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 most common polyposis syndrome and frequently unrecognised.
Diagnosis uses the WHO clinical criteria, based on the size, cumulative number and location of serrated polyps across a lifetime of colonoscopies. People with the syndrome have a raised risk of colorectal cancer, both at diagnosis and later. The statement advises meticulous inspection, clearing the colon of polyps, and frequent surveillance colonoscopy; surgery is for cancer or a polyp burden expert endoscopists cannot manage. No common germline variant underlies the syndrome, so germline testing is advised only when criteria for another hereditary syndrome are met. First-degree relatives have a raised colorectal cancer risk and should be offered colonoscopy.
The practical change is in recognition: serrated polyps accumulate over several colonoscopies, often by different endoscopists, and the syndrome is only diagnosed if someone counts them. Each colonoscopy report should be read against previous ones.
- Count serrated polyps cumulatively across all previous colonoscopies, not just the current one.
- Apply the WHO criteria when serrated polyps are numerous, large or proximal.
- Offer frequent surveillance with careful clearing once the syndrome is diagnosed.
- Offer colonoscopic screening to first-degree relatives.
- Reserve germline testing for those meeting criteria for another hereditary syndrome.
Why it matters
The syndrome is common but only diagnosed when someone adds up polyps across several reports, and relatives are left unscreened when it is missed.
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