Clinical and endoscopic characteristics of colorectal traditional serrated adenomas with dysplasia/adenocarcinoma in a Korean population

Table 1 Baseline characteristics of patients with traditional serrated adenomas, n = 193

Variables	n (%)
Patient-related factors
Age (years), mean ± SD (range)	63.2 ± 13.8 (18.0-89.0)
Sex
Male	93 (48.2)
Female	100 (51.8)
BMI (kg/m2), mean ± SD (range)	23.9 ± 3.4 (17.4-37.7)
Obesity
Underweight (< 18.5)	6 (3.1)
Normal (18.5 ≤ n < 23.0)	76 (39.4)
Overweight (23.0 ≤ n < 25.0)	45 (23.3)
Obesity (≥ 25.0)	66 (34.2)
Alcohol
None	89 (46.1)
Quit	51 (26.4)
Current	53 (27.5)
Smoking
None	134 (69.4)
Quit	34 (17.6)
Current	25 (13.0)
Hypertension	81 (42.0)
Diabetes mellitus	40 (20.7)
Dyslipidemia	31 (16.1)
Anti-platelet agent (n = 49, 25.4%)
Aspirin	32 (16.6)
Warfarin/NOAC	5 (2.6)
Dual anti-platelet agent	12 (6.2)
History of colorectal cancer	27 (14.0)
Symptom
None	168 (87.0)
Gastrointestinal bleeding	24 (12.4)
Obstruction	1 (0.5)
Lesion-related factors
Size (mm), mean ± SD (range)	18.1 ± 13.5 (3.0-70.0)
Diminutive (1-5 mm)	16 (8.3)
Small (6-9 mm)	46 (23.8)
Large (> 10 mm)	131 (67.9)
Location
Cecum	3 (1.6)
Ascending colon	27 (14)
Transverse colon	20 (10.4)
Descending colon	9 (4.7)
Sigmoid colon	60 (31.1)
Rectum	74 (38.3)
Color
White	82 (42.5)
Red	111 (57.5)
Morphology (Paris classification)
0-Ip, 0-Isp	85 (44.1)
0-Is	67 (34.7)
0-IIa	34 (17.6)
0-IIa + IIc	7 (3.6)
Border
Distinct	164 (85.0)
Irregular	29 (15.0)
Mucosal surface
Smooth	89 (46.1)
Lobular	104 (53.9)
Dysplasia (n = 71, 36.8%)
LGD	51 (26.4)
HGD	14 (7.3)
ADC	6 (3.1)
Associated lesion (n = 104, 53.9%)
Hyperplastic polyp	17 (8.8)
Sessile serrated lesion	2 (1.0)
Traditional serrated adenoma	10 (5.2)
Conventional adenoma with LGD	62 (32.1)
Conventional adenoma with HGD/ADC	13 (6.7)
Procedure-related factors
Removal methods
Cold biopsy	1 (0.5)
Cold snare EMR	6 (3.1)
Conventional EMR	121 (62.7)
ESD	52 (26.9)
Operation	11 (5.7)
Observation	2 (1.0)
Post-procedural complications (n = 93, 48.2%)
Bleeding	92 (47.7)
Perforation	1 (0.8)
Treatment methods of complications
APC	18 (9.3)
Coagrasper	35 (18.1)
Hemoclipping	40 (20.7)

BMI: Body mass index; NOAC: Novel oral anticoagulants; LGD: Low grade dysplasia; HGD: High grade dysplasia; ADC: Adenocarcinoma; EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; APC: Argon plasma coagulation.

Table 2 Comparison of clinical characteristics between traditional serrated adenomas without and with dysplasia or adenocarcinoma, n (%)

Variables	TSAOs (n = 122)	TSADs (n = 71)	P value
Age (years), mean ± SD (range)	61.1 ± 14.5 (18.0-84.0)	66.7 ± 11.8 (36.0-85.1)	0.072
Sex			0.234
Male	63 (51.6)	30 (42.3)
Female	59 (48.4)	41 (57.7)
BMI (n = 499), mean ± SD (range)	24.1 ± 3.7 (17.4-37.7)	23.7 ± 2.9 (17.7-30.6)	0.128
Obesity			0.726
Underweight (< 18.5)	3 (2.5)	3 (4.2)
Normal (18.5-23.0)	46 (37.7)	30 (42.3)
Overweight (23.0-25.0)	31 (25.4)	14 (19.7)
Obesity (≥ 25.0)	42 (34.4)	24 (33.8)
Alcohol			0.177
None	52 (42.6)	37 (52.1)
Quit	31 (25.4)	20 (28.2)
Current	39 (32.0)	14 (19.7)
Smoking			0.681
None	82 (67.2)	52 (73.2)
Quit	23 (18.9)	11 (15.5)
Current	17 (13.9)	8 (11.3)
Hypertension	45 (36.9)	36 (50.7)	0.061
Diabetes mellitus	29 (23.8)	11 (15.5)	0.171
Dyslipidemia	21 (17.2)	10 (14.1)	0.568
Anti-platelet agent (n = 49)			0.521
Aspirin	23 (18.9)	9 (12.7)
Warfarin/NOAC	3 (2.5)	2 (2.8)
Dual anti-platelet agent	9 (7.4)	3 (4.2)
History of colorectal cancer	16 (13.1)	11 (15.5)	0.671
Symptom			0.051
None	111 (91.0)	57 (80.3)
Gastrointestinal bleeding	10 (8.2)	14 (19.7)
Obstruction	1 (0.8)	0 (0.0)
Lesion-related factors
Size (mm), mean ± SD (range)	12.7 ± 8.0 (3.0-55.0)	27.3 ± 15.9 (5.0-70.0)	0.003
Diminutive (1-5 mm)	16 (13.1)	0 (0.0)
Small (6-9 mm)	31 (25.4)	15 (21.1)
Large (> 10 mm)	75 (61.5)	56 (78.9)
Location			0.177
Cecum	1 (0.8)	2 (2.8)
Ascending colon	13 (10.7)	14 (19.7)
Transverse colon	12 (9.8)	8 (11.3)
Descending colon	8 (6.6)	1 (1.4)
Sigmoid colon	42 (34.4)	18 (25.4)
Rectum	46 (37.7)	28 (39.4)
Color			0.001
White	63 (51.6)	19 (26.8)
Red	59 (48.4)	52 (73.2)
Morphology (Paris classification)			0.005
0-Ip, 0-Isp	53 (43.4)	32 (45.1)
0-Is	35 (28.7)	32 (45.1)
0-IIa	30 (24.6)	4 (5.6)
0-IIa + IIc	4 (3.3)	3 (4.2)
Border			< 0.001
Distinct	114 (93.4)	50 (70.4)
Irregular	8 (6.6)	21 (29.6)
Mucosal surface			0.058
Smooth	62 (50.8)	27 (38.0)
Lobular	60 (49.2)	44 (62.0)
Associated lesion (n = 104, 53.9%)
Non-neoplastic lesions (n = 17, 8.8%)	5 (4.2)	12 (16.2)	< 0.001
Hyperplastic polyp	5 (4.2)	12 (16.2)
Neoplastic lesions (n = 87, 45.1%)	48 (40.3)	39 (52.7)	< 0.001
Sessile serrated lesion	1 (0.8)	1 (1.4)
Traditional serrated adenoma	3 (2.5)	7 (9.5)
Conventional adenoma with LGD	37 (31.1)	25 (33.8)
Conventional adenoma with HGD/ADC	7 (5.9)	6 (8.1)
Procedure-related factors
Removal methods			< 0.001
Cold biopsy	1 (0.8)	0 (0.0)
Cold EMR	6 (4.9)	0 (0.0)
Conventional EMR	97 (79.5)	24 (44.4)
ESD	13 (10.7)	22 (40.7)
Operation	3 (2.5)	8 (14.8)
Observation	2 (1.6)	0 (0.0)
Post-procedural complications (n = 93, 48.2%)			< 0.001
Bleeding	44 (36.1)	48 (67.6)
Perforation	1 (0.8)	0 (0.0)
Treatment method of complication			< 0.001
APC	15 (12.3)	3 (4.2)
Coagrasper	17 (13.9)	18 (25.4)
Hemoclipping	13 (10.7)	27 (38.0)

TSAO: Traditional serrated adenoma without dysplasia or adenocarcinoma; TSAD: Traditional serrated adenoma with dysplasia or adenocarcinoma; BMI: Body mass index; NOAC: Novel oral anticoagulants; LGD: Low grade dysplasia; HGD: High grade dysplasia; ADC: Adenocarcinoma; EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; APC: Argon plasma coagulation.

Table 3 Univariate logistic regression analysis of risk factors associated with traditional serrated adenomas with dysplasia or adenocarcinoma

Variables	Odds ratio	95% confidence interval	P value
Sex
Male	0.685	0.380-1.236	0.209
Female	1.0
Obesity
Normal (18.5-23.0)	1.0
Underweight (< 18.5)	1.533	0.290-8.105	0.615
Overweight (23.0-25.0)	0.692	0.317-1.512	0.356
Obesity (≥ 25.0)	0.876	0.444-1.730	0.703
Symptom
Gastrointestinal bleeding	2.726	1.140-6.521	0.024
Color
White	1.0
Red	3.209	1.735-5.934	< 0.001
Morphology (Paris classification)
0-Ip, 0-Isp	1.0
0-Is	1.514	0.791-2.900	0.211
0-IIa	0.221	0.071-0.685	0.009
0-IIa + IIc	1.242	0.261-5.911	0.785
Border
Distinct	1.0
Irregular	5.985	2.484-14.423	< 0.001
Mucosal surface
Smooth	1.0
Lobular	1.684	0.928-3.057	0.087

Table 4 Multivariate logistic regression analysis of risk factors associated with traditional serrated adenoma with dysplasia or adenocarcinoma

Variables	Odds ratio	95% confidence interval	P value
Symptom
Gastrointestinal bleeding	2.828	1.022-7.824	0.045
Color
White	1.0
Red	1.889	0.896-3.981	0.095
Morphology (Paris classification)
0-Ip, 0-Isp	1.0
0-Is	1.121	0.528-2.380	0.766
0-IIa	0.497	0.150-1.647	0.253
0-IIa + IIc	1.176	0.213-6.489	0.852
Border
Distinct	1.0
Irregular	7.314	2.508-21.333	< 0.001
Mucosal surface
Smooth	1.0
Lobular	2.424	1.147-5.125	0.020