Sessile serrated adenoma/polyp (SSA/P) and traditional serrated adenoma (TSA) are colorectal polyp subtypes with recognised malignant potential. Because these serrated lesions can undergo transformation into colorectal cancer, treatment is indicated once they are identified.

Clinical Scenario

This protocol covers patients with colorectal polyps confirmed or suspected to represent sessile serrated adenoma/polyp (SSA/P) or traditional serrated adenoma (TSA). Both lesion types carry a risk of malignant transformation and require active management tailored to specific lesion characteristics.

Treatment Approach

The primary intervention is endoscopic resection. The decision to proceed with removal is guided by lesion size and the presence or suspicion of co-existing dysplastic change — the specific criteria and their application vary by lesion type. The complete protocol details how these factors determine the resection threshold for SSA/P versus TSA.

References

DOI: 10.1007/s00535-021-01776-1

SSA/P and TSA have the potential to develop into cancer, so treatment is recommended (recommendation weak [agreement rate 100%], level of evidence C).
SSA/P and TSA may undergo malignant transformation and therefore should be treated.
Endoscopic resection should be performed for SSA/P.
As with typical adenomas, resection is advised for TSA ≥ 5 mm in diameter.
Most studies have recommended that SSA/P lesions ≥ 10 mm in diameter be resected.
However, when co-existence of dysplasia and/or cancer is suspected, serrated lesions should be removed regardless of size.

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Treatment of Colon Polyp in Sessile Serrated Adenoma/Polyp (SSA/P) or Traditional Serrated Adenoma (TSA)

Clinical Scenario

Treatment Approach

References