A review and consensus statement from the US Multi-Society Task Force on Colorectal Cancer describes serrated polyposis syndrome as the commonest polyposis syndrome and one that frequently goes unrecognised. Diagnosis uses World Health Organization criteria based on the size, cumulative lifetime number and location of serrated polyps throughout the colon — so the count must be tallied across colonoscopies, not judged from one.
People with the syndrome have a raised risk of colorectal cancer both at diagnosis and over time. The statement recommends meticulous inspection, endoscopic clearing of the colon and frequent surveillance colonoscopy to reduce incident cancer, with surgery for those with cancer or a polyp burden expert endoscopists cannot manage.
No common germline variant underlies the syndrome, so genetic testing is advised only when a patient meets criteria for a known hereditary syndrome. First-degree relatives have a higher risk of colorectal cancer and should have colonoscopic screening.
The statement is from US societies, and specific surveillance intervals should be taken from the full document. Its central demand — count serrated polyps across a patient's history — costs nothing to adopt.
- Tally serrated polyps across all of a patient's colonoscopies, not just the current one, against WHO criteria.
- Record polyp size, number and location clearly so the cumulative count can be made later.
- Arrange frequent surveillance colonoscopy with the aim of clearing all relevant polyps.
- Advise first-degree relatives to have colonoscopic screening.
- Reserve germline testing for patients who meet criteria for a known hereditary syndrome.
Why it matters
The diagnosis is missed because no single colonoscopy shows the whole picture.
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