The US Multi-Society Task Force on Colorectal Cancer has published a review and consensus statement on serrated polyposis syndrome, which it describes as the commonest polyposis syndrome and one that often goes unrecognised.
Diagnosis rests on WHO clinical criteria based on the size, cumulative lifetime number and location of serrated polyps throughout the colon — which means it is often only recognised by adding up polyps across several colonoscopies. People with the syndrome have a higher risk of both prevalent and incident colorectal cancer. The statement recommends meticulous inspection, clearance of the colon and frequent surveillance; surgery is reserved for cancer or a polyp burden that expert endoscopists cannot manage. There is no common germline variant, so genetic testing is indicated only if criteria for another hereditary syndrome are met. First-degree relatives are at higher risk and should be offered colonoscopic screening.
The practical failure point is counting: each endoscopist sees a few serrated lesions, and the cumulative total is never tallied.
- Tally serrated polyps across all of a patient's colonoscopies, not just the current one.
- Apply the WHO criteria when the cumulative count or size of proximal serrated lesions is high.
- Do not order routine germline testing for serrated polyposis unless another hereditary syndrome is suspected.
- Advise first-degree relatives to have screening colonoscopy.
Why it matters
The diagnosis depends on adding up findings across procedures, which rarely happens.
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