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Serrated epithelial change (SEC) is a newly described histologic finding, mostly associated with inflammatory bowel disease (IBD), in which colon biopsies show crypt distortion and some crypts that do not reach the muscularis mucosa. Expert pathologists consider it to be distinct from both hyperplastic polyp and sessile serrated polyp.
To determine the prevalence of SEC in IBD and its possible association with dysplasia, investigators at a single U.S. tertiary referral center retrospectively reviewed all pathology specimens in 187 patients with confirmed IBD and ≥1 histologic findings of SEC without prior dysplasia. Median follow-up was 28 months. Results were as follows:
The prevalence of SEC in 2004 was 2.5% and in 2008 was 3%.
The location of SEC was predominantly left-sided; 37% occurred in the left colon and 38% in the rectum.
Only 22% of SEC histologic findings were obtained from endoscopically visible lesions.
Fifteen of 187 patients (8%) had synchronous dysplasia (2 with colorectal cancer), and 24 of 112 patients (21%) had metachronous dysplasia (6 with high-grade dysplasia or cancer).
Dysplasia was located in the same colon segment as SEC in 68% of cases.
In a multivariable analysis, predictors of dysplasia included older age at IBD diagnosis (odds ratio, 1.06), male gender (OR, 3.86), family history of colorectal cancer (OR, 6.48), and SEC at follow-up (OR, 1.43).
Parian A et al. The association between serrated epithelial changes and colorectal dysplasia in inflammatory bowel disease. Gastrointest Endosc 2015 Dec 17; [e-pub]. (http://dx.doi.org/10.1016/j.gie.2015.12.010)
Comment
Most of us in clinical practice have never seen “serrated epithelial change” on a pathology report. This is a story that we'll have to follow, particularly the uncertainties as to whether SEC lesions are consistently endoscopically visible with or without chromoendoscopy and whether SEC constitutes a variant molecular pathway to cancer in patients with IBD. It might be good to alert your expert GI pathologist (if you have one) to this topic.