Sessile serrated adenomas: an evidence-based guide to management.
The concept of serrated colorectal neoplasia and a serrated pathway to colorectal cancer (CRC) is relatively new and continuing to evolve, but it has become highly relevant to gastroenterologists, pathologist, and oncologists alike. Sessile serrated adenomas (SSA) are now thought to be the major precursor lesion of serrated pathway cancers, which represent up to one-third of all sporadic CRC cases. However, despite their increasingly recognized importance, relatively little is known about the epidemiology and natural history of SSAs, and the molecular and epigenetic aspects are incompletely understood. Endoscopists must be aware of the unique features of SSAs so that the practice of colonoscopic screening for CRC can include optimized detection, removal, and appropriate surveillance of SSAs and other serrated precursor lesions. In this review, we discuss the history, epidemiology, and pathologic aspects of SSAs, as well as a recommended management approach and a discussion of uncertainties and opportunities for future research.
Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina. Electronic address: sethc@med.unc.edu.
Seth D
SD
Crockett
Department of Pathology, Fairview Southdale Hospital, Edina, Minnesota.
Dale C
DC
Snover
Division of Gastroenterology, Department of Veterans Affairs Eastern Colorado Health Care System and University of Colorado School of Medicine, Denver, Colorado.
Dennis J
DJ
Ahnen
Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
John A
JA
Baron
D000236:Adenoma / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D006801:Humans
Colonoscopy; Colorectal Cancer Screening; Endoscopic Detection; Polypectomy; Serrated Neoplasia; Sessile Serrated Adenoma; Sessile Serrated Polyp