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. 2015 Mar;13(1):156-70.
doi: 10.1007/s11938-015-0046-y.

Sessile serrated polyps: detection, eradication, and prevention of the evil twin

Joshua C Obuch  1 , Courtney M Pigott, Dennis J Ahnen
Affiliations

Sessile serrated polyps: detection, eradication, and prevention of the evil twin

Joshua C Obuch et al. Curr Treat Options Gastroenterol. 2015 Mar.

Abstract

The sessile serrated polyp (SSP), also known as sessile serrated adenoma, is the evil twin among the colorectal cancer precursors. As will be described, these lesions have multiple aliases (serrated adenoma, serrated polyp, or serrated lesion among others), they hang out in a bad neighborhood (the poorly prepped right colon), they hide behind a mask of mucus, they are difficult for witnesses (pathologists) to identify, they are difficult for police (endoscopists) to find, they are difficult to permanently remove from the society (high incomplete resection rate), they can be impulsive (progress rapidly to colorectal cancer (CRC)), and enforcers (gastroenterologists) do not know how best to control them (uncertain surveillance recommendations). There is no wonder that there is a need to understand these lesions well, learn how best to prevent the colonic mucosa from going down this errant path or, if that fails, detect these deviants and eradicate them from the colonic society. These lesions should be on endoscopists' most wanted list.

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Conflict of interest statement

Conflict of Interest

Joshua C. Obuch and Courtney M. Pigott declare that they have no conflict of interest. Dennis J. Ahnen has received board membership payments and paid travel accommodations from EXACT Sciences, Inc., and board membership payments from Cancer Prevention Pharmaceuticals.

Figures

Figure 1
Figure 1. Proposed Serrated Pathway to Colorectal Cancer
Normal colonic crypts have regular test-tube like crypts with a smooth lumen. Hyperplastic polyps (HP) have serrations in the upper two-thirds of the crypt. In SSPs, serrations extend deeper into the crypt and the crypt base is often dilated and may have a boot or inverted “T” shape. SSPs with cytologic dysplasia (SSP-CD) have focal areas of conventional dysplasia (arrows) that are thought to rapidly progress to sporadic MSI-H CRCs. Modified from refs [3, 12, 13], photographs from Dr. Russell Nash.
See this image and copyright information in PMC

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