Overview
Traditional serrated adenomas are a subtype of colorectal polyps characterized by serrated architecture and molecular features distinct from conventional adenomas, often associated with microsatellite instability and hypermethylation of the CpG island methylator phenotype (CIMP) genes 3.Diagnosis
Endoscopic identification with characteristic serrated morphology 3.
Histopathological confirmation showing serrated architecture with inconspicuous crypts and branching patterns 3.
Molecular testing for BRAF mutations and MLH1 promoter hypermethylation to differentiate from sessile serrated lesions 3.Management
Endoscopic removal (polypectomy) for adenomas ≤1 cm 3.
Consider surgical resection for larger lesions or those with high-grade dysplasia 3.
Surveillance colonoscopy intervals vary based on lesion size, histology, and patient risk factors 3.Special Populations
Pediatrics: Limited data; caution advised due to potential for severe adverse reactions with traditional Chinese medicine injections (TCMIs) 12.
Elderly: Higher risk of adverse drug reactions (ADRs) within one week post-administration, particularly within the 41-80 years age group 1.
Comorbidities: Combination with cephalosporins increases risk of adverse events, especially anaphylactic reactions; avoid concurrent use when possible 2.Key Recommendations
Exercise caution with traditional Chinese medicine injections, especially in pediatric patients and elderly individuals due to increased risk of severe ADRs 12 (Evidence: Moderate).
Monitor closely for immediate adverse reactions, particularly within the first week post-administration, particularly in elderly patients 1 (Evidence: Moderate).
Avoid concurrent use of TCMIs like Qingkailing with cephalosporins to minimize risk of serious adverse events 2 (Evidence: Moderate).References
1 Huang R, Cai Y, Yang L, Shangguan X, Ghose B, Tang S. Safety of traditional Chinese medicine injection based on spontaneous reporting system from 2014 to 2019 in Hubei Province, China. Scientific reports 2021. link
2 Wu BL, He WX, Ke M, Shang-Guan XF, He GF, Huang R. A Retrospective Analysis on 1330 Adverse Event Reports of Qingkailing in China: Further Perception of Its Risks and Rational Use. Current medical science 2018. link
3 Wang L, Yuan Q, Marshall G, Cui X, Cheng L, Li Y et al.. Adverse drug reactions and adverse events of 33 varieties of traditional Chinese medicine injections on National Essential medicines List (2004 edition) of China: an overview on published literatures. Journal of evidence-based medicine 2010. link