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The serrated class of colorectal polyps (vs. conventional adenoma class) includes sessile serrated polyp (SSP) or adenoma, hyperplastic polyp, and traditional serrated adenoma. The SSP is both common (unlike the traditional serrated adenoma) and, based on its molecular features and observational study findings, seems to be the main precursor of hyper-methylated colorectal cancers. Hyperplastic polyps, conversely, are not generally considered precancerous.
In general, evidence is lacking on whether endoscopists can differentiate hyperplastic polyps from SSPs during real-time colonoscopy. The latter tend to be larger and distributed more toward the proximal colon. A recent Japanese study using high-magnification colonoscopes (not generally ava…