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The World Health Organization (WHO) recommends using the term “serrated lesions,” as not all lesions are polyps. The name comes from the system of glandular crypts visible on microscopic examination, which resembles a saw tooth. The WHO classification:
1) Hyperplastic polyps: The most common type of serrated polyps. They are usually <5 mm in diameter and are located in the rectum and sigmoid colon. They are not precancerous lesions.
2) Sessile serrated adenomas/polyps: These are usually flat or slightly raised lesions, often covered with brown, difficult to rinse mucus. Most often they are located in the right half of the large intestine. They are precancerous lesions and should be completely removed with loop diathermy if encountered.
3) Traditional serrated adenomas: These are rare precancerous lesions. They usually appear as sessile polyps in the left half of the large intestine and require complete removal.
Serrated polyps may be singular, multiple, or constitute serrated polyposis syndrome (SPS). SPS refers to ≥5 serrated polyps proximal to the sigmoid colon, with ≥2 being >10 mm in diameter; any number of serrated polyps proximal to the sigmoid colon in someone who has a first-degree relative with serrated polyposis; or ≥20 serrated polyps of any size distributed throughout the colon.
Surveillance after polypectomy is based on the size of the polyp, number of polyps, and features of dysplasia: see Table 1 in Colorectal Cancer Screening.
