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The Pocket-Creation Procedure of Endoscopic Submucosal Dissection for Large Rectal Laterally Spreading Tumors
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Serrated adenomas.

Wilfredo E De Jesus-Monge1, Carmen Gonzalez-Keelan, Marcia Cruz-Correa

  • 1University of Puerto Rico Medical Sciences Campus, Clinical Research Center, San Juan, PR 00936.

Current Gastroenterology Reports
|September 22, 2009
PubMed
Summary

Sessile serrated adenomas (SSAs) and traditional serrated adenomas (TSAs) are precursors to colorectal cancer. Early detection via colonoscopy and appropriate surveillance are key to preventing progression.

Area of Science:

  • Gastroenterology and Oncology
  • Colorectal Cancer Prevention
  • Endoscopic Polypectomy

Background:

  • Serrated adenomas, including sessile serrated adenomas (SSAs) and traditional serrated adenomas (TSAs), represent a distinct pathway in colorectal neoplasia.
  • SSAs are typically found in the proximal colon and lack cytologic dysplasia, while TSAs are more common in the rectosigmoid and exhibit cytologic dysplasia.
  • These lesions have the potential to progress to colorectal adenocarcinoma through various molecular alterations.

Purpose of the Study:

  • To highlight the importance of colonoscopy for the early detection and management of serrated adenomas.
  • To outline the recommended surveillance intervals following the removal of SSAs and TSAs.

Main Methods:

  • Colonoscopy enables comprehensive visualization of the entire colon.

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  • Allows for immediate biopsy sampling or polypectomy during the same session.
  • Histopathological examination differentiates between SSA and TSA, noting the presence or absence of dysplasia.

    • Main Results:

    • Colonoscopy is the sole modality for early detection of serrated adenomas.
    • Excision or surgical resection is indicated for SSAs without dysplasia (proximal colon) and SSAs or TSAs (rectosigmoid).
    • Postpolypectomy surveillance guidelines recommend 5-year intervals for SSAs without dysplasia and 3-year intervals for TSAs.

    Conclusions:

    • Timely endoscopic intervention and appropriate follow-up surveillance are crucial for preventing the progression of serrated adenomas to colorectal cancer.
    • Adherence to recommended surveillance intervals based on polyp type and location can significantly reduce recurrence and malignancy risk.