Sessile serrated adenoma: from identification to resection

Dig Liver Dis. 2015 Feb;47(2):95-102. doi: 10.1016/j.dld.2014.09.006. Epub 2014 Oct 25.


Until the past two decades, almost all colorectal polyps were divided into two main groups: hyperplastic polyps and adenomas. Sessile serrated adenomas presented endoscopic, pathological and molecular profiles distinct from others polyps. Previously under-diagnosed, physicians now identified sessile serrated adenomas. The serrated neoplastic pathway is accounting for up to one-third of all sporadic colorectal cancers and sessile serrated adenomas have been identified as the main precursor lesions in serrated carcinogenesis. By analogy with the adenoma-adenocarcinoma sequence, the sessile serrated adenomas-adenocarcinoma sequence, has been identified. The development of endoscopic resection techniques permits the consideration of a non-surgical approach as the first option regardless of the size of the lesion. Sessile serrated adenoma warrants the watchfulness of physicians and requires an optimal quality of the colonoscopy procedure, a thorough evaluation of the lesion, an adequate endoscopic resection and follow-up colonoscopies in accordance with sessile serrated adenomas guidelines. We herein present a review on sessile serrated adenomas focusing on their pathological specificities, epidemiology, treatment modalities and follow-up.

Keywords: Colonoscopy; Colorectal cancer; Histology; Molecular pathology; Serrated adenoma.

Publication types

  • Review

MeSH terms

  • Adaptor Proteins, Signal Transducing / genetics
  • Adenocarcinoma / genetics*
  • Adenoma / diagnosis*
  • Adenoma / genetics
  • Adenoma / surgery
  • Colonic Polyps / diagnosis*
  • Colonic Polyps / genetics
  • Colonic Polyps / surgery
  • Colonoscopy
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / genetics
  • Colorectal Neoplasms / surgery
  • DNA Methylation
  • DNA Mismatch Repair / genetics
  • Humans
  • Intestinal Polyps / diagnosis
  • Intestinal Polyps / genetics
  • Intestinal Polyps / surgery
  • Microsatellite Instability
  • MutL Protein Homolog 1
  • Nuclear Proteins / genetics
  • Proto-Oncogene Proteins B-raf / genetics


  • Adaptor Proteins, Signal Transducing
  • MLH1 protein, human
  • Nuclear Proteins
  • Proto-Oncogene Proteins B-raf
  • MutL Protein Homolog 1