Abstract
Background and Objectives
Serrated epithelial change (SEC) is an increasingly recognized histologic finding
in patients with inflammatory bowel disease (IBD) and may be associated with an increased
risk of colorectal dysplasia. SEC is defined as colonic mucosa with goblet cell–rich
epithelium and serrated crypt architecture without basal crypt distortion or dysplasia.
This study aimed to characterize the clinical, endoscopic, and histologic features
of SEC in IBD patients and determine the incidence of associated dysplasia.
Materials and Methods
A retrospective single-center study was conducted at a tertiary referral hospital.
IBD patients with histologically confirmed SEC from colonic biopsies between January
1, 2015 and December 31, 2024 were identified via pathology database searches. Patients
without follow-up colonoscopy or flexible sigmoidoscopy were excluded. Clinical, endoscopic,
and histologic data were extracted from electronic records. Descriptive statistics
were used to summarize demographics, endoscopic findings, and histologic data. Median
values were reported for age and follow-up time; mean values described disease duration.
Results
Twenty-six IBD patients (16 Crohn's disease, 10 ulcerative colitis) with SEC were
analyzed (14 males; median age 58 years). Mean disease duration was 15 years, with
a median follow-up of 24.5 months. The estimated prevalence of SEC was . A total of
30 SEC specimens were identified, most commonly located in the cecum (30%), rectum
(23.3%), and transverse colon (16.7%). SEC presented as nodular or polypoid lesions
in 60% of cases and was detected by high-definition white light endoscopy in 61.5%
of patients. Multifocal SEC occurred in 19.2% of patients. Endoscopic and histologic
inflammations were present in approximately half of the cases. Only one patient (3.8%)
developed low-grade dysplasia adjacent to SEC.
Conclusion
SEC was predominantly observed in patients with long-standing IBD as polypoid or nodular
lesions proximal to the splenic flexure and associated with mucosal inflammation.
A solitary case of colorectal dysplasia was observed. Larger prospective studies are
needed to clarify SEC's role in colorectal carcinogenesis and to guide dysplasia surveillance
strategies in IBD.
Keywords
serrated epithelial change - inflammatory bowel disease - dysplasia - endoscopy
