The US Multi-Society Task Force on Colorectal Cancer has published a review and consensus statement on serrated polyposis syndrome in Gastroenterology (30 September).
It describes the syndrome as the commonest polyposis syndrome and one that is often missed. Diagnosis uses the WHO clinical criteria, which count the size, cumulative lifetime number and location of serrated polyps — so the diagnosis may only become apparent across several colonoscopies. Patients carry increased colorectal cancer risk. The statement advises careful inspection, clearing the colon and frequent surveillance, with surgery for cancer or polyp burden that expert endoscopists cannot manage. No common germline variant explains it, so genetic testing is advised only when criteria for a known hereditary syndrome are met. First-degree relatives are at higher risk and should have screening colonoscopy.
The practical change is in record-keeping: counting serrated polyps across procedures, not one at a time.
- Count serrated polyps cumulatively across colonoscopies, not per procedure
- Apply the WHO criteria: size, total number and location
- Clear the colon and surveil frequently once the diagnosis is made
- Offer screening colonoscopy to first-degree relatives
- Reserve germline testing for those meeting criteria for a known hereditary syndrome
Why it matters
A syndrome defined by cumulative counts is missed when each colonoscopy is read in isolation.
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