What is the significance of a 10mm hyperplastic polyp in the sigmoid colon?

From the Guidelines

A hyperplastic polyp measuring 10 mm in the sigmoid colon should be completely removed via polypectomy during colonoscopy, as recommended by the most recent guidelines 1.

Key Considerations

• The polyp should be removed using cold snare polypectomy (CSP), as it is safe and effective for polyps <10 mm in size, with low rates of incomplete polyp removal and risk of complications 1.
• After removal, the tissue should be sent for pathological examination to confirm the hyperplastic nature and rule out any dysplastic changes.
• Follow-up colonoscopy is recommended in 7-10 years for most patients with normal risk profiles.

Rationale

• Hyperplastic polyps of this size are generally considered benign lesions with minimal malignant potential, especially when located in the left colon (sigmoid) 1.
• However, complete removal is still recommended because larger hyperplastic polyps (≥10 mm) should be evaluated histologically to confirm they are not serrated lesions, which carry higher cancer risk 1.
• Patients should maintain a healthy lifestyle with regular exercise, high-fiber diet, limited red meat consumption, and avoidance of tobacco and excessive alcohol to reduce overall colorectal cancer risk.

Additional Recommendations

• No specific medication is needed for treatment of the polyp itself.
• The technique of CSP differs from that of hot snare polypectomy (HSP), and ideally, the polyp should be positioned at the 5:00 position, with the snare opened with the tip against the mucosa proximal to the polyp 1.
• Postpolypectomy oozing is common but usually ceases spontaneously, and other techniques to improve polyp retrieval include pulling the polyp into suction channel during resection 1.

From the Research

Hyperplastic Polyp Sigmoid 10 mm

• A hyperplastic polyp in the sigmoid colon that is 10 mm in size is considered small to medium in size.
• According to the study by 2, individuals with numerous, <10-mm, rectosigmoid hyperplastic polyps are at average risk for the development of metachronous advanced adenomatous neoplasia.
• The study by 3 found that individuals with 5- to 9-mm proximal hyperplastic polyps are at an increased risk for metachronous large serrated polyps.
• The study by 4 found that patients with small and diminutive proximal hyperplastic polyps have higher rates of synchronous advanced neoplasia compared with patients without serrated lesions.
• The study by 5 found that proximal and large hyperplastic and nondysplastic serrated polyps detected by colonoscopy are associated with neoplasia.
• The study by 6 found that a significant proportion of recently reported right-sided hyperplastic polyps may be sessile serrated adenomas, and that size >5 mm and location in the right side of the colon are independent predictors of reclassification.

Risk of Metachronous Neoplasia

• The risk of metachronous neoplasia in individuals with small hyperplastic polyps is not well established, but studies suggest that it may be higher than previously thought 2, 3, 4.
• The location and number of hyperplastic polyps may also play a role in the risk of metachronous neoplasia 2, 3.
• Further study is needed to determine the optimal surveillance strategy for individuals with small hyperplastic polyps 2, 3, 4.

Surveillance Recommendations

• Current guidelines suggest that individuals with small hyperplastic polyps do not need surveillance colonoscopy and should be followed akin to individuals with a normal colonoscopy 2.
• However, some studies suggest that close surveillance intervals may be appropriate for patients with 5- to 9-mm proximal hyperplastic polyps 3.
• The decision to perform surveillance colonoscopy should be individualized based on the patient's risk factors and the characteristics of the polyp 2, 3, 4.