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Serrated lesions: A challenging enemy.

Alexa Trovato¹, Alla Turshudzhyan², Micheal Tadros³

¹Albany Medical College, Albany, NY 12208, United States.

World Journal of Gastroenterology

|October 11, 2021

Summary

Sessile serrated lesions (SSLs) are key precursors to colorectal cancer (CRC). A new scoring system aids endoscopists in detecting and removing these challenging lesions during colonoscopy.

Keywords:

Colonoscopy Colorectal cancer screening Hyperplastic polyps Polyps Sessile serrated lesions Traditional serrated adenomas

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Area of Science:

Gastroenterology and Oncology
Endoscopic Imaging and Diagnostics

Background:

Serrated pathway lesions, particularly sessile serrated lesions (SSLs), account for a significant portion of colorectal cancer (CRC) development.
SSLs are premalignant and pose detection and removal challenges, contributing to post-colonoscopy CRC.
Accurate characterization of serrated lesions is crucial for effective management and prevention of CRC.

Discussion:

A retrospective study developed a diagnostic scoring system to improve endoscopic detection and removal of SSLs.
Key visual indicators for SSLs include indistinct borders and the presence of a mucus cap.
High-quality colonoscopy and proper bowel preparation are essential, especially for proximal colon lesions.

Key Insights:

Indistinct borders and mucus caps are vital features for recognizing and diagnosing serrated lesions.
The indistinct nature of some SSLs complicates complete endoscopic resection.
A scoring system incorporating mucus cap, indistinct borders, and a minimum size of five millimeters can enhance SSL detection.

Outlook:

Improving SSL detection rates through standardized diagnostic criteria is imperative.
Enhanced endoscopic techniques and training are needed to overcome challenges in the proximal colon.
Further research may refine scoring systems for earlier and more accurate serration lesion identification.