8 % of patients with immediate surveillance interval recommendations on the day of colonoscopy, compared with 47.1 % when using pathology-based management. Chart analysis of surveillance interval assignments showed 63.3 % adherence to pathology-based guidelines. Conclusion The PBRD strategy surpassed the 90 % agreement with the pathology-based standard for determining surveillance interval, reduced the need for pathology examinations, and increased the proportion of patients receiving immediate surveillance interval recommendations. The PBRD strategy does not require expertise in optical diagnosis and may replace histological characterization of small and diminutive colorectal polyps.

scholarly journals A78 COMPARISON OF THE NICE, SANO, AND WASP CLASSIFICATIONS FOR OPTICAL DIAGNOSIS OF SMALL COLORECTAL POLYPS

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 92-93
Author(s):  
R Djinbachian ◽  
H Pohl ◽  
E Marchand ◽  
P Marques ◽  
M Bouin ◽  
...  
Keyword(s):  
Correct Diagnosis ◽  
Colorectal Polyps ◽  
Classification Systems ◽  
Optical Diagnosis ◽  
Polyp Detection ◽  
Detection Rates ◽  
Adenoma Detection ◽  
Multiple Classification ◽  
Surveillance Interval ◽  
Adenoma Detection Rates

Abstract Background Optical diagnosis can be used as an alternative to pathology for the evaluation of colorectal polyps. There exist multiple classification systems that can be used to assist in performing optical diagnosis. Aims The aim of this study was to compare three different optical diagnosis classifications (NICE, SANO and WASP) when using Optivista and iScan image enhanced endoscopy (IEE). Methods The study included subjects between 45–80 years undergoing an elective screening, surveillance, or diagnostic colonoscopy with optical diagnosis using Optivista or iScan IEE. Three validated IEE scales (NICE, SANO and WASP classifications) were used for all optical diagnoses. Primary outcome was the agreement with pathology for surveillance intervals determined when using NICE, SANO and WASP for polyps 1-10mm. Secondary outcomes for polyps 1-10mm included accuracy of polyp diagnosis and negative predictive value (NPV) for rectosigmoid adenomas. Results A total of 399 patients were prospectively enrolled in the trial. The polyp detection and adenoma detection rates were 58.6% and 38.8% respectively. The proportion of correct surveillance interval assignment when at least one optical diagnosis was made was 92.9% when using NICE, 92.3% when using SANO, 89.5% when using WASP (p=0.656). Correct diagnosis was made for 74.2% of polyps when using NICE, 74.2% when using SANO, 65.6% when using WASP (p=0.012). The NPV for rectosigmoid adenomas was 91.2% when using NICE, 90.5% when using SANO, 87.5% when using WASP. Conclusions For optical diagnosis using Optivista and iScan IEE, all studied classifications performed equally for surveillance interval assignment. WASP had lower proportion of correct diagnoses on a polyp level and lower NPV for rectosigmoid adenomas. Funding Agencies None

scholarly journals A76 INCOMPLETE RESECTION OF 1-20MM COLORECTAL POLYPS: A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 90-91 ◽  
Author(s):  
R Djinbachian ◽  
R Iratni ◽  
M Durand ◽  
P Marques ◽  
D von Renteln
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Meta Analysis ◽  
Significant Proportion ◽  
Assessment Method ◽  
Colorectal Polyps ◽  
Incomplete Resection ◽  
Polyp Size ◽  
Funding Agencies ◽  
Snare Polypectomy

Abstract Background Colonoscopy has been used as a screening or surveillance tool for colorectal cancer (CRC), however, a minority of patients develop post-colonoscopy interval CRC. Incomplete resection of colorectal polyps is thought to be a major cause of post-colonoscopy interval CRC. Aims We were interested in studying the incomplete resection rate (IRR) of colorectal polyps and factors associated with incomplete resection in a systematic review and meta-analysis. Methods We conducted a systematic review and meta-analysis using MEDLINE, EMBASE, EBM Reviews, and CINAHL of all studies reporting on IRR of polyps 1-20mm published until March 2019. Exclusion criteria were: Inclusion of IBD cohorts; referrals for difficult polypectomy; polyp size &gt;20mm; endoscopic submucosal dissection; conference abstracts; non-english language. Primary outcome was histologic IRR for polypectomies. Secondary outcomes included IRR for all studies; IRR for polyps 1-10mm and 10-20mm; IRR with or without submucosal injection; IRR based on assessment method of completeness; IRR for different polypectomy methods. Results 6148 records were identified through initial search and 37 studies with a total of 11962 polyps were included in our quantitative analysis. Histologic IRR for polypectomies (snare and forceps) was 10.54% (95%CI 8.56–12.53). IRR for all included studies was 9.05% (95%CI 7.54–10.56). IRR was lower for polyps 1-10mm than polyps 10-20mm; 8.85% (95%CI 7.27–10.44) vs 18.08% (95%CI 10.30–25.87). IRR was statistically significantly lower when only evaluated using imaging enhanced endoscopy (IEE) (0.69%; 95%CI 0.02–1.35) compared to post polypectomy margin biopsies (7.19%; 95%CI 5.39–8.99). Histologic IRR for snare polypectomy (8.79%; 95%CI 6.96–10.62) was lower than histologic IRR for forceps polypectomy (17.75; 95%CI 10.49–25.01). Conclusions Incomplete resection of 1-20mm colorectal polyps occurs in a significant proportion of polypectomies. Incomplete resection occurs more frequently in larger (10-20mm) polyps. Visual inspection with IEE after polypectomy underestimates IRR in comparison to post polypectomy biopsies. Snare polypectomy had lower IRR when compared with forceps. Funding Agencies None

scholarly journals Influence of patient age and colorectal polyp size on histopathology findings

2014 ◽  
Vol 27 (2) ◽  
pp. 109-113 ◽  
Author(s):  
Silvana Marques e SILVA ◽  
Viviane Fernandes ROSA ◽  
Antônio Carlos Nóbrega dos SANTOS ◽  
Romulo Medeiros de ALMEIDA ◽  
Paulo Gonçalves de OLIVEIRA ◽  
...  
Keyword(s):  
Demographic Data ◽  
Colorectal Polyp ◽  
Proximal Colon ◽  
Colorectal Polyps ◽  
University Hospital ◽  
Consecutive Series ◽  
Polyp Size ◽  
Patient Age ◽  
Cross Sectional ◽  
Patient Âgé

BACKGROUND: Colorectal cancer is a major cause of morbidity and mortality and can arise through the adenoma-carcinoma sequence. Colonoscopy is considered the method of choice for population-wide cancer screening. AIM: To assess the characteristics of endoscopically resected polyps in a consecutive series of patients who underwent colonoscopy at a university hospital and compare histopathology findings according to patient age and polyp size. METHODS: Retrospective, cross-sectional of 1950 colonoscopy reports from consecutively examined patients. The sample was restricted to reports that mentioned colorectal polyps. A chart review was carried out for collection of demographic data and histopathology results. Data were compared for polyps sized ≤0.5 cm and ≥0.6 cm and then for polyps sized ≤1.0 cm and ≥1.1 cm. Finally, all polyps resected from patients aged 49 years or younger were compared with those resected from patients aged 50 years or older. RESULTS: A total of 272 colorectal polyps were resected in 224 of the 1950 colonoscopies included in the sample (11.5%). Polyps >1 cm tended to be pedunculated (p=0.000) and were more likely to exhibit an adenomatous component (p=0.001), a villous component (p=0.000), and dysplasia (p=0.003). These findings held true when the size cutoff was set at 0.5 cm. Patients aged 50 years or older were more likely to have sessile polyps (p=0.023) and polyps located in the proximal colon (p=0.009). There were no significant differences between groups in histopathology or presence of dysplasia. CONCLUSION: Polyp size is associated with presence of adenomas, a villous component, and dysplasia, whereas patient age is more frequently associated with sessile polyps in the proximal colon.

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