Sessile serrated adenoma: from identification to resection

Area of Science:

• Gastroenterology
• Pathology
• Oncology

Background:

• Colorectal polyps were historically classified as hyperplastic polyps or adenomas.
• Sessile serrated adenomas (SSAs) possess distinct endoscopic, pathological, and molecular features.
• SSAs are now recognized as the primary precursor lesions in serrated carcinogenesis, a pathway contributing to one-third of sporadic colorectal cancers.

Purpose of the Study:

• To review the pathological specificities of sessile serrated adenomas.
• To discuss the epidemiology, treatment modalities, and follow-up strategies for SSAs.
• To highlight the importance of SSAs in the context of the newly identified sessile serrated adenomas-adenocarcinoma sequence.

Main Methods:

• Literature review focusing on sessile serrated adenomas.
• Analysis of pathological, endoscopic, and molecular data related to SSAs.
• Synthesis of current understanding regarding the serrated neoplastic pathway and SSA progression.

Main Results:

• Sessile serrated adenomas are increasingly recognized as significant precursors in colorectal cancer development.
• The sessile serrated adenomas-adenocarcinoma sequence is analogous to the traditional adenoma-adenocarcinoma sequence.
• Advanced endoscopic resection techniques allow for non-surgical management of SSAs, irrespective of size.

Conclusions:

• Sessile serrated adenomas require heightened physician awareness and meticulous colonoscopy practices.
• Optimal endoscopic resection and adherence to follow-up guidelines are essential for managing SSAs.
• Effective management of SSAs is critical for preventing colorectal cancer progression through the serrated pathway.