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Usefulness of narrow-band imaging for the detection of remnant sessile-serrated adenoma (SSA) tissue after endoscopic resection: the KASID multicenter study

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Abstract

Background

A sessile-serrated adenoma (SSA) has a high risk for incomplete resection. Little is known regarding how to immediately detect remnant SSA tissue after endoscopic resection. We investigated the usefulness of narrow-band imaging (NBI) to detect remnant SSA tissue after endoscopic mucosal resection (EMR).

Methods

We performed a prospective randomized study on 138 patients who had suspicious SSA on colonoscopy at five centers. After EMR on the suspected SSA determined on the endoscopic morphology, all lesions were randomized into two inspection methods, NBI and white light endoscopy (WLE), to detect remnant tissue on the resected margin. If remnant tissue was detected, an additional resection was performed. Finally, we obtained quadrant biopsies on the resection margin to evaluate the incomplete resection. The proportion of incomplete resection was calculated by combining the detection of remnant tissue and the positivity of SSA cells on the final quadrant biopsies. The primary outcome was the proportion of remnant tissue detection, and the secondary outcome was the proportion of incomplete resection of SSA.

Results

In all, 145 lesions from 138 patients were removed. The diagnostic rate of SSA was 87.6% (127/145). After randomization, NBI inspection was performed on 69 lesions, and WLE inspection was performed on 76 lesions. The histologic diagnostic rate of SSA was 89.9% (62/69) in the NBI group and 85.5% (65/76) in the WLE group (p > 0.05). There were no significant differences in the detection of remnant tissue (12.9% (8/62) vs. 15.4% (10/65), p > 0.05), the proportion of SSA in remnant tissue (11.3% (7/62) vs. 12.3% (8/65), p > 0.05), or the proportion of incomplete resection (6.5 (4/62) vs. 10.8 (7/65), p > 0.05) between the NBI and WLE inspection groups, respectively.

Conclusion

NBI was not superior to WLE for detecting remnant SSA tissue after EMR and could not decrease the proportion of incomplete resection of SSA.

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Funding

This work was supported by the Soonchunhyang University Research Fund.

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Authors and Affiliations

  1. Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea

    Yunho Jung

  2. Department of Internal Medicine, Soonchunhyang University College of Medicine, 59 Daesagwan ro, Yongsan gu, Seoul, 04401, Korea

    Jung Rock Moon, Seong Ran Jeon & Hyun Gun Kim

  3. Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea

    Jae Myung Cha

  4. Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

    Hyo-Joon Yang

  5. Biostatistical Consulting Unit, Soonchunhyang University College of Medicine, Seoul, Korea

    Suyeon Park

  6. Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea

    Yumi Ahn

  7. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Jeong-Sik Byeon

Authors
  1. Yunho Jung
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  2. Jung Rock Moon
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  8. Jeong-Sik Byeon
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Contributions

HGK and JSB contributed equally to this article. YJ and JRM: Analysis and interpretation of data; writing up of the first draft of the paper. HGK, JSB: Study concept and design; Patient recruitment; SYP: Analysis and interpretation of data; Critical revision of the manuscript for important intellectual content. SRJ, JMC, HJY: Patient recruitment; Analysis and interpretation of data; Critical revision of the manuscript for important intellectual content.

Corresponding authors

Correspondence to Jeong-Sik Byeon or Hyun Gun Kim.

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Disclosures

Dr. Yunho Jung, Dr. Jung Rock Moon, Dr. Seong Ran Jeon, Dr. Jae Myung Cha, Dr. Hyo-Joon Yang, Dr. Suyeon Park, RN. Yumi Ahn, Dr. Jeong-Sik Byeon, MD and Dr. Hyun Gun Kim have no conflict of interest or financial ties to disclose.

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Jung, Y., Moon, J.R., Jeon, S.R. et al. Usefulness of narrow-band imaging for the detection of remnant sessile-serrated adenoma (SSA) tissue after endoscopic resection: the KASID multicenter study. Surg Endosc 35, 5217–5224 (2021). https://doi.org/10.1007/s00464-020-08016-2

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