Serrated lesions of the colorectum: Review and recommendations from an expert panel

Douglas Rex, Dennis J. Ahnen, John A. Baron, Kenneth P. Batts, Carol A. Burke, Randall W. Burt, John R. Goldblum, José G. Guillem, Charles Kahi, Matthew F. Kalady, Michael J. O'Brien, Robert D. Odze, Shuji Ogino, Susan Parry, Dale C. Snover, Emina Emilia Torlakovic, Paul E. Wise, Joanne Young, James Church

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Abstract

Serrated lesions of the colorectum are the precursors of perhaps one-third of colorectal cancers (CRCs). Cancers arising in serrated lesions are usually in the proximal colon, and account for a disproportionate fraction of cancer identified after colonoscopy. We sought to provide guidance for the clinical management of serrated colorectal lesions based on current evidence and expert opinion regarding definitions, classification, and significance of serrated lesions. A consensus conference was held over 2 days reviewing the topic of serrated lesions from the perspectives of histology, molecular biology, epidemiology, clinical aspects, and serrated polyposis. Serrated lesions should be classified pathologically according to the World Health Organization criteria as hyperplastic polyp, sessile serrated adenoma/polyp (SSA/P) with or without cytological dysplasia, or traditional serrated adenoma (TSA). SSA/P and TSA are premalignant lesions, but SSA/P is the principal serrated precursor of CRCs. Serrated lesions have a distinct endoscopic appearance, and several lines of evidence suggest that on average they are more difficult to detect than conventional adenomatous polyps. Effective colonoscopy requires an endoscopist trained in the endoscopic appearance of serrated lesions. We recommend that all serrated lesions proximal to the sigmoid colon and all serrated lesions in the rectosigmoid 5 mm in size, be completely removed. Recommendations are made for post-polypectomy surveillance of serrated lesions and for surveillance of serrated polyposis patients and their relatives.

Original languageEnglish
Pages (from-to)1315-1329
Number of pages15
JournalAmerican Journal of Gastroenterology
Volume107
Issue number9
DOIs
StatePublished - Sep 2012

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Adenoma
Polyps
Colonoscopy
Colorectal Neoplasms
Adenomatous Polyps
Molecular Epidemiology
Expert Testimony
Sigmoid Colon
Molecular Biology
Neoplasms
Consensus
Histology
Colon

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Rex, D., Ahnen, D. J., Baron, J. A., Batts, K. P., Burke, C. A., Burt, R. W., ... Church, J. (2012). Serrated lesions of the colorectum: Review and recommendations from an expert panel. American Journal of Gastroenterology, 107(9), 1315-1329. https://doi.org/10.1038/ajg.2012.161

Serrated lesions of the colorectum : Review and recommendations from an expert panel. / Rex, Douglas; Ahnen, Dennis J.; Baron, John A.; Batts, Kenneth P.; Burke, Carol A.; Burt, Randall W.; Goldblum, John R.; Guillem, José G.; Kahi, Charles; Kalady, Matthew F.; O'Brien, Michael J.; Odze, Robert D.; Ogino, Shuji; Parry, Susan; Snover, Dale C.; Torlakovic, Emina Emilia; Wise, Paul E.; Young, Joanne; Church, James.

In: American Journal of Gastroenterology, Vol. 107, No. 9, 09.2012, p. 1315-1329.

Research output: Contribution to journalArticle

Rex, D, Ahnen, DJ, Baron, JA, Batts, KP, Burke, CA, Burt, RW, Goldblum, JR, Guillem, JG, Kahi, C, Kalady, MF, O'Brien, MJ, Odze, RD, Ogino, S, Parry, S, Snover, DC, Torlakovic, EE, Wise, PE, Young, J & Church, J 2012, 'Serrated lesions of the colorectum: Review and recommendations from an expert panel', American Journal of Gastroenterology, vol. 107, no. 9, pp. 1315-1329. https://doi.org/10.1038/ajg.2012.161
Rex, Douglas ; Ahnen, Dennis J. ; Baron, John A. ; Batts, Kenneth P. ; Burke, Carol A. ; Burt, Randall W. ; Goldblum, John R. ; Guillem, José G. ; Kahi, Charles ; Kalady, Matthew F. ; O'Brien, Michael J. ; Odze, Robert D. ; Ogino, Shuji ; Parry, Susan ; Snover, Dale C. ; Torlakovic, Emina Emilia ; Wise, Paul E. ; Young, Joanne ; Church, James. / Serrated lesions of the colorectum : Review and recommendations from an expert panel. In: American Journal of Gastroenterology. 2012 ; Vol. 107, No. 9. pp. 1315-1329.
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