Gut Liver.  2014 Nov;8(6):582-589. 10.5009/gnl14248.

Pathogenesis and Management of Serrated Polyps: Current Status and Future Directions

• Anderson J

• KMID: 2070073
• DOI: http://doi.org/10.5009/gnl14248

Abstract

Hyperplastic or serrated polyps were once believed to have little to no clinical significance. A subset of these polyps are now considered to be precursors to colorectal cancers (CRC) in the serrated pathway that may account for at least 15% of all tumors. The serrated pathway is distinct from the two other CRC pathways and involves an epigenetic hypermethylation mechanism of CpG islands within promoter regions of tumor suppressor genes. This process results in the formation of CpG island methylator phenotype tumors. Serrated polyps are divided into hyperplastic polyps, sessile serrated adenomas/polyps (SSA/Ps), and traditional serrated adenomas (TSAs). The SSA/P and the TSA have the potential for dysplasia and subsequent malignant transformation. The SSA/Ps are more common and are more likely to be flat than TSAs. Their flat morphology may make them difficult to detect and thus explain the variation in detection rates among endoscopists. Challenges for endoscopists also include the difficulty in pathological interpretation as well surveillance of these lesions. Furthermore, serrated polyps may be inadequately resected by endoscopists. Thus, it is not surprising that the serrated pathway has been linked with interval cancers. This review will provide the physician or clinician with the knowledge to manage patients with serrated polyps.

Keyword

Serrated; Hyperplastic; Sessile serrated adenoma/polyp; Hypermethylation; Serrated polyposis syndrome

MeSH Terms

Adaptor Proteins, Signal Transducing/genetics/metabolism
Adenomatous Polyps/genetics/metabolism/*surgery
Colonoscopy
Colorectal Neoplasms/genetics/metabolism/*surgery
DNA Methylation
Humans
Intestinal Polyposis/genetics/metabolism/*surgery
Intestinal Polyps/genetics/metabolism/*surgery
Nuclear Proteins/genetics/metabolism
Proto-Oncogene Proteins/genetics/metabolism
Proto-Oncogene Proteins B-raf/genetics/metabolism
ras Proteins/genetics/metabolism
Adaptor Proteins, Signal Transducing
Nuclear Proteins
Proto-Oncogene Proteins
Proto-Oncogene Proteins B-raf