British Society of Gastroenterology position statement on serrated polyps in the colon and rectum

Serrated polyps have been recognised in the last decade as important premalignant lesions accounting for between 15% and 30% of colorectal cancers. There is therefore a clinical need for guidance on how to manage these lesions; however, the evidence base is limited. A working group was commission by the British Society of Gastroenterology (BSG) Endoscopy section to review the available evidence and develop a position statement to provide clinical guidance until the evidence becomes available to support a formal guideline. The scope of the position statement was wide-ranging and included: evidence that serrated lesions have premalignant potential; detection and resection of serrated lesions; surveillance strategies after detection of serrated lesions; special situations—serrated polyposis syndrome (including surgery) and serrated lesions in colitis; education, audit and benchmarks and research questions. Statements on these issues were proposed where the evidence was deemed sufficient, and re-evaluated modified via a Delphi process until>80% agreement was reached. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool was used to assess the strength of evidence and strength of recommendation for finalised statements. Key recommendation: we suggest that until further evidence on the efficacy or otherwise of surveillance are published, patients with sessile serrated lesions (SSLs) that appear associated with a higher risk of future neoplasi...
Source: Gut - Category: Gastroenterology Authors: Tags: Open access Guidelines Source Type: research

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Conclusion Indigo carmine chromoendoscopy improves early detection of residual disease post polypectomy, reducing incomplete resection rates. [...] © Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text
Source: Endoscopy International Open - Category: Gastroenterology Authors: Tags: Original article Source Type: research
AbstractPurposeTo determine if there is an association between diverticular disease and colon cancer diagnoses with a secondary outcome of assessing other known risk factors for colon cancer. Colon cancer and diverticular disease have many shared symptoms and risk factors; the association between the two has been debated for many years.Methods36 cases of colon cancer and 144 age- and sex-matched controls were identified from records at an outpatient endoscopy center in Georgia. These cases and controls then were subject to a retrospective chart review to obtain any known risk factor data points for both diverticular diseas...
Source: Journal of Gastrointestinal Cancer - Category: Cancer & Oncology Source Type: research
ConclusionThe fusion fascia of Fredet is useful to achieve CME and D3-L in right colon cancers with reduced risk of intraoperative complications. This structure is particularly suitable for minimally invasive surgery; therefore, we encourage awareness of the fascia of Fredet by colorectal surgeons.
Source: Surgical Endoscopy - Category: Surgery Source Type: research
Authors: Gupta V, East JE Abstract Serrated polyps are considered precursor lesions that account for 15% to 30% of colorectal cancers, and they are overrepresented as a cause of interval cancers. They are difficult to detect and resect comprehensively; however, recent data suggest that high definition endoscopy, chromoendoscopy (via spray catheter, pump or orally), narrow band imaging, split-dose bowel preparation and a slower withdrawal (>6 minutes) can all improve detection. Cold snare resection is effective and safe for these lesions, including cold snare piecemeal endoscopic mucosal resection, which is likel...
Source: Gut and Liver - Category: Gastroenterology Tags: Gut Liver Source Type: research
Conclusions: Solitary PJPs did not recur in this study. Although examination of the entire gastrointestinal tract using esophagogastroduodenoscopy, enteroscopy, and colonoscopy is desirable to exclude Peutz-Jeghers syndrome, follow-up endoscopy after endoscopic polyp resection may be unnecessary, once the diagnosis of a solitary PJP is made. PMID: 31582972 [PubMed]
Source: Gastroenterology Research and Practice - Category: Gastroenterology Tags: Gastroenterol Res Pract Source Type: research
CONCLUSIONS: This study demonstrates that cancer-negative forceps biopsies of large colorectal polyps, referred for endoscopic resection, are not reliable. Considering that endoscopic resection of lesions containing superficial cancer is plausible, the clinical value of forceps biopsies in lesions suitable for endoscopic resection is questionable. See Video Abstract at http://links.lww.com/DCR/A984. LAS BIOPSIAS CON FÓRCEPS NO SON CONFIABLES EN EL ESTUDIO DE LAS LESIONES COLORRECTALES GRANDES REFERIDAS PARA RESECCIÓN ENDOSCÓPICA: ¿DEBERÍAN ABANDONARSE? ANTECEDENTES: Las biopsias se ...
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Original Contributions: Colorectal Cancer Source Type: research
ConclusionsOur results suggest that there is not a strong association between SSA/Ps and subsequent advanced colorectal neoplasia during the 5  years following SSA/P removal.
Source: Cancer Causes and Control - Category: Cancer & Oncology Source Type: research
Once it became clear that most colorectal cancers developed from premalignant colon polyps, screening colonoscopy with removal of these polyps became the focus of colon cancer prevention with demonstrable effectiveness. The brilliant simplicity of the flexible cautery snare quickly became the standard method for polypectomy, and the use of partial colon resections to remove precancerous colon polyps plummeted. As colonoscopy evolved with an emphasis on higher detection of adenomas and identification of subtle flat colon lesions such as sessile serrated adenomas, the need for improved polypectomy techniques has become obvious.
Source: Gastrointestinal Endoscopy Clinics of North America - Category: Gastroenterology Authors: Tags: Foreword Source Type: research
A key to successful colorectal cancer (CRC) prevention is complete colon polyp removal. The quality of colonoscopy is currently defined by how well we identify neoplastic lesions, as measured by adenoma detection rates (ADRs). A higher ADR correlates with lower rates of interval colon cancers.1 However, the completeness and skills of resection are important factors as well, but they are not current quality metrics and would be an onerous task to measure in daily practice.
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Tags: Original article Source Type: research
ConclusionColon polyps are incompletely resected in a small but potentially significant percentage of cases. IRR are similar with the use of cold jumbo forceps and cold snare. Use of cold jumbo forceps may result in more successful tissue retrieval as compared to cold snare.
Source: Surgical Endoscopy - Category: Surgery Source Type: research
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