Prospective evaluation of endoscopic criteria characteristic of sessile serrated adenomas/polyps

Toshio Uraoka, Reiji Higashi, Joichiro Horii, Keita Harada, Keisuke Hori, Hiroyuki Okada, Motowo Mizuno, Jun Tomoda, Nobuya Ohara, Takehiro Tanaka, Han Mo Chiu, Naohisa Yahagi, Kazuhide Yamamoto

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Differentiating sessile serrated adenoma/polyp (SSA/P) from hyperplastic polyp (HP) is clinically important in determining the necessity of endoscopic resection or recommending appropriate surveillance. There are few reports of characterization of SSA/P using narrowband imaging and chromoendoscopy with and without magnification. We aimed to establish imaging criteria to aid real-time diagnosis of SSA/P. Methods: Patients with pale sessile or flat lesions of 6 mm or greater were prospectively enrolled in this multicenter trial. Nine endoscopic criteria, determined in real time, were investigated for possible association with SSA/P. Endoscopic mucosal resection was performed; specimens were retrieved and analyzed by histopathological examination. Results: In 63 patients, 89 lesions were detected, including 41 HP, 38 SSA/P, five mixed polyps, and five other lesions. Right-side colon location, lesion size of 10 mm or greater, excessive mucus, the presence of a varicose microvascular vessel (VMV) noted with high-magnification narrowband imaging, and type III<inf>H</inf> pit pattern were each commonly associated with SSA/P compared with HP. Multivariate analysis substantiated three independent endoscopic criteria for SSA/P: the presence of VMV (p = 0.001), lesion size of 10 mm or greater (p = 0.0017), and right-side location (p = 0.0041), with odds ratios of 8.2, 7.2, and 6.1, respectively. The presence of VMV had a significantly higher specificity (87.8 %) than the other two independent endoscopic criteria (p = 0.0007 and p = 0.0008, respectively), but a lower sensitivity (57.9 %), whereas a combination of the three criteria (two or more positive) increased the sensitivity significantly (89.5 % and p = 0.0033) and had a higher degree of accuracy (82.3 %). Conclusions: Three endoscopic criteria individually and in combination were effective in predicting a diagnosis of SSA/P without the need for chromoendoscopy.

Original languageEnglish
Pages (from-to)555-563
Number of pages9
JournalJournal of Gastroenterology
Volume50
Issue number5
DOIs
Publication statusPublished - 2015 May 1

Fingerprint

Polyps
Adenoma
Narrow Band Imaging
Mucus
Multicenter Studies
Colon
Multivariate Analysis
Odds Ratio

Keywords

  • Colonoscopy
  • Magnification endoscopy
  • Narrowband imaging
  • Pit pattern
  • Sessile serrated adenoma/polyp
  • Varicose microvascular vessel

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Uraoka, T., Higashi, R., Horii, J., Harada, K., Hori, K., Okada, H., ... Yamamoto, K. (2015). Prospective evaluation of endoscopic criteria characteristic of sessile serrated adenomas/polyps. Journal of Gastroenterology, 50(5), 555-563. https://doi.org/10.1007/s00535-014-0999-y

Prospective evaluation of endoscopic criteria characteristic of sessile serrated adenomas/polyps. / Uraoka, Toshio; Higashi, Reiji; Horii, Joichiro; Harada, Keita; Hori, Keisuke; Okada, Hiroyuki; Mizuno, Motowo; Tomoda, Jun; Ohara, Nobuya; Tanaka, Takehiro; Chiu, Han Mo; Yahagi, Naohisa; Yamamoto, Kazuhide.

In: Journal of Gastroenterology, Vol. 50, No. 5, 01.05.2015, p. 555-563.

Research output: Contribution to journalArticle

Uraoka, T, Higashi, R, Horii, J, Harada, K, Hori, K, Okada, H, Mizuno, M, Tomoda, J, Ohara, N, Tanaka, T, Chiu, HM, Yahagi, N & Yamamoto, K 2015, 'Prospective evaluation of endoscopic criteria characteristic of sessile serrated adenomas/polyps', Journal of Gastroenterology, vol. 50, no. 5, pp. 555-563. https://doi.org/10.1007/s00535-014-0999-y
Uraoka, Toshio ; Higashi, Reiji ; Horii, Joichiro ; Harada, Keita ; Hori, Keisuke ; Okada, Hiroyuki ; Mizuno, Motowo ; Tomoda, Jun ; Ohara, Nobuya ; Tanaka, Takehiro ; Chiu, Han Mo ; Yahagi, Naohisa ; Yamamoto, Kazuhide. / Prospective evaluation of endoscopic criteria characteristic of sessile serrated adenomas/polyps. In: Journal of Gastroenterology. 2015 ; Vol. 50, No. 5. pp. 555-563.
@article{dd39317796fe4202a2968b77e8c50e0e,
title = "Prospective evaluation of endoscopic criteria characteristic of sessile serrated adenomas/polyps",
abstract = "Background: Differentiating sessile serrated adenoma/polyp (SSA/P) from hyperplastic polyp (HP) is clinically important in determining the necessity of endoscopic resection or recommending appropriate surveillance. There are few reports of characterization of SSA/P using narrowband imaging and chromoendoscopy with and without magnification. We aimed to establish imaging criteria to aid real-time diagnosis of SSA/P. Methods: Patients with pale sessile or flat lesions of 6 mm or greater were prospectively enrolled in this multicenter trial. Nine endoscopic criteria, determined in real time, were investigated for possible association with SSA/P. Endoscopic mucosal resection was performed; specimens were retrieved and analyzed by histopathological examination. Results: In 63 patients, 89 lesions were detected, including 41 HP, 38 SSA/P, five mixed polyps, and five other lesions. Right-side colon location, lesion size of 10 mm or greater, excessive mucus, the presence of a varicose microvascular vessel (VMV) noted with high-magnification narrowband imaging, and type IIIH pit pattern were each commonly associated with SSA/P compared with HP. Multivariate analysis substantiated three independent endoscopic criteria for SSA/P: the presence of VMV (p = 0.001), lesion size of 10 mm or greater (p = 0.0017), and right-side location (p = 0.0041), with odds ratios of 8.2, 7.2, and 6.1, respectively. The presence of VMV had a significantly higher specificity (87.8 {\%}) than the other two independent endoscopic criteria (p = 0.0007 and p = 0.0008, respectively), but a lower sensitivity (57.9 {\%}), whereas a combination of the three criteria (two or more positive) increased the sensitivity significantly (89.5 {\%} and p = 0.0033) and had a higher degree of accuracy (82.3 {\%}). Conclusions: Three endoscopic criteria individually and in combination were effective in predicting a diagnosis of SSA/P without the need for chromoendoscopy.",
keywords = "Colonoscopy, Magnification endoscopy, Narrowband imaging, Pit pattern, Sessile serrated adenoma/polyp, Varicose microvascular vessel",
author = "Toshio Uraoka and Reiji Higashi and Joichiro Horii and Keita Harada and Keisuke Hori and Hiroyuki Okada and Motowo Mizuno and Jun Tomoda and Nobuya Ohara and Takehiro Tanaka and Chiu, {Han Mo} and Naohisa Yahagi and Kazuhide Yamamoto",
year = "2015",
month = "5",
day = "1",
doi = "10.1007/s00535-014-0999-y",
language = "English",
volume = "50",
pages = "555--563",
journal = "Journal of Gastroenterology",
issn = "0944-1174",
publisher = "Springer Japan",
number = "5",

}

TY - JOUR

T1 - Prospective evaluation of endoscopic criteria characteristic of sessile serrated adenomas/polyps

AU - Uraoka, Toshio

AU - Higashi, Reiji

AU - Horii, Joichiro

AU - Harada, Keita

AU - Hori, Keisuke

AU - Okada, Hiroyuki

AU - Mizuno, Motowo

AU - Tomoda, Jun

AU - Ohara, Nobuya

AU - Tanaka, Takehiro

AU - Chiu, Han Mo

AU - Yahagi, Naohisa

AU - Yamamoto, Kazuhide

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Background: Differentiating sessile serrated adenoma/polyp (SSA/P) from hyperplastic polyp (HP) is clinically important in determining the necessity of endoscopic resection or recommending appropriate surveillance. There are few reports of characterization of SSA/P using narrowband imaging and chromoendoscopy with and without magnification. We aimed to establish imaging criteria to aid real-time diagnosis of SSA/P. Methods: Patients with pale sessile or flat lesions of 6 mm or greater were prospectively enrolled in this multicenter trial. Nine endoscopic criteria, determined in real time, were investigated for possible association with SSA/P. Endoscopic mucosal resection was performed; specimens were retrieved and analyzed by histopathological examination. Results: In 63 patients, 89 lesions were detected, including 41 HP, 38 SSA/P, five mixed polyps, and five other lesions. Right-side colon location, lesion size of 10 mm or greater, excessive mucus, the presence of a varicose microvascular vessel (VMV) noted with high-magnification narrowband imaging, and type IIIH pit pattern were each commonly associated with SSA/P compared with HP. Multivariate analysis substantiated three independent endoscopic criteria for SSA/P: the presence of VMV (p = 0.001), lesion size of 10 mm or greater (p = 0.0017), and right-side location (p = 0.0041), with odds ratios of 8.2, 7.2, and 6.1, respectively. The presence of VMV had a significantly higher specificity (87.8 %) than the other two independent endoscopic criteria (p = 0.0007 and p = 0.0008, respectively), but a lower sensitivity (57.9 %), whereas a combination of the three criteria (two or more positive) increased the sensitivity significantly (89.5 % and p = 0.0033) and had a higher degree of accuracy (82.3 %). Conclusions: Three endoscopic criteria individually and in combination were effective in predicting a diagnosis of SSA/P without the need for chromoendoscopy.

AB - Background: Differentiating sessile serrated adenoma/polyp (SSA/P) from hyperplastic polyp (HP) is clinically important in determining the necessity of endoscopic resection or recommending appropriate surveillance. There are few reports of characterization of SSA/P using narrowband imaging and chromoendoscopy with and without magnification. We aimed to establish imaging criteria to aid real-time diagnosis of SSA/P. Methods: Patients with pale sessile or flat lesions of 6 mm or greater were prospectively enrolled in this multicenter trial. Nine endoscopic criteria, determined in real time, were investigated for possible association with SSA/P. Endoscopic mucosal resection was performed; specimens were retrieved and analyzed by histopathological examination. Results: In 63 patients, 89 lesions were detected, including 41 HP, 38 SSA/P, five mixed polyps, and five other lesions. Right-side colon location, lesion size of 10 mm or greater, excessive mucus, the presence of a varicose microvascular vessel (VMV) noted with high-magnification narrowband imaging, and type IIIH pit pattern were each commonly associated with SSA/P compared with HP. Multivariate analysis substantiated three independent endoscopic criteria for SSA/P: the presence of VMV (p = 0.001), lesion size of 10 mm or greater (p = 0.0017), and right-side location (p = 0.0041), with odds ratios of 8.2, 7.2, and 6.1, respectively. The presence of VMV had a significantly higher specificity (87.8 %) than the other two independent endoscopic criteria (p = 0.0007 and p = 0.0008, respectively), but a lower sensitivity (57.9 %), whereas a combination of the three criteria (two or more positive) increased the sensitivity significantly (89.5 % and p = 0.0033) and had a higher degree of accuracy (82.3 %). Conclusions: Three endoscopic criteria individually and in combination were effective in predicting a diagnosis of SSA/P without the need for chromoendoscopy.

KW - Colonoscopy

KW - Magnification endoscopy

KW - Narrowband imaging

KW - Pit pattern

KW - Sessile serrated adenoma/polyp

KW - Varicose microvascular vessel

UR - http://www.scopus.com/inward/record.url?scp=84928985089&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84928985089&partnerID=8YFLogxK

U2 - 10.1007/s00535-014-0999-y

DO - 10.1007/s00535-014-0999-y

M3 - Article

C2 - 25270966

AN - SCOPUS:84928985089

VL - 50

SP - 555

EP - 563

JO - Journal of Gastroenterology

JF - Journal of Gastroenterology

SN - 0944-1174

IS - 5

ER -