Editorial
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2021; 27(34): 5625-5629
Published online Sep 14, 2021. doi: 10.3748/wjg.v27.i34.5625
Serrated lesions: A challenging enemy
Alexa Trovato, Alla Turshudzhyan, Micheal Tadros
Alexa Trovato, Albany Medical College, Albany, NY 12208, United States
Alla Turshudzhyan, Department of Medicine, University of Connecticut, School of Medicine, Farmingdale, CT 06032, United States
Micheal Tadros, Department of Gastroenterology, Albany Medical Center, Albany, NY 12208, United States
Author contributions: Trovato A, Turshudzhyan A, and Tadros M all wrote the manuscript and contributed equally to this work; all authors have read and approve the final manuscript.
Conflict-of-interest statement: There are no financial arrangements to disclose in the development of this editorial from any of the authors. All appropriate consent was obtained. There is no conflict of interest to disclose from any of the authors.
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: Micheal Tadros, FACG, MD, Associate Professor, Doctor, Department of Gastroenterology, Albany Medical Center, 43 New Scotland Ave, Albany, NY 12208, United States. tadrosm1@amc.edu
Received: May 3, 2021
Peer-review started: May 3, 2021
First decision: June 2, 2021
Revised: June 11, 2021
Accepted: August 17, 2021
Article in press: August 17, 2021
Published online: September 14, 2021
Abstract

The serrated pathway accounts for 30%-35% of colorectal cancer (CRC). Unlike hyperplastic polyps, both sessile serrated lesions (SSLs) and traditional serrated adenomas are premalignant lesions, yet SSLs are considered to be the principal serrated precursor of CRCs. Serrated lesions represent a challenge in detection, classification, and removal–contributing to post-colonoscopy cancer. Therefore, it is of the utmost importance to characterize these lesions properly to ensure complete removal. A retrospective cohort study developed a diagnostic scoring system for SSLs to facilitate their detection endoscopically and subsequent removal. From the study, it can be ascertained that both indistinct border and mucus cap are essential in both recognizing and diagnosing serrated lesions. The proximal colon poses technical challenges for some endoscopists, which is why high-quality colonoscopy plays such an important role. The indistinct border of some SSLs poses another challenge due to difficult complete resection. Overall, it is imperative that gastroenterologists use the key features of mucus cap, indistinct borders, and size of at least five millimeters along with a high-quality colonoscopy and a good bowel preparation to improve the SSL detection rate.

Keywords: Sessile serrated lesions, Colonoscopy, Polyps, Colorectal cancer screening, Hyperplastic polyps, Traditional serrated adenomas

Core Tip: Serrated lesions represent a challenge in detection, classification, and removal. The mucus cap, flat nature, and indistinct borders make these lesions difficult to localize endoscopically. Therefore, it is important to characterize these lesions properly to ensure complete removal and a reduction in post-colonoscopy cancer. A study recently developed a diagnostic scoring system for sessile serrated lesions to facilitate their detection endoscopically and removal. The study shows that both indistinct border and mucus cap are essential in both recognizing and diagnosing serrated lesions, further emphasizing the importance of a good colon preparation and a high-quality colonoscopy.