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Serrated pathway: a paradigm shift in CRC prevention
  1. Evelien Dekker,
  2. Joep Evert Godfried IJspeert
  1. Department of Gastroenterology & Hepatology, Academic Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Dr Evelien Dekker, Department of Gastroenterology & Hepatology,Academic Medical Center,Amsterdam,1105 AZ ,The Netherlands; e.dekker{at}

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In the prevention of colorectal cancer (CRC), hyperplastic polyps have long been regarded as innocent bystanders and only adenomas were thought to be precursors for CRC. Therefore, focus during colonoscopy was on adenomas only. In the past decade, evidence has accumulated that serrated polyps might progress to cancer as well via the serrated neoplasia pathway. On the one hand, patients with multiple serrated polyps, nowadays classified as having serrated polyposis syndrome, demonstrated an increased risk of CRC development, and small cancers were detected within serrated lesions. On the other hand, a growing body of circumstantial evidence suggests that at least 15% of all CRCs arise through the serrated neoplasia pathway, and an even larger proportion of postcolonoscopy CRCs arise from serrated polyps.1

This growing body of evidence has gradually led to a paradigm shift in both cancer prevention as well as treatment strategies. To reduce the number of postcolonoscopy CRCs and to optimise current clinical care for patients with serrated polyps, several issues are at stake. The new British Society of Gastroenterology (BSG) position statement on serrated polyps in the colon and rectum is therefore timely as well as important.2 It discusses current knowledge on serrated polyps and provides recommendations for daily clinical practice as well as research. We hope that this publication will increase the awareness among clinicians on this topic and will be an incentive for appropriate management of these lesions. In the light of rapidly developing evidence on this topic, we would like to comment on this excellent work of the BSG.

As the terminology of serrated polyps is confusing, and does not help to bring a clear message to the general gastrointestinal practice, the BSG proposes new terminology. We support the proposal of the BSG to simplify the WHO classification slightly by renaming ‘sessile serrated adenomas/polyps’ …

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  • Contributors ED and JI equally contributed to the planning, conductment and reporting of this commentary. ED and JI are both responsible for the overall content of this study.

  • Competing interests ED receives research support and equipment on loan from fujifilm and olympus.

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

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