| BackgroundAlthough the screening program for colorectal cancer has been widely implemented in the United States,colorectal cancer related mortality still occupied second place[1],it is important that the serrated pathway has now been identified as a unique pathway of carcinogenesis of colorectal cancer development,and could account for 35%of all the sporadic colorectal cancer[2].Compared with the slower growth and more traditional form of polypoid adenoma,serrated adenoma has its unique characteristics enable it to evade existing means of screening and monitoring.For example,sessile serrated adenomas/polyps?SSA/Ps?are flat,mainly located in the right colon,and thought to have a rapid growth potential,leading to a lower detection rate of serrated adenoma.At present,the natural process of serrated adenoma are still unknown,the existing guidelines are mainly based on expert opinion,and for now,in order to recognize the clinical features,endoscopic findings and pathological features of serrated adenoma,more further studies are still needed.Aim:Explore the detection rate,clinical-endoscopic and pathological features of SA in Suzhou.MethodWe retrospectively reviewed colonoscopy records from June 2006 to June 2016 at three institutions?The First Affiliated Hospital of Soochow University,Suzhou Municipal Hospital,Suzhou Wuzhong People?s Hospital?and identified 38 cases of endoscopically or surgically resected serrated lesions,calculated the detection rate and analyzed the clinical,endoscopic and histopathological features of these cases.ResultOf all the patients,there were 23 males and 15 females,aged from 32 to 80 years old,with an average age of 58.34±13.17 years old.With single polyps?87.1%?are more common,the detection rate by colonoscopy of SA in the same period was 0.18%.In all the cases,there were 8 cases of SSA/P?21.1%?,20 cases of TSA?52.6%?and 10 cases of mixed SA?26.3%?.The morphology of the polyps under endoscopy was mainly sessile type?36.8%?and pedicle type?31.6%?,and most of the lesions were<10 mm?57.9%?.There was a statistically significant correlation between the size of polyps and the pathological types of SAs?F=8.410,P=0.001?.We found 5 cases of SSA/Ps were with glandular epithelial dysplasia?62.5%?,and 1 cases of adenoma canceration?12.5%?,5cases of SSA/Ps were located in the left colon?62.5%?.The patient's clinical manifestations?abdominal pain,change of stool characteristics?and endoscopic features?II-O pit pattern?has statistical significance for the identification of the pathological types of SA?X2=6.708,6.568,6.959,P=0.035,0.037,0.031,respectively?.Conclusion1?Colorectal SA is relatively rare in clinical,in Suzhou,the detection rate of these lesions is lower,which may be related to the regional factors,the lack of clinical attention and uniform pathological diagnostic criteria;2?Different subtypes of colorectal SAs are characterized by distinctive morphology and distribution,magnifying endoscopy helps identification;3?Different subtypes of colorectal SAs have different potential of malignant progression,especially the higher malignant potential of SSA/P;4?A clear classification of colorectal SA,selecting the appropriate surgical approach,and a long-term follow-up study for the development and prognosis of these cases are necessary. |
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