Endoscopic Hallmarks of Sessile Serrated Lesions: A Systematic Review of an Evolving Concept.

Background and

Objectives

Sessile serrated lesions (SSLs) are increasingly recognized as relevant precursors in alternative pathways of colorectal carcinogenesis, yet their endoscopic recognition remains challenging. Materials and

Methods

We conducted a systematic review of studies reporting endoscopic and patient-related features associated with SSLs. PubMed/MEDLINE was searched for studies published between 2003 and November 2025. Eleven studies including 13,453 participants were identified.

Results

Frequently reported endoscopic hallmarks included proximal colon location, larger lesion size, flat or slightly elevated morphology, indistinct borders, mucous cap, cloud-like surface, and pit-pattern features consistent with Kudo/Fujii types III-IV. Considerable heterogeneity in definitions and analytical reporting was observed.

Conclusions

Although several features may raise suspicion for SSLs, standardized evidence remains limited, supporting a cautious and comprehensive approach to polyp assessment.