What is it about?

Although sessile serrated adenoma/polyps (SSA/Ps) are considered to be premalignant lesions and rapidly progress to carcinomas after they develop cytological dysplasia (CD), a treatment strategy for SSA/Ps in Asian countries is still being debated and has not yet been established. The present study aimed to propose a treatment strategy for SSA/Ps.

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Why is it important?

Histopathological data of patients, who underwent colonoscopy at our center between January 2011 and December 2016, were reviewed. Data of patients with ≥1 SSA/P were retrieved, and clinicopathological characteristics were retrospectively analyzed. A total of 281 patients with 326 SSA/Ps, including 258 patients who had 300 SSA/Ps without CD (SSA/Ps-CD[-]) and 23 patients who had 26 SSA/Ps with CD (SSA/Ps-CD[+]), were evaluated in this study. Although SSA/Ps-CD(+) were often found in older female patients and in the proximal colon, there were no significant differences between SSA/Ps-CD(-) and SSA/Ps-CD(+). Endoscopic morphological findings, such as large or small nodules on the surface and partial protrusion of the lesions, were significantly more common in SSA/Ps-CD(+) than in SSA/Ps-CD(-). Although the diagnostic ability of nodule/protrusion in lesions to predict CD within SSA/Ps was very high with an accuracy of 93.9% and a negative predictive value of 95.4%, sensitivity was low at 46.2%. SSA/Ps-CD(+) were significantly larger than SSA/Ps-CD(-), and the rate of CD within SSA/Ps significantly increased with lesion size (≤5 mm, 0%; 6-9 mm, 6.0%; ≥10 mm, 13.6%).

Perspectives

We propose removing all SSA/Ps ≥6 mm in order to remove high-risk SSA/Ps-CD(+), with high sensitivity.

Dr Wataru Sano
Sano Hospital

Read the Original

This page is a summary of: Clinical and endoscopic evaluations of sessile serrated adenoma/polyps with cytological dysplasia, Journal of Gastroenterology and Hepatology, March 2018, Wiley,
DOI: 10.1111/jgh.14099.
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