Failure to recognize serrated polyposis syndrome in a cohort with large sessile colorectal polyps

Sessile Serrated Adenomas: Why Conventional Endoscopy Is Okay for Unconventional Polyps

“…Pereyra et al [1] reported that these lesions are identifiable by luminal surface features such as excess proximal localization, flat morphology, red surface color, and the presence of a mucus cap, as shown in their paper. Endoscopic presentation is subtle: Polyps in Pereyra' s study were few (1.6 per patient) and small (43 % were 5 mm or smaller), requiring heightened awareness for identification, which, reassuringly, were recognized without specialized endoscopic equipment, facilitating their complete removal and pathological review.…”

“…Sessile serrated adenomas (SSA) are premalignant flat lesions localized predominantly in the proximal colon, which, until recently, had often been unrecognized by the endoscopist [1]. Pereyra et al [2] report in this issue of Digestive Diseases and Sciences that these lesions can be successfully identified using conventional colonoscopy.…”

“…Since SSA progression to CRC can be prevented through polypectomy [1], awareness of these lesions among endoscopists and pathologists is important. Since criteria for pathological diagnosis of SSA are evolving, SSA may be underdiagnosed [6].…”

“…Also excluded from the study were patients carrying a diagnosis of inflammatory bowel disease, familial adenomatous polyposis, or the serrated polyposis syndrome [1]. As endoscopists improve their ability to identify SSA, it will be of potentially great value to understand the involvement of SSA in those conditions, in particular with regard to the pathology, clinical features, and carcinogenesis pathways in comparison with sporadic SSA.…”

Serrated polyposis syndrome: a silent killer when undetected

“…A recent large retrospective study demonstrated that, once cleared from all polyps and under close surveillance, CRC risk in these patients is only moderately increased [3]. However, most cases of SPS remain unrecognized and as a consequence patients do not receive proper surveillance intervals, significantly increasing their risk of developing CRC [4,5]. For this reason it is important that endoscopists become acquainted with the diagnosis, risk, and optimal treatment strategies for SPS [6].…”