New US Guidance Defines How to Diagnose, Clear and Survey Serrated Polyposis Syndrome: Gastroenterology | 30 September 2026

What Did the Guideline Find?

The Task Force recommends diagnosing serrated polyposis syndrome using the 2019 WHO cumulative-lifetime criteria, making accurate documentation of every serrated lesion’s number, size and location essential. After diagnosis, the colon should undergo a 3–6-month clearance phase, preferably by an endoscopist with strong sessile-serrated-lesion detection performance, followed by surveillance every 1–2 years. Patients with a substantially reduced polyp burden may be considered for a three-year interval.

Endoscopic management is preferred when the burden remains controllable; referral to an advanced endoscopist should precede colectomy unless colorectal cancer is present. Routine broad germline testing is not recommended because SPS has no single common causative variant; testing should instead be driven by features suggesting another hereditary syndrome. First-degree relatives should begin colonoscopy at 40 years, 10 years before the youngest family CRC, or five years before the youngest SPS diagnosis—whichever occurs earliest. Gastrointestinal Endoscopy

Why Does It Matter?

SPS is frequently missed when polyp counts are not accumulated across procedures. The new guidance turns longitudinal pathology and colonoscopy documentation into an active cancer-prevention tool.

GastroAGI Takeaway

Do not reset the serrated-polyp count after each colonoscopy—SPS is a cumulative diagnosis that changes surveillance for both patients and relatives.