The Serrated Polyp Pathway: Is It Time to Alter Surveillance Guidelines?

Area of Science:

• Gastroenterology
• Colorectal Cancer Screening
• Pathology

Background:

• Serrated polyps (SPs) are a precursor to colorectal cancer (CRC).
• Current surveillance guidelines for SPs require review based on emerging data.
• Accurate identification and classification of SPs are crucial for risk stratification.

Purpose of the Study:

• To review current surveillance guidelines for serrated polyps (SPs).
• To discuss how recent studies inform surveillance interval selection for patients with SPs.
• To highlight the association between SPs and increased risk of neoplasia.

Main Methods:

• Literature review of current surveillance guidelines for SPs.
• Analysis of recent studies on SPs and associated neoplasia risk.
• Discussion of pathological reclassification of SPs.

Main Results:

• Large and/or proximal SPs, particularly sessile serrated polyps (SSPs), are linked to higher risks of synchronous and metachronous neoplasia, including CRC.
• Patients with multiple or dysplastic SSPs face the highest risk.
• Many SPs are reclassified as SSPs by expert pathologists, underscoring the need for vigilance regardless of initial subtype.

Conclusions:

• Enhanced surveillance is recommended for patients with a history of large/proximal SPs and SSPs.
• Improved identification, resection, and diagnosis of SSPs are needed.
• Closer surveillance aims to mitigate the risk of interval colorectal cancer.