Colorectal cancer (CRC) is a multigenic disease with numerous gene expression profiles. The conventional adenoma-carcinoma pathway and the alternative serrated neoplasia pathway are two major colorectal cancer development pathways. Typical APC mutation and chromosomal instability usually initiate the conventional pathway while mutations of BRAF or KRAS, CpG island methylator phenotype (CIMP), and microsatellite instability (MSI) indicate the serrated neoplasia pathway. During endoscopy screening and even pathological evaluation, Serrated lesions can easily go unnoticed due to their anatomical position, morphology, and histological characteristics, in spite of their malicious potential. It has been demonstrated that in CRC pathogenesis, environmental factors such the gut microbiota composition, are quite important. The preference of serrated lesions in specific gut regions suggests that microbe species composition might be linked to host genetic changes during the development of serrated wounds. Most researches have focused on conventional adenomas, whereas the pathophysiology and function of microorganisms in the formation of serrated lesions are still unknown even though, serrated lesions and conventional adenomas are biologically distinct. For In this study, the researchers looked at the role of gut microbiota in the serrated neoplasia pathway of colorectal carcinogenesis, as well as its particular clinical and molecular features, and potential mechanisms involved.