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New consensus recommendations by the U.S. Multi-Society Task Force (MSTF) on Colorectal Cancer (CRC) address serrated polyposis syndrome (SPS), which is the most common gastrointestinal polyp syndrome yet is widely underrecognized and often goes undiagnosed. SPS is a clinical syndrome characterized by an increased number of serrated lesions and is associated with an increased risk of CRC.

The MSTF offers 11 evidence-based recommendations to increase awareness and identification of SPS among gastroenterologists and surgical endoscopists. It also offers clinical strategies for improving SPS diagnosis, surgical and endoscopic management, CRC risk assessment and surveillance intervals, and genetic risk assessment.

"These recommendations emphasize recognition of the syndrome, including by tracking numbers of serrated polyps over multiple colonoscopies. Best practices are also described for identification of serrated lesions during colonoscopy, as well as endoscopic resection of serrated lesions and surveillance of serrated polyposis patients," said lead author Douglas K. Rex, M.D., MACP, MACG, MASGE, AGAF.

The task force is charged with developing recommendations for best practices for CRC screening and surveillance and the general prevention of CRC. It is composed of representatives from the American College of Gastroenterology, American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy.

The consensus document is published in the American Journal of Gastroenterology.

"This set of clinical recommendations addresses the major issues related to identification and diagnosis of SPS in patients and affected relatives as well as management of SPS," the authors write.

Recommendations from the MSTF

Improving SPS diagnosis

The MSTF recommends that the 2019 World Health Organization criteria be used for diagnosis of SPS. These criteria include the size, cumulative lifetime number and location of serrated polyps throughout the colon. When multiple serrated polyps are detected during colonoscopy, the authors recommend detailing the number, size and location in the procedure report and continuing to do so at least until an SPS diagnosis is established. The task force recommends colonoscopy in SPS be performed by endoscopists with documented adequate detection of sessile serrated lesions during routine colonoscopy, and with high-definition white light colonoscopy with or without virtual or dye spray chromoendoscopy.

SPS management

In patients without concurrent CRC, the authors recommend endoscopy as the preferred strategy over surgery for primary management of SPS. For individuals with SPS whose polyp burden is deemed endoscopically unmanageable, the MSTF suggests referral to an advanced endoscopic resection expert before surgical resection. In SPS patients, the group recommends that SSLs and hyperplastic polyps be resected by cold snare—with or without submucosal injection for larger lesions—except when dysplastic areas are endoscopically evident.

CRC risk in SPS and surveillance intervals

The task force recommends clearance colonoscopy at a three- to six-month interval, followed by a one- to two-year surveillance phase. In patients with greatly reduced polyp burdens at surveillance, the authors suggest that three-year intervals can be considered.

Genetic risk assessment

SPS lacks an established genetic basis. The MSTF recommends that germline genetic testing in patients with diagnosed SPS be performed only when there are concurrent nonserrated polyps that may indicate that genetic testing is warranted. The authors suggest first-degree relatives of individuals with SPS undergo colonoscopy at age 40, 10 years before the youngest age at CRC diagnosis, or five years before the youngest age at SPS diagnosis in the family, whichever is earlier.

More information: Douglas K. Rex et al, Serrated Polyposis Syndrome: A Review and Consensus Statement by the US Multi-Society Task Force on Colorectal Cancer, American Journal of Gastroenterology (2026). DOI: 10.14309/ajg.0000000000004081

Provided by American College of Gastroenterology

Source: MedicalXpress

Original article: https://medicalxpress.com/news/2026-10-serrated-polyposis-syndrome.html