Serrated polyposis syndrome may go undiagnosed even in structured colorectal cancer screening programmes performed by endoscopists with otherwise good quality indices

We have read the article by Ijspeert et al with great interest as it comprises the largest series of colonoscopies concerning the serrated polyposis syndrome (SPS) published so far.1 SPS is characterised by multiple serrated polyps (SP) throughout the colon and it is associated with an increased risk of colorectal cancer (CRC).2 A 5-year cumulative incidence of CRC during surveillance after clearing of all relevant polyps of 1.5% has been reported.2 Recently published guidelines recommend resection of all clinically relevant lesions and starting annual colonoscopy surveillance thereafter.3 Therefore, early recognition and treatment of SPS is important to achieve low long-term risk of CRC.4

We retrospectively analysed 4161 primary screening colonoscopies of average-risk individuals aged ≥50 years performed by 15 different experienced gastroenterologists (≥300 colonoscopies of all indications per year during the study period) from one academic centre and six...

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