Serrated polyposis is common, often missed, and puts relatives at risk: a US multi-society consensus

The edition in brief

The US Multi-Society Task Force on Colorectal Cancer describes serrated polyposis syndrome as the most common polyposis syndrome and often unrecognised. Diagnosis rests on WHO criteria for the size, number and location of serrated polyps. Management is careful inspection, clearing the colon and frequent surveillance, with surgery for cancer or unmanageable polyp burden; routine germline testing is not indicated, and first-degree relatives should have colonoscopic screening. In a Dutch national cohort of 8,914 people treated for Barrett-related dysplasia or cancer, 90% had no prior endoscopy, including 65% of those treated endoscopically, and most advanced disease was in that group. A meta-analysis of 12 studies (2,323 patients) found early liver transplantation for alcohol-related liver disease gave similar mortality to standard timing (RR 0.94), with a non-significant trend to more relapse and a longer stay. Among 345 children with a first variceal bleed across 44 centres, 6-week mortality was 4.1%, worse with cirrhosis, decompensation and sclerotherapy. The FDA lists a Class II recall of one premixed intravenous pantoprazole product. The pearl: give prophylactic antibiotics to every patient with cirrhosis and upper GI bleeding.