From the Guidelines
Hyperplastic colon polyps are typically considered to be non-neoplastic and have a low risk of progressing to colorectal cancer, and as a result, they are often not treated with medication, but rather removed during a colonoscopy if they are large or cause symptoms 1, 2, 3.
Diagnosis and Treatment
- The diagnosis of hyperplastic colon polyps is usually made during a colonoscopy, and the treatment is typically removal of the polyp during the procedure 4, 5.
- In general, it is recommended to remove hyperplastic polyps that are larger than 5 mm in size, as they have a higher risk of progressing to colorectal cancer 6, 7.
- For smaller polyps, surveillance colonoscopy is usually recommended, with the timing depending on the number, size, and location of the polyps, as well as the patient's individual risk factors 2, 3.
Surveillance Schedule
- The surveillance schedule for patients with hyperplastic colon polyps depends on the number, size, and location of the polyps, as well as the patient's individual risk factors 2, 5.
- Patients with small rectal hyperplastic polyps should be considered to have normal colonoscopies, and therefore the interval before the subsequent colonoscopy should be 10 years, unless they have a hyperplastic polyposis syndrome 2, 3.
- Patients with a history of hyperplastic polyps may be advised to take a daily aspirin, 81-100 mg, to reduce the risk of developing new polyps and colorectal cancer, although this should be discussed with a healthcare provider to weigh the potential benefits and risks 1, 4.
Key Points
- Hyperplastic colon polyps are typically non-neoplastic and have a low risk of progressing to colorectal cancer.
- Removal of hyperplastic polyps during colonoscopy is usually recommended for polyps larger than 5 mm in size.
- Surveillance colonoscopy is recommended for smaller polyps, with the timing depending on individual risk factors.
- Daily aspirin may be recommended for patients with a history of hyperplastic polyps to reduce the risk of developing new polyps and colorectal cancer.
From the Research
Diagnosis of Hyperplastic Colon Polyp
- Hyperplastic polyps are typically small, sessile polyps (5 mm) located in the rectosigmoid area 8
- They can be diagnosed through endoscopy, and their size and location can be determined 8
- Large hyperplastic polyps (20 mm in size) are rare and can be difficult to distinguish from other types of polyps 8
Treatment of Hyperplastic Colon Polyp
- Hyperplastic polyps can be removed through endoscopic polypectomy on an outpatient basis without complications 8
- The standard technique for removing hyperplastic polyps is sufficient, and patients should be followed with successive endoscopies 8
- For patients with hyperplastic polyposis, frequent colonoscopic surveillance is necessary to prevent colorectal cancer 9
Risk of Colorectal Cancer
- Hyperplastic polyps are generally considered to be non-neoplastic and have little or no potential to progress to colorectal cancer 10
- However, some studies suggest that certain subsets of hyperplastic polyps may have malignant potential, particularly those that are large, multiple, or proximally located 10, 9
- Patients with hyperplastic polyposis are at high risk for colorectal cancer, with 54% of patients in one study developing colorectal cancer despite frequent colonoscopic surveillance 9
Management of Small and Diminutive Polyps
- The clinical significance of small and diminutive polyps is debated, but studies suggest that they have a low prevalence of advanced pathology and may exhibit little or slow growth 11
- A "diagnose and discard" strategy for diminutive adenomas and a "diagnose and leave behind" strategy for diminutive hyperplastic polyps may offer risk and cost reduction without compromising effectiveness 11