Serrated adenomas of the colon: diagnostics and treatment
Aim. The objective of the present study was to improve diagnostics and optimize the choice of the strategy for the treatment of the patients presenting with flat serrated neoplasms of the colon with the use of the combination of the modern clarifying endoscopic technologies. Materials and methods. A total of 1860 endoscopic interventions for the removal of epithelial neoplasms were performed in the Department of Endoscopic Diagnostics and Surgery, A.N. Ryzhikh State Research Centre of Coloproctology, Ministry of Health of the Russian Federation, during the period between 2013 and 2014. As many as 4860 neoplastic lesions of various size and shape were excised from different segments of the colon in 1815 patients. The high-definition videoendoscopes were used at the stage of endoscopic diagnostics of epithelial neoplasms preceding their extirpation. The examination was carried out in both white light and in the narrow light spectrum (i.e. in the NBI and i-Scan regimens). In addition, chromoendoscopy and sometimes punch biopsy were used. The morphological investigation of the removed neoplasms was followed by the evaluation of the diagnostic effectiveness of the examination in the white light and with the application of various visualizing technologies. Results. A total of 1451 neoplastic structures (31% of their total number) were removed and referred for the morphological study. 77.5% of the neoplasms thus obtained were adenomatous polyps, 6% hyperplastic polyps, 7.5% serrated neoplasms, and 9% had a different structure. The relatively frequent occurrence of serrated neoplasms amounting to 7.5% suggests the high prevalence of such colonic tumours in the general population. Conclusion. Videocolonoscopy with the use of the modern visualizing technologies provides the most efficient tool for clarifying diagnostics and treatment of the flat colonic neoplasms. The accuracy of differential diagnostics between “sessile” serrated neoplasms and hyperplastic polyps of a similar endoscopic visual appearance is of primary importance for the choice of the surgical strategy and depends on the knowledge of characteristic endoscopic semiotics and the experience with the application of the modern visualizing technologies.