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Curriculum based clinical reviews
Curriculum review: serrated lesions of the colorectum
  1. Angad Singh Dhillon1,
  2. Hajir Ibraheim2,
  3. Susi Green3,
  4. Noriko Suzuki1,
  5. Siwan Thomas-Gibson1,
  6. Ana Wilson1
  1. 1 Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK
  2. 2 Guy's and Saint Thomas' NHS Foundation Trust, London, UK
  3. 3 Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  1. Correspondence to Dr Angad Singh Dhillon, Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK; angad.dhillon123{at}


Colorectal cancer (CRC) is the second leading cause of death from cancer in the UK. Sporadic CRC evolves by the cumulative effect of genetic and epigenetic alterations. Typically, over the course of several years, this leads to the transformation of normal colonic epithelium to benign adenomatous polyp, low-grade to high-grade dysplasia and finally cancer—the adenoma-carcinoma sequence. Over the last decade, the serrated neoplasia pathway which progresses by methylation of tumour suppressing genes has been increasingly recognised as an important alternative pathway accounting for up to 30% of CRC cases. Endoscopists should be aware of the unique features of serrated lesions so that their early detection, appropriate resection and surveillance interval can be optimised.

  • colorectal polyps
  • serrated polyps. word count – 2862

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  • Contributors ASD: manuscript planning, writing, submission, responsible for overall content. HI: manuscript review and editing, question writing. AW: manuscript review and editing. SG: manuscript planning. STG: manuscript review and editing, provision of original images. NS: provision of original images.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.