Abstract
Background: Sessile serrated adenoma/polyp is notorious for its malignancy potential and the difficulty to be detected and distinguished under endoscopy. This systematic review and meta-analysis aimed to evaluate endoscopic characteristics of SSA/P and delineate features that inform distinction between SSA/P and other types of lesions, including hyperplasitc polyp (HP) and conventional adenoma. Methods: MEDLINE, Embase and Cochrane Library from the inception to September 9, 2020 were searched for cohort, cross-sectional or case-control studies comparing endoscopic characteristics of SSA/P and other polyps. The primary outcome measure was the odds of finding specific endoscopic characteristics in patients with SSA/P compared with other types of polys in patients undergoing colorectal cancer screening. Findings: We included 74 studies from 16 countries comprising 34,535 SSA/P. Compared with HP, SSA/P was more likely to be in the right colon (OR 5.45; 95% CI 4.13-7.17; P 5mm vs. <=5mm OR 5.60; 95% CI 3.82-8.22; P<0.01); in Paris-0-II morphology (OR 2.33; 95%CI 1.45-3.70; P<0.01); having mucus cap (OR 8.48; 95% CI 4.86-14.8; P<0.01); vague margin under white light endoscopy (OR 2.71; 95% CI 1.88-3.92; P<0.01); having expended crypt opening (OR 5.09; 95% CI 1.87-13.9; P<0.01), varicose microvascular vessels (OR 6.17; 95% CI 1.57-24.3; P<0.01) and thick branched vessel (OR 5.17; 95% CI 1.81-15.8; P<0.01) under magnified narrow band imaging and type II-O pit pattern (OR 18.56; 95% CI 8.45-40.7; P<0.01) under magnified chromoendoscopy. Interpretations: We systematically synthesised current evidence on the discriminating endoscopic features of SSA/P. These findings could enhance the detection of SSA/P in endoscopy practice. Review Registration: PROSPERO (CRD42018099945, 27/06/2018). Funding Statement: This study was supported by a grant from CAMS Innovation Fund for Medical Sciences (CIFMS; No. 2016 ‑ I2M ‑ 1 ‑ 002) and a grant from Peking Union Medical College (2019zlgc0503). Declaration of Interests: We declare no competing interests.
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