Endoscopic Features of Mucous Cap Polyps: A Way to Predict Serrated Polyps

Abstract

Background/AimsThe aims of the study were to identify whether a mucous-cap predicts the presence of serrated polyps, and to determine whether additional endoscopic findings predict the presence of a sessile serrated adenomas/polyp (SSA/P). MethodsWe analyzed 147 mucous-capped polyps with corresponding histology, during 2011–2014. Eight endoscopic features (presence of borders, elevation, rim of debris, location in the colon, size ≥10 mm, varicose vessels, nodularity, and alteration in mucosal folds) of mucous-capped polyps were examined to see if they can predict SSA/Ps. ResultsA total of 86% (n=126) of mucous-capped polyps were from the right sided serrated pathway (right-sided hyperplastic [n=83], SSA/Ps [n=43], traditional serrated adenoma [n=1]), 10% (n=15) were left-sided hyperplastic polyps, and 3% (n=5) were from the adenoma-carcinoma sequence. The presence of a mucous cap combined with varicose vessels was the only significant predictor for SSA/Ps. The other seven characteristics were not found to be statistically significant for SSA/Ps, although location in the colon and the presence of nodularity trended towards significance. ConclusionsOur study suggests that mucous-capped polyps have high predictability for being a part of the serrated pathway. Gastroenterologists should be alert for a mucous-capped polyp with varicose veins, as these lesions have a higher risk of SSA/P.

Endoscopic features of sessile serrated adenoma/polyps under narrowband imaging: A retrospective study

“…Considering a reported higher sensitivity of dark spots than that in our study, chromoendoscopy is necessary to identify accurately the pit pattern. Some studies have reported that a mucus cap is a good indicator of SSA/P, whereas in our study only 20.4% of SSA/P presented with this feature, which is probably due to the thorough rinsing we performed during the colonoscopy. Although careful irrigation is important for screening colorectal diseases to obtain a good view of the lesions, observation before rinsing is also of great importance for detecting SSA/P.…”

“…Before the evaluation, five endoscopic features under NBI were determined as follows: (a) dark spots, defined as dilated crypt openings inside the crypts that are at least twice larger than the surrounding normal mucosa and were thought to be type II‐O pits after being sprayed with dye; (b) a clouded surface, defined as a mild, nodule‐like surface which resembles accumulated cumulus clouds; (c) a mucus cap, defined as an accumulation of mucus on the surface of a lesion, including clear and bile‐stained mucus, which can be easily removed after rinsing; (d) DBV, defined as thickened capillary vessels with branching presenting on the surface of the lesions that differ from the “meshed capillary vessels” in the CP classification; and (e) CP classification. Typical images of these five endoscopic features are shown in Figure .…”

Coagulase-negative staphylococci (CoNS) as a significant etiological factor of laryngological infections: a review

“…Therefore, polyps occur elsewhere in the body where there is a mucous membrane. The presence of polyps and accompanying mucosal edema is one of the main observations at examination [82]. The polyps may be involved in chronic sinusitis.…”

How to Detect Sessile Serrated Adenoma/Polyps

“…In a current issue of Clinical endoscopy , Moy et al investigated whether a mucous- capped polyp, one of the most common endoscopic features of SSA/Ps, can predict the presence of serrated polyps [ 13 ]. They examined the endoscopic features of 147 mucous-capped polyps to determine if they could predict SSA/Ps.…”

“…They examined the endoscopic features of 147 mucous-capped polyps to determine if they could predict SSA/Ps. Among these, there were 127 (86%) serrated polyps (right-sided hyperplastic polyps, SSA/Ps, or traditional serrated adenomas), and only 43 (29%) SSA/Ps [ 13 ]. To find the predictive features of SSA/Ps, they also evaluated other endoscopic characteristics of mucous- capped polyps such as polyp size (≥10 mm), the distinct border, elevation, rim of debris, location, varicos vessels, nodular surface and alterations in the fold contour.…”