Kim KH, Myung E, Oh HH, Im CM, Seo YE, Kim JS, Lim CJ, You GR, Cho SB, Lee WS, Noh MG, Lee KH, Joo YE. Clinical and endoscopic characteristics of colorectal traditional serrated adenomas with dysplasia/adenocarcinoma in a Korean population. World J Gastrointest Oncol 2025; 17(2): 101780 [DOI: 10.4251/wjgo.v17.i2.101780]
Corresponding Author of This Article
Young-Eun Joo, MD, PhD, Professor, Department of Internal Medicine, Chonnam National University Medical School, No. 264 Seoyang Road, Hwasun-eup 58128, South Korea. yejoo@chonnam.ac.kr
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Feb 15, 2025; 17(2): 101780 Published online Feb 15, 2025. doi: 10.4251/wjgo.v17.i2.101780
Clinical and endoscopic characteristics of colorectal traditional serrated adenomas with dysplasia/adenocarcinoma in a Korean population
Ki-Hyun Kim, Eun Myung, Hyung Hoon Oh, Chan-Muk Im, Young-Eun Seo, Je-Seong Kim, Chae-June Lim, Ga-Ram You, Sung-Bum Cho, Wan-Sik Lee, Myung-Giun Noh, Kyung-Hwa Lee, Young-Eun Joo
Ki-Hyun Kim, Eun Myung, Hyung Hoon Oh, Chan-Muk Im, Young-Eun Seo, Je-Seong Kim, Chae-June Lim, Ga-Ram You, Sung-Bum Cho, Wan-Sik Lee, Young-Eun Joo, Department of Internal Medicine, Chonnam National University Medical School, Hwasun-eup 58128, South Korea
Myung-Giun Noh, Kyung-Hwa Lee, Department of Pathology, Chonnam National University Medical School, Hwasun-eup 58128, South Korea
Co-first authors: Ki-Hyun Kim and Eun Myung.
Author contributions: Kim KH and Myung E wrote the main text, they contributed equally as co-first author; Kim KH, Myung E, and Joo YE generated the idea and performed the computations; Oh HH, Im CM, Seo YE, Kim JS, Lim CJ, and You GR collected and analyzed the data; Oh HH, Im CM, and Kim KH collected the endoscopic images; Noh MG and Lee KH collected the pathological images; Cho SB, Lee WS, and Joo YE reviewed the analyzed statistical results; Joo YE supervised all processes; and all authors discussed the results and contributed to the final manuscript.
Supported by The First Research in Lifetime Grant from Chonnam National University Hospital Biomedical Research Institute, No. HCRI23005.
Institutional review board statement: The study was performed in accordance with the ethical principles of the Declaration of Helsinki and was approved by the Institutional Review Board of Chonnam National University Hwasun Hospital (No. CNUHH-2024-181).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used and/or analysed during the current study available from the first or corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Young-Eun Joo, MD, PhD, Professor, Department of Internal Medicine, Chonnam National University Medical School, No. 264 Seoyang Road, Hwasun-eup 58128, South Korea. yejoo@chonnam.ac.kr
Received: September 26, 2024 Revised: October 28, 2024 Accepted: November 29, 2024 Published online: February 15, 2025 Processing time: 114 Days and 4.2 Hours
Abstract
BACKGROUND
Traditional serrated adenoma (TSA) is a rare and precancerous lesion of colorectal cancer. The clinical and endoscopic differentiations between TSAs without dysplasia or adenocarcinoma (TSAOs) and TSAs with dysplasia or adenocarcinoma (TSADs) remain unclear.
AIM
To evaluate the characteristics of colorectal TSAs and compare the characteristics of TSAOs with those of TSADs.
METHODS
This retrospective study included 193 patients who underwent endoscopic resection and received a pathologic diagnosis of TSA. We reviewed the medical, endoscopic, and histopathologic records of patients who underwent endoscopic resection of TSAs between January 2010 and December 2023.
RESULTS
TSAs were more frequently located in the rectosigmoid colon. Most TSAs had 0-Ip, 0-Isp, or 0-Is morphologies. The TSAD lesions were larger than TSAO lesions. TSAD lesions more commonly had a red color and an irregular border than TSAO lesions. TSAOs were usually treated using conventional endoscopic mucosal resection, whereas TSADs were treated using conventional endoscopic mucosal resection, endoscopic submucosal dissection, and surgery. Post-polypectomy bleeding was more common with TSADs than with TSAOs. Univariate analysis showed that gastrointestinal bleeding, red color, 0-IIa, irregular border, and lobular mucosal surface were significantly associated with TSADs. Multivariate analysis showed that gastrointestinal bleeding, an irregular border, and a lobular mucosal surface were significantly associated with TSADs.
CONCLUSION
TSAs with gastrointestinal bleeding, an irregular border, and a lobular mucosal surface are associated with an increased risk of dysplasia or adenocarcinoma.
Core Tip: Traditional serrated adenoma (TSA) is recognized as a precancerous lesion. However, the endoscopic features associated with the presence or absence of dysplasia or adenocarcinoma have not yet been clearly defined. In our study, we analyzed the medical records of 193 patients diagnosed with TSAs following endoscopic resection at Chonnam National University Hwasun Hospital. In our study, TSAs with dysplasia or adenocarcinoma was associated with gastrointestinal bleeding, an irregular border, and a lobular mucosal surface. These findings are expected to serve as important factors in determining the treatment strategy for the lesions.
