Post written by Evelien Dekker, MD, PhD, from the Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands.

In this edition of Top Tips, this study highlights the clinical significance of serrated polyps, focusing on optimal recognition, removal, and appropriate follow-up strategies.

In recent years, a growing body of evidence has highlighted the role of serrated polyps in colorectal cancer development. To prevent colorectal cancer arising from serrated polyps, it is crucial to accurately identify and effectively remove them.

Sessile serrated lesions (SSLs) are the most prevalent neoplastic serrated polyps, making accurate differentiation from hyperplastic polyps essential. This can be effectively achieved using the Workgroup serrAted polypS and Polyposis (WASP) classification.

To minimize the risk of incomplete resection, SSLs should be delineated with a submucosal injection before removal. SSLs without dysplasia can be safely resected using cold snare polypectomy. However, thorough inspection with narrow-band imaging prior to resection is crucial to identify dysplastic features, as dysplastic areas require deeper resection than conventional EMR.

It also is essential to carefully examine the colon for additional SSLs and to remain alert during withdrawal. Serrated polyposis syndrome (SPS), characterized by the presence of multiple serrated polyps throughout the colon, is the most common polyposis syndrome. Given their elevated cancer risk, SPS patients require more rigorous follow-up, with surveillance intervals ranging from 1 to 2 years. Advancements in recent years have significantly improved our understanding of serrated polyp management.

However, gaps remain, particularly in establishing robust evidence for classification for optimal recognition and follow-up of SSLs with dysplasia. Furthermore, as surveillance intervals for SPS patients continue to vary between 1 and 2 years across different countries, further research is needed to define their precise risk profile and optimize follow-up strategies.

 A sessile serrated lesion with dysplasia has endoscopic features similar to adenomas. A, Within the round yellow circle, features of a NBI international Colorectal Endoscopic classification type 2 polyp are visible, suggesting an optical diagnosis of a small conventional adenoma. B, This image shows the same polyp while using narrow-band imaging, and the delineation is now more clearly visible (dashed yellow line).

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