Treat Traditional Serrated Adenomas as Advanced Lesions
Douglas K. Rex, MD, MASGE, reviewing Trivedi M, et al. Clin Gastroenterol Hepatol 2022 Oct 12.
Traditional serrated adenomas (TSAs) are rare lesions. They are predominantly in the left side of the colon, and unlike sessile serrated lesions, they can be bulky.
In this study, 853 U.S. veterans with a baseline TSA were identified from large databases. Among a subset of 378 veterans who had at least one surveillance colonoscopy, 65.1% had high-risk neoplasia identified on follow-up. The incidence of colorectal cancer at 5 years was 1.3%, compared with 0.28% in individuals with normal colonoscopies (hazard ratio [HR], 3.70) and similar to the rate in patients with baseline advanced adenomas (1.6%; HR, 0.86; not significantly different).
COMMENTThis study supports the U.S. Multi-Society Task Force on Colorectal Cancer recommendation to treat TSAs, regardless of their size, like advanced lesions. This study is important because it is hard for any individual center to accumulate large numbers of TSAs because of their rarity. Traditional serrated adenomas are also frequently “missed” in clinical practice, mistaken by pathologists for conventional tubulovillous adenomas.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Trivedi M, Godil S, Demb J, et al. Baseline characteristics and longitudinal outcomes of traditional serrated adenomas: a cohort study. Clin Gastroenterol Hepatol 2022 Oct 12. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2022.09.030)
