Small Colorectal Polyps

Abstract

Small (<10 mm) and diminutive (<6 mm) polyps harbour high-grade dysplasia or cancer in 0.3-5% of cases. The potential to grow and develop advanced histology is low. Traditional guidelines still recommend the removal of all polyps. Visual characterisation with modern endoscopic technology could enable us to leave diminutive hyperplastic polyps in situ and remove but discard small polyps. In expert hands, high-definition white-light endoscopy and virtual chromoendoscopy can reach an accuracy of more than 90% in distinguishing between hyperplastic and adenomatous pathology. For less experienced endoscopists the values are lower and therefore the concept is not yet fit for routine use. Polyps can be removed completely with snares but not with forceps. The cold snaring technique in particular has proved safe and effective for small polyps. With more experience in the future a ‘cut and discard' strategy for small polyps and a ‘do not resect' strategy for diminutive polyps will save money and time to deal with more advanced lesions.

Distribution, size and shape of colorectal adenomas as determined by a colonoscopist with a high lesion detection rate: Influence of age, sex and colonoscopy indication

“…According to the literature, ‘minute’ polyps were those with a diameter up to 5 mm; and ‘small’ polyps were between 6–9 mm. 18 More than 50% of adenomas were in the minute polyps, and 23% of the minute polyps and 40–50% of the small polyps had adenomatous histology. The clinical significance of small adenomas remains unclear; the negative correlation found between ADR and colon carcinoma mortality 8 could be due to removal of small adenomas or to more thorough colonoscopy, with higher detection rates of right-sided advanced but flat lesions.…”

“…High ADR in our patient population is mostly due to detection of small and minute adenomas. According to the literature, ‘minute’ polyps were those with a diameter up to 5 mm; and ‘small’ polyps were between 6–9 mm 18 . More than 50% of adenomas were in the minute polyps, and 23% of the minute polyps and 40–50% of the small polyps had adenomatous histology.…”

“…The size of small polyps was estimated against the opened biopsy forceps. According to the literature, ‘minute’ polyps are those with a diameter up to 5 mm; ‘small’ polyps were divided into sizes, 6–7 mm and 8–9 mm 18 . The shape of the polyps was reported according to the Paris classification 17 .…”

“…According to the literature, ‘minute’ polyps are those with a diameter up to 5 mm; ‘small’ polyps were divided into sizes, 6–7 mm and 8–9 mm. 18 The shape of the polyps was reported according to the Paris classification. 17 Histological samples were analyzed by experienced pathologists (MO and KHP).…”

Colorectal carcinogenesis: Insights into the cell death and signal transduction pathways: A review

“…Three types of colonic polyps include hyperplastic polyps, adenomatous polyps and malignant polyps[ 13 ]. These small colorectal polyps vary in size, ranging from small (< 10 mm) to diminutive (< 6 mm), and develop into cancer in 3%-5% of cases[ 14 ]. The larger polyps have a greater chance of developing into a tumor.…”