Gastroenterology

Gastroenterology

Volume 158, Issue 6, May 2020, Pages 1520-1523
Gastroenterology

Commentary
Update on the World Health Organization Criteria for Diagnosis of Serrated Polyposis Syndrome

https://doi.org/10.1053/j.gastro.2019.11.310Get rights and content

Section snippets

WHO’s 2010 vs 2019 Criteria

The “old” criteria I2010 and III2010 have been slightly altered, and are now listed as criteria I2019 and II2019 in the updated guideline of 2019 (Figure 1). For criterion I2010, 2 adjustments were made. First, whereas criterion I2010 only included polyps proximal to the sigmoid colon, SPs in the sigmoid colon are now included in criterion I2019. This decision is based on several cohort studies showing that ≤50% of CRCs in patients with SPS occur in the rectosigmoid, suggesting that patients

Adopting the Updated Clinical Criteria

Aside from the abandonment of the old criterion II, some alterations in the updated criteria make them more restrictive than 2010’s criteria (ie, polyps have to be ≥5 mm for criterion I2019; a minimum of 5 proximal polyps for criterion II2019), whereas another alteration makes them less restrictive (ie, polyps have to be proximal to rectum instead of sigmoid for criterion I2019). Theoretically, some patients could therefore “lose” their SPS diagnosis by not fulfilling 2019’s criteria anymore.

SPS: One Syndrome, Two Phenotypes

As was the case with the 2010 criteria, the updated criteria clearly distinguish 2 SPS phenotypes: one predominantly proximal phenotype with several large SP (criterion I2019), and a more distal phenotype which might manifest with predominantly small/diminutive hyperplastic polyps in the rectum or sigmoid (criterion II2019). Cohort studies from the past decade have greatly increased our understanding of the difference and overlap between these 2 phenotypes. Most of these studies have applied

Personalized Surveillance

Following cohort studies reporting a high CRC incidence during surveillance,1, 2, 3, 4,17,19, 20, 21 international guidelines recommend stringent endoscopic surveillance regimens after initial polyp clearance, with many guidelines recommending annual surveillance14,22 to all patients with SPS regardless their phenotype. However, as explained, CRC risk is variable among patients with SPS. Strict adherence to these recommendations might therefore lead to overtreatment for those that are on the

Summary

In the recently released fifth edition of the WHO Classification of Tumours of the Digestive System Tumors, the WHO updates the diagnostic criteria for SPS, making several important changes (Figure 1).8 The most important change is the abandonment of criterion II2010, while minor alterations have been made to criterion I2010 and III2010 (Figure 1). Despite still being arbitrary, these criteria are an effective tool for identification of a population with a strong CRC predisposition, requiring

Acknowledgments

Dutch-Spanish-British Serrated Polyposis Syndrome collaboration representing members: Evelien Dekker (University of Amsterdam, Amsterdam, the Netherlands), Joep E.G. IJspeert (University of Amsterdam, Amsterdam, the Netherlands), Arne G.C. Bleijenberg (University of Amsterdam, Amsterdam, the Netherlands), Francesc Balaguer (University of Barcelona, Barcelona, Spain), Maria Pellisé (University of Barcelona, Barcelona, Spain), Sabela Carballal (University of Barcelona, Barcelona, Spain), Liseth

References (22)

  • J.E.G. IJspeert et al.

    Detection rate of serrated polyps and serrated polyposis syndrome in colorectal cancer screening cohorts: a European overview

    Gut

    (2017)

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      Secondary outcomes were the association among HP size (small vs diminutive), location (rectosigmoid or proximal to the sigmoid), and number of HPs on metachronous neoplasia development. Given the number of cancers diagnosed distal to the splenic flexure in individuals with sessile serrated polyposis syndrome, we grouped the descending colon together with the proximal colon.15,16 Individuals with both proximal and distal HPs were analyzed for overall comparison of HP versus normal index colonoscopy but not the comparison between HP location on metachronous neoplasia.

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    Conflicts of interest The authors have made the following disclosures: ED has contributed as a co-author to the World Health Organization’s 2019 diagnostic criteria for serrated polyposis syndrome.

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