Serrated Neoplasia of the Colon: What Do We Really Know?

  • Tanvir Haque
  • Kevin G. Greene
  • Seth D. Crockett
GI Oncology (R Bresalier, Section Editor)
Part of the following topical collections:
  1. Topical Collection on GI Oncology


Colonoscopy offers incomplete protection from colorectal cancer, particularly in the right colon. Part of this inadequacy may be related to serrated neoplasia. Serrated polyps of the colorectum are now understood to be a heterogeneous group of polyps, some of which are cancer precursors, such as the sessile serrated adenoma (SSA) and the traditional serrated adenoma (TSA). In contrast to conventional adenomas, there is limited published literature on the epidemiology and natural history of these lesions. Furthermore, existing guidelines regarding screening and surveillance practices for these polyps are based largely on expert opinion without firm evidence. In this review, we describe the current understanding of the molecular biology, histopathology, and endoscopic features of serrated neoplasia of the colorectum, with an emphasis on aspects relevant to the practicing gastroenterologist.


Serrated pathway Sessile serrated adenoma Sessile serrated polyp Traditional serrated adenoma Hyperplastic polyp Epidemiology Natural history Endoscopy Colonoscopy 


Compliance with Ethics Guidelines

Conflict of Interest

Dr. Crockett has nothing to disclose.

Dr. Greene has nothing to disclose.

Dr. Haque has nothing to disclose.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63(1):11–30.PubMedCrossRefGoogle Scholar
  2. 2.
    Nishihara R, Wu K, Lochhead P, Morikawa T, Liao X, Qian ZR, et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med. 2013;369(12):1095–105.PubMedCrossRefGoogle Scholar
  3. 3.
    Zauber AG, Winawer SJ, O’Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366(8):687–96.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009;104(3):739–50.PubMedCrossRefGoogle Scholar
  5. 5.
    Farrar WD, Sawhney MS, Nelson DB, Lederle FA, Bond JH. Colorectal cancers found after a complete colonoscopy. Clin Gastroenterol Hepatol. 2006;4(10):1259–64.PubMedCrossRefGoogle Scholar
  6. 6.
    Khalid O, Radaideh S, Cummings OW, O’Brien MJ, Goldblum JR, Rex DK. Reinterpretation of histology of proximal colon polyps called hyperplastic in 2001. World J Gastroenterol. 2009;15(30):3767–70.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Snover DC, Jass JR, Fenoglio-Preiser C, Batts KP. Serrated polyps of the large intestine: a morphologic and molecular review of an evolving concept. Am J Clin Pathol. 2005;124(3):380–91.PubMedCrossRefGoogle Scholar
  8. 8.
    Leggett B, Whitehall V. Role of the serrated pathway in colorectal cancer pathogenesis. Gastroenterology. 2010;138(6):2088–100.PubMedCrossRefGoogle Scholar
  9. 9.
    Huang CS, Farraye FA, Yang S, O’Brien MJ. The clinical significance of serrated polyps. Am J Gastroenterol. 2011;106(2):229–40. quiz 41.PubMedCrossRefGoogle Scholar
  10. 10.•
    Snover DC. Update on the serrated pathway to colorectal carcinoma. Hum Pathol. 2011;42(1):1–10. This paper provides an excellent and comprehensive overview of serrated neoplasia, written by Dr. Dale Snover, a pathologist and international expert in the field. PubMedCrossRefGoogle Scholar
  11. 11.
    Jass JR. Serrated adenoma of the colorectum and the DNA-methylator phenotype. Nature Clin Pract Oncol. 2005;2(8):398–405.CrossRefGoogle Scholar
  12. 12.••
    Rex DK, Ahnen DJ, Baron JA, Batts KP, Burke CA, Burt RW et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol. 2012;107(9):1315–29; quiz 4, 30. This is the recently published Expert Consensus Panel report that provides detailed surveillance guidelines for serrated polyps, as well as a comprehensive review of relevant evidence. Google Scholar
  13. 13.
    Longacre TA, Fenoglio-Preiser CM. Mixed hyperplastic adenomatous polyps/serrated adenomas. A distinct form of colorectal neoplasia. Am J Surg Pathol. 1990;14(6):524–37.PubMedCrossRefGoogle Scholar
  14. 14.
    Torlakovic E, Snover DC. Serrated adenomatous polyposis in humans. Gastroenterology. 1996;110(3):748–55.PubMedCrossRefGoogle Scholar
  15. 15.
    Torlakovic E, Skovlund E, Snover DC, Torlakovic G, Nesland JM. Morphologic reappraisal of serrated colorectal polyps. Am J Surg Pathol. 2003;27(1):65–81.PubMedCrossRefGoogle Scholar
  16. 16.•
    Torlakovic EE, Gomez JD, Driman DK, Parfitt JR, Wang C, Benerjee T, et al. Sessile serrated adenoma (SSA) vs. traditional serrated adenoma (TSA). Am J Surg Pathol. 2008;32(1):21–9. This report provides a comprehensive overview of the distinguishing pathologic features of TSAs and SSAs. PubMedCrossRefGoogle Scholar
  17. 17.
    Snover D. Serrated adenomas. Am J Clin Pathol. 2005;124(4):611–2. author reply 2-5.PubMedGoogle Scholar
  18. 18.
    Bosman FTCF, Hruban RH, et al. WHO classification of tumours pathology and genetics tumours of the digestive system. 4th ed. Berlin: Springer-Verlag; 2010.Google Scholar
  19. 19.
    Weston AP, Campbell DR. Diminutive colonic polyps: histopathology, spatial distribution, concomitant significant lesions, and treatment complications. Am J Gastroenterol. 1995;90(1):24–8.PubMedGoogle Scholar
  20. 20.
    Lieberman DA, Prindiville S, Weiss DG, Willett W. Risk factors for advanced colonic neoplasia and hyperplastic polyps in asymptomatic individuals. JAMA. 2003;290(22):2959–67.PubMedCrossRefGoogle Scholar
  21. 21.
    Sweetser S, Smyrk TC, Sinicrope FA. Serrated colon polyps as precursors to colorectal cancer. Clin Gastroenterol Hepatol. 2013;11(7):760–7. quiz e54-5.PubMedCrossRefGoogle Scholar
  22. 22.
    Groff RJ, Nash R, Ahnen DJ. Significance of serrated polyps of the colon. Curr Gastroenterol Rep. 2008;10(5):490–8.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.•
    Lash RH, Genta RM, Schuler CM. Sessile serrated adenomas: prevalence of dysplasia and carcinoma in 2139 patients. J Clin Pathol. 2010;63(8):681–6. This report is the largest cross-sectional study of SSAs and TSAs yet published. PubMedCrossRefGoogle Scholar
  24. 24.
    Higuchi T, Sugihara K, Jass JR. Demographic and pathological characteristics of serrated polyps of colorectum. Histopathology. 2005;47(1):32–40.PubMedCrossRefGoogle Scholar
  25. 25.
    Fu Z, Shrubsole MJ, Smalley WE, Wu H, Chen Z, Shyr Y, et al. Lifestyle factors and their combined impact on the risk of colorectal polyps. Am J Epidemiol. 2012;176(9):766–76.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Carr NJ, Mahajan H, Tan KL, Hawkins NJ, Ward RL. Serrated and non-serrated polyps of the colorectum: their prevalence in an unselected case series and correlation of BRAF mutation analysis with the diagnosis of sessile serrated adenoma. J Clin Pathol. 2009;62(6):516–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Li SC, Burgart L. Histopathology of serrated adenoma, its variants, and differentiation from conventional adenomatous and hyperplastic polyps. Arch Pathol Lab Med. 2007;131(3):440–5.PubMedGoogle Scholar
  28. 28.
    Ha SY, Lee SM, Lee EJ, Kang SY, Jang KT, Park CK, et al. Filiform serrated adenoma is an unusual, less aggressive variant of traditional serrated adenoma. Pathology. 2012;44(1):18–23.PubMedCrossRefGoogle Scholar
  29. 29.
    Yantiss RK, Oh KY, Chen YT, Redston M, Odze RD. Filiform serrated adenomas: a clinicopathologic and immunophenotypic study of 18 cases. Am J Surg Pathol. 2007;31(8):1238–45.PubMedCrossRefGoogle Scholar
  30. 30.
    Boparai KS, Mathus-Vliegen EM, Koornstra JJ, Nagengast FM, van Leerdam M, van Noesel CJ, et al. Increased colorectal cancer risk during follow-up in patients with hyperplastic polyposis syndrome: a multicentre cohort study. Gut. 2010;59(8):1094–100.PubMedCrossRefGoogle Scholar
  31. 31.
    Edelstein DL, Axilbund JE, Hylind LM, Romans K, Griffin CA, Cruz-Correa M, et al. Serrated polyposis: rapid and relentless development of colorectal neoplasia. Gut. 2013;62(3):404–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Bengoechea O, Martinez-Penuela JM, Larrinaga B, Valerdi J, Borda F. Hyperplastic polyposis of the colorectum and adenocarcinoma in a 24-year-old man. Am J Surg Pathol. 1987;11(4):323–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Guarinos C, Sanchez-Fortun C, Rodriguez-Soler M, Alenda C, Paya A, Jover R. Serrated polyposis syndrome: molecular, pathological and clinical aspects. World J Gastroenterol. 2012;18(20):2452–61.PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Spring KJ, Zhao ZZ, Karamatic R, Walsh MD, Whitehall VL, Pike T, et al. High prevalence of sessile serrated adenomas with BRAF mutations: a prospective study of patients undergoing colonoscopy. Gastroenterology. 2006;131(5):1400–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Williams AR, Balasooriya BA, Day DW. Polyps and cancer of the large bowel: a necropsy study in Liverpool. Gut. 1982;23(10):835–42.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Min YW, Lee JH, Lee SH, Park DI, Han DS, Rhee PL, et al. Prevalence of proximal colon serrated polyps in a population at average risk undergoing screening colonoscopy: a multicenter study. Clin Res Hepatol Gastroenterol. 2012;36(6):604–8.PubMedCrossRefGoogle Scholar
  37. 37.••
    Hetzel JT, Huang CS, Coukos JA, Omstead K, Cerda SR, Yang S, et al. Variation in the detection of serrated polyps in an average risk colorectal cancer screening cohort. Am J Gastroenterol. 2010;105(12):2656–64. This paper describes the wide variation in both endoscopic detection and pathologic interpretation of serrated polyps. PubMedCrossRefGoogle Scholar
  38. 38.
    Buda A, De Bona M, Dotti I, Piselli P, Zabeo E, Barbazza R, et al. Prevalence of different subtypes of serrated polyps and risk of synchronous advanced colorectal neoplasia in average-risk population undergoing first-time colonoscopy. Clin Transl Gastroenterol. 2012;3:e6.PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Kumbhari V, Behary J, Hui JM. Prevalence of adenomas and sessile serrated adenomas in Chinese compared with Caucasians. J Gastroenterol Hepatol. 2013;28(4):608–12.PubMedCrossRefGoogle Scholar
  40. 40.
    Martinez ME, McPherson RS, Levin B, Glober GA. A case-control study of dietary intake and other lifestyle risk factors for hyperplastic polyps. Gastroenterology. 1997;113(2):423–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Erhardt JG, Kreichgauer HP, Meisner C, Bode JC, Bode C. Alcohol, cigarette smoking, dietary factors and the risk of colorectal adenomas and hyperplastic polyps–a case control study. Eur J Nutr. 2002;41(1):35–43.PubMedCrossRefGoogle Scholar
  42. 42.
    Ji B-T, Weissfeld JL, Chow W-H, Huang W-Y, Schoen RE, Hayes RB. Tobacco smoking and colorectal hyperplastic and adenomatous polyps. Cancer Epidemiol Biomark Prev: Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol. 2006;15(5):897–901.CrossRefGoogle Scholar
  43. 43.
    Kearney J, Giovannucci E, Rimm EB, Stampfer MJ, Colditz GA, Ascherio A, et al. Diet, alcohol, and smoking and the occurrence of hyperplastic polyps of the colon and rectum (United States). Cancer Causes Control. 1995;6(1):45–56.PubMedCrossRefGoogle Scholar
  44. 44.
    Morimoto LM, Newcomb PA, Ulrich CM, Bostick RM, Lais CJ, Potter JD. Risk factors for hyperplastic and adenomatous polyps: evidence for malignant potential? Cancer Epidemiol Biomark Prev: Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol. 2002;11(10 Pt 1):1012–8.Google Scholar
  45. 45.
    Omata F, Brown WR, Tokuda Y, Takahashi O, Fukui T, Ueno F, et al. Modifiable risk factors for colorectal neoplasms and hyperplastic polyps. Intern Med. 2009;48(3):123–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Shrubsole MJ, Wu H, Ness RM, Shyr Y, Smalley WE, Zheng W. Alcohol drinking, cigarette smoking, and risk of colorectal adenomatous and hyperplastic polyps. Am J Epidemiol. 2008;167(9):1050–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Anderson JC, Rangasamy P, Rustagi T, Myers M, Sanders M, Vaziri H, et al. Risk factors for sessile serrated adenomas. J Clin Gastroenterol. 2011;45(8):694–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Burnett-Hartman AN, Passarelli MN, Adams SV, Upton MP, Zhu LC, Potter JD, et al. Differences in epidemiologic risk factors for colorectal adenomas and serrated polyps by lesion severity and anatomical site. Am J Epidemiol. 2013;177(7):625–37.PubMedCrossRefGoogle Scholar
  49. 49.
    Yang S, Farraye FA, Mack C, Posnik O, O’Brien MJ. BRAF and KRAS Mutations in hyperplastic polyps and serrated adenomas of the colorectum: relationship to histology and CpG island methylation status. Am J Surg Pathol. 2004;28(11):1452–9.PubMedCrossRefGoogle Scholar
  50. 50.
    O’Brien MJ, Yang S, Mack C, Xu H, Huang CS, Mulcahy E, et al. Comparison of microsatellite instability, CpG island methylation phenotype, BRAF and KRAS status in serrated polyps and traditional adenomas indicates separate pathways to distinct colorectal carcinoma end points. Am J Surg Pathol. 2006;30(12):1491–501.PubMedCrossRefGoogle Scholar
  51. 51.
    Weisenberger DJ, Siegmund KD, Campan M, Young J, Long TI, Faasse MA, et al. CpG island methylator phenotype underlies sporadic microsatellite instability and is tightly associated with BRAF mutation in colorectal cancer. Nat Genet. 2006;38(7):787–93.PubMedCrossRefGoogle Scholar
  52. 52.
    Kambara T, Simms LA, Whitehall VL, Spring KJ, Wynter CV, Walsh MD, et al. BRAF mutation is associated with DNA methylation in serrated polyps and cancers of the colorectum. Gut. 2004;53(8):1137–44.PubMedCentralPubMedCrossRefGoogle Scholar
  53. 53.
    Gupta AK, Pretlow TP, Schoen RE. Aberrant crypt foci: what we know and what we need to know. Clin Gastroenterol Hepatol. 2007;5(5):526–33.PubMedCrossRefGoogle Scholar
  54. 54.
    Rosenberg DW, Yang S, Pleau DC, Greenspan EJ, Stevens RG, Rajan TV, et al. Mutations in BRAF and KRAS differentially distinguish serrated versus non-serrated hyperplastic aberrant crypt foci in humans. Cancer Res. 2007;67(8):3551–4.PubMedCrossRefGoogle Scholar
  55. 55.
    Fu B, Yachida S, Morgan R, Zhong Y, Montgomery EA, Iacobuzio-Donahue CA. Clinicopathologic and genetic characterization of traditional serrated adenomas of the colon. Am J Clin Pathol. 2012;138(3):356–66.PubMedCentralPubMedCrossRefGoogle Scholar
  56. 56.
    Kim KM, Lee EJ, Kim YH, Chang DK, Odze RD. KRAS mutations in traditional serrated adenomas from Korea herald an aggressive phenotype. Am J Surg Pathol. 2010;34(5):667–75.PubMedGoogle Scholar
  57. 57.
    Patil DT, Shadrach BL, Rybicki LA, Leach BH, Pai RK. Proximal colon cancers and the serrated pathway: a systematic analysis of precursor histology and BRAF mutation status. Mod Pathol. 2012;25(10):1423–31.PubMedCrossRefGoogle Scholar
  58. 58.
    Makinen MJ, George SM, Jernvall P, Makela J, Vihko P, Karttunen TJ. Colorectal carcinoma associated with serrated adenoma–prevalence, histological features, and prognosis. J Pathol. 2001;193(3):286–94.PubMedCrossRefGoogle Scholar
  59. 59.
    Goldstein NS. Small colonic microsatellite unstable adenocarcinomas and high-grade epithelial dysplasias in sessile serrated adenoma polypectomy specimens: a study of eight cases. Am J Clin Pathol. 2006;125(1):132–45.PubMedCrossRefGoogle Scholar
  60. 60.
    Garcia-Solano J, Perez-Guillermo M, Conesa-Zamora P, Acosta-Ortega J, Trujillo-Santos J, Cerezuela-Fuentes P, et al. Clinicopathologic study of 85 colorectal serrated adenocarcinomas: further insights into the full recognition of a new subset of colorectal carcinoma. Hum Pathol. 2010;41(10):1359–68.PubMedCrossRefGoogle Scholar
  61. 61.
    Tonooka T, Sano Y, Fujii T, Kato S, Yoshino T, Fu KI, et al. Adenocarcinoma in solitary large hyperplastic polyp diagnosed by magnifying colonoscope: report of a case. Dis Colon Rectum. 2002;45(10):1407–11.PubMedCrossRefGoogle Scholar
  62. 62.
    Cooper HS, Patchefsky AS, Marks G. Adenomatous and carcinomatous changes within hyperplastic colonic epithelium. Dis Colon Rectum. 1979;22(3):152–6.PubMedCrossRefGoogle Scholar
  63. 63.
    Sheridan TB, Fenton H, Lewin MR, Burkart AL, Iacobuzio-Donahue CA, Frankel WL, et al. Sessile serrated adenomas with low- and high-grade dysplasia and early carcinomas: an immunohistochemical study of serrated lesions “caught in the act”. Am J Clin Pathol. 2006;126(4):564–71.PubMedCrossRefGoogle Scholar
  64. 64.
    O’Brien MJ, Yang S, Clebanoff JL, Mulcahy E, Farraye FA, Amorosino M, et al. Hyperplastic (serrated) polyps of the colorectum: relationship of CpG island methylator phenotype and K-ras mutation to location and histologic subtype. Am J Surg Pathol. 2004;28(4):423–34.PubMedCrossRefGoogle Scholar
  65. 65.
    Lynch HT, Smyrk T, Jass JR. Hereditary nonpolyposis colorectal cancer and colonic adenomas: aggressive adenomas? Semin Surg Oncol. 1995;11(6):406–10.PubMedCrossRefGoogle Scholar
  66. 66.
    Oono Y, Fu K, Nakamura H, Iriguchi Y, Yamamura A, Tomino Y, et al. Progression of a sessile serrated adenoma to an early invasive cancer within 8 months. Dig Dis Sci. 2009;54(4):906–9.PubMedCrossRefGoogle Scholar
  67. 67.
    Yamauchi T, Watanabe M, Hasegawa H, Yamamoto S, Endo T, Kabeshima Y, et al. Serrated adenoma developing into advanced colon cancer in 2 years. J Gastroenterol. 2002;37(6):467–70.PubMedCrossRefGoogle Scholar
  68. 68.
    Hiraoka S, Kato J, Fujiki S, Kaji E, Morikawa T, Murakami T, et al. The presence of large serrated polyps increases risk for colorectal cancer. Gastroenterology. 2010;139(5):1503–10. 10 e1-3.PubMedCrossRefGoogle Scholar
  69. 69.
    Alvarez C, Andreu M, Castells A, Quintero E, Bujanda L, Cubiella J, et al. Relationship of colonoscopy-detected serrated polyps with synchronous advanced neoplasia in average-risk individuals. Gastrointest Endosc. 2013;78(2):333–41 e1.PubMedCrossRefGoogle Scholar
  70. 70.
    Li D, Jin C, McCulloch C, Kakar S, Berger BM, Imperiale TF, et al. Association of large serrated polyps with synchronous advanced colorectal neoplasia. Am J Gastroenterol. 2009;104(3):695–702.PubMedCrossRefGoogle Scholar
  71. 71.••
    Schreiner MA, Weiss DG, Lieberman DA. Proximal and large hyperplastic and nondysplastic serrated polyps detected by colonoscopy are associated with neoplasia. Gastroenterology. 2010;139(5):1497–502. This paper describes the elevated risk of synchronous and metachronous neoplasia associated with proximal and large serrated polyps. PubMedCrossRefGoogle Scholar
  72. 72.
    Vu HT, Lopez R, Bennett A, Burke CA. Individuals with sessile serrated polyps express an aggressive colorectal phenotype. Dis Colon Rectum. 2011;54(10):1216–23.PubMedCrossRefGoogle Scholar
  73. 73.
    Snover DC. Sessile serrated adenoma/polyp of the large intestine: a potentially aggressive lesion in need of a new screening strategy. Dis Colon Rectum. 2011;54(10):1205–6.PubMedCrossRefGoogle Scholar
  74. 74.
    Pai RK, Hart J, Noffsinger AE. Sessile serrated adenomas strongly predispose to synchronous serrated polyps in non-syndromic patients. Histopathology. 2010;56(5):581–8.PubMedCrossRefGoogle Scholar
  75. 75.
    Goldstein NS, Bhanot P, Odish E, Hunter S. Hyperplastic-like colon polyps that preceded microsatellite-unstable adenocarcinomas. Am J Clin Pathol. 2003;119(6):778–96.PubMedCrossRefGoogle Scholar
  76. 76.
    Teriaky A, Driman DK, Chande N. Outcomes of a 5-year follow-up of patients with sessile serrated adenomas. Scand J Gastroenterol. 2012;47(2):178–83.PubMedCrossRefGoogle Scholar
  77. 77.
    Lu FI, van Niekerk DW, Owen D, Tha SPL, Turbin DA, Webber DL. Longitudinal outcome study of sessile serrated adenomas of the colorectum: an increased risk for subsequent right-sided colorectal carcinoma. Am J Surg Pathol. 2010;34(7):927–34.PubMedCrossRefGoogle Scholar
  78. 78.
    Lazarus R, Junttila OE, Karttunen TJ, Makinen MJ. The risk of metachronous neoplasia in patients with serrated adenoma. Am J Clin Pathol. 2005;123(3):349–59.PubMedCrossRefGoogle Scholar
  79. 79.
    Limketkai BN, Lam-Himlin D, Arnold CA, Arnold MA. The cutting edge of serrated polyps: a practical guide to approaching and managing serrated colon polyps. Gastrointest Endosc. 2013;77(3):360–75.PubMedCrossRefGoogle Scholar
  80. 80.
    Tadepalli US, Feihel D, Miller KM, Itzkowitz SH, Freedman JS, Kornacki S, et al. A morphologic analysis of sessile serrated polyps observed during routine colonoscopy (with video). Gastrointest Endosc. 2011;74(6):1360–8.PubMedCrossRefGoogle Scholar
  81. 81.
    Lambert R, Kudo SE, Vieth M, Allen JI, Fujii H, Fujii T, et al. Pragmatic classification of superficial neoplastic colorectal lesions. Gastrointest Endosc. 2009;70(6):1182–99.PubMedCrossRefGoogle Scholar
  82. 82.
    Ishigooka S, Nomoto M, Obinata N, Oishi Y, Sato Y, Nakatsu S, et al. Evaluation of magnifying colonoscopy in the diagnosis of serrated polyps. World J Gastroenterol. 2012;18(32):4308–16.PubMedCentralPubMedCrossRefGoogle Scholar
  83. 83.
    Kahi CJ, Hewett DG, Norton DL, Eckert GJ, Rex DK. Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy. Clin Gastroenterol Hepatol. 2011;9(1):42–6.PubMedCrossRefGoogle Scholar
  84. 84.
    de Wijkerslooth TR, Stoop EM, Bossuyt PM, Tytgat KM, Dees J, Mathus-Vliegen EM, et al. Differences in proximal serrated polyp detection among endoscopists are associated with variability in withdrawal time. Gastrointest Endosc. 2013;77(4):617–23.PubMedCrossRefGoogle Scholar
  85. 85.
    Crockett SD, Snover DC, Ahnen DJ, Baron JA. Sessile Serrated Adenomas: An evidence-based guide to management. Clin Gastroenterol Hepatol. 2013.Google Scholar
  86. 86.
    East JE, Saunders BP, Jass JR. Sporadic and syndromic hyperplastic polyps and serrated adenomas of the colon: classification, molecular genetics, natural history, and clinical management. Gastroenterol Clin North Am. 2008;37(1):25–46. v.PubMedCrossRefGoogle Scholar
  87. 87.
    Pohl H, Srivastava A, Bensen SP, Anderson P, Rothstein RI, Gordon SR, et al. Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study. Gastroenterology. 2013;144(1):74–80 e1.PubMedCrossRefGoogle Scholar
  88. 88.
    Glatz K, Pritt B, Glatz D, Hartmann A, O’Brien MJ, Blaszyk H. A multinational, internet-based assessment of observer variability in the diagnosis of serrated colorectal polyps. Am J Clin Pathol. 2007;127(6):938–45.PubMedCrossRefGoogle Scholar
  89. 89.
    Farris AB, Misdraji J, Srivastava A, Muzikansky A, Deshpande V, Lauwers GY, et al. Sessile serrated adenoma: challenging discrimination from other serrated colonic polyps. Am J Surg Pathol. 2008;32(1):30–5.PubMedCrossRefGoogle Scholar
  90. 90.
    Singh H, Bay D, Ip S, Bernstein CN, Nugent Z, Gheorghe R, et al. Pathological reassessment of hyperplastic colon polyps in a city-wide pathology practice: implications for polyp surveillance recommendations. Gastrointest Endosc. 2012;76(5):1003–8.PubMedCrossRefGoogle Scholar
  91. 91.
    Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012;143(3):844–57.PubMedCrossRefGoogle Scholar
  92. 92.
    Hoff G, Bretthauer M, Garborg K, Eide TJ. New polyps, old tricks: controversy about removing benign bowel lesions. Bmj. 2013;347:f5843.PubMedCrossRefGoogle Scholar
  93. 93.
    Heldwein W, Dollhopf M, Rosch T, Meining A, Schmidtsdorff G, Hasford J, et al. The Munich Polypectomy Study (MUPS): prospective analysis of complications and risk factors in 4000 colonic snare polypectomies. Endoscopy. 2005;37(11):1116–22.PubMedCrossRefGoogle Scholar
  94. 94.
    Nakao Y, Saito S, Ohya T, Aihara H, Arihiro S, Kato T, et al. Endoscopic features of colorectal serrated lesions using image-enhanced endoscopy with pathological analysis. Eur J Gastroenterol Hepatol. 2013;25(8):981–8.PubMedCrossRefGoogle Scholar
  95. 95.
    Kutsukawa M, Kudo SE, Ikehara N, Ogawa Y, Wakamura K, Mori Y et al. Efficiency of endocytoscopy in differentiating types of serrated polyps. Gastrointest Endosc. 2013.Google Scholar
  96. 96.
    Lidgard GP, Domanico MJ, Bruinsma JJ, Light J, Gagrat ZD, Oldham-Haltom RL, et al. Clinical performance of an automated stool DNA assay for detection of colorectal neoplasia. Clin Gastroenterol Hepatol. 2013;11(10):1313–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Tanvir Haque
    • 1
  • Kevin G. Greene
    • 2
  • Seth D. Crockett
    • 1
  1. 1.Division of Gastroenterology and HepatologyUniversity of North Carolina School of MedicineChapel HillUSA
  2. 2.Department of Pathology and Laboratory MedicineUniversity of North Carolina School of MedicineChapel HillUSA

Personalised recommendations