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Sessile Serrated Adenomas: How to Detect, Characterize and Resect
( Michael X. Ma ),( Michael J. Bourke ) 대한간학회 2017 Gut and Liver Vol.11 No.6
Serrated polyps are important contributors to the burden of colorectal cancers (CRC). These lesions were once consid-ered to have no malignant potential, but currently up to 30% of all CRC are recognized to arise from the serrated neopla-sia pathway. The primary premalignant lesions are sessile serrated adenomas/polyps (SSA/Ps), although traditional serrated adenomas are relatively uncommon. Compared to conventional adenomas, SSA/Ps are morphologically subtle with indistinct borders, may be difficult to detect endoscopi-cally, are more prevalent than previously thought, are as-sociated with synchronous and metachronous advanced neoplasia, and have a higher risk of incomplete resection. Al-though many lesions remain “dormant,” progressive disease is associated with the development of dysplasia and more rapid progression to CRC. As a result, SSA/Ps are strongly implicated in the development of interval cancers. These fac-tors represent unique challenges that require a meticulous approach to their management. In this review, we sum-marize the contemporary literature on the characterization, detection and resection of SSA/Ps. (Gut Liver 2017;11:747-760)