Gut Check on Gastroenterology Archive

It used to be relatively simple for gastroenterologists to determine colonoscopy surveillance intervals when removing right-sided polyps: We considered whether the polyp was hyperplastic or adenomatous and its size. Now, we have a new classification system that includes adenomas, hyperplastic lesions, sessile serrated polyps (SSPs), and sessile serrated adenomas (SSAs) — all of which may require various surveillance intervals depending on their number and size.

In my practice, I have noticed an evolution in my pathologist’s understanding of this new nomenclature, and in accuracy of reporting lesions — especially with regard to the important distinction between an SSP and an SSA. Early on, all sessile serrated lesions were being classified as SSAs despite these lesions being relatively uncommon, but recently, most are being classified as the more common SSPs.

What has been your experience? Specifically…

• Are you aware of the new polyp classification nomenclature and its impact on colonoscopy surveillance intervals?
• Is your pathologist reporting SSA instead of SSP more than 10% of the time?
• If yes, have you explained that SSPs should greatly outnumber SSAs?
• What surveillance interval do you recommend for a patient with an 8-mm, hyperplastic, right-sided polyp? An 8-mm adenoma? An 8-mm SSP? An 8-mm SSA?

Looking forward to hearing about your experiences and practice patterns.