{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T11:52:33Z","timestamp":1781783553467,"version":"3.54.5"},"reference-count":38,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>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\u2013IV. 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.<\/jats:p>","DOI":"10.3390\/medicina62061185","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T10:25:34Z","timestamp":1781778334000},"page":"1185","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Endoscopic Hallmarks of Sessile Serrated Lesions: A Systematic Review of an Evolving Concept"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3153-1130","authenticated-orcid":false,"given":"Adrian","family":"Mit\u0103","sequence":"first","affiliation":[{"name":"Department of Medical Semiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4403-3117","authenticated-orcid":false,"given":"Liviu","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Medical Assistance, Faculty of Medical Care, Titu Maiorescu University of Bucharest, 040051 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana","family":"Criciotoiu","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iancu Emil","family":"Ple\u015fea","sequence":"additional","affiliation":[{"name":"Doctoral School, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Pathology, Bagdasar\u2014Arseni Emergency Clinical Hospital, 041915 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. 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