No Repeat EGD Surveillance is Needed for Sessile Serrated Adenomas Found on EGD
Sessile serrated adenomas (SSAs) found on esophagogastroduodenoscopy (EGD) do not require routine upper endoscopic surveillance, even in patients with serrated polyposis syndrome (SPS). The available guidelines specifically address this scenario and recommend against upper GI surveillance.
Key Guideline Recommendation
The British Society of Gastroenterology position statement explicitly states that upper GI surveillance for polyposis is not necessary in patients with SPS where other genetic causes have been excluded 1. This represents the highest-quality guideline evidence available on this specific question.
Clinical Context and Reasoning
Why No Upper GI Surveillance?
- Serrated lesions are predominantly a colorectal phenomenon: The malignant potential and surveillance data for sessile serrated lesions are derived entirely from colorectal studies 1
- Upper GI serrated lesions are exceedingly rare: While case reports exist of duodenal traditional serrated adenomas 2, 3, these represent exceptional findings rather than a pattern requiring systematic surveillance
- No evidence of increased upper GI cancer risk: Even in high-risk populations with SPS, there is no demonstrated elevation in upper GI malignancy risk that would justify surveillance 1
What You Should Do Instead
Focus surveillance efforts on the colon, where the evidence supports benefit:
- If the patient has SSAs ≥10 mm or any serrated lesion with dysplasia in the colon, offer colonoscopic surveillance at 3 years 1
- If the patient meets WHO criteria for SPS (based on colonic polyps), provide 1-2 yearly colonoscopic surveillance 1
- Refer patients with SPS to clinical genetics services 1
Important Caveats
Complete resection of the upper GI lesion is essential: If you found an SSA on EGD, ensure complete endoscopic resection was achieved. For lesions ≥20 mm resected piecemeal, a site check at 2-6 months is reasonable to confirm complete removal 1, but this is a resection verification check, not ongoing surveillance.
Consider genetic syndromes if the clinical picture is unusual: The rare duodenal serrated adenomas reported in the literature 2, 3 occurred in patients without clear syndromic features. If you encounter multiple upper GI serrated lesions or other concerning features, genetic evaluation may be warranted, but this is distinct from routine surveillance.
The Bottom Line
The finding of an SSA on EGD is an incidental discovery that does not change your surveillance approach. After ensuring complete resection, redirect your attention to colonoscopic surveillance based on the patient's colonic polyp burden, which is where the cancer risk and surveillance benefit have been demonstrated.