From the Guidelines
The recommended management for individuals with serrated polyposis syndrome (SPS) includes intensive colonoscopic surveillance with complete removal of all polyps, with patients undergoing colonoscopy every 1-2 years, as supported by the most recent guidelines from the British Society of Gastroenterology (BSG) 1. The goal of this management approach is to reduce the risk of colorectal cancer (CRC), which is substantially increased in SPS patients, with a lifetime risk of up to 40% 1. Key aspects of SPS management include:
- Colonoscopic surveillance every 1-2 years, with careful inspection of the entire colon and removal of all polyps, particularly those ≥5mm 1
- Consideration of colectomy with ileorectal anastomosis for patients with numerous or large polyps that cannot be managed endoscopically 1
- Colonoscopy screening for first-degree relatives of individuals with SPS, beginning at age 40 or 10 years earlier than the youngest diagnosis in the family 1
- No specific medications are recommended for SPS management, with the focus on endoscopic surveillance and polyp removal 1 This intensive surveillance approach is justified by the tendency for serrated polyps to be flat, subtle, and located in the right colon, making them easier to miss during standard colonoscopy, as well as their potential to progress to cancer through alternative molecular pathways compared to conventional adenomas 1. The most recent guidelines from the BSG, published in 2020, provide a strong recommendation for yearly colonoscopic surveillance for patients with SPS, with the option to extend the interval to 2 years if no polyps ≥10 mm are identified at subsequent surveillance examinations 1. Overall, the management of SPS requires a comprehensive and multidisciplinary approach, with a focus on reducing the risk of CRC and improving patient outcomes.
From the Research
Serrated Polyposis Syndrome Management
The recommended management for individuals with serrated polyposis syndrome (SPS) involves regular endoscopic surveillance and polyp removal to reduce the risk of colorectal cancer. Key aspects of management include:
- Endoscopic control of polyp burden: Studies have shown that achieving endoscopic control of polyp burden is feasible and effective in reducing the risk of colorectal cancer 2, 3.
- Surveillance intervals: The optimal surveillance interval is still debated, but studies suggest that expanding surveillance intervals to 24 months may be safe and effective for patients who have achieved endoscopic control of polyp burden 2, 4.
- Polyp removal: Complete removal of all polyps ≥3 mm is recommended to prevent the development of colorectal cancer 5.
- Risk stratification: Patients with SPS can be stratified into different risk groups based on their polyp burden and other factors, allowing for personalized surveillance and management plans 4.
Key Findings
- A study of 115 patients with SPS found that achieving endoscopic control of polyp burden required a mean of 2.84 colonoscopies over 20.4 months, and that expansion of surveillance intervals to 24 months was safe and effective for patients who had achieved control 2.
- A prospective cohort study of 271 patients with SPS found that a personalized surveillance protocol based on polyp burden was effective in reducing the burden of colonoscopies while maintaining a low incidence of colorectal cancer 4.
- Another study of 50 patients with SPS found that annual endoscopic surveillance with complete removal of all polyps ≥3 mm prevented the development of colorectal cancer and reduced the risk of advanced neoplasia 5.
- A study of 96 patients with SPS in New Zealand found that community-based surveillance with serial colonoscopy was effective in reducing polyp burden and preventing colorectal cancer 6.
- A prospective observational study of 28 patients with SPS found that endoscopic management with chromoendoscopy and standardized surveillance was feasible and effective in reducing polyp burden and preventing colorectal cancer 3.