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Our view of serrated polyps has come a long way in the last two decades, moving from seeing them as benign lesions that do not develop into cancer to recognising them as lesions that may account for up to one-third of all colorectal cancers (CRCs).1 The ‘serrated pathway’ to CRC is now widely accepted, and serrated lesions are now a target for identification and removal at screening colonoscopy. They represent a special challenge for colonoscopists as they are difficult to detect and are up to 3.7 times more likely than adenomas to be incompletely resected.2 It is assumed that removal of precursor serrated lesions prevents development of CRC in the future; however, direct evidence for this is much more limited than for adenomas. Work on intensive surveillance of patients with serrated polyposis syndrome suggests that effective detection and resection can reduce cancer risk in a polyposis scenario.3
The role of adenomas in colonoscopic screening is not just limited to being a removable precursor lesion that halts the ‘adenoma–carcinoma sequence’ to reduce future risk. Adenoma size and multiplicity also predicts future risk of developing further advanced adenomas or CRC. On this basis, international guidelines have recommended surveillance examinations after large or multiple adenomas have been resected.4 5 Data to support such an approach for serrated polyps have been much more limited, in part because we do not have large longitudinal datasets at times where serrated polyps were being effectively detected by colonoscopists, and correctly classified by pathologists. The study by Li et al in Gut is therefore a very welcome addition …
Contributors JEE wrote the manuscript and is the guarantor.
Funding JEE is funded by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health.
Competing interests JEE has served on clinical advisory boards for Lumendi, Boston Scientific and Paion; has served on the clinical advisory board and has share options in Satisfai Health; and reports speaker fees from Falk. He is an associate editor for the Journal of Gastroenterology and Hepatology.
Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Provenance and peer review Commissioned; externally peer reviewed.