Sessile Serrated Polyps: Detection, Eradication, and Prevention of the Evil Twin

Abstract

Opinion Statement The sessile serrated polyp (SSP), also known as sessile serrated adenoma, is the evil twin among the colorectal cancer precursors. As will be described, these lesions have multiple aliases (serrated adenoma, serrated polyp or serrated lesion among others), they hang out in a bad neighborhood (the poorly prepped right colon), they hide behind a mask of mucus, they are difficult for witnesses (pathologists) to identify, they are difficult for police (endoscopists) to find, they are difficult to permanently remove from society (high incomplete resection rate), they can be impulsive (progress rapidly to CRC) and enforcers (gastroenterologists) don’t know how best to control them (uncertain surveillance recommendations). There is no wonder that there is a need to understand these lesions well, learn how best to prevent the colonic mucosa from going down this errant path or, if that fails, to detect these deviants and eradicate them from colonic society. These lesions should be on the endoscopists’ most wanted list.

Understanding the contribution of family history to colorectal cancer risk and its clinical implications: A state‐of‐the‐science review

“…These polyps are particularly important because they are more difficult to identify and remove than conventional adenomas. Furthermore, they appear to contribute disproportionately to interval CRCs (CRCs that develop in the interval between routine screening examinations) . There are essentially no data related to CRC risk based on an FH of serrated polyps.…”

“…Furthermore, they appear to contribute disproportionately to interval CRCs (CRCs that develop in the interval between routine screening examinations). 37 There are essentially no data related to CRC risk based on an FH of serrated polyps. These unresolved issues highlight the need for more studies to refine our understanding of familial risk associated with both adenomas and serrated lesions.…”

A statewide program providing colorectal cancer screening to the uninsured of South Carolina

“…The following quality metrics and clinical outcomes were evaluated: colonic preparation quality (% excellent/good preparation), cecal intubation rate (% of patients where cecum was reached during screening), polyp detection rate (PDR) (ie, % of colonoscopies in which 1 polyps were removed during the procedure), and adenoma detection rate (ADR) (ie, % of colonoscopies in which 1 adenomas were identified via pathological examination). Patients were further classified based upon the most advanced polyp biopsied during colonoscopy or procedure outcome, as follows: 1) cancer, carcinoid, or lesion requiring surgical intervention; 2) advanced polyps, classified as any polyp 1 cm in diameter, including hyperplastic, traditional serrated or sessile serrated, and any polyp with villous components and/or high-grade dysplasia [38][39][40][41] ; 3) nonadvanced adenoma <1 cm in diameter; (4) hyperplastic polyps <1 cm in diameter; (5) biopsied polyps with nonsignificant pathology; or (6) no biopsies performed. Patients who had a colonoscopy with polypectomy but no associated pathology report were excluded from the analysis.…”

Serrated polyps as precursor lesions of colorectal cancer: current status and future directions. Mini-review.

“…This mutation inhibits apoptosis as the colonocytes reach the epithelial surface, BRAF or KRAS is frequently mutated, and these mutations are most probably the initiating event in the majority of lesions [31] resulting in epithelial crowding, which is thought to be responsible for the serrated morphology. [21,24] Based on these data, MVHP are now considered to be precursors of the development of SSA/P [31].…”