Li-Chun Chang1,2, Chia-Hung Tu1,3, Been-Ren Lin4, Chia-Tung Shun5, Weng-Feng Hsu6, Jin-Tung Liang4, Hsiu-Po Wang1, Ming-Shiang Wu1, Han-Mo Chiu1,3. 1. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. 2. Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan. 3. Health Management Center, National Taiwan University Hospital, Taipei, Taiwan. 4. Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan. 5. Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan. 6. Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
Abstract
BACKGROUND AND AIM: Endoscopic diagnosis of sessile serrated adenoma/polyp (SSA/P) is challenging because of their subtle appearance. Narrow-band imaging (NBI) is useful for diagnosis, but its utility with concurrent chromoendoscopy (CE), especially to detect small SSA/P, is unproven. METHODS: This prospective study enrolled 367 consecutive patients who underwent screening colonoscopy with the finding of serrated polyps. Patients were divided into derivation and validation cohorts: Diagnostic criteria using different endoscopic modalities were generated by regression analysis in the derivation cohort and were validated in the validation cohort for sensitivity, specificity, and accuracy. RESULTS: There were 180 patients with 119 SSA/P and 147 hyperplastic polyps (HP) in the derivation cohort and 187 patients with 177 SSA/P and 125 HP in the validation cohort. With white-light endoscopy plus NBI, mucus cap, surface grooves, and expanded crypt were most associated with SSA/P. With white-light endoscopy plus CE, II-O pit pattern, mucus cap, and superficial telangiectasia were most associated with SSA/P. With the combined use of these three modalities, II-O pit pattern, mucus cap, and surface grooves were most associated with SSA/P. For large serrated polyp, NBI in combination with CE had a better accuracy than NBI alone (91% vs 86%, P = 0.025) to distinguish SSA/P from HP. CE alone had a better accuracy than NBI alone for distinguishing small SSA/P from small HP (85% vs 72%, P < 0.0001). CONCLUSION: Compared with NBI alone, adjunctive use of CE can improve the diagnostic accuracy for distinguishing SSA/P from HP, especially for small SSA/P.
BACKGROUND AND AIM: Endoscopic diagnosis of sessile serrated adenoma/polyp (SSA/P) is challenging because of their subtle appearance. Narrow-band imaging (NBI) is useful for diagnosis, but its utility with concurrent chromoendoscopy (CE), especially to detect small SSA/P, is unproven. METHODS: This prospective study enrolled 367 consecutive patients who underwent screening colonoscopy with the finding of serrated polyps. Patients were divided into derivation and validation cohorts: Diagnostic criteria using different endoscopic modalities were generated by regression analysis in the derivation cohort and were validated in the validation cohort for sensitivity, specificity, and accuracy. RESULTS: There were 180 patients with 119 SSA/P and 147 hyperplastic polyps (HP) in the derivation cohort and 187 patients with 177 SSA/P and 125 HP in the validation cohort. With white-light endoscopy plus NBI, mucus cap, surface grooves, and expanded crypt were most associated with SSA/P. With white-light endoscopy plus CE, II-O pit pattern, mucus cap, and superficial telangiectasia were most associated with SSA/P. With the combined use of these three modalities, II-O pit pattern, mucus cap, and surface grooves were most associated with SSA/P. For large serrated polyp, NBI in combination with CE had a better accuracy than NBI alone (91% vs 86%, P = 0.025) to distinguish SSA/P from HP. CE alone had a better accuracy than NBI alone for distinguishing small SSA/P from small HP (85% vs 72%, P < 0.0001). CONCLUSION: Compared with NBI alone, adjunctive use of CE can improve the diagnostic accuracy for distinguishing SSA/P from HP, especially for small SSA/P.
Authors: Ahmed Amine Alaoui; Kussil Oumedjbeur; Roupen Djinbachian; Étienne Marchand; Paola N Marques; Mickael Bouin; Simon Bouchard; Daniel von Renteln Journal: Endosc Int Open Date: 2021-04-22