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INTRODUCTION: Risk factors for serrated polyps (SPs) are not well understood. METHODS: Multivariable analyses of data from a multicenter colonoscopy-based study estimated odds ratios for having either a sessile serrated lesion or traditional serrated adenoma according to participant characteristics. RESULTS: Six thousand seventy-eighty participants were included in the analyses (565 with either a sessile serrated lesion or traditional serrated adenoma). White race was associated with a higher risk of SPs compared with Black race (adjusted odds ratio 4.64, 95% confidence interval 1.89–11.41). Obesity and current smoking were also associated with a higher risk of SPs. DISCUSSION: White race, smoking, and obesity are risk factors for precancerous SPs. [ABSTRACT FROM AUTHOR]

Introduction: We investigated coexisting lesion types in patients with invasive colorectal cancer (CRC) in a multinational study for comprehending the adenoma-carcinoma and serrated pathway about the development of CRC. Methods: We retrospectively reviewed 3,050 patients enrolled in the international randomized controlled trial (ATLAS study) to evaluate the colorectal polyp detection performance of image-enhanced endoscopy in 11 institutions in four Asian countries/regions. In the current study, as a subgroup analysis of the ATLAS study, 92 CRC patients were extracted and compared to 2,958 patients without CRC to examine the effects of age, sex, and coexisting lesion types (high-grade adenoma [HGA], low-grade adenoma with villous component [LGAV], 10 adenomas, adenoma ≥10 mm, sessile serrated lesions [SSLs], and SSLs with dysplasia [SSLD]). Additional analyses of coexisting lesion types were performed according to sex and location of CRC (right- or left-sided). Results: A multivariate analysis showed that HGA (odds ratio [95% confidence interval] 4.29 [2.16–8.18]; p < 0.01), LGAV (3.02 [1.16–7.83], p = 0.02), and age (1.04 [1.01–1.06], p = 0.01) were independently associated with CRC. According to sex, the coexisting lesion types significantly associated with CRC were LGAV (5.58 [1.94–16.0], p < 0.01) and HGA (4.46 [1.95–10.20], p < 0.01) in males and HGA (4.82 [1.47–15.80], p < 0.01) in females. Regarding the location of CRC, SSLD (21.9 [1.31–365.0], p = 0.03) was significant for right-sided CRC, and HGA (5.22 [2.39–11.4], p < 0.01) and LGAV (3.46 [1.13–10.6], p = 0.02) were significant for left-sided CRC. Conclusions: The significant coexisting lesions in CRC differed according to sex and location. These findings may contribute to comprehending the pathogenesis of CRC. [ABSTRACT FROM AUTHOR]

The serrated pathway to colorectal cancers (CRCs) is a significant pathway encompassing five distinct types of lesions, namely hyperplastic polyps (HPs), sessile serrated lesions (SSLs), sessile serrated lesions with dysplasia (SSL-Ds), traditional serrated adenomas (TSAs), and serrated adenoma unclassified. In contrast to the conventional adenoma-carcinoma pathway, the serrated pathway primarily involves two mechanisms: BRAF/KRAS mutations and CpG island methylator phenotype (CIMP). HPs are the most prevalent non-malignant lesions, while SSLs play a crucial role as precursors to CRCs, On the other hand, traditional serrated adenomas (TSAs) are the least frequently encountered subtype, also serving as precursors to CRCs. It is crucial to differentiate these lesions based on their unique morphological characteristics observed in histology and colonoscopy, as the identification and management of these serrated lesions significantly impact colorectal cancer screening programs. The management of these lesions necessitates the crucial steps of removing premalignant lesions and implementing regular surveillance. This article provides a comprehensive summary of the epidemiology, histologic features, molecular features, and detection methods for various serrated polyps, along with recommendations for their management and surveillance. [ABSTRACT FROM AUTHOR]

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]

Background: Sessile serrated lesions (SSLs) are precursors of colon cancer, especially in cases of large, right colon. However, they are difficult to not only detect, but only clarify the margin of the lesion, which can lead to the poor endoscopic treatment outcomes. Aims: This study evaluated the usefulness of acetic acid spray with narrow-band imaging (A-NBI) for the better visualization of the margin of SSLs. Methods: From January 2013 to March 2022, patients with superficial elevated polyps suspected of being SSLs ≥ 10 mm with an endoscopic diagnosis that had been endoscopically resected at Hiroshima City Hiroshima Citizens Hospital were enrolled. Endoscopic images with white-light imaging (WLI), narrow-band imaging (NBI), indigo-carmine (IC), and A-NBI were recorded in each lesion and were randomly arranged and assessed by 10 endoscopists. We compared the visibility score (1 to 4) and color differences (ΔE) between inside and outside of the lesions among WLI, NBI, IC, and A-NBI. Results: Forty-one lesions in 33 cases were included, and a total of 164 images were evaluated. As for the visibility score, most of the lesions were scored as 1 or 2 on WLI, whereas most were scored 4 on A-NBI. The median ΔE of A-NBI was also significantly higher than that of WLI, NBI, or IC (20.5 vs. 8.3 vs. 8.2 vs. 12.3, P < 0.01). A significant correlation was observed between the color difference and visibility score (r = 0.53, P < 0.01). Conclusions: A-NBI may be a useful modality for identifying the margin of SSLs. [ABSTRACT FROM AUTHOR]

Background: It is essential to accurately distinguish small benign hyperplastic colon polyps (HP) from sessile serrated lesions (SSL) or adenomatous polyps (TA) based on endoscopic appearances. Our objective was to determine the accuracy and inter-observer agreements for the endoscopic diagnosis of small polyps. Methods: High-quality endoscopic images of 30 small HPs, SSLs, and TAs were used randomly to create two-timed PowerPoint slide sets—one with and another one without information on polyp size and location. Seven endoscopists viewed the slides on two separate occasions 90 days apart, identified the polyp type, and graded their confidence level. Overall and polyp-specific accuracies were assessed for the group and individual endoscopists. Chi-square tests and Kappa (κ) statistics were used to compare differences as appropriate. Results: When polyp size and location were provided, overall accuracy was 67.1% for TAs, 50.0% for SSLs, and 41.4% for HPs; the corresponding accuracies were 60%, 44.3%, and 34.3% when polyp size and location were withheld (p <.001). Inter-observer agreement was moderate for TAs (κ = 0.50) and fair for SSLs (κ = 0.26) and HPs (κ = 0.29); the corresponding inter-observer agreements were 0.44, 0.31, and 0.17 with polyp size and location withheld. Accuracy was not affected by knowledge of polyp size, location, or confidence level. Endoscopists with ≥ 10 years (vs. < 10 years) of colonoscopy experience had marginally higher (56% vs. 40%, p = 0.05) accuracy for SSL diagnosis. Conclusions: The ability to distinguish between small TAs, SSLs, and HPs on their endoscopic appearance is poor regardless of the endoscopists' knowledge of polyp size and location. [ABSTRACT FROM AUTHOR]

Background and Aim: The reported prevalence and risk factors for sessile serrated lesions (SSLs) show significant variation. We aimed to specifically study the prevalence and potential risk factors of SSLs in an average risk colorectal cancer (CRC) screening population of Chinese subjects. Methods: This is a case–control study of prospectively collected data from a territory‐wide colorectal screening program in Hong Kong. Information on risk factors was obtained from questionnaires completed prior to screening colonoscopy. We compared subjects with SSLs against controls without these lesions to identify potential risk factors using multivariable logistic regression. Results: Of 12 039 asymptomatic screening subjects, 6011 subjects received a screening colonoscopy with 2214 subjects (36.8%) having conventional adenomas, 486 subjects (8.1%) having hyperplastic polyps, and 85 subjects (1.4%) having SSLs only. Of these subjects, three had synchronous advanced adenomas and were excluded from the analysis. More than 60% of these lesions were in the proximal colon. We compared these 82 subjects with SSLs only and 3226 controls without any polyps. After multivariable logistic regression, age ≥ 66 years, smoking, and diabetes mellitus (DM) were significant independent risk factors for SSLs. Conclusion: In this study, we report the prevalence of SSLs to be 1.4%. Age ≥ 66 years, smoking, and DM were independent risk factors for these lesions. Our findings provide relevant new data that should be taken into consideration when designing region‐specific surveillance programs for SSLs with the ultimate goal of reducing the risk of CRC. [ABSTRACT FROM AUTHOR]

Introduction. Polypectomy has been shown to reduce the incidence of colorectal cancer. The ESGE guidelines from 2017 recommends that cold snare polypectomy should be used for removal of the diminutive polyps, smaller than 5 mm and also for sessile polyps 6 - 9 mm in size. This recommendation is based on lower complication rates and higher complete resections. Objectives. The goal of the study is to establish if the cold snare polypectomy is safe in removing the polyps smaller than 1 cm. Methods. The patients with polyps detected at colonoscopy between 2020-2022 years in the Gastroenterology Clinic from the Emergency Hospital, Targu-Mures entered this study. Results. From the total number of the polyps (753), 623 (82,73%) were adenoma and 130 (17,26%) were sessile. From the last group 83 were hyperplastic polyps, 35 sessile serrated lesions (SSL) and 12 traditional serrated adenomas (TSA). The hyperplastic polyps and 75% of the SSA were resected with cold snare, being less than 1cm. There were no bleedings and no complications. The rest of the SSL were resected by hot snare, with no complications either. Conclusions. Cold snare polypectomy is safe in serrated lesions less than 1 cm. There are recently published studies that demonstrated that cold snare polypectomy is safe also in SSA larger than 1 cm, however this has to be further established in the future guidelines. [ABSTRACT FROM AUTHOR]