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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Usefulness of analyzing endoscopic features in identifying the colorectal serrated sessile lesions with and without dysplasia
Rui-Gang Wang, Yu-Tang Ren, Xuan Jiang, Lai Wei, Xiao-Fei Zhang, Hao Liu, Bo Jiang
Rui-Gang Wang, Yu-Tang Ren, Xuan Jiang, Bo Jiang, Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
Lai Wei, Center for Hepatobiliary and Pancreatic Diseases, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
Xiao-Fei Zhang, Center for Clinical Epidemiology and Statistics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
Hao Liu, Department of Pathology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
Author contributions: Wang RG completed the research design, data collection and analysis, and the writing and revision of the essay; Ren YT assisted in data analysis; Ren YT and Jiang X assisted in data collection; Jiang X assisted in the research design; Wei L provided guidance on the study design and method selection; Zhang XF assisted in the completion of statistical methods and participated in data analysis; Liu H assisted in completing the histopathological diagnosis of the enrolled cases; Jiang B provided guidance on the research methods and design, and assisted in completing the revision of the essay.
Institutional review board statement: The study was reviewed and approved by the Beijing Tsinghua Changgung Hospital Institutional Review Board (approval No. 21439-0-02).
Informed consent statement: All cases that signed an informed consent form and underwent endoscopic resection.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Bo Jiang, MD, Chief Doctor, Chief Physician, Doctor, Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Changping District, Beijing 102218, China. jba00920@btch.edu.cn
Received: July 8, 2023
Peer-review started: July 8, 2023
First decision: August 30, 2023
Revised: September 11, 2023
Accepted: September 23, 2023
Article in press: September 25, 2023
Published online: October 16, 2023
BACKGROUND
Sessile serrated lesions (SSLs) are often missed on colonoscopy, and studies have shown this to be an essential cause of interstitial colorectal cancer. The SSLs with dysplasia (SSL-D+), in particular, have a faster rate of carcinogenesis than conventional tubular adenomas. Therefore, there is a clinical need for some endoscopic features with independent diagnostic value for SSL-D+s to assist endoscopists in making immediate diagnoses, thus improving the quality of endoscopic examination and treatment.
AIM
To compare the characteristics of SSLs, including those with and without dysplasia (SSL-D+ and SSL-D-), based on white light and image-enhanced endoscopy, to achieve an immediate differential diagnosis for endoscopists.
METHODS
From January 2017 to February 2023, cases of colorectal SSLs confirmed by colonoscopy and histopathology at the Gastrointestinal Endoscopy Center of Beijing Tsinghua Changgung Hospital were collected. The general, endoscopic, and histopathological data were reviewed and analyzed to determine the diagnostic utility. Univariate analysis was used to find potential diagnostic factors, and then multivariate regression analysis was performed to derive endoscopic features with independent diagnostic values for the SSL-D+.
RESULTS
A total of 228 patients with 253 lesions were collected as a result. There were 225 cases of colorectal SSL-D-s and 28 cases of SSL-D+s. Compared to the colorectal SSL-D-, the SSL-D+ was more common in the right colon (P = 0.027) with complex patterns of depression, nodule, and elevation based on cloud-like surfaces (P = 0.003), reddish (P < 0.001), microvascular varicose (P < 0.001), and mixed type (Pit II, II-O, IIIL, IV) of crypt opening based on Pit II-O (P < 0.001). Multifactorial logistic regression analysis indicated that lesions had a reddish color [odds ratio (OR) = 18.705, 95% confidence interval (CI): 3.684-94.974], microvascular varicose (OR = 6.768, 95%CI: 1.717-26.677), and mixed pattern of crypt opening (OR = 20.704, 95%CI: 2.955-145.086) as the independent predictors for SSL-D+s.
CONCLUSION
The endoscopic feature that has independent diagnostic value for SSL-D+ is a reddish color, microvascular varicose, and mixed pattern of crypt openings.
Core Tip: The colonoscopic features of colorectal sessile serrated lesions (SSLs) make them easy to be overlooked in screening, which is an essential reason for the emergence of interstage colorectal cancer. With the advancement of endoscopic techniques and refinement of the serrated carcinoma pathway, the SSL is gradually being recognized by endoscopists, especially for SSL with dysplasia (SSL-D+), which requires extra attention. In this study, we analyzed the endoscopic features of SSLs with and without dysplasia, and found characteristics that could independently diagnose SSL-D+ by multifactorial analysis, which is informative for immediate diagnosis by endoscopists.
