What are the outcomes of sessile serrated lesions?

From the Guidelines

Studying sessile serrated lesions (SSLs) outcomes is crucial to understand their natural history, optimal management, and risk factors, and research questions should focus on areas such as long-term malignant transformation rates, effectiveness of endoscopic removal techniques, optimal surveillance intervals, molecular markers for risk stratification, and patient factors influencing recurrence rates or malignant transformation. When investigating SSLs, it's essential to consider the spectrum of colorectal cancer (CRC) and the different pathways involved, including the serrated pathway, as discussed in the British Society of Gastroenterology position statement on serrated polyps in the colon and rectum 1. Some potential research questions for studying SSLs outcomes include:

• Investigating the long-term malignant transformation rates of untreated SSLs compared to conventional adenomas, examining what percentage progress to colorectal cancer over 5-10 years
• Evaluating the effectiveness of different endoscopic removal techniques (cold snare polypectomy versus endoscopic mucosal resection) on complete resection rates and recurrence of SSLs
• Studying the optimal surveillance intervals following SSL removal, comparing outcomes between patients receiving follow-up colonoscopy at 1,3, or 5 years, as recommended by the British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines 1
• Investigating molecular markers that predict which SSLs are most likely to progress to dysplasia or cancer, which would be valuable for risk stratification, considering the genetic mutation of BRAF or KRAS genes and the methylation of tumour suppressing genes (CpG island methylator phenotype (CIMP)) 1
• Examining whether specific patient factors (age, gender, smoking status, medication use) influence SSL recurrence rates or malignant transformation, which could help identify high-risk populations, and considering the evidence on the risks associated with different levels of bowel preparation quality and completeness of colonoscopy 1. These research questions address critical knowledge gaps regarding the natural history, optimal management, and risk factors associated with SSLs, which remain less understood than conventional adenomas despite their significant contribution to colorectal cancer development through the serrated pathway.

From the Research

Research Questions for Studying Sessile Serrated Lesions Outcomes

The following research questions can be explored to study the outcomes of sessile serrated lesions:

• What are the clinical and endoscopic characteristics of sessile serrated lesions with dysplasia/carcinoma compared to those without dysplasia 2?
• What is the molecular pathogenesis of serrated colorectal lesions, and how do they develop into colorectal carcinoma 3?
• Can sessile serrated lesions with dysplasia be detected and diagnosed early, and what are the implications for preventing colorectal cancer 4?
• What are the challenges in detecting and removing serrated lesions, and how can they be overcome to prevent post-colonoscopy cancer 5?
• What is the morphological and molecular characterization of colorectal sessile serrated lesions with dysplasia, and how do they differ from other types of serrated lesions 6?

Potential Areas of Investigation

Some potential areas of investigation for studying sessile serrated lesions outcomes include:

• The natural history of sessile serrated lesions and their progression to dysplasia and carcinoma
• The development of diagnostic scoring systems for sessile serrated lesions to facilitate their detection and removal
• The role of molecular alterations, such as BRAF and APC mutations, in the development and progression of sessile serrated lesions
• The impact of high-quality colonoscopy and bowel preparation on the detection and removal of serrated lesions
• The comparison of outcomes between different types of serrated lesions, such as sessile serrated lesions and traditional serrated adenomas

Key Factors to Consider

When studying sessile serrated lesions outcomes, some key factors to consider include:

• Lesion size and morphology, such as the presence of a mucus cap or nodules/protrusions
• The location of the lesion, such as the proximal or distal colon
• The presence of dysplasia or carcinoma, and the grade of dysplasia
• The molecular characteristics of the lesion, such as the presence of BRAF or APC mutations
• The quality of colonoscopy and bowel preparation, and the experience of the endoscopist