title: Failure to recognize serrated polyposis syndrome in a cohort with large sessile colorectal polyps.
abstract: BACKGROUND
  Serrated polyposis syndrome (SPS) is a rare condition of multiple serrated colorectal polyps and cancers. Colorectal cancer risk is increased in SPS.
  
  
  OBJECTIVE
  We determined the prevalence of SPS in a cohort of patients with large (≥ 2 cm) sessile colorectal polyps and the rate at which the diagnosis was made by the clinicians.
  
  
  METHODS
  Review of patient care database. The 2010 World Health Organization (WHO) criteria were used to identify cases of SPS.
  
  
  METHODS
  Tertiary academic center.
  
  
  METHODS
  529 consecutive patients referred for endoscopic resection of a sessile colorectal polyp ≥ 2 cm.
  
  
  METHODS
  Prevalence of SPS in the cohort and frequency with which the referring physician and the endoscopist recognized SPS.
  
  
  RESULTS
  Of the 529 patients, 20 (4%) met the WHO criteria for SPS. Only 1 of these cases was suspected by a referring physician. Twelve cases (60%) were either diagnosed or suspected by the endoscopist at our center. Compared with all other patients without SPS, those with SPS were more likely to have an index lesion (the lesion that led to referral) that was serrated (60% vs 3.8%), to have a cecal or ascending colon index lesion (70% vs 45%), and to be current smokers (42% vs 15%). Including the first colonoscopy to remove the index lesion and 26 follow-up colonoscopies, the endoscopist at our center removed 183 serrated polyps from the 20 patients with SPS; of those polyps, 68 were >1 cm. Three patients were referred for surgical resection of involved colon. Eighteen of the 20 patients with SPS met the WHO criterion of 5 serrated polyps proximal to the sigmoid, of which 2 are >1 cm. Failure to recognize SPS by the referring physician was at least partly related to unrecognized serrated lesions. Failure to recognize SPS by the endoscopist at our institution was the result of not systematically applying WHO criteria to the polyp findings.
  
  
  CONCLUSIONS
  Retrospective study.
  
  
  CONCLUSIONS
  SPS was common in a cohort of patients with large sessile colorectal polyps, and it was frequently unrecognized. These data suggest the need for better detection of serrated lesions, better awareness of SPS, and more consistent application of SPS criteria to the polyp findings of individual patients.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
authors.forename: Krishna C
authors.initials: KC
authors.lastname: Vemulapalli
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Rex
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003108:Colonic Diseases / Q000175:diagnosis* / Q000473:pathology; D003111:Colonic Polyps / Q000175:diagnosis / Q000473:pathology*; D003113:Colonoscopy; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D044483:Intestinal Polyposis / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies; D012907:Smoking; D013577:Syndrome