In the prevention of colorectal cancer (CRC), hyperplastic polyps have long been regarded as innocent bystanders and only adenomas were thought to be precursors for CRC. Therefore, focus during colonoscopy was on adenomas only. In the past decade, evidence has accumulated that serrated polyps might progress to cancer as well via the serrated neoplasia pathway. On the one hand, patients with multiple serrated polyps, nowadays classified as having serrated polyposis syndrome, demonstrated an increased risk of CRC development, and small cancers were detected within serrated lesions. On the other hand, a growing body of circumstantial evidence suggests that at least 15% of all CRCs arise through the serrated neoplasia pathway, and an even larger proportion of postcolonoscopy CRCs arise from serrated polyps.1 This growing body of evidence has gradually led to a paradigm shift in both cancer prevention as well as treatment strategies. To reduce the number of postcolonoscopy CRCs and to optimise current clinical care for patients with serrated polyps, several issues are at stake. The new British Society of Gastroenterology (BSG) position statement on serrated polyps in the colon and rectum is therefore timely as well as important.2 It discusses current knowledge on serrated polyps and provides recommendations for daily clinical practice as well as research. We hope that this publication will increase the awareness among clinicians on this topic and will be an incentive for appropriate management of these lesions. In the light of rapidly developing evidence on this topic, we would like to comment on this excellent work of the BSG. As the terminology of serrated polyps is confusing, and does not help to bring a clear message to the general gastrointestinal practice, the BSG proposes new terminology. We support the proposal of the BSG to simplify the WHO classification slightly by renaming ‘sessile serrated adenomas/polyps’ …

中文翻译：

---

锯齿状通路：CRC预防的范式转变

在结直肠癌（CRC）的预防中，增生性息肉长期以来被视为无辜的旁观者，只有腺瘤被认为是结直肠癌的前兆。因此，结肠镜检查的重点仅是腺瘤。在过去十年中，越来越多的证据表明锯齿状息肉也可能通过锯齿状瘤形成途径发展为癌症。一方面，多发锯齿状息肉患者，现在被归类为锯齿状息肉综合征，显示出 CRC 发展的风险增加，并且在锯齿状病变内检测到小的癌症。另一方面，越来越多的间接证据表明，至少 15% 的 CRC 是通过锯齿状瘤形成途径产生的，而更大比例的结肠镜检查后 CRC 是由锯齿状息肉引起的。1 越来越多的证据逐渐导致癌症预防和治疗策略的范式转变。为了减少结肠镜检查后 CRC 的数量并优化当前对锯齿状息肉患者的临床护理，有几个问题处于危险之中。因此，新的英国胃肠病学会 (BSG) 关于结肠和直肠锯齿状息肉的立场声明既及时又重要。2 它讨论了有关锯齿状息肉的最新知识，并为日常临床实践和研究提供了建议。我们希望本出版物将提高临床医生对这一主题的认识，并鼓励适当管理这些病变。鉴于有关该主题的证据迅速发展，我们想对 BSG 的这项出色工作发表评论。由于锯齿状息肉的术语令人困惑，并且无助于为一般胃肠道实践带来明确的信息，因此 BSG 提出了新术语。我们支持 BSG 的提议，通过重命名“无柄锯齿状腺瘤/息肉”来稍微简化 WHO 分类……