CLINICAL SIGNIFICANCE AND MANAGEMENT OF SERRATED POLYPOSIS SYNDROME

Abstract

Serrated polyposis syndrome (SPS) is characterized by multiple serrated lesions in the colorectum and recognized globally as a high-risk entity for colorectal cancer. The diagnostic criteria were first established by the World Health Organization in 2010 and revised in 2019 to improve clinical validity by excluding diminutive lesions, rectum-predominant cases, and family history as standalone criteria. The etiology of SPS is multifactorial, involving genetic factors, such as ring finger protein 43 mutations, epigenetic alterations mediated by the CpG island methylator phenotype, gut microbiota, and lifestyle influences. Clinically, SPS is strongly associated with colorectal cancer; therefore, complete resection of lesions≥5mm followed by surveillance colonoscopy every 1-3 years is recommended. Besides the serrated pathway, the adenoma-carcinoma sequence has been implicated in tumorigenesis. Future challenges include elucidating the risk of extracolonic malignancies, clarifying familial clustering, identifying genetic backgrounds, and establishing Japan-specific surveillance strategies aligned with international guidelines.