{
  "abstract": "Background Sessile serrated lesions (SSLs) are important precursors in the serrated colorectal cancer pathway but remain difficult to detect owing to flat morphology and subtle proximal appearance. National guidance increasingly highlights SSL detection as a quality metric. This study assessed six-year trends, operator performance, enhanced imaging use, and demographic patterns associated with SSL detection in a large UK tertiary endoscopy service.Methods We retrospectively analysed 72,983 colonoscopies (2018–2023) and an SSL-positive cohort (n=787). Operators were classified as Bowel Cancer Screening Programme (BCSP) or non-BCSP using an official roster. Annual SSL detection rates were calculated where denominators were available. Associations were evaluated between detection, operator group, use of narrow-band imaging (NBI) or chromoendoscopy, and serrated-lesion training. Ethnicity data were available for >98% of SSL cases.Results SSL detection rose from 0.1% in 2018 to 2.73% in 2022. BCSP operators consistently demonstrated higher detection (mean 2.0%) than non-BCSP operators (0.3%). Operators who completed dedicated serrated-lesion training showed higher performance compared with those without training. Use of NBI or dye-based chromoendoscopy was associated with substantially improved proximal SSL detection (9.4% vs. 4.1% with white-light alone). Lesions remained predominantly proximal across all years.Ethnicity analysis showed that 88.8% of SSL patients were White, compared with 79% locally and 82% nationally. Asian (0.25%) and Black (0%) patients were markedly underrepresented. These demographic patterns mirror emerging data suggesting possible variation in serrated-pathway disease or differences in referral, recognition, or access, and merit further investigation.Conclusions SSL detection increased markedly over six years in this high-volume service, supported by enhanced imaging uptake and serrated-lesion training. Operator variation and ethnic disparities highlight key areas for targeted quality improvement. Integrating SSL detection into routine quality dashboards and monitoring demographic indicators may strengthen colorectal cancer prevention strategies.",
  "authors": [
    {
      "affiliations": [
        "University Hospitals of Leicester, Leicester, United Kingdom"
      ],
      "name": "Sudarshan Kadri"
    }
  ],
  "title": "P328 Improving sessile serrated lesion detection: six-year trends, operator variation, and ethnic disparities in a high-volume UK service",
  "uid": "f84e6bbb-ae78-5d00-b372-adbee20977db"
}