Endoscopic and surgical management of serrated colonic polyps

Léonard, Daniel; Dozois, Eric J.; Smyrk, Thomas C.; Suwanthanma, Weerapat; Baron, Todd H.; Cima, Robert R.; Larson, David W.

doi:10.1002/bjs.7654

Cited by 17 publications

(8 citation statements)

References 67 publications

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“…As with other polyposis syndromes therefore, surgical resection should be seriously considered when colonoscopic removal of polyps is not feasible, in order to reduce cancer risk 155. These surgical principles apply when cancer is detected in the context of SPS.…”

Section: Special Situations: Sps and Serrated Polyps In Colitismentioning

confidence: 99%

British Society of Gastroenterology position statement on serrated polyps in the colon and rectum

East

Atkin

Bateman

et al. 2017

Gut

277

266

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Serrated polyps have been recognised in the last decade as important premalignant lesions accounting for between 15% and 30% of colorectal cancers. There is therefore a clinical need for guidance on how to manage these lesions; however, the evidence base is limited. A working group was commission by the British Society of Gastroenterology (BSG) Endoscopy section to review the available evidence and develop a position statement to provide clinical guidance until the evidence becomes available to support a formal guideline. The scope of the position statement was wide-ranging and included: evidence that serrated lesions have premalignant potential; detection and resection of serrated lesions; surveillance strategies after detection of serrated lesions; special situations—serrated polyposis syndrome (including surgery) and serrated lesions in colitis; education, audit and benchmarks and research questions. Statements on these issues were proposed where the evidence was deemed sufficient, and re-evaluated modified via a Delphi process until >80% agreement was reached. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool was used to assess the strength of evidence and strength of recommendation for finalised statements. Key recommendation: we suggest that until further evidence on the efficacy or otherwise of surveillance are published, patients with sessile serrated lesions (SSLs) that appear associated with a higher risk of future neoplasia or colorectal cancer (SSLs ≥10 mm or serrated lesions harbouring dysplasia including traditional serrated adenomas) should be offered a one-off colonoscopic surveillance examination at 3 years (weak recommendation, low quality evidence, 90% agreement).

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Section: Special Situations: Sps and Serrated Polyps In Colitismentioning

confidence: 99%

British Society of Gastroenterology position statement on serrated polyps in the colon and rectum

East

Atkin

Bateman

et al. 2017

Gut

277

266

View full text Add to dashboard Cite

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“…The serrated neoplastic pathway may contribute to the occurrence of some postcolonoscopy cancers, as some precursor lesions, especially sessile serrated adenomas/polyps (SSA/P), are easily overlooked during colonoscopy (5,6) and are more challenging to remove endoscopically (7). It is generally accepted that large, proximal, or dysplastic (LPD) serrated polyps (SP) purport significant risk for malignant transformation, whereas nondysplastic small distal serrated polyps do not (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Simple Clinical Risk Score Identifies Patients with Serrated Polyps in Routine Practice

Bouwens

Winkens

Rondagh

et al. 2013

Cancer Prevention Research

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Large, proximal, or dysplastic (LPD) serrated polyps (SP) need accurate endoscopic recognition and removal as these might progress to colorectal cancer. Herewith, we examined the risk factors for having 1 LPD SP. We developed and validated a simple SP risk score as a potential tool for improving their detection. We reviewed clinical, endoscopic, and histologic features of serrated polyps in a study of patients undergoing elective colonoscopy (derivation cohort). A self-administered questionnaire was obtained. We conducted logistic regression analyses to identify independent risk factors for having 1 LPD SP and incorporated significant variables into a clinical score. We subsequently tested the performance of the SP score in a validation cohort. We examined 2,244 patients in the derivation and 2,402 patients in the validation cohort; 6.3% and 8.2% had 1 LPD SP, respectively. Independent risk factors for LPD SPs were age of more than 50 years [OR 2.2; 95% confidence interval (CI), 1.3-3.8; P ¼ 0.004], personal history of serrated polyps (OR 2.6; 95% CI, 1.3-4.9; P ¼ 0.005), current smoking (OR 2.2; 95% CI, 1.4-3.6; P ¼ 0.001), and nondaily/no aspirin use (OR 1.8; 95% CI, 1.1-3.0; P ¼ 0.016). In the validation cohort, a SP score 5 points was associated with a 3.0-fold increased odds for LPD SPs, compared with patients with a score <5 points. In the present study, age of more than 50 years, a personal history of serrated polyps, current smoking, and nondaily/no aspirin use were independent risk factors for having LPD SPs. The SP score might aid the endoscopist in the detection of such lesions. Cancer Prev Res; 6(8); 855-63. Ó2013 AACR.

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“…[3][4][5] The significance of serrated polyps in the general population with respect to carcinoma risk stratification, endoscopic surveillance, and management is becoming increasingly clear and has recently been incorporated into clinical consensus guidelines. [6][7][8] Patients with extensive, longstanding colonic inflammatory bowel disease, mainly ulcerative and Crohn's colitis, face an increased risk of developing colorectal cancer compared with the general population. 9,10 Surveillance colonoscopy is advo-cated and widely practiced in these patients as a means of reducing cancer mortality by permitting early detection and management of neoplasia in the form of dysplasia or early, curable carcinoma.…”

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confidence: 99%

Serrated colorectal polyps in inflammatory bowel disease

Harpaz

McBride

et al. 2015

Modern Pathology

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Serrated colorectal polyps, which, besides hyperplastic polyps, comprise sessile serrated adenomas/polyps and traditional serrated adenomas, are presumptive precursors of at least 20% of sporadic colorectal carcinomas; however, their significance in patients with inflammatory bowel disease is unclear. We retrospectively evaluated 78 serrated polyps, removed over a 14-year period from 6602 inflammatory bowel disease patients undergoing endoscopic surveillance, with respect to morphologic, clinicopathologic, and molecular features, and compared rates of advanced neoplasia (high-grade dysplasia and carcinoma) development following the index serrated polyp diagnosis to reference inflammatory bowel disease cohorts without serrated polyps. Serrated polyps negative for dysplasia, which morphologically resembled sporadic sessile serrated adenoma/polyps, occurred mainly in females, in the proximal colon, and contained BRAF mutations. Serrated polyps with low-grade dysplasia resembled sporadic traditional serrated adenomas and occurred mainly in males, in the distal colon, and contained KRAS mutations. Serrated polyps indefinite for dysplasia were morphologically heterogeneous, but similar to serrated polyps positive for low-grade dysplasia with respect to male predominance, left-sided location, and KRAS mutation rates. Rates of prevalent neoplasia associated with serrated polyps positive for lowgrade dysplasia, indefinite for dysplasia, and negative for dysplasia were 76, 39, and 11%, respectively (Po 0.001). Actuarial 10-year rates of incident advanced neoplasia after an initial diagnosis of serrated polyp positive for low-grade dysplasia, indefinite for dysplasia, and negative for dysplasia were 17, 8, and 0%, respectively, the first and last being significantly different (P = 0.02) and comparable to those of corresponding reference populations of inflammatory bowel disease patients with and without low-grade dysplasia at baseline, respectively. We conclude that in serrated polyps from inflammatory bowel disease patients, dysplasia grade correlates with morphology, sex, anatomic location, BRAF and KRAS mutation status, prevalent conventional neoplasia, and rates of advanced neoplasia development. Modern Pathology (2015Pathology ( ) 28, 1584Pathology ( -1593 doi:10.1038/modpathol.2015 published online 25 September 2015 Recognition of the serrated neoplasia pathway to colorectal carcinoma has enhanced our understanding of sporadic carcinogenesis in the general population. Serrated polyps, which encompass, besides hyperplastic polyps, sessile serrated adenomas/ polyps and traditional serrated adenomas, have been implicated in the pathogenesis of at least 20% of sporadic colorectal carcinomas. 1,2 Sessile serrated adenoma/polyps are usually located in the proximal colon, predominate in women, and harbor BRAF mutations, whereas traditional serrated adenomas are usually left sided, occur more often in men, and contain KRAS mutations. [3][4][5] The significance of serrated polyps in the general population with respect to c...

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Endoscopic and surgical management of serrated colonic polyps

Abstract: Even though the neoplastic potential of certain subtypes of serrated polyp is heavily supported, further studies are needed to make definitive endoscopic and surgical recommendations.

Cited by 17 publications

References 67 publications

British Society of Gastroenterology position statement on serrated polyps in the colon and rectum

British Society of Gastroenterology position statement on serrated polyps in the colon and rectum

Simple Clinical Risk Score Identifies Patients with Serrated Polyps in Routine Practice

Serrated colorectal polyps in inflammatory bowel disease

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