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Objective To compare the endoscopic features between colorectal sessile serrated lesions and hyperplastic polyps, and to establish and assess a predictive model. Methods A total of 116 SSL lesions（94 patients） and 208 HP lesions（172 patients） which underwent colonoscopic lesion resection and confirmed by pathology from June 2019 to June 2022 at Fuding Hospital, Fujian University of Traditional Chinese Medicine were retrospective analyzed. The lesions were randomly divided into either a derivation sample or a validation sample using 1∶1 allocation according to the random number. In the derivation sample, SSL endoscopic features were used to establish a predictive model to distinguish between SSL and HP, in which predictors were identified by univariate and multivariate logistic regression analysis and predictive efficacy was evaluated by receiver operating characteristic （ROC） curve analysis. The predictive efficacy was assessed in the validation sample. Results Compared with HP, SSL was more common in the right colon with diameter > 5 mm and more likely to be manifested as: unclear boundary, irregular morphology, cumulus‐like surface, surface mucus, varicose microvascular vessel and II‐O pit pattern（P < 0.001）. Diameter > 5 mm （OR = 7.717, 95% CI:2.141 ~ 27.810, P = 0.002）, surface mucus （OR = 12.063, 95% CI: 3.925 ~ 37.072, P < 0.001） and unclear boundary（ OR = 7.020, 95% CI:2.118 ~ 23.260, P = 0.001） were predictors to diagnose SSL. Predictive model was built in the derivation sample with area under the ROC curve of 0.924（95% CI:0.884 ~ 1.000, P < 0.001）. In the validation sample, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the predictive model were 93.10%, 94.23%, 93.83%, 90.00% and 96.08%, respectively. Conclusion Diameter > 5 mm, surface mucus and unclear boundary were predictors to diagnose SSL. Our predictive model have good predictive value, and it provide an important reference information for the endoscopists to make the correct diagnosis. [ABSTRACT FROM AUTHOR]