Serrated lesions in colorectal cancer screening: detection, resection, pathology and surveillance

Key messages Colorectal cancer can occur via more than one molecular pathway. The serrated pathway probably accounts for 20%–30% of colorectal cancer. Histopathological nomenclature for serrated lesions varies internationally. We suggest the terms hyperplastic polyp (HP), sessile serrated polyp (SSP), and traditional serrated adenoma to describe these lesions. Colonoscopy is the best detection tool for serrated polyps, but detection rates are variable. Chromoendoscopy and slower withdrawal time are the only interventions that have been demonstrated to increase serrated lesion detection. High-definition endoscopy and right colon retroflexion may have a role. All polyps proximal to the recto-sigmoid junction should be removed. A benchmark rate of 4.5% for detection of proximal serrated lesions (HPs plus SSPs proximal to splenic flexure) in screening has been suggested for US-based colonoscopic screening, but implementing a target for serrated lesions in clinical practice is currently impractical. DNA-based detection...
Source: Gut - Category: Gastroenterology Authors: Tags: Endoscopy, GUT Recent advances in clinical practice, Colon cancer Source Type: research