The Importance of Increased Serrated Polyp Detection Rate

Based on the World Health Organization (WHO) criteria, serrated lesions were classified as sessile serrated adenoma/polyp (SSA/P), traditional serrated adenoma (TSA), and hyperplastic polyp (HP). Large serrated lesions are found to be associated with advanced colonic adenoma in the colon. Serrated lesions of the colorectum are believed to account for 15-20 % of all colorectal cancers via the "serrated neoplastic pathway" with SSA/P being the main precursor lesion. Serrated lesions are also thought to account for around 30 % of cancers that develop after a negative colonoscopy or the interval cancers. While serrated lesions are often flat or sessile and inconspicuous on conventional white light colonoscopy, missed lesions are not uncommon. Increased detection of serrated lesions may potentially reduce the incidence and mortality of colorectal cancers, especially the risk of interval cancers. Further research shall be directed to improve detection of serrated lesions by colonoscopy.