Claire Fan1, Adam Younis1, Christine E Bookhout2, Seth D Crockett3. 1. Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA. 2. Department of Pathology, University of North Carolina School of Medicine, Chapel Hill, NC, USA. 3. Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, CB#7080, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA. sethc@med.unc.edu.
Abstract
PURPOSE OF REVIEW: The purpose of this review is to summarize the management of serrated colorectal polyps (SPs), with a particular focus on the most common premalignant SP, sessile serrated adenoma or polyp (SSA/P). These lesions present a challenge for endoscopists with respect to detection and resection, and are also susceptible to pathologic misdiagnosis. RECENT FINDINGS: Patients with SSA/Ps are at an increased risk of future colorectal neoplasia, including advanced polyps and cancer. Reasonable benchmarks for SP detection rates are 5-7% for SSA/Ps and 10-12% for proximal SPs. Certain endoscopic techniques such as chromoendoscopy, narrow band imaging, water immersion, and wide-angle viewing may improve SSA/P detection. Emerging endoscopic techniques such as underwater polypectomy, suction pseudopolyp technique, and piecemeal cold snare polypectomy are helpful tools for the endoscopist's armamentarium for removing SSA/Ps. Proper orientation of SSA/P specimens can improve the accuracy of pathology readings. Patients with confirmed SSA/Ps and proximal HPs should undergo surveillance at intervals similar to what is recommended for patients with conventional adenomas. Patients with SSA/Ps may also be able to lower their risk of future polyps by targeting modifiable risk factors including tobacco and alcohol use and high-fat diets. NSAIDs and aspirin appear to be protective agents. SPs and SSA/Ps in particular are important colorectal cancer precursors that merit special attention to ensure adequate detection, resection, and surveillance.
PURPOSE OF REVIEW: The purpose of this review is to summarize the management of serrated colorectal polyps (SPs), with a particular focus on the most common premalignant SP, sessile serrated adenoma or polyp (SSA/P). These lesions present a challenge for endoscopists with respect to detection and resection, and are also susceptible to pathologic misdiagnosis. RECENT FINDINGS:Patients with SSA/Ps are at an increased risk of future colorectal neoplasia, including advanced polyps and cancer. Reasonable benchmarks for SP detection rates are 5-7% for SSA/Ps and 10-12% for proximalSPs. Certain endoscopic techniques such as chromoendoscopy, narrow band imaging, water immersion, and wide-angle viewing may improve SSA/P detection. Emerging endoscopic techniques such as underwater polypectomy, suction pseudopolyp technique, and piecemeal cold snare polypectomy are helpful tools for the endoscopist's armamentarium for removing SSA/Ps. Proper orientation of SSA/P specimens can improve the accuracy of pathology readings. Patients with confirmed SSA/Ps and proximal HPs should undergo surveillance at intervals similar to what is recommended for patients with conventionaladenomas. Patients with SSA/Ps may also be able to lower their risk of future polyps by targeting modifiable risk factors including tobacco and alcohol use and high-fat diets. NSAIDs and aspirin appear to be protective agents. SPs and SSA/Ps in particular are important colorectal cancer precursors that merit special attention to ensure adequate detection, resection, and surveillance.
Entities:
Keywords:
Colonoscopy; Colorectal cancer prevention; Polypectomy; Quality metrics; Serrated polyps
Authors: Joep E G IJspeert; Barbara A J Bastiaansen; Monique E van Leerdam; Gerrit A Meijer; Susanne van Eeden; Silvia Sanduleanu; Erik J Schoon; Tanya M Bisseling; Manon Cw Spaander; Niels van Lelyveld; Marloes Bargeman; Junfeng Wang; Evelien Dekker Journal: Gut Date: 2015-03-09 Impact factor: 23.059
Authors: Joseph C Anderson; Lynn F Butterly; Christina M Robinson; Julia E Weiss; Christopher Amos; Amitabh Srivastava Journal: Gastroenterology Date: 2017-09-18 Impact factor: 22.682
Authors: Douglas K Rex; Dennis J Ahnen; John A Baron; Kenneth P Batts; Carol A Burke; Randall W Burt; John R Goldblum; José G Guillem; Charles J Kahi; Matthew F Kalady; Michael J O'Brien; Robert D Odze; Shuji Ogino; Susan Parry; Dale C Snover; Emina Emilia Torlakovic; Paul E Wise; Joanne Young; James Church Journal: Am J Gastroenterol Date: 2012-06-19 Impact factor: 10.864
Authors: Rune Erichsen; John A Baron; Stephen J Hamilton-Dutoit; Dale C Snover; Emina Emilia Torlakovic; Lars Pedersen; Trine Frøslev; Mogens Vyberg; Stanley R Hamilton; Henrik Toft Sørensen Journal: Gastroenterology Date: 2015-12-08 Impact factor: 22.682
Authors: Dan Yoon; Hyoun-Joong Kong; Byeong Soo Kim; Woo Sang Cho; Jung Chan Lee; Minwoo Cho; Min Hyuk Lim; Sun Young Yang; Seon Hee Lim; Jooyoung Lee; Ji Hyun Song; Goh Eun Chung; Ji Min Choi; Hae Yeon Kang; Jung Ho Bae; Sungwan Kim Journal: Sci Rep Date: 2022-01-07 Impact factor: 4.379