Finding Sessile Serrated Adenomas: Is It Possible to Identify Them During Conventional Colonoscopy?

• Published in: Digestive diseases and sciences Vol. 59; no. 12; pp. 3021 - 3026
• Main Authors: Pereyra, Lisandro, Gómez, Estanislao J., González, Raquel, Fischer, Carolina, Eraña, Gastón Babot, Torres, Alfredo G., Correa, Leandro, Mella, José M., Panigadi, Guillermo N., Luna, Pablo, Pedreira, Silvia C., Cimmino, Daniel G., Boerr, Luis A.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-12-2014; Springer; Springer Nature B.V
• Subjects: Adenoma - classification; Adenoma - diagnosis; Adenoma - pathology; Biochemistry; Colonic Neoplasms - diagnosis; Colonic Neoplasms - pathology; Colonoscopy; Colonoscopy - standards; Colorectal cancer; Female; Gastroenterology; Hepatology; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Oncology; Original Article; Pneumoviridae; Transplant Surgery; Sessile serrated adenoma; Colorectal cancer screening; Serrated polyps; Colonoscopy
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-014-3295-z

Background and Aim
Proximal colorectal cancer may arise from sessile serrated adenomas (SSAs). Recognition of these lesions during colonoscopy can optimize the endoscopic approach. We aimed to identify specific endoscopic features of SSA with conventional colonoscopy.
Methods
Patients undergoing screening colonoscopies from January 2011 to September 2012, in whom colonic polyps were found, were prospectively included in our study. Polyp morphology, location, polyp pit pattern (Kudo classification), and other previously reported features of SSA were evaluated. Histological examination was conducted independently by two pathologists. Multivariate analysis was performed to identify independent predictors of SSA.
Results
A total of 272 patients were included, and 440 polyps were evaluated (1.6 polyps per patient). Thirty-four polyps (8 %) were SSA, 135 (31 %) hyperplastic, and 249 (56 %) adenomas. The most prevalent endoscopic features of SSA were right-side location (94 %), type II Kudo pit pattern (91 %), mucus cap (41 %), flat morphology (29 %) and red-colored surface (26 %). Multivariate analysis revealed that flat morphology (
p
 = 0.002, OR = 3.81 CI 1.53–9.09), red-colored surface (
p
 < 0.001, OR = 12.97 CI 4.43–37.69), right-side location (
p
 < 0.001, OR = 22.21 CI 5.09–135.94) and mucus cap (
p
 < 0.001, OR 8.77 CI 3.76–20.44) were independent predictors of SSA.
Conclusion
We were able to identify specific features of SSA during conventional colonoscopy, which may help to identify, and therefore to optimize the endoscopic approach of these lesions.