Prevalence of sessile serrated adenoma/polyp in hyperplastic appearing diminutive rectosigmoid polyps

Abstract

Background The American Society for Gastrointestinal Endoscopy recommends that distal colon hyperplastic lesions can be left in place without resection if adenomatous histology can be excluded with > 90% negative predictive value. However, some of the lesions could be sessile serrated adenoma/polyp (SSA/P), which is also precancerous. Aim Describe the prevalence of SSA/P in hyperplastic appearing diminutive rectosigmoid polyps. Methods We prospectively placed 513 consecutive diminutive rectosigmoid polyps that appeared hyperplastic to an expert endoscopist in individual bottles for pathologic examination. Each polyp was examined by 3 expert gastrointestinal pathologists. Results The prevalence of SSA/P in the study polyps ranged from 0.6% to 2.1%. The endoscopists lowest negative predictive value for the combination of adenomas plus SSA/P was 96.7% Conclusions The prevalence of SSA/P in diminutive rectosigmoid hyperplastic appearing polyps is very low. These results support the safety and feasibility of a “do not resect” policy for diminutive hyperplastic appearing rectosigmoid polyps.