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Serrated polyposis: rapid and relentless development of colorectal neoplasia
  1. Daniel L Edelstein1,
  2. Jennifer E Axilbund2,
  3. Linda M Hylind1,
  4. Katharine Romans2,
  5. Constance A Griffin3,
  6. Marcia Cruz-Correa1,4,
  7. Francis M Giardiello1,2,3
  1. 1Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  3. 3Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  4. 4Department of Medicine, University of Puerto Rico, San Juan, Puerto Rico
  1. Correspondence to Dr Francis M Giardiello, Department of Medicine, The Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21205, USA; fgiardi{at}


Objective Serrated (hyperplastic) polyposis (SP) is a rare disorder with multiple colorectal hyperplastic polyps and often sessile serrated adenomas/polyps (SSA/P) or adenomas. Although associated with colorectal cancer, the course of SP is not well described.

Design 44 patients with SP were studied. The results of 146 colonoscopies with median follow-up of 2.0 years (range 0–30) and a median of 1.0 years (range 0.5–6) between surveillance colonoscopies were evaluated. Findings from oesophogastroduodenoscopy examinations were analysed.

Results The mean age at diagnosis of SP was 52.5±11.9 years (range 22–78). In two pedigrees (5%) another family member had SP. None of 22 patients had gastroduodenal polyps. All patients had additional colorectal polyps at surveillance colonoscopy. SSA/P or adenomas were found in 25 patients (61%) at first colonoscopy and 83% at last colonoscopy. Recurrent SSA/P or adenomas occurred in 68% of patients at surveillance colonoscopy. Three patients had colorectal cancer. Eleven patients (25%) underwent surgery (mean time from diagnosis of SP 2.0±0.9 years). After surgery all seven surveyed patients developed recurrent polyps in the retained colorectum (4/7 had SSA/P or adenomas). No association was found between colorectal neoplasia and sex, age at diagnosis of SP or initial number of colorectal polyps.

Conclusions In SP, rapid and unrelenting colorectal neoplasia development continues in the intact colorectum and retained segment after surgery. These findings support the possibility of annual colonoscopic surveillance, consideration for colectomy when SSA/P or adenomas are encountered and frequent postoperative endoscopic surveillance of the retained colorectum.

  • Hyperplastic polyps
  • sessile serrated adenomas/polyps
  • premalignant
  • adenomas
  • colorectal cancer
  • colorectal cancer genes
  • colorectal cancer screening
  • colorectal neoplasia
  • colorectal neoplasm

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  • Funding Supported in part by the John G Rangos Sr Charitable Foundation, The Clayton Fund, NIH grants P50 CA 62924-17.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by The Johns Hopkins Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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