Analysis Of Endoscopic Features For Colorectal Sessile Serrated Adnoma/Polyp

Urbanski,etc.[1] in 1984,the first reports the morphological features of 1 case with hyperplastic polyp and adenomatous polyp histology characteristics of polyps.Longacre in 1990 [2] to this type of polyp in pathological has done detailed research,named mixed hyperplastic adenomatous polyps/serrated adenomas,(MHAP/SA),and suggests to "serrated adenomas diagnosis of these lesions.Since then,SA as a special kind of incidence on colorectal cancer to the attention of the pathologist and endoscopic scientists.As clinical discovery and pathological detection rate increased,sessile serrated adenoma(SSA/P)gradually got the attention of the clinicians,then for its histopathological features,such as the change of molecular biology research,found that it is different from the traditional "polyps-adenoma " change way,as there is a special " serrated pathway",and highly malignant tendency,belong to the precancerous lesion of colorectal cancer,therefore,for SSA/P early found,treatment,and closely follow-up,is very important.In recent years,the SSA/P has got more and more digestive physician’s attention,realize the SSA/P can be suddenly turn into malignant tumor and directly into the submucosal and muscular,with other serrated lesions(such as HP and TSA)are different.The incidence of SSA/P in the domestic,morphological features and prognosis research still needs further observation.There is more and more evidence on the right side of the colon cancer may be composed of undetected SSA/P.Studies have found that the past as part of the cancerous potential of so-called HP is actuallythe SSA/P,Lu followed-up of 40 cases of SSA/P and 55 patients with HP,CRC incidence l2.5 % and 1.8%,respectively,prompted SSA/P can be high-risk lesions.As part of the SSA/P can be characterized by HP because of similar small polyps,endoscopic biopsy forceps in addition,the SSA/P have higher potential of cancer,more to be a complete resection.Now both endoscopy and pathology to detect SSA/P remains to be improved,and the SSA/P endoscopic diagnosis research is not sufficient,therefore,this study based on pathological diagnosis of SSA/P and polyps,endoscopic features were analyzed,and provide further evidence to SSA/P diagnosis.Objective To evaluate the predicting indicators of conventional endoscopic for SSA/P and provide the basis further evidence to SSA/P diagnosis.Methods A total of 109 cases of SSA/P and randomly selected 218 cases polyps in 5647 cases polyps,January 2014 to January 2017 were retrospectively analyzed.The indicators of endoscopic features were analysed.Results Sampling and polyp group age,gender,location of baseline have no difference,compared with polyps and sampling group,serrated adenomas are more likely to be distributed in the proximal colon(P < 0.05),and compared with polyps and sampling group,SSA/P has larger diameter(P≤0.0001);SSA/P group and sampling group comparison,the age of patients were larger(59.21 ±11.31 vs.56.00 ±12.14,P = 0.011),the former lesion diameter is larger than the latter,56.9% greater than 1 cm in diameter,which is 91.3% less than 1 cm in diameter,(P = 0.000);The SSA/P group is located in the proximal colon 50 cases(45.9%),located in the distal colon 59 patients(54.1%),the polyps group located in the proximal colon,78 cases(35.8%),140 cases(64.2%)in distal colon(P=0.092);The former group of type I 54 cases(49.5%),and type IIin 49 cases(45.0%),LST type 6 cases(5.5%),the latter group type I1 35 cases(61.9%),and type II 75 cases(34.4%),LST type 8 cases(3.7%)(P = 0.036);The pit patterns of SSA/P are type I in 3 patients(2.8%),type II 76 cases(70.0%),type III 10 cases(9.2%),type IV 4 cases(3.7%),unable to identify 10 cases(9.2%),the pit patterns of polyps type I 35 cases(16.1%),type II 50 cases(23.0%),type III 76 cases(34.9%),type IV 13 cases(6.0%),type V 4 cases(2.0%),and unable toidentify 40 cases(18.3%),(P = 0.014);CP type: SSA/P group 31 cases(28.4%)for type I,II,65 cases(59.6%),type III 13 cases(11.9%),the polyps group,175 cases of type I(80.3%),type II 41 cases(18.8%),type III 2 cases(0.9%),(P = 0.000),the former group 94 cases mucus cap,14 cases of no mucous cap,1 cases unable to identify,the latter group of 37 cases with mucus cap,166 cases of mucous cap,15 cases,unable to identify(P=0.002).The former 55 patients with vascular enlargement,53 cases without vascular enlargement,1 case of can’t identification,the latter group 27 cases with vascular enlargement,188 cases of vascular enlargement,3 cases unable to identify.(P = 0.015);The SSA/P group of 46 cases with dysplasia or cancer,63 cases without dysplasia or cancer,the polyps group 2 cases with dysplasia or cancer,216 cases without dysplasia or cancer(P≤0.0001).The former the A/B/other doctors diagnose 66/39/4 cases,which respectively by A/B/other doctors diagnose 117/83/18 cases(P = 0.224).Conclusion SSA/P is CRC precancerous lesions,and easily confused with other colorectal polyps,compared with polyps,lesion location,the pit pattern,CP type,surface structure characteristics existed a significant difference.