ARE DIMINUTIVE AND SMALL POLYPS DANGEROUS?

Aims:

Small colonic (6 – 9 mm) and diminutive (1 – 5 mm) polyps are frequently found at colonoscopy. Histology remains to this day the gold-standard for the evaluation of polyps despite important histo-pathological inter-observer differences in the distinction between adenomas and hyperplastic polyps. Due to the relatively high prevalence and clinical insignificance of small hyperplastic polyps on the left side of the colon, the cost associated with their removal and pathological study remains unjustified.

Methods:

The aim of this study was to identify the histological features of diminutive and small polyps in order to verify the safety of strategies proposing to resect only polyps of 10 mm or more. Patients who underwent polypectomy in 2017 were identified through our endoscopy database and those with polyps < 1 cm were enrolled.

Results:

Two hundred and four patients (117 men and 87 women, sex ratio M/W = 1.34) were identified. The mean age was 63.57 ± 12.14 years (31 to 90 years). There were 431 polyps of which 239 (55.45%) were diminutive. Sixty-three percent of all polyps were on the left colon and 30.3% (n = 131) were hyperplastic. Eighteen percent of the polyps on the right side were hyperplastic versus 37.26% on the left side. This histological difference was statistically significant (p < 0.0001). High grade dysplasia (HGD) was present in 14% of adenomatous polyps and serrated polyps were observed in 11.5% of cases. Adenocarcinoma was found in 3 small polyps on the left side (9 mm) causing a rate of degeneration at 0.69%.

Conclusions:

These data demonstrate that only a third of the polyps on the left side were hyperplastic, mainly represented by diminutive polyps (< 5 mm). However the pathological findings of small polyps (6 – 9 mm) are not reassuring proving that polypectomy remains well justified.