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PubMed This is a summary of 18 peer-reviewed journal articles Updated
Gastroenterology

Managing Serrated Polyposis Syndrome: Your Roadmap to Prevention

At a Glance

Serrated Polyposis Syndrome (SPS) is a silent condition involving multiple precancerous polyps in the colon. It is highly manageable through an initial "clearing phase" to remove polyps, followed by routine surveillance colonoscopies every 1 to 2 years to prevent colorectal cancer.

Finding out you have Serrated Polyposis Syndrome (SPS) can be overwhelming. The term “syndrome” often sounds frightening, and hearing that you have an increased risk of colorectal cancer (CRC) can cause significant anxiety [1]. It is important to know that these feelings are valid, but the diagnosis is actually a powerful tool for prevention. By identifying this condition early, you and your medical team can take proactive steps to dramatically reduce your risk and manage your health effectively [2][3].

If you feel perfectly fine right now, that is normal. SPS is a completely silent condition that typically causes no symptoms at all [4].

Understanding the Shift from “Hyperplastic Polyposis”

In the past, this condition was called Hyperplastic Polyposis Syndrome. The name was changed to Serrated Polyposis Syndrome to more accurately reflect the nature of the polyps being found [5].

For a long time, doctors believed that hyperplastic polyps (a type of common, small polyp) were always harmless. However, researchers discovered the serrated pathway, a biological route where certain types of polyps—looking “saw-toothed” or serrated under a microscope—can develop into cancer if left alone [6][7]. The new name covers a broader range of these “saw-toothed” growths, including sessile serrated lesions (SSLs) and traditional serrated adenomas (TSAs), ensuring that doctors focus on removing all potentially precancerous growths [8][9].

The 2019 WHO Diagnostic Criteria

To make a formal diagnosis of SPS, doctors use simplified guidelines established by the World Health Organization (WHO) in 2019 [10]. You generally meet the criteria for SPS if your colonoscopy findings match either of these two rules:

Criterion What the Doctor Sees
Criterion I At least 5 serrated polyps located “proximal to the rectum” (in the upper parts of the colon). All must be at least 5 mm in size, and at least 2 of them must be 10 mm or larger [11][10].
Criterion II More than 20 serrated polyps of any size, spread throughout the entire colon, with at least 5 of them located “proximal to the rectum” [11][10].

These criteria were simplified from older versions to help doctors identify at-risk patients more quickly and start them on a management plan sooner [10].

Taking Control: Why Screening Works

While the initial risk of cancer is higher in people with SPS, the long-term outlook is very positive for those who stay current with their medical care. The goal of treatment is to “clear” the colon and then maintain it [1].

  • The Clearing Phase: Initially, you may need colonoscopies more frequently to remove all polyps larger than 5 mm [4].
  • The Surveillance Phase: Once your colon is “clear,” you will typically have a colonoscopy every 1 to 2 years [12][13].
  • Enhanced Detection: Doctors may use chromoendoscopy—a technique involving special blue dyes or digital filters—to make flat or subtle serrated polyps easier to see and remove [14][15].

Research shows that for patients who follow these proactive screening schedules, the incidence of colorectal cancer is significantly reduced [2][3]. Most patients can manage the syndrome entirely through colonoscopies, with surgery only being necessary in rare cases where polyps cannot be safely removed with an endoscope [16].

Because your risk is elevated and these polyps can be flat and “stealthy,” consider asking your doctor if they have specific experience managing SPS. In some cases, seeking care at a dedicated advanced endoscopy center can be beneficial.

Family Considerations

Because SPS can have a genetic component, your diagnosis also helps protect your family. It is generally recommended that your first-degree relatives (parents, siblings, and children) begin their own colonoscopy screenings, often starting at age 40 or even earlier, to ensure they are also protected [17][18]. For a full guide on this, read our page on Protecting Your Family.

Common questions in this guide

What are the 2019 WHO diagnostic criteria for Serrated Polyposis Syndrome?
You generally meet the criteria if a colonoscopy reveals at least 5 serrated polyps in the upper colon (with two being 10 mm or larger), or more than 20 serrated polyps spread throughout the entire colon.
How often do I need a colonoscopy if I have SPS?
Once your colon is cleared of polyps larger than 5 mm, you will typically need a surveillance colonoscopy every 1 to 2 years. Your doctor may use special dyes or lights, called chromoendoscopy, to find flat polyps during these procedures.
Does Serrated Polyposis Syndrome cause any symptoms?
No, SPS is a completely silent condition and typically causes no symptoms at all. Most people feel perfectly fine, which is why routine colonoscopy screenings are essential for detecting and removing precancerous polyps early.
Do my family members need to be tested for SPS?
Yes, because the condition can have a genetic link, it is recommended that your first-degree relatives (parents, siblings, and children) begin colonoscopy screenings, often starting around age 40 or earlier.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Which of the 2019 WHO criteria (Criterion I or Criterion II) do I meet based on my colonoscopy results?
  2. 2.Am I currently in the 'clearing phase' of my treatment, or have we reached the 'surveillance' stage?
  3. 3.What is the recommended interval for my next colonoscopy, and will you use chromoendoscopy (blue dye or special light) to help find flat polyps?
  4. 4.How should I share this information with my children, siblings, or parents so they can be screened appropriately?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (18)
  1. 1

    Risk of Colorectal Cancer in Serrated Polyposis Syndrome: A Systematic Review and Meta-analysis.

    Muller C, Yamada A, Ikegami S, et al.

    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2022; (20(3)):622-630.e7 doi:10.1016/j.cgh.2021.05.057.

    PMID: 34089849
  2. 2

    Reducing the polyp burden in serrated polyposis by serial colonoscopy: the impact of nationally coordinated community surveillance.

    Parry S, Burt RW, Win AK, et al.

    The New Zealand medical journal 2017; (130(1451)):57-67.

    PMID: 28253245
  3. 3

    Feasibility and Safety of Endoscopic Control for Patients with Serrated Polyposis Syndrome.

    Nakaoka M, Chiba H, Kobayashi M, et al.

    Digestive diseases (Basel, Switzerland) 2024; (42(1)):31-40 doi:10.1159/000534968.

    PMID: 37967542
  4. 4

    Optimal Endoscopic Treatment and Surveillance of Serrated Polyps.

    Gupta V, East JE

    Gut and liver 2020; (14(4)):423-429 doi:10.5009/gnl19202.

    PMID: 31581390
  5. 5

    Current Approaches in Managing Colonic Serrated Polyps and Serrated Polyposis.

    van Toledo DEFWM, IJspeert JEG, Dekker E

    Annual review of medicine 2022; (73()):293-306 doi:10.1146/annurev-med-042220-024703.

    PMID: 35084990
  6. 6

    [A Case of Serrated Polyposis Syndrome with Early Colon Cancer].

    Suzuki O, Chika N, Tachikawa T, et al.

    Gan to kagaku ryoho. Cancer & chemotherapy 2015; (42(12)):2215-7.

    PMID: 26805315
  7. 7

    Management of Serrated Polyps of the Colon.

    Fan C, Younis A, Bookhout CE, Crockett SD

    Current treatment options in gastroenterology 2018; (16(1)):182-202 doi:10.1007/s11938-018-0176-0.

    PMID: 29445907
  8. 8

    Microvesicular hyperplastic polyp and sessile serrated lesion of the large intestine: a biological continuum or separate entities?

    Bateman AC, Booth AL, Gonzalez RS, Shepherd NA

    Journal of clinical pathology 2023; (76(7)):429-434 doi:10.1136/jcp-2023-208783.

    PMID: 36927607
  9. 9

    Serrated polyps of the colon and rectum: Remove or not?

    Sano W, Hirata D, Teramoto A, et al.

    World journal of gastroenterology 2020; (26(19)):2276-2285 doi:10.3748/wjg.v26.i19.2276.

    PMID: 32476792
  10. 10

    Impact of changing diagnostic criteria on the diagnosis of serrated polyposis syndrome.

    McWhinney CD, Lahr RE, Lee CJ, et al.

    Endoscopy international open 2023; (11(1)):E39-E42 doi:10.1055/a-1958-2529.

    PMID: 36618871
  11. 11

    Germline variant testing in serrated polyposis syndrome.

    Murphy A, Solomons J, Risby P, et al.

    Journal of gastroenterology and hepatology 2022; (37(5)):861-869 doi:10.1111/jgh.15791.

    PMID: 35128723
  12. 12

    Serrated Polyposis Syndrome with a Synchronous Colon Adenocarcinoma Treated by an Endoscopic Mucosal Resection.

    Lee SH, Lee SJ, Park SC, et al.

    The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 2020; (76(3)):159-163 doi:10.4166/kjg.2020.76.3.159.

    PMID: 32969364
  13. 13

    Endoscopic control of polyp burden and expansion of surveillance intervals in serrated polyposis syndrome.

    MacPhail ME, Thygesen SB, Patel N, et al.

    Gastrointestinal endoscopy 2019; (90(1)):96-100 doi:10.1016/j.gie.2018.11.016.

    PMID: 30465771
  14. 14

    Panchromoendoscopy Increases Detection of Polyps in Patients With Serrated Polyposis Syndrome.

    López-Vicente J, Rodríguez-Alcalde D, Hernández L, et al.

    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2019; (17(10)):2016-2023.e6 doi:10.1016/j.cgh.2018.10.029.

    PMID: 30366156
  15. 15

    Reassessment colonoscopy to diagnose serrated polyposis syndrome in a colorectal cancer screening population.

    Rivero-Sanchez L, Lopez-Ceron M, Carballal S, et al.

    Endoscopy 2017; (49(1)):44-53 doi:10.1055/s-0042-115640.

    PMID: 27741536
  16. 16

    High incidence of advanced colorectal neoplasia during endoscopic surveillance in serrated polyposis syndrome.

    Rodríguez-Alcalde D, Carballal S, Moreira L, et al.

    Endoscopy 2019; (51(2)):142-151 doi:10.1055/a-0656-5557.

    PMID: 30068004
  17. 17

    Hereditary or Not? Understanding Serrated Polyposis Syndrome.

    Stanich PP, Pearlman R

    Current treatment options in gastroenterology 2019; (17(4)):692-701 doi:10.1007/s11938-019-00256-z.

    PMID: 31673925
  18. 18

    The (ir)relevance of the abandoned criterion II for the diagnosis of serrated polyposis syndrome: a retrospective cohort study.

    Bleijenberg AGC, IJspeert JEG, Rodríguez-Alcalde D, et al.

    Familial cancer 2020; (19(2)):153-160 doi:10.1007/s10689-019-00156-2.

    PMID: 31853684

This page is for informational purposes only and does not replace professional medical advice. Always consult your gastroenterologist about your specific colonoscopy screening schedule and treatment plan.

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