A consensus statement from the US Multi-Society Task Force on Colorectal Cancer sets out the recognition and management of serrated polyposis syndrome. Its central claim is a recognition problem rather than a treatment one: this is the most common polyposis syndrome, and it often goes unrecognised. Diagnosis rests on World Health Organization clinical criteria based on the size, cumulative lifetime number and colonic location of serrated polyps — not on a genetic test.

That last point is the one most likely to change behaviour. The statement records no common germline pathogenic variant associated with the syndrome, and confines germline testing to people who meet criteria for a known hereditary syndrome in the appropriate clinical setting. A negative panel therefore does not exclude serrated polyposis, and ordering one instead of counting polyps is the wrong test.

For the surgeon, two things follow. Surgery is indicated where cancer is diagnosed or where the polyp burden cannot be cleared endoscopically by an expert endoscopist — so the decision to operate should follow an attempt by someone with that expertise, not precede it. And first-degree relatives carry a raised colorectal cancer risk and should be offered colonoscopic screening, which means the diagnosis generates work outside the index patient.

In Indian practice, where serrated lesions are under-recognised and withdrawal-time and detection-rate auditing is uneven, the practical step is upstream: the syndrome cannot be diagnosed from a colonoscopy that did not look carefully for flat right-sided serrated lesions in the first place.

Count and locate serrated polyps cumulatively across a patient's colonoscopies — the diagnosis is made on clinical criteria, not genetics
Do not order a germline panel to exclude serrated polyposis; reserve testing for patients meeting criteria for a known hereditary syndrome
Refer for expert endoscopic clearance before deciding on colectomy, unless cancer is already diagnosed
Tell every patient given this diagnosis that their first-degree relatives should have colonoscopic screening, and document that you did
Ensure right-sided flat lesions are actively sought at colonoscopy — the syndrome is missed at the detection step, not the diagnostic one

Why it matters

A diagnosis that is missed rather than mistreated means the intervention is how carefully the colon is inspected, not what is prescribed.

Don't overread it

A consensus statement synthesises existing evidence rather than adding new trial data, and the underlying evidence for surveillance intervals in this syndrome remains limited.