Endoscopic diagnosis of sessile serrated polyp: A systematic review

Kashida, Hiroshi

doi:10.1111/den.13263

Cited by 18 publications

(18 citation statements)

References 41 publications

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“…To endoscopically diagnose colorectal polyps, we used the updated Paris Endoscopic Classification of superficial neoplastic lesions in the digestive tract [10]. We primarily diagnosed a polyp as a sessile serrated polyp (SSP) according to the following findings: proximal location; flat, elevated, or sessile; irregular shape; indistinctive border; cloud-like surface; mucus cap; normal or pale color; none or dilated vessels, and/or dilated crypts [11]. Polyp size was measured by placing a closed snare or forceps, which has a thickness of 2 mm, against the lesion.…”

Section: Diagnosis Of Polypsmentioning

confidence: 99%

Expert endoscopists with high adenoma detection rates frequently detect diminutive adenomas in proximal colon

et al. 2020

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Background and study aims Adenoma detection rate (ADR) is an important quality indicator in colonoscopy, and improved ADR decreases the incidence of colorectal cancer. We investigated differences in polyp detection according to the endoscopist’s ADR. Patients and methods We performed a propensity-score matching study using baseline patient characteristics of age, sex, body mass index, family history of colorectal cancer, smoking, drinking, indication for colonoscopy, bowel preparation, and colonoscope type. We compared polyp detection and colonoscopy procedures between patients who underwent colonoscopy by high-ADR endoscopists (high ADR group) and by low-ADR endoscopists (low ADR group). Results We matched 334 patients in the high ADR group with 334 in the low ADR group. The ADR was 44.0 % and 26.9 % for the high-ADR and low-ADR endoscopists, respectively. Proximal, nonprotruding, and diminutive adenomas were more frequently detected by high-ADR endoscopists than by low-ADR endoscopists (all P < 0.001); similarly, more high-risk adenomas were detected by high-ADR endoscopists (P = 0.028). Furthermore, more sessile serrated polyps detected by high-ADR endoscopists (P = 0.041). High-ADR endoscopists more frequently performed pancolonic chromoendoscopy (P < 0.001). Conclusions Expert detectors often found nonprotruding and diminutive adenomas in the proximal colon along with increased detection rate of high-risk adenomas. Low-ADR endoscopists need to recognize the features of missed adenomas to improve their ADRs.

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Section: Diagnosis Of Polypsmentioning

confidence: 99%

Expert endoscopists with high adenoma detection rates frequently detect diminutive adenomas in proximal colon

et al. 2020

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“…Endoscopically, SSLs usually measure > 5 mm, are frequently covered by mucus called ‘‘mucus cap’’, and have indistinct borders and a cloud-like surface[ 7 ]. The features of SSLs under magnifying narrow-band imaging (NBI) are varicose microvascular vessels and expanded crypt openings[ 8 ]. The feature of SSLs on chromoendoscopy is a type II open-shape pit pattern.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic diagnosis for colorectal sessile serrated lesions

Nishizawa¹,

Yoshida²,

Toyoshima³

et al. 2021

WJG

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BACKGROUND Hyperplastic polyps are considered non-neoplastic, whereas sessile serrated lesions (SSLs) are precursors of cancer via the ‘‘serrated neoplastic pathway’’. The clinical features of SSLs are tumor size (> 5 mm), location in the proximal colon, coverage with abundant mucus called the ‘‘mucus cap’’, indistinct borders, and a cloud-like surface. The features in magnifying narrow-band imaging are varicose microvascular vessels and expanded crypt openings. However, accurate diagnosis is often difficult. AIM To develop a diagnostic score system for SSLs. METHODS We retrospectively reviewed consecutive patients who underwent endoscopic resection during colonoscopy at the Toyoshima endoscopy clinic. We collected data on serrated polyps diagnosed by endoscopic or pathological examination. The significant factors for the diagnosis of SSLs were assessed using logistic regression analysis. Each item that was significant in multivariate analysis was assigned 1 point, with the sum of these points defined as the endoscopic SSL diagnosis score. The optimal cut-off value of the endoscopic SSL diagnosis score was determined by receiver-operating characteristic curve analysis. RESULTS Among 1288 polyps that were endoscopically removed, we analyzed 232 diagnosed as serrated polyps by endoscopic or pathological examination. In the univariate analysis, the location (proximal colon), size (> 5 mm), mucus cap, indistinct borders, cloud-like surface, and varicose microvascular vessels were significantly associated with the diagnosis of SSLs. In the multivariate analysis, size (> 5 mm; P = 0.033), mucus cap ( P = 0.005), and indistinct borders ( P = 0.033) were independently associated with the diagnosis of SSLs. Size > 5 mm, mucus cap, and indistinct borders were assigned 1 point each and the sum of these points was defined as the endoscopic SSL diagnosis score. The receiver-operating characteristic curve analysis showed an optimal cut-off score of 3, which predicted pathological SSLs with 75% sensitivity, 80% specificity, and 78.4% accuracy. The pathological SSL rate for an endoscopic SSL diagnosis score of 3 was significantly higher than that for an endoscopic SSL diagnosis score of 0, 1, or 2 ( P < 0.001). CONCLUSION Size > 5 mm, mucus cap, and indistinct borders were significant endoscopic features for the diagnosis of SSLs. Serrated polyps with these three features should be removed during colonoscopy.

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“…Sessile serrated polyps are lesions more frequently missed, [ 94 ] with a higher rate of incomplete resection during colonoscopy [ 95 ] and a lower susceptibility to bleed. The reasons could be due to their proximal location, small size, flat or sessile morphology, and endoscopic appearance (mucus cap and irregular shape) [ 95 ]. Thus, sessile serrated polyps could be responsible for both PCCRCs and FIT interval cancers.…”

Section: Discussionmentioning

confidence: 99%

Future Prospects of Colorectal Cancer Screening: Characterizing Interval Cancers

Ibáñez‐Sanz

Sanz‐Pamplona

Garcia

2021

Cancers

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Tumors that are not detected by screening tests are known as interval cancers and are diagnosed clinically after a negative result in the screening episode but before the next screening invitation. Clinical characteristics associated with interval colorectal cancers have been studied, but few molecular data are available that describe interval colorectal cancers. A better understanding of the clinical and biological characteristics associated with interval colorectal cancer may provide new insights into how to prevent this disease more effectively. This review aimed to summarize the current literature concerning interval colorectal cancer and its epidemiological, clinical, and molecular features.

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Endoscopic diagnosis of sessile serrated polyp: A systematic review

Cited by 18 publications

References 41 publications

Expert endoscopists with high adenoma detection rates frequently detect diminutive adenomas in proximal colon

Expert endoscopists with high adenoma detection rates frequently detect diminutive adenomas in proximal colon

Endoscopic diagnosis for colorectal sessile serrated lesions

Future Prospects of Colorectal Cancer Screening: Characterizing Interval Cancers

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