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Current Treatment Options in Gastroenterology

Published in:

01-03-2018 | Colon (JC Anderson, Section Editor)

Management of Serrated Polyps of the Colon

Authors: Claire Fan, MD, Adam Younis, MD, Christine E. Bookhout, MD, Seth D. Crockett, MD MPH

Published in: Current Treatment Options in Gastroenterology | Issue 1/2018

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.

Summary

SPs and SSA/Ps in particular are important colorectal cancer precursors that merit special attention to ensure adequate detection, resection, and surveillance.

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Title: Management of Serrated Polyps of the Colon
Authors: Claire Fan, MD
Adam Younis, MD
Christine E. Bookhout, MD
Seth D. Crockett, MD MPH
Publication date: 01-03-2018
Publisher: Springer US
Published in: Current Treatment Options in Gastroenterology / Issue 1/2018
Print ISSN: 1092-8472
Electronic ISSN: 1534-309X
DOI: https://doi.org/10.1007/s11938-018-0176-0

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