Clinical features of upper gastrointestinal serrated lesions: An endoscopy database analysis of 98746 patients

Abstract

Aim: To analyse the clinical features of patients with the serrated lesions in the upper gastrointestinal tract (UPGI) tract.

Methods: Patients who underwent routine esophagogastroduodenoscopy (EGD) at the Digestive Endoscopy Centre of General Hospital, Tianjin Medical University between January 2011 and December 2015 were consecutively recruited. Patients with UPGI serrated lesions were consecutively identified. The patients' demographics and histopathology were recorded. The colorectal findings for patients who underwent colonoscopy simultaneously or within six months were also extracted from the colonoscopy database. In addition, we analysed differences in colorectal neoplasia detection between the study patients and randomly selected patients matched for age and gender who did not exhibit serrated lesions and who also underwent colonoscopy in the same period.

Results: A total of 21 patients out of 98746 patients (0.02%) who underwent EGD were confirmed to have serrated lesions with predominantly crenated, sawtooth-like configurations. The mean age of the 21 patients was (55.3 ± 17.2) years, and 11 patients were male (52.4%). In terms of the locations of the serrated lesions, 17 were found in the stomach (including 3 in the cardia, 9 in the corpus and 5 in the antrum), 3 were found in the duodenum, and 1 was found in the esophagus. Serrated lesions were found in different mucosal lesions, with 14 lesions were detected in polyps (8 hyperplastic polyps and 6 serrated adenomas with low grade dysplasia), 3 detected in Ménétrier gastropathy, 3 detected in an area of inflammation or ulcer, and 1 detected in the intramucosal carcinoma of the duodenum. In addition, colonoscopy data were available for 18 patients, and a significantly higher colorectal adenoma detection rate was observed in the UPGI serrated lesions group than in the randomly selected age- and gender-matched group without serrated lesions who also underwent colonoscopy in the same period (38.9% vs 11.1%, OR = 5.091, 95%CI: 1.534-16.890, P = 0.010). The detection rate of advanced adenoma was also higher in the UPGI serrated lesions group (22.2% vs 4.2%, OR = 6.571, 95%CI: 1.322-32.660, P = 0.028).

Conclusion: Serrated lesions in the UPGI were detected in various mucosal lesions with different pathological morphologies. Moreover colonoscopy is recommended for the detection of concurrent colorectal adenoma for these patients.

Keywords: Clinical features; Colorectal adenoma; Colorectal cancer; Serrated lesions; Upper gastrointestinal tract.

Figure 1

Typical pathological images of serrated lesions in upper gastrointestinal tract. Serrated lesions characterized by epithelial cells with luminal infolding and a serrated growth pattern were shown. A: Serrated hyperplasia in esophagitis (× 40); B: Serrated hyperplasia in the Ménétrier gastropathy: marked foveolar hyperplasia and glandular cysts with serrated lesions in the stomach (× 100); C: Hyperplastic polyp in the stomach: a serrated polyp without overt cytological atypia showed narrowed crypt bases that were predominantly lined with immature cells (× 100); D: Serrated adenoma with low grade dysplasia in the duodenum: a serrated polyp with enlarged nuclei, a pencil-shaped, hyperchromaticity and nuclear stratification (× 100).