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Serrated Appendiceal Lesions Common in Serrated Polyposis but Not Clinically Important

Douglas K. Rex, MD, MASGE reviewing van Toledo DEFWM, et al. Endoscopy 2023 Feb 24.

Some previous work has suggested that the prevalence of advanced lesions in the appendix is high enough to warrant routine appendectomy in patients with serrated polyposis (SPS).

In this study from the Netherlands, 34 patients with SPS who underwent right hemicolectomy for other reasons, such as cancer and polyp burden, had their appendix evaluated for serrated lesions. Fourteen patients had one or more serrated polyps in the appendix, but none were advanced.

Among 171 total patients, including 110 who underwent endoscopic surveillance, only one developed a detectable advanced lesion in the appendix, and 3 had nonadvanced lesions.


These data indicate that although the appendiceal orifice in patients with SPS should be examined carefully during colonoscopy, most appendiceal lesions are not endoscopically detectable. Fortunately, advanced appendiceal lesions and cancer in SPS are rare, and these data do not support routine appendectomy in SPS.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Douglas K. Rex, MD, MASGE

Bio and Disclosures


van Toledo DEFWM, IJspeert JEG, Bleijenberg AGC , Bastiaansen BAJ , van Noesel CJM, Dekker E. Appendiceal lesions in serrated polyposis patients are easily overlooked but only seldomly lead to colorectal cancer. Endoscopy 2023 Feb 24. (Epub ahead of print) (