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More Evidence Needed for Management of Serrated Polyps

Consensus guideline suggesting removal of all polyps should not preclude opportunity to learn more
THURSDAY, Oct. 10 (HealthDay News) -- Consensus recommendations indicate that serrated polyps should be removed, but a lack of evidence and understanding may be preventing optimal management, according to an analysis published online Oct. 8 in BMJ.
Geir Hoff, M.B., Ch.B., from Telemark Hospital in Skien, Norway, and colleagues discuss evidence relating to the risks and benefits of removal of serrated polyps, which are poorly understood.
The researchers note that serrated polyps are more difficult to detect than adenomas and can be hard to distinguish from surrounding normal bowel mucosa. Removal of these proximal sessile polyps is associated with increased risk of perforation or major bleeding, with an 11.7 percent risk of major complications for endoscopic removal of polyps ≥20 mm, compared with 5.3 percent for polyps of the same morphology located to the distal colon or rectum. Screening for colorectal cancer is increasing the diagnosis of serrated polyps, but there is an absence of evidence of how to manage these polyps. Current recommendations suggest removing all serrated polyps, but the risk of adopting these guidelines is that it will prevent the opportunity to study the natural course of these polyps and different management options.
"Although we may need guidelines for management of serrated polyps for medicolegal reasons, we should not allow them to delay or prevent the generation of further evidence, particularly through randomized trials," the authors write.
Full Text (http://www.bmj.com/content/347/bmj.f5843.full?rss=1 )
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