Serrated polyposis syndrome is the commonest polyposis syndrome and routinely goes unrecognised. A US Multi-Society Task Force review restates how to diagnose it, from the World Health Organization criteria based on the size, cumulative number and location of serrated polyps, and how to reduce the raised colorectal cancer risk that comes with it.
The mainstay is endoscopic: meticulous inspection, complete clearance of the colon and frequent surveillance colonoscopy. Surgery is reserved for patients who already have cancer, or whose polyp burden cannot be managed endoscopically by expert endoscopists. There is no common germline variant, so routine genetic testing is not indicated unless the patient meets criteria for a known hereditary syndrome.
Two practical points for surgeons: recognise the syndrome before defaulting to colectomy, since most disease is controlled endoscopically, and screen first-degree relatives, who carry a heightened colorectal cancer risk and should have colonoscopy.
- Serrated polyposis syndrome is the most common polyposis syndrome and is often unrecognised.
- Management is primarily endoscopic: thorough clearance and frequent surveillance colonoscopy.
- Reserve surgery for established cancer or a polyp burden beyond expert endoscopic control.
- Routine germline testing is not indicated without features of a known hereditary syndrome.
- Screen first-degree relatives with colonoscopy, as they are at heightened colorectal cancer risk.
Why it matters
The syndrome is common and missed, and knowing it is usually controlled endoscopically changes when a surgeon reaches for colectomy.
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