Opinion Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2020; 26(19): 2276-2285
Published online May 21, 2020. doi: 10.3748/wjg.v26.i19.2276
Serrated polyps of the colon and rectum: Remove or not?
Wataru Sano, Daizen Hirata, Akira Teramoto, Mineo Iwatate, Santa Hattori, Mikio Fujita, Yasushi Sano
Wataru Sano, Daizen Hirata, Akira Teramoto, Mineo Iwatate, Santa Hattori, Mikio Fujita, Yasushi Sano, Gastrointestinal Center, Sano Hospital, Hyogo 655-0031, Japan
Author contributions: Sano W wrote the manuscript; Hirata D, Teramoto A, Iwatate M, Hattori S, Fujita M, and Sano Y reviewed the manuscript and approved the final version.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wataru Sano, MD, Doctor, Gastrointestinal Center, Sano Hospital, 2-5-1 Shimizugaoka, Tarumi, Kobe, Hyogo 655-0031, Japan. watasano@yahoo.co.jp
Received: December 24, 2019
Peer-review started: December 24, 2019
First decision: March 27, 2020
Revised: April 1, 2020
Accepted: April 29, 2020
Article in press: April 29, 2020
Published online: May 21, 2020
Abstract

In recent years, the serrated neoplasia pathway where serrated polyps arise as a colorectal cancer has gained considerable attention as a new carcinogenic pathway. Colorectal serrated polyps are histopathologically classified into hyperplastic polyps (HPs), sessile serrated lesions, and traditional serrated adenomas; in the serrated neoplasia pathway, the latter two are considered to be premalignant. In western countries, all colorectal polyps, including serrated polyps, apart from diminutive rectosigmoid HPs are removed. However, in Asian countries, the treatment strategy for colorectal serrated polyps has remained unestablished. Therefore, in this review, we described the clinicopathological features of colorectal serrated polyps and proposed to remove HPs and sessile serrated lesions ≥ 6 mm in size, and traditional serrated adenomas of any size.

Keywords: Hyperplastic polyp, Sessile serrated adenoma/polyp, Sessile serrated lesion, Traditional serrated adenoma, Cytological dysplasia, Cryptal dysplasia

Core tip: In western countries, generally all colorectal polyps are removed, including serrated polyps, except rectosigmoid hyperplastic polyps ≤ 5 mm in size. However, no treatment strategy has been developed for colorectal serrated polyps in Asian countries. Hence, in this review, we described the clinicopathological features of colorectal serrated polyps and proposed to remove hyperplastic polyps and sessile serrated lesions ≥ 6 mm in size, and traditional serrated adenomas of any size by narrow-band imaging observation.