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Sessile serrated adenoma/polyps: Where are we at in 2016?

View Article: PubMed Central - PubMed

ABSTRACT

It is currently known that colorectal cancers (CRC) arise from 3 different pathways: the adenoma to carcinoma chromosomal instability pathway (50%-70%); the mutator “Lynch syndrome” route (3%-5%); and the serrated pathway (30%-35%). The World Health Organization has classified serrated polyps into three types of lesions: hyperplastic polyps (HP), sessile serrated adenomas/polyps (SSA/P) and traditional serrated adenomas (TSA), the latter two strongly associated with development of CRCs. HPs do not cause cancer and TSAs are rare. SSA/P appear to be the responsible precursor lesion for the development of cancers through the serrated pathway. Both HPs and SSA/Ps appear morphologically similar. SSA/P are difficult to detect. The margins are normally inconspicuous. En bloc resection of these polyps can hence be troublesome. A careful examination of borders, submucosal injection of a dye solution (for larger lesions) and resection of a rim of normal tissue around the lesion may ensure total eradication of these lesions.

No MeSH data available.


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Resection of a sessile serrated adenomas/polyps with dye of submucosal layer with indigo carmine - no residual lesion.
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Figure 2: Resection of a sessile serrated adenomas/polyps with dye of submucosal layer with indigo carmine - no residual lesion.

Mentions: Numerous studies have grim numbers in regards to SSA/P complete resection rates[46-48]. Against these odds, a more recent study from our group[49] studied the resection of 2000 lateral spreading tumors and attributed the high recurrence to the inconspicuous margins of the SSA/P, which was overcome with IEE techniques. Submucosal instillation of a dye based solution (for larger lesions), a careful examination of borders and a rim of normal tissue resected together with the lesion may have affected the high rate of complete removal of the SSA/P. It is evident the contribution that advanced endoscopy apparel and endoscopist’s expertise is essential[50] in order to keep the recurrence of resection as low as 7%, as described by Pellise et al[49] (Figure 2).


Sessile serrated adenoma/polyps: Where are we at in 2016?
Resection of a sessile serrated adenomas/polyps with dye of submucosal layer with indigo carmine - no residual lesion.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016375&req=5

Figure 2: Resection of a sessile serrated adenomas/polyps with dye of submucosal layer with indigo carmine - no residual lesion.
Mentions: Numerous studies have grim numbers in regards to SSA/P complete resection rates[46-48]. Against these odds, a more recent study from our group[49] studied the resection of 2000 lateral spreading tumors and attributed the high recurrence to the inconspicuous margins of the SSA/P, which was overcome with IEE techniques. Submucosal instillation of a dye based solution (for larger lesions), a careful examination of borders and a rim of normal tissue resected together with the lesion may have affected the high rate of complete removal of the SSA/P. It is evident the contribution that advanced endoscopy apparel and endoscopist’s expertise is essential[50] in order to keep the recurrence of resection as low as 7%, as described by Pellise et al[49] (Figure 2).

View Article: PubMed Central - PubMed

ABSTRACT

It is currently known that colorectal cancers (CRC) arise from 3 different pathways: the adenoma to carcinoma chromosomal instability pathway (50%-70%); the mutator “Lynch syndrome” route (3%-5%); and the serrated pathway (30%-35%). The World Health Organization has classified serrated polyps into three types of lesions: hyperplastic polyps (HP), sessile serrated adenomas/polyps (SSA/P) and traditional serrated adenomas (TSA), the latter two strongly associated with development of CRCs. HPs do not cause cancer and TSAs are rare. SSA/P appear to be the responsible precursor lesion for the development of cancers through the serrated pathway. Both HPs and SSA/Ps appear morphologically similar. SSA/P are difficult to detect. The margins are normally inconspicuous. En bloc resection of these polyps can hence be troublesome. A careful examination of borders, submucosal injection of a dye solution (for larger lesions) and resection of a rim of normal tissue around the lesion may ensure total eradication of these lesions.

No MeSH data available.


Related in: MedlinePlus