Serrated polyps: New classifications highlight clinical importance

Aim Many lesions previously classified as hyperplastic polyps and therefore thought to be innocuous have been reclassified as sessile serrated adenomas/polyps (SSA/Ps), establishing their place in the serrated pathway and underscoring their malignant potential. The clinical relevance of this new nomenclature is incompletely defined. This study examines the incidence and characteristics of colorectal SSA/Ps and describes other associated colorectal neoplasia. Method A single institution pathology database was searched for the diagnosis of SSA/Ps between January 2004 and October 2007. SSA/Ps found by colonoscopy were included. Patient demographics, SSA/P characteristics and associated colonoscopic findings were retrospectively recorded. Results A total of 585 SSA/Ps were removed during 519 colonoscopies in 483 patients performed by 64 different endoscopists. This represented an overall incidence of SSA/Ps per colonoscopy of 2.1% in the 28054 colonoscopies performed during the study period. The median SSA/P size was 0.8cm (range 0.2-4.5) and 188 (69%) were ≥1.0cm. Of the 585 SSA/Ps, 366 (63%) were right-sided, 129 (22%) were in the left colon and 90 (15%) were in the rectum. Also, 439 synchronous polyps of other histology (mainly adenomas and hyperplastic polyps) were found during the same 519 colonoscopies. Conclusion SSA/Ps are rare lesions found during colonoscopy that may coexist with small hyperplastic polyps. Because SSA/Ps are part of the serrated oncogenic pathway, all, even those appearing to be hyperplastic, should be removed or biopsied for diagnosis. Careful review of historical lesions with application of new definitions may redefine risk for malignancy.