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Serrated polyposis syndrome (SPS; formerly ‘hyperplastic polyposis syndrome’) has emerged as by far the most common colorectal polyp syndrome.1 ,2 SPS is characterised by some combination of large and/or numerous serrated class lesions and is associated with an increased risk of colorectal cancer (CRC).3 A genetic basis for SPS has not yet been discovered, and many cases do not have a family history of SPS or even CRC. Thus, any current definition of SPS must be clinical and based on colonoscopic findings and the pathology of polyps removed during colonoscopy. Most clinicians accept the WHO criteria for diagnosis of SPS as reasonable working criteria for clinical studies as well as clinical practice. The WHO proposes three criteria, and satisfaction of any of the three criteria is sufficient to diagnose SPS (box 1). It is critical that clinicians understand that ‘serrated class’ lesions can include hyperplastic polyps (HPs) or sessile serrated polyps (SSPs; also known as sessile serrated adenoma) or even the relatively rare ‘traditional serrated adenoma’ when counting lesions to determine whether the WHO criteria have been met in a patient. Criteria 1 and 3 (box 1) constitute the two phenotypes of SPS that are most relevant to the discussion of colonoscopic control and prevention of CRC in patients with SPS. The first job of every colonoscopist with regard to SPS is to know the current criteria for SPS and apply them during colonoscopy so that the diagnosis of SPS is made and appropriate management started.
WHO criteria for diagnosis of serrated polyposis syndrome (SPS)*
▸ Criterion 1: at least 5 serrated serrated class polyps proximal to the sigmoid of which at least two are >1 cm in size.
▸ Criterion 2: any serrated class polyp proximal to the sigmoid in a first degree relative with SPS.
▸ Criterion …