British Society of Gastroenterology position statement on serrated polyps in the colon and rectum

Gut. 2017 Jul;66(7):1181-1196. doi: 10.1136/gutjnl-2017-314005. Epub 2017 Apr 27.


Serrated polyps have been recognised in the last decade as important premalignant lesions accounting for between 15% and 30% of colorectal cancers. There is therefore a clinical need for guidance on how to manage these lesions; however, the evidence base is limited. A working group was commission by the British Society of Gastroenterology (BSG) Endoscopy section to review the available evidence and develop a position statement to provide clinical guidance until the evidence becomes available to support a formal guideline. The scope of the position statement was wide-ranging and included: evidence that serrated lesions have premalignant potential; detection and resection of serrated lesions; surveillance strategies after detection of serrated lesions; special situations-serrated polyposis syndrome (including surgery) and serrated lesions in colitis; education, audit and benchmarks and research questions. Statements on these issues were proposed where the evidence was deemed sufficient, and re-evaluated modified via a Delphi process until >80% agreement was reached. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool was used to assess the strength of evidence and strength of recommendation for finalised statements. Key recommendation: we suggest that until further evidence on the efficacy or otherwise of surveillance are published, patients with sessile serrated lesions (SSLs) that appear associated with a higher risk of future neoplasia or colorectal cancer (SSLs ≥10 mm or serrated lesions harbouring dysplasia including traditional serrated adenomas) should be offered a one-off colonoscopic surveillance examination at 3 years (weak recommendation, low quality evidence, 90% agreement).


Publication types

  • Practice Guideline
  • Review

MeSH terms

  • Adenoma / diagnosis
  • Adenoma / genetics
  • Adenoma / surgery
  • Adenomatous Polyposis Coli / diagnosis
  • Benchmarking
  • Biomarkers / analysis
  • Cell Transformation, Neoplastic
  • Colitis / complications
  • Colonic Polyps / diagnosis*
  • Colonic Polyps / genetics
  • Colonic Polyps / surgery*
  • Colonoscopy
  • CpG Islands / genetics
  • DNA / isolation & purification
  • DNA Methylation
  • Feces / chemistry
  • Humans
  • Parasympatholytics / therapeutic use
  • Polyps / diagnosis*
  • Polyps / genetics
  • Polyps / surgery*
  • Precancerous Conditions / diagnosis
  • Precancerous Conditions / surgery
  • Rectal Diseases / diagnosis*
  • Rectal Diseases / genetics
  • Rectal Diseases / surgery*
  • Terminology as Topic
  • Watchful Waiting


  • Biomarkers
  • Parasympatholytics
  • DNA