Serrated polyposis syndrome (SPS) is perhaps the least understood and most prevalent polyposis syndrome currently known and is associated with an increased prevalence of colorectal cancer (CRC).1,2 In screening populations, prevalence rates of up to 1:127 are reported.3 Little is known about the pathophysiology, but likely a combination of genetic and environmental factors (most notably smoking) lies at the heart of this disease.1,2 The limited understanding of the syndrome’s etiology has led to the use of clinical diagnostic criteria, which were arbitrarily defined by the World Health Organization (WHO).