British Society of Gastroenterology position statement on serrated polyps in the colon and rectum
James E. East,Wendy Atkin,Adrian C Bateman,Susan K. Clark,Sunil Dolwani,Shara N Ket,Simon J. Leedham,Perminder Phull,Matthew D. Rutter,Matthew D. Rutter,Neil A. Shepherd,Ian Tomlinson,Colin J Rees +12 more
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TLDR
It is suggested that until further evidence on the efficacy or otherwise of surveillance are published, patients with sessile serrated lesions that appear associated with a higher risk of future neoplasia or colorectal cancer should be offered a one-off colonoscopic surveillance examination at 3 years.Abstract:
Serrated polyps have been recognised in the last decade
as important premalignant lesions accounting for
between 15% and 30% of colorectal cancers. There is
therefore a clinical need for guidance on how to manage
these lesions; however, the evidence base is limited. A
working group was commission by the British Society of
Gastroenterology (BSG) Endoscopy section to review the
available evidence and develop a position statement to
provide clinical guidance until the evidence becomes
available to support a formal guideline. The scope of the
position statement was wide-ranging and included:
evidence that serrated lesions have premalignant
potential; detection and resection of serrated lesions;
surveillance strategies after detection of serrated lesions;
special situations—serrated polyposis syndrome
(including surgery) and serrated lesions in colitis;
education, audit and benchmarks and research
questions. Statements on these issues were proposed
where the evidence was deemed sufficient, and reevaluated
modified via a Delphi process until >80%
agreement was reached. The Grading of
Recommendations, Assessment, Development and
Evaluations (GRADE) tool was used to assess the
strength of evidence and strength of recommendation
for finalised statements. Key recommendation: we
suggest that until further evidence on the efficacy or
otherwise of surveillance are published, patients with
sessile serrated lesions (SSLs) that appear associated
with a higher risk of future neoplasia or colorectal
cancer (SSLs ≥10 mm or serrated lesions harbouring
dysplasia including traditional serrated adenomas)
should be offered a one-off colonoscopic surveillance
examination at 3 years (weak recommendation, low
quality evidence, 90% agreement).read more
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TL;DR: These consensus guidelines are the first guidelines that take into account the introduction of national bowel cancer screening and incorporate surveillance of patients following resection of either adenomatous or serrated polyps and also post-colorectal cancer resection.
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TL;DR: New issues have emerged since the 2006 guideline, including risk of interval CRC, proximal CRC, and the role of serrated polyps in colon carcinogenesis, which suggests that adherence to prior guidelines is poor.
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