Gastrointestinal Endoscopy
Volume 74, Issue 6 , Pages 1360-1368, December 2011

A morphologic analysis of sessile serrated polyps observed during routine colonoscopy (with video)

  • Uma S. Tadepalli, BA

      Affiliations

    • Department of Medicine (Division of Gastroenterology), Mount Sinai Medical Center, New York, New York, USA
    • ,
  • Dennis Feihel, BA

      Affiliations

    • Department of Medicine (Division of Gastroenterology), Mount Sinai Medical Center, New York, New York, USA
    • ,
  • Kenneth M. Miller, MD

      Affiliations

    • Department of Medicine (Division of Gastroenterology), Mount Sinai Medical Center, New York, New York, USA
    • ,
  • Steven H. Itzkowitz, MD

      Affiliations

    • Department of Medicine (Division of Gastroenterology), Mount Sinai Medical Center, New York, New York, USA
    • ,
  • Joseph S. Freedman, MD

      Affiliations

    • Department of Medicine (Division of Gastroenterology), Mount Sinai Medical Center, New York, New York, USA
    • ,
  • Susan Kornacki, MD

      Affiliations

    • Department of Pathology, New York University School of Medicine, New York, New York, USA
    • ,
  • Lawrence B. Cohen, MD

      Affiliations

    • Department of Medicine (Division of Gastroenterology), Mount Sinai Medical Center, New York, New York, USA
    • ,
  • Neville D. Bamji, MD

      Affiliations

    • Department of Medicine (Division of Gastroenterology), Mount Sinai Medical Center, New York, New York, USA
    • ,
  • Carol A. Bodian, PhD

      Affiliations

    • Department of Anesthesiology (Division of Biostatistics), Mount Sinai Medical Center, New York, New York, USA
    • ,
  • James Aisenberg, MD

      Affiliations

    • Department of Medicine (Division of Gastroenterology), Mount Sinai Medical Center, New York, New York, USA
    • Corresponding Author InformationReprint requests: James Aisenberg, MD, Mount Sinai Medical Center, 311 East 79th Street, New York, NY 10021

Received 14 March 2011; accepted 4 August 2011. published online 21 October 2011.

Background

Proximal colorectal cancer may arise from sessile serrated polyps (SSPs), which are often inconspicuous during colonoscopy. The gross morphologic characteristics of SSPs have not been systematically described, and this omission may contribute to colonoscopists overlooking them.

Objectives

To analyze the gross morphologic characteristics of SSPs detected during routine colonoscopy.

Design

Retrospective analysis of high-resolution endoscopic video clips depicting SSPs in situ.

Setting

Outpatient gastroenterology practice.

Patients

A total of 124 subjects undergoing surveillance or screening colonoscopy after split-dose bowel preparation.

Interventions

Analysis of 158 SSPs performed by using validated descriptors.

Main Outcome Measurements

The prevalence of morphologic characteristics related to polyp shape, color, and texture.

Results

A total of 158 SSPs were studied. For 7 visual descriptors, a κ coefficient of ≥0.7 was achieved, indicating good to excellent intraobserver agreement. The most prevalent visual descriptors were the presence of a mucous cap (63.9%), rim of debris or bubbles (51.9%), alteration of the contour of a fold (37.3%), and interruption of the underlying mucosal vascular pattern (32.3%). The most common “sentinel signs” were the presence of a mucous cap and alteration of the contour of a mucosal fold (each 24.6%), rim of debris or bubbles (21.7%), and a dome-shaped protuberance (20.3%). When comparing SSPs with adenomatous polyps, the frequencies of 5 of 7 morphologic characteristics and the distribution of sentinel signs differed (P < .01).

Limitations

Single-site, retrospective analysis.

Conclusions

SSPs exhibit distinct, variable morphologic characteristics. Many do not display classic features such as a mucous cap. Enhanced appreciation of these morphologic characteristics may improve SSP detection and thereby colorectal cancer prevention.

Abbreviations:  AP, adenomatous polyp, HD, high definition, HP, hyperplastic polyp, NBI, narrow-band imaging, OR, odds ratio, S/S, screening and surveillance, SSP, sessile serrated polyp, SVE, standard video endoscopy

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 DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: Dr. Itzkowitz, consultant, Exact Science; Dr. Cohen: consultant, Salix. The other authors disclosed no financial relationships relevant to this publication. This study was supported by independent investigator grants to U.S. Tadepalli, J. Freedman, and D. Feihel from the Digestive Disease Research Foundation.

 If you would like to chat with an author of this article, you may contact Dr Aisenberg at j.aisenberg@nyga.md.

PII: S0016-5107(11)02067-0

doi:10.1016/j.gie.2011.08.008

Gastrointestinal Endoscopy
Volume 74, Issue 6 , Pages 1360-1368, December 2011

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