Management of Serrated Polyps of the Colon

Abstract

Patients with SSA/Ps are at an increased risk of future colorectal neoplasia, including advanced polyps and cancer. Reasonable benchmarks for SP detection rates are 5-7% for SSA/Ps and 10-12% for proximal SPs. Certain endoscopic techniques such as chromoendoscopy, narrow band imaging, water immersion, and wide-angle viewing may improve SSA/P detection. Emerging endoscopic techniques such as underwater polypectomy, suction pseudopolyp technique, and piecemeal cold snare polypectomy are helpful tools for the endoscopist's armamentarium for removing SSA/Ps. Proper orientation of SSA/P specimens can improve the accuracy of pathology readings. Patients with confirmed SSA/Ps and proximal HPs should undergo surveillance at intervals similar to what is recommended for patients with conventional adenomas. Patients with SSA/Ps may also be able to lower their risk of future polyps by targeting modifiable risk factors including tobacco and alcohol use and high-fat diets. NSAIDs and aspirin appear to be protective agents. SPs and SSA/Ps in particular are important colorectal cancer precursors that merit special attention to ensure adequate detection, resection, and surveillance.

Terminology, Molecular Features, Epidemiology, and Management of Serrated Colorectal Neoplasia

“…Serrated Neoplasia: State of the Science 957 (for larger lesions) procedures. 136 In recent years, there has been an interest in alternative resection methods, such as underwater endoscopic mucosal resection and piecemeal cold-snare polypectomy, though additional research is needed to establish the efficacy and safety of these techniques. 137,138 There is some evidence that SSLs, and particularly large SSLs, may be prone to incomplete resection.…”

Computer aided detection for laterally spreading tumors and sessile serrated adenomas during colonoscopy

“…It is noteworthy that precancerous lesions with a flat morphology, smooth surface, indistinct boundaries or isochromatic with background are more susceptible to be missed [2,3,4]. Given these subtle features of morphology and color, nonpolypoid laterally spreading tumors (LSTs) and sessile serrated adenoma/polyps (SSA/Ps) are among the easist-to-miss lesions [5,6]. LSTs extend laterally along the colon wall without a polypoid morphology [7,8].…”

“…The LSTs have a remarkable high risk of malignancy transformation, studies have shown that 63.1% of the investigated LSTs are adenomas with villous structures [6] 20.9%-36.0% of LSTs were found to have high grade intraepithelial neoplasia (HGIN), moreover, LSTs can also develop into a submucosal invasive cancer [6,9,10]. Serrated polyps (SPs) are the second most common type of colon polyps, among which, SSA/Ps take about 10-20% of SPs [11,12] and 5-10% [5] of lesions found during screening colonoscopy. SSA/Ps are a high-risk precursor for CRC via serrated pathway [5,13,14], the estimated 10-year risk for CRC transformation from SSA/Ps ranges from 2.56% to 4.43% according to the existence of cytological dysplasia [15] and are dependent on the size [16].…”

“…Serrated polyps (SPs) are the second most common type of colon polyps, among which, SSA/Ps take about 10-20% of SPs [11,12] and 5-10% [5] of lesions found during screening colonoscopy. SSA/Ps are a high-risk precursor for CRC via serrated pathway [5,13,14], the estimated 10-year risk for CRC transformation from SSA/Ps ranges from 2.56% to 4.43% according to the existence of cytological dysplasia [15] and are dependent on the size [16]. The detection of SSA/Ps via colonoscopy is always difficult due to the pale color and flat morphology [17].…”

The “Difficult” Colorectal Polyps and Adenomas: Practical Aspects

“…The outcome quality and the degree of safety provided by colonoscopy are mainly influenced by the technical skill and experience of the endoscopist in identifying and removing polyps. It has been shown that there is important difference between endoscopists for detection rates of conventional and sessile serrated polyps [3,4].…”