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British Society of Gastroenterology position statement on serrated polyps in the colon and rectum
  1. James E East1,
  2. Wendy S Atkin2,
  3. Adrian C Bateman3,
  4. Susan K Clark4,
  5. Sunil Dolwani5,
  6. Shara N Ket1,
  7. Simon J Leedham6,
  8. Perminder S Phull7,
  9. Matt D Rutter8,9,
  10. Neil A Shepherd10,
  11. Ian Tomlinson11,
  12. Colin J Rees9,12
  1. 1 Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
  2. 2 Department of Surgery and Cancer, Imperial College London, London, UK
  3. 3 Department of Cellular Pathology, Southampton General Hospital, Southampton, UK
  4. 4 The Polyposis Registry, St. Mark's Hospital, London, UK
  5. 5 Cancer Screening, Prevention and Early Diagnosis Group, Division of Population Medicine, Cardiff University, Cardiff, UK
  6. 6 Gastrointestinal Stem-cell Biology Laboratory, Oxford Centre for Cancer Gene Research, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
  7. 7 Department of Digestive Disorders, Aberdeen Royal Infirmary, Aberdeen, UK
  8. 8 Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Cleveland, UK
  9. 9 School of Medicine, Durham University, Durham, UK
  10. 10 Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Cheltenham, UK
  11. 11 Oxford Centre for Cancer Gene Research, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
  12. 12 Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK
  1. Correspondence to Dr James E East, Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK; james.east{at}


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 neoplasia or colorectal cancer (SSLs ≥10 mm or serrated lesions harbouring dysplasia including traditional serrated adenomas) should be offered a one-off colonoscopic surveillance examination at 3 years (weak recommendation, low quality evidence, 90% agreement).


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  • Competing interests JEE: Lumendi, Olympus, Cosmo Pharmaceuticals; WSA: Eiken (MAST is the UK distributor); SJL: Cancer Research UK (Grant); CJR: ARC Medical, Olympus.

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

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