Should We Perform Polypectomy for All Colorectal Polyps, or Follow-Up?

Abstract

Background: There is controversy as to whether all colorectal polyps detected on colonoscopy should be removed. This study evaluated the histopathological characteristics of colorectal polyps in Turkish patients, and further determined their relationship to age, gender, size, and location. We aimed to determine the risk of neoplasms in patients with small polyps (≤5 mm), and emphasize the importance of polyp removal. Materials and Methods: Of 4,145 colonoscopies reviewed between July 2004 and June 2006, 791 polypectomies and 211 polyp biopsies were performed in 576 patients. Results: Of the 1,002 polyps histologically analyzed, 586 (58.5%) were non-neoplastic, and 396 (39.5%) were neoplastic. For the remaining 20 (2%), data are missing. Among the neoplastic polyps, 311 (78.5%) were tubular, 41 (10.4%) were tubulovillous, 31 (7.8%) were villous, and 13 (3.3%) showed a malignant transformation. 63% of the non-neoplastic polyps were hyperplastic, and the remaining 37% were inflammatory polyps. Both neoplastic and non-neoplastic polyps were located predominantly in the left colon (rectum, sigmoid, descending colon). Though only 31.7% of the polyps measuring <5 mm were neoplastic, 82.4% of the polyps >20 mm in size were neoplastic. There was no significant gender difference in distribution of either neoplastic or non-neoplastic polyps. The peak prevalence of both neoplastic and non-neoplastic polyps occurred in the 50–70-year age group. Conclusion: About half of the colorectal polyps are neoplastic in patients more than 50 years old. Even small polyps seen during colonoscopy should be removed and subjected to histological analysis. Western guidelines regarding colorectal polyps may also be applicable for the Turkish population.