From the Guidelines
Patients with small colorectal hyperplastic polyps should have a follow-up colonoscopy in 10 years, as they are considered to have normal colonoscopies. This recommendation is based on the guidelines for colonoscopy surveillance after polypectomy, which suggest that patients with small rectal hyperplastic polyps have no increased risk for colorectal cancer and should be rescreened as appropriate for average-risk individuals 1. The guidelines also note that patients with hyperplastic polyposis syndrome, characterized by multiple or large hyperplastic polyps, are at increased risk for adenomas and colorectal cancer and require more intensive follow-up evaluation 1.
Some key points to consider in the follow-up of hyperplastic polyps include:
- The size and location of the polyps, with larger or proximally located polyps potentially requiring more frequent surveillance
- The presence of serrated polyposis syndrome, which may require more intensive follow-up
- The importance of maintaining a healthy lifestyle, including regular physical activity, a diet rich in fruits and vegetables, limited red meat consumption, and avoiding smoking, to reduce the risk of polyp recurrence
- The need for patients to report any new symptoms, such as rectal bleeding, changes in bowel habits, or abdominal pain, between colonoscopies
It is essential to note that the follow-up recommendations are based on the understanding that while most hyperplastic polyps are benign, some may have malignant potential, particularly larger ones or those with certain histological features 1. Therefore, a 10-year follow-up interval is recommended for patients with small distal hyperplastic polyps, as they have a very low risk of future neoplasia 1.
From the Research
Hyperplastic Polyp Follow-Up
- The follow-up of hyperplastic polyps is an important aspect of colorectal cancer prevention, as some hyperplastic polyps have malignant potential 2, 3, 4, 5, 6.
- Studies have shown that non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin may reduce the risk of hyperplastic polyps 2, 3, 4, 6.
- A study published in 2010 found that regular use of aspirin was inversely associated with hyperplastic polyps, with an odds ratio of 0.8 (95% CI = 0.7-0.9) 2.
- Another study published in 2017 found that the use of NSAIDs was associated with a reduced risk of serrated polyps, including hyperplastic polyps, with a relative risk of 0.77 (95% CI = 0.65-0.92) 3.
- A colonoscopy-based case-control study published in 2011 found that the use of baby aspirin was associated with a reduced risk of hyperplastic polyps, with an odds ratio of 0.74 (95% CI = 0.56-0.97) 4.
- However, a retrospective case-control study published in 2010 found that distal hyperplastic polyps were not significantly associated with synchronous proximal neoplasms, and that routine colonoscopy may not be necessary for patients with distal hyperplastic polyps found on screening flexible sigmoidoscopy 5.
- A systematic review published in 2004 found that aspirin significantly reduced the recurrence of sporadic adenomatous polyps, but there was no significant difference for the outcomes of colorectal cancer or adverse events 6.
Risk Factors for Hyperplastic Polyps
- Smoking and alcohol intake have been found to increase the risk of hyperplastic polyps 3.
- Body mass index (BMI) and high intake of fat or meat have also been found to increase the risk of hyperplastic polyps 3.
- In contrast, factors that have been found to decrease the risk of hyperplastic polyps include the use of NSAIDs or aspirin, and high intake of folate, calcium, or fiber 3.
Follow-Up Recommendations
- The follow-up of hyperplastic polyps should be individualized based on the patient's risk factors and medical history 5.
- Patients with a history of cancer, advancing age, or non-Caucasian ethnicity may require more frequent follow-up 5.
- The use of NSAIDs or aspirin may be recommended for patients with hyperplastic polyps, as they may reduce the risk of recurrence 2, 3, 4, 6.