Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
J Dig Dis. 2024 Jul;25(7):424-435. doi: 10.1111/1751-2980.13302. Epub 2024 Aug 5.
We aimed to compare the clinical and endoscopic characteristics of sessile serrated lesions (SSLs) with dysplasia/carcinoma (SSLD/Cs) and SSLs without dysplasia in this systematic review and meta-analysis.
MEDLINE, EMBASE, and Cochrane Library databases and Clinicaltrials.gov were searched for relevant studies published up to August 28, 2023. The primary outcome was lesion size in SSLD/Cs and SSLs without dysplasia. The secondary outcomes included risk of dysplasia/carcinoma, morphology (classified based on the Paris classification), and lesion features such as mucus cap and nodules/protrusions in the two groups.
Thirteen studies with 14 381 patients were included. The proportion of SSLD/Cs ≥10 mm was significantly higher than that of SSLs without dysplasia (odds ratio [OR] 3.82, 95% confidence interval [CI] 1.21-12.02, p = 0.02). There was no significant difference in the risk of dysplasia/carcinoma between the proximal (OR 0.80, 95% CI 0.57-1.14) and distal colon (OR 1.25, 95% CI 0.88-1.77, p = 0.21). The 0-Ip (OR 2.47, 95% CI 1.50-4.09) and 0-IIa + Is (OR 10.38, 95% CI 3.08-34.98) morphologies were more prevalent among SSLD/Cs, whereas the 0-IIa morphology (OR 0.38, 95% CI 0.22-0.65) was more prevalent among SSLs without dysplasia (all p < 0.001). Furthermore, mucus cap (OR 0.61, 95% CI 0.42-0.89, p = 0.01) was more common among SSLs without dysplasia, whereas nodules/protrusions (OR 7.80, 95% CI 3.07-19.85, p < 0.001) were more common in SSLD/Cs.
SSLs >10 mm, 0-Ip or 0-IIa + Is morphologies, and those with nodules/protrusions are significantly associated with dysplasia/carcinoma.
本系统评价和荟萃分析旨在比较有和无发育不良/癌变（SSL-D/C）的无蒂锯齿状病变（SSL）的临床和内镜特征。
检索 MEDLINE、EMBASE 和 Cochrane 图书馆数据库以及 Clinicaltrials.gov，以获取截至 2023 年 8 月 28 日发表的相关研究。主要结局是 SSL-D/C 和无发育不良 SSL 的病变大小。次要结局包括发育不良/癌变风险、形态（基于巴黎分类进行分类）以及两组中病变特征，如黏液帽和结节/隆起。
纳入了 13 项研究共 14381 例患者。SSL-D/C 中≥10mm 的比例明显高于无发育不良 SSL（优势比 [OR]3.82，95%置信区间 [CI]1.21-12.02，p=0.02）。近端结肠（OR0.80，95%CI0.57-1.14）和远端结肠（OR1.25，95%CI0.88-1.77，p=0.21）的发育不良/癌变风险无显著差异。0-Ip（OR2.47，95%CI1.50-4.09）和 0-IIa+Is（OR10.38，95%CI3.08-34.98）形态在 SSL-D/C 中更为常见，而无发育不良 SSL 中更常见的是 0-IIa 形态（OR0.38，95%CI0.22-0.65，均 p<0.001）。此外，无发育不良 SSL 中黏液帽（OR0.61，95%CI0.42-0.89，p=0.01）更为常见，而 SSL-D/C 中结节/隆起（OR7.80，95%CI3.07-19.85，p<0.001）更为常见。
10mm、0-Ip 或 0-IIa+Is 形态以及有结节/隆起的 SSL 与发育不良/癌变显著相关。
