{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T14:41:39Z","timestamp":1789828899438,"version":"4.0.1"},"reference-count":61,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Serrated\u2010carcinoma pathway accounts for approximately 15%\u201330% of sporadic colorectal cancers (CRC) and contributes disproportionately to right\u2010sided interval cancers. Key precursors include sessile serrated lesion (SSL) and SSL with dysplasia (SSLD); traditional serrated adenoma, and also the recently described superficially serrated adenoma which warrants attention. However, high\u2010quality evidence guiding best practice for resection indications, technique selection, and post\u2010resection surveillance intervals remains limited and varied, with differences between Western and Japanese guidelines. This narrative review integrates clinicopathologic and practical perspectives to provoke further discussion for a standardized universal guideline approach. For nondysplastic SSLs, cold polypectomy techniques may be considered in selected lesions with defined margins and detailed documentation, whereas those with suspected dysplasia, non\u2010lifting or scarring, requiring en bloc resection, favor endoscopic mucosal resection or endoscopic submucosal dissection for accurate histopathology. Surveillance should be prioritized by histopathology and completeness of resection, with an index shorter interval assessment of the resection site at 6\u201312\u2009months after piecemeal resection or when margins are involved or indeterminate, followed by risk\u2010tiered intervals. Because the detection of serrated lesions determines resection type, quality and surveillance interval, endoscopists should standardize bowel preparation, lesion assessment after mucus cap clearance, use image\u2010enhanced endoscopy when appropriate, and apply targeted dye spray when borders are indistinct. Finally, we outline priority research; prospective, serrated lesion\u2010focused cohorts and trials\u2014to ascertain durable outcomes of cold snare resection strategies, refine surveillance intervals, and reconcile regional practice differences, with the overarching goal of reducing post\u2010colonoscopy interval CRC and overall CRC incidence with high\u2010quality colonoscopy.<\/jats:p>","DOI":"10.1111\/den.70197","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T08:03:26Z","timestamp":1781078606000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Endoscopic Assessment and Management of Colorectal Serrated Lesions: Current Comparative Practice, Challenges, and Future Directions"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4425-4331","authenticated-orcid":false,"given":"Toshio","family":"Uraoka","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine  Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2992-9863","authenticated-orcid":false,"given":"Yasushi","family":"Yamasaki","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9257-5842","authenticated-orcid":false,"given":"Kenichiro","family":"Imai","sequence":"additional","affiliation":[{"name":"Division of Endoscopy Shizuoka Cancer Center  Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirohito","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine  Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keigo","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine  Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Itoi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine  Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroko","family":"Hosaka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine  Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5067-552X","authenticated-orcid":false,"given":"Shiko","family":"Kuribayashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine  Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hemchand","family":"Ramberan","sequence":"additional","affiliation":[{"name":"Sentara Health Gastroenterology Specialists  Newport News Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3814-298X","authenticated-orcid":false,"given":"Yoji","family":"Takeuchi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine  Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.12.066"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.pas.0000213313.36306.85"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.trecan.2023.09.011"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-314005"},{"key":"e_1_2_9_6_1","volume-title":"Digestive System Tumours. 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