Endoscopic characteristics to differentiate sessile serrated lesion and microvesicular hyperplastic polyp from goblet cell-rich hyperplastic polyp

Backgrounds Among colorectal serrated polyps (SPs), sessile serrated lesions (SSLs) and hyperplastic polyps (HPs) show a similar endoscopic appearance. However, the endoscopic distinctions between the two categories, microvesicular HP (MVHP) and goblet cell-rich HP (GCHP) are not well understood. Therefore, we compared the endoscopic features of SSL, MVHP, and GCHP. Methods This retrospective, cross-sectional study was conducted at the Toyoshima Endoscopy Clinic. We examined the polyp size, location, Paris classification type, mucus cap, indistinct border, expanded crypt opening, varicose microvascular vessels, and JNET classification type. Multivariable analysis of each endoscopic finding using a binomial logistic regression model determined the factors that predicted SP histology. Results A total of 670 SPs were enrolled in this study, comprising 159 SSLs, 361 MVHPs, and 150 GCHPs. On comparing the SSL + MVHP group and GCHP, a mucus cap (partial regression coefficient 1.705), expanded crypt opening (1.828), and varicose microvascular vessels (1.270) were more often observed in SSL + MVHP group compared with GCHP. In the comparison between MVHP and GCHP, a mucus cap (1.564), expanded crypt opening (1.802), and varicose microvascular vessels (1.288) were more often found in MVHP in contrast to GCHP. When comparing SSL and MVHP, SSLs were more likely to be in the proximal colon (0.662) and were larger (0.198) than MVHPs. No significant differences were observed in other endoscopic findings. Conclusions SSL and MVHP have endoscopic appearances that differ from those of GCHP. Considering MVHP and GCHP as distinct entities may aid in the endoscopic diagnosis of SPs.