Objective: To investigate the morphological features of colorectal sessile serrated adenoma/polyp (SSA/P) and hyperplastic polyp (HP) by white light endoscope (WLE) and Image enhancement endoscope (IEE) . Methods: The data of 7 384 patients who underwent colonoscopy at the Center of Digestive Endoscopy, Peking University International Hospital from August 1, 2016 to February 29, 2018 were analyzed retrospectively. WLE and IEE[Fuji intelligent chromo endoscopy (FICE) or Blue Laser Imaging (BLI) ]were used to compare the morphological features of SSA/P with HP, SSA/P-CD(+)with SSA/P-CD(-). The diagnostic values of endoscopic features in SSA/P and SSA/P-CD(+)were analyzed. Results: A total of 3 401 polyps were detected in 7 384 patients, including 164 SSA/Ps (135 patients). During the same period, there were 270 HPs (223 patients) in accordance with the admission criteria. Compared with HP group, SSA/P group was more common in the right colon with a diameter>5 mm and more likely to be manifested as: Ⅱ-O pit pattern, surface mucus, cumulus-like surface, irregular morphology, VMV, redness, and also more likely to be associated with colon adenoma, colon cancer elsewhere in the colorectum. The differences were statistically significant (P<0.01). Compared with SSA/P-CD(-)group, SSA/P-CD(+)group was more common in the right colon with a diameter>5 mm and more likely to be manifested as: Ⅱ-O pit pattern, surface mucus, cumulus-like surface, irregular morphology, VMV. The differences were statistically significant (P<0.001). The differential diagnosis between SSA/P and HP was predicted by combining any two endoscopic morphological features (right colon, Ⅱ-O pit pattern, surface mucus, cumulus surface, irregular morphology, VMV, diameter>5 mm, at least 2 of 7 endoscopic features). The sensitivity, specificity, accuracy, positive likelihood ratio and negative likelihood ratio were 59.15%, 95.56%, 81.80%, 13.32 and 0.43, respectively. Similarly, the differential diagnosis between SSA/P-CD(+) and HP was predicted. The sensitivity, specificity, accuracy, positive likelihood ratio and negative likelihood ratio were 92.16%, 95.56%, 95.02%, 20.76 and 0.08, respectively. Conclusion: Comprehensive analysis of the WLE and FICE/BLI morphological features of the lesions can effectively distinguish SSA/P from HP, especially SSA/P-CD(+) from HP.
目的： 比较结直肠无蒂锯齿状腺瘤/息肉（SSA/P）与增生性息肉（HP）在白光内镜和图像增强模式（IEE）下的形态特征。 方法： 回顾性分析2016年8月1日至2018年2月29日于北京大学国际医院内镜中心接受结肠镜检查的7 384例患者的临床资料。对白光+IEE[内镜智能分光比色技术（FICE）或蓝激光成像技术（BLI）]下，SSA/P与HP、SSA/P伴细胞异型（SSA/P-CD(+)）与SSA/P不伴细胞异型（SSA/P-CD(-)）的形态特征进行比较；分析内镜下形态特征对SSA/P、SSA/P-CD(+)的诊断价值。 结果： 7 384例患者共检出息肉3 401枚。其中，SSA/P 164枚（135例患者），对照组HP 270枚（223例患者）。与HP组相比，SSA/P以右半结肠、直径>5 mm多见，多表现为Ⅱ-O型腺管开口、表面黏液、积云样表面、形态不规则、曲张微血管、颜色发红，更易合并其他部位结肠腺瘤、结肠癌，差异有统计学意义（P<0.01）。与SSA/P-CD(-)组相比，SSA/P-CD(+)组以右半结肠、直径>5 mm多见，多表现为Ⅱ-O型腺管开口、表面黏液、积云样表面、形态不规则、曲张微血管，差异有统计学意义（P<0.001）。联合上述任意两项内镜下形态特征，对SSA/P进行诊断：灵敏度：59.15%，特异度：95.56%，准确性：81.80%，阳性似然比：13.32，阴性似然比：0.43；对SSA/P-CD(+)进行诊断：灵敏度：92.16%，特异度：95.56%，准确性：95.02%，阳性似然比：20.76，阴性似然比：0.08。 结论： 通过观察病变在白光和FICE/BLI模式下的形态特征，可有效区分SSA/P与HP，特别是SSA/P-CD(+)与HP。.
Keywords: Colonic polyp; Cytologic dysplasia; Hyperplastic polyp; Sessile serrated adenoma/polyp.