title: Endoscopic features of sessile serrated adenomas: validation by international experts using high-resolution white-light endoscopy and narrow-band imaging.
abstract: BACKGROUND
  Sessile serrated adenomas/polyps (SSAs/Ps) are premalignant lesions susceptible to being easily overlooked by endoscopists. A detailed description of the endoscopic appearance of SSAs/Ps might help endoscopists to recognize these lesions to improve the effectiveness of colonoscopy.
  
  
  OBJECTIVE
  To identify various endoscopic features of SSAs/Ps using high-resolution white-light endoscopy (HR-WLE) and narrow-band imaging (NBI).
  
  
  METHODS
  Retrospective image evaluation study.
  
  
  METHODS
  Single tertiary referral center.
  
  
  METHODS
  Forty-5 patients with serrated polyposis syndrome undergoing surveillance colonoscopies.
  
  
  METHODS
  HR-WLE and NBI images of 150 polyps (50 SSAs/Ps, 50 hyperplastic polyps [HPs], and 50 adenomas) were systematically assessed by 5 experts using various endoscopic descriptors.
  
  
  METHODS
  The prevalence of specific endoscopic features observed in SSAs/Ps versus HPs.
  
  
  RESULTS
  Multivariate analysis demonstrated that indistinct borders (OR, 3.11; 95% CI, 1.57-6.15) and a cloud-like surface (OR, 2.65; 95% CI, 1.21-5.78) were associated with SSA/P histology on HR-WLE. On NBI, a cloud-like surface (OR, 4.91; 95% CI, 2.42-9.97), indistinct borders (OR, 2.38; 95% CI, 1.14-4.96), irregular shape (OR, 3.17; 95% CI, 1.59-6.29), and dark spots inside the crypts (OR, 2.05; 95% CI, 1.02-4.11) were found to be endoscopic predictors of SSA/P histology. The sensitivity, specificity, and accuracy of NBI for differentiating serrated polyps containing either none or all 4 endoscopic SSA/P features were, respectively, 89%, 96%, and 93%.
  
  
  CONCLUSIONS
  Retrospective, image evaluation analysis.
  
  
  CONCLUSIONS
  The current study demonstrates that SSAs/Ps possess several specific endoscopic features compared with HPs. Recognition of these characteristics might assist endoscopists in the differentiation of these lesions and could possibly facilitate endoscopic detection of these rather subtle lesions.
authors: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors: Yark
authors: Y
authors: Hazewinkel
authors: Maria
authors: M
authors: López-Cerón
authors: James E
authors: JE
authors: East
authors: Amit
authors: A
authors: Rastogi
authors: Maria
authors: M
authors: Pellisé
authors: Takeshi
authors: T
authors: Nakajima
authors: Susanne
authors: S
authors: van Eeden
authors: Kristien M A J
authors: KM
authors: Tytgat
authors: Paul
authors: P
authors: Fockens
authors: Evelien
authors: E
authors: Dekker
mesh_terms: D000236:Adenoma / Q000473:pathology*; D000368:Aged; D003111:Colonic Polyps / Q000473:pathology*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062048:Narrow Band Imaging; D012189:Retrospective Studies