Serrated polyps: demographic, endoscopic and histological features

Serrated polyps account for up to 30% of colorectal cancer cases and are linked to interval cancers. Due to their clinical relevance and frequent underdiagnosis, this study evaluated the epidemiological profile, endoscopic and histopathological characteristics, and subtypes of serrated polyps, including those occurring synchronously with conventional adenomas.

This cross-sectional observational study reviewed medical records of patients undergoing colorectal lesion resection at a Therapeutic Endoscopy Center in southern Brazil between 2013 and 2018. Variables analyzed included age, sex, serrated polyp subtype and size, anatomical location, and presence of synchronous conventional adenomas.

A total of 222 patients were included (65.3% female), with a mean age of 60.6 years. Among 431 resected lesions, 329 were serrated polyps: 144 traditional serrated adenomas (TSAs), 126 sessile serrated lesions and 59 hyperplastic polyps. Age was significantly associated with TSA occurrence, with a 3% increase in likelihood per additional year. The mean number of polyps per patient was 1.94, and ~70% measured 10-20 mm. Most TSAs (80%) were located in the right colon. Serrated polyps coexisting with synchronous adenomas represented 24% of cases, with TSAs being the most frequent subtype; no significant differences in age or sex were observed in this subgroup.

These findings highlight the predominance of TSAs, their right-sided colon predilection, and association with increasing age. Synchronous adenomas were present in approximately one-quarter of patients, emphasizing the importance of careful detection and characterization of serrated polyps in clinical practice.