title: Serrated adenoma prevalence in inflammatory bowel disease surveillance colonoscopy, and characteristics revealed by chromoendoscopy and virtual chromoendoscopy.
abstract: BACKGROUND
  Sessile or nonpolypoid neoplastic lesions, including sessile serrated adenomas (SSAs), are difficult to detect in patients with inflammatory bowel disease (IBD).
  
  
  OBJECTIVE
  To assess the prevalence and endoscopic features of SSA in IBD patients undergoing surveillance colonoscopy using novel endoscopic techniques.
  
  
  METHODS
  Histology results of biopsies from a cohort of 87 patients (47 men; median age 51.4 years; median duration of disease 16.9 years; ulcerative colitis [n=40], Crohn disease [n=43], ischemic colitis [n=4]) with longstanding colonic IBD undergoing surveillance colonoscopy were reviewed. Lesions of dysplasia (adenoma-like mass, or dysplasia-associated lesion or mass), SSAs, adenoma-like polyps, hyperplastic polyps and inflammatory polyps were identified. Surveillance colonoscopy using high-definition alone, or with iScan (Pentax, USA) dye-sprayed or virtual chromoendoscopy was performed. Lesion characteristics were described before histological diagnosis.
  
  
  RESULTS
  Fourteen SSAs were detected in 87 (11%) IBD patients. The endoscopic characteristics of SSA lesions were: nonpolypoid appearance (86%), predominant localization in the proximal colon (79%), >6 mm in size (79%), cloudy cover (64%), Kudo pit pattern modified type IIO (86%) and irregular spiral vascular pattern (79%). Among the 44 SSAs and hyperplastic polyps found in the present study, the above characteristics of SSA at colonoscopy had a sensitivity of 92.86% (95% CI 66.06% to 98.8%) and specificity of 93.33% (95% CI 77.89% to 98.99%) in predicting a histological diagnosis of SSA (positive predictive value 86.67%, negative predictive value 96.55%).
  
  
  CONCLUSIONS
  SSAs are a common finding at surveillance colonoscopy in IBD and have several characteristic features. Further studies are needed to evaluate the natural history of these lesions in IBD patients.
authors.forename: Marietta
authors.initials: M
authors.lastname: Iacucci
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.forename: Miriam
authors.initials: M
authors.lastname: Fort Gasia
authors.forename: Stefan
authors.initials: S
authors.lastname: Urbanski
authors.forename: Xianyong
authors.initials: X
authors.lastname: Gui
authors.forename: Bertus
authors.initials: B
authors.lastname: Eksteen
authors.forename: Gregory
authors.initials: G
authors.lastname: Eustace
authors.forename: Gilaad G
authors.initials: GG
authors.lastname: Kaplan
authors.forename: Remo
authors.initials: R
authors.lastname: Panaccione
mesh_terms: D000236:Adenoma / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003093:Colitis, Ulcerative / Q000473:pathology*; D003110:Colonic Neoplasms / Q000473:pathology*; D003111:Colonic Polyps / Q000473:pathology; D003113:Colonoscopy / Q000379:methods*; D004396:Coloring Agents; D003424:Crohn Disease / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014584:User-Computer Interface; D055815:Young Adult
chemical_list: D004396:Coloring Agents