Whither the hyperplastic and serrated polyp?

Linked color imaging improves visibility of colorectal serrated lesion by high color contrast to surrounding mucosa

OBJECTIVES

This study aimed to objectively evaluate the efficacy of linked color imaging (LCI) in diagnosing colorectal serrated lesions by utilizing visibility scores and color differences.

METHODS

We examined 89 serrated lesions, including 36 hyperplastic polyps (HPs), 47 sessile serrated lesions (SSLs), and six traditional serrated adenomas (TSAs). Visibility changes were scored by six endoscopists as follows: 4, excellent; 3, good; 2, fair; and 1, poor. Furthermore, images obtained by white-light imaging (WLI) or LCI were assessed using the CIELAB color space in the lesion and adjacent mucosa. We calculated the mean color values (L*, a*, and b*) measured at five regions of interest of the sample lesion and surrounding mucosa and derived the color difference (ΔE*).

RESULTS

The visibility scores of both HPs and SSLs in LCI were significantly higher than that in WLI (HPs, 3.67/2.89, P < 0.001; SSLs, 3.07/2.36, P < 0.001). Furthermore, SSLs showed a significantly higher L* value and significantly lower a* and b* values in LCI than the adjacent mucosae (L*, 61.76/58.23, P = 0.016; a*, 14.91/17.58, P = 0.019; b*, 20.42/24.21, P = 0.007), while WLI produced no significant difference in any color value. A similar trend was apparent in HPs. In all serrated groups, LCI revealed significantly greater ΔE* values between the lesion and adjacent mucosa than WLI (HPs, 11.54/6.12; SSLs, 13.43/7.67; TSAs, 35.00/22.48).

CONCLUSION

Linked color imaging showed higher color contrast between serrated lesions and the surrounding mucosae compared with WLI, indicating improved visibility of colorectal serrated lesion using LCI.

Serrated Polyposis Syndrome: Increasing Awareness and Importance

Serrated polyposis syndrome (SPS) was formerly considered a rare condition. In the past decade, it has gained increasing recognition due to its close association with colorectal cancer (CRC). Diagnosis is made based on the updated World Health Organization (WHO) criteria of having serrated polyps (SPs) proximal to the rectum, all being ≥5 mm in size, with at least two being ≥10 mm in size (criterion I), and a more distal phenotype that presents with greater than 20 SPs of any size throughout the large bowel with five being proximal to the rectum (criterion II). There are three subtypes of SP: hyperplastic polyp (HP), sessile serrated lesion (SSL), and traditional serrated adenoma (TSA). We present a 61-year-old Caucasian male who was referred for surveillance colonoscopy due to a history of colon polyps. A total of 28 polyps were completely removed, 21 of which were found to be SPs, three of which were >10 mm in size, meeting the WHO criteria for SPS. A follow-up colonoscopy was recommended in one year. It is now recognized that SPS are significant contributors to the development of CRC. The United States Multi-Society Preventive Task Force recently updated their consensus statement in 2020 with specific guidance for surveillance of SPs. It is important to emphasize that the diagnostic criteria apply to cumulative polyp count over the individual’s lifetime. The optimal surveillance for SPS remains unclear.

Confounders in Adenoma Detection at Initial Screening Colonoscopy: A Factor in the Assessment of Racial Disparities as a Risk for Colon Cancer

Background and Aims

The incidence and mortality of colorectal cancer is persistently highest in Black/African-Americans in the United States. While access to care, barriers to screening, and poverty might explain these findings, there is increased interest in examining biological factors that impact the colonic environment. Our group is examining biologic factors that contribute to disparities in development of adenomas prospectively. In preparation for this and to characterize a potential patient population, we conducted a retrospective review of initial screening colonoscopies in a cohort of patients.

Methods

A retrospective review was performed on initial average risk screening colonoscopies on patients (age 45-75 years) during 2012 at three institutions. Descriptive statistics and multivariable logistic regression models were used to examine the relationship between potential risk factors and the detection of adenomas.

Results

Of the 2225 initial screening colonoscopies 1495 (67.2%) were performed on Black/African-Americans and 566 (25.4%) on Caucasians. Multivariable logistic regression revealed that older age, male sex, current smoking and teaching gastroenterologists were associated with higher detection of adenomas and these were less prevalent among Black/African-Americas except for age. Neither race, ethnicity, BMI, diabetes mellitus, HIV nor insurance were associated with adenoma detection.

Conclusion

In this sample, there was no association between race and adenoma detection. While this may be due to a lower prevalence of risk factors for adenomas in this sample, our findings were confounded by a lower detection rate by consultant gastroenterologists at one institution. The study allowed us to rectify the problem and characterize patients for future trials.