Journal
WORLD JOURNAL OF GASTROENTEROLOGY
Volume 22, Issue 34, Pages 7754-7759Publisher
BAISHIDENG PUBLISHING GROUP INC
DOI: 10.3748/wjg.v22.i34.7754
Keywords
Colonoscopy; Sessile serrated adenoma/polyp; Serrated lesion; Colorectal polyps; Colorectal cancer; Polypectomy; Image enhancing endoscopy; Narrow band imaging, Endocytoscopy
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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.
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