Post colonoscopy colorectal cancer is arguable one of the 'hardest' quality measures in colonoscopy. Until now, it has been difficult to identify cases often presenting several years after their colonoscopy and sometimes to a different institution. From September, NHS endoscopy units will have access to a bespoke online resource identifying cases of PCCRC. From September, this online tool will be used to audit the 1400 PCCRC cases which we see in the NHS every year. Roland Valori explains the idea behind the audit. 

In this podcast we discuss Serrated Polyps with Prof Neil Shepherd. There is much more to these lesions than Size and Number!   Did you know that there appears to be two distinct syndromes and it's the Site of the lesions which distinguishes the two?  That is just the start.  It gets weirder !  


We cover a huge amount of ground and headings include (in chronological order):

• Serrated polyps - one or two distinct syndromes?
• Can you tell histologically?
• How does the Serrated Polyposis Syndrome fit ?
• What matters the most when deciding on the significance of a serrated polyp?
• Dysplasia inside a serrated polyp? - Well it's complicated ! 
• The heterogeneity of serrated lesions is also problematic
• Could AI help the Pathologist in the future?
• How can we identify patients with serrated polyposis syndrome ?
• Can we explain finding both serrated and adenomatous polyps in serrate polyposis syndrome?
• Why should I refer patient with serrated polyposis syndrome to geneticists?
• Can we tell which cancer has developed from a serrated precursor?
• What is the link between serrated polyps and colitis?
• The weird issue of stromal changes below serrated polyps
• 'Mixed polyp' or 'collision polyp'?
• How can we as endoscopist help the pathologist?
• Do you believe in DISCARD?
• What remains the remit of the pathologist to diagnose?

There have been some recent developments shedding welcome light on the issue of cancer in colitis.  We take a closer look at the papers and have a chat with Lauranne Derikx about her research.  To my surprise, I find that my long lamented 'cancer field theory' is very much alive !  

References 
■ Derikx LAAP, Kievit W, Drenth JPH et.al. Prior Colorectal Neoplasia Is Associated With Increased Risk of Ileoanal Pouch Neoplasia in IBD. Gastroenterology 2014;146:119-28.
■ de Jong ME, van Tilburg SB, Nissen LHC et.al. Long-term Risk of advanced Neoplasia after finding LGD in pts with IBD - A Nationwide Cohort Study. Journal of Crohn's and Colitis 2019;1485-91.
■ de Jong ME, Kanne H, Nissen LHC et.al. Increased risk of HGD and CRC in IBD patients with recurrent LGD. GIE 2020;91:1334-42.
■ Wijnands AM, de Jong ME, Lutgens MWMD. Prognostic factors for advanced colorectal neoplasia in inflammatory bowel disease: systematic review and meta-analysis. Gastroenterology 2020; 22 December