From the Guidelines
Patients with sessile serrated adenomas (SSAs) in the colon should be offered a one-off colonoscopic surveillance examination at 3 years if the SSA is ≥10 mm or harbors dysplasia, including traditional serrated adenomas, as recommended by the British Society of Gastroenterology position statement 1. This approach is based on the understanding that SSAs have premalignant potential and are associated with an increased risk of colorectal cancer, particularly when they are large or contain dysplasia. The management of SSAs involves complete removal endoscopically with clear margins confirmed by pathology. Key considerations in the management of SSAs include:
- Size of the lesion: Lesions ≥10 mm are considered at higher risk for future neoplasia or colorectal cancer.
- Presence of dysplasia: SSAs with dysplasia, including traditional serrated adenomas, are at higher risk.
- Completeness of removal: Ensuring clear margins is crucial for reducing the risk of recurrence.
- Surveillance strategy: A one-off colonoscopic surveillance examination at 3 years is recommended for high-risk SSAs, as supported by the British Society of Gastroenterology position statement 1 and further emphasized by the guidelines from the British Society of Gastroenterology, Association of Coloproctology of Great Britain and Ireland, and Public Health England 1. It is essential to recognize that the evidence base for managing SSAs is limited, and recommendations are largely based on consensus and the available evidence, which suggests that the risk of future colorectal cancer is increased in individuals with advanced serrated polyps to a level similar to that post-adenoma detection 1.
From the Research
Characteristics of Sessile Serrated Adenomas (SSAs) in the Colon
- SSAs have distinct endoscopic, pathological, and molecular profiles compared to other polyps 2
- They are considered precursors to colorectal cancer through the serrated neoplastic pathway, accounting for up to one-third of all sporadic colorectal cancers 2
- Key characteristics of SSAs include:
Diagnosis and Treatment of SSAs
- Accurate diagnosis of SSAs is crucial, but often challenging 3, 5
- Endoscopic criteria, such as size, location, and presence of a mucus cap, can aid in diagnosis 3, 4
- Endoscopic submucosal dissection (ESD) is a safe and effective treatment option for SSAs, with high en bloc resection and R0 resection rates 6
- ESD may be preferred over endoscopic mucosal resection (EMR) for larger lesions or those with high-grade dysplasia 6
Clinical Significance of SSAs
- SSAs are underdiagnosed in clinical practice, which may lead to inadequate surveillance and increased risk of interval colorectal carcinomas 5
- The diagnosis of SSAs requires a high level of suspicion and careful evaluation of endoscopic and pathological features 2, 5
- Optimal quality of colonoscopy procedures, thorough evaluation of lesions, and adequate endoscopic resection and follow-up are essential for managing SSAs 2