From the Guidelines
A diminutive polyp is a small growth that protrudes from the lining of the colon or rectum, typically measuring less than 5 millimeters in size, with a low risk of developing into colorectal cancer. These tiny polyps are commonly found during routine colonoscopy screenings and are generally considered to be hyperplastic in nature, meaning they consist of an overgrowth of normal cells rather than abnormal cells 1. However, some diminutive polyps can be adenomas, which have a small potential for malignant transformation if left untreated for many years.
Characteristics of Diminutive Polyps
- Typically measure less than 5 millimeters in size
- Often hyperplastic in nature
- Low risk of developing into colorectal cancer
- Can be adenomas with a small potential for malignant transformation
When discovered during a colonoscopy, the gastroenterologist will typically remove diminutive polyps immediately through a procedure called polypectomy, which involves using small instruments to cut or snare the polyp 1. The removed tissue is then sent for pathological examination to determine its exact nature. Cold snare polypectomy is recommended for the removal of diminutive polyps due to its high complete resection rates and safety profile 1. Regular colonoscopy screenings are important for detecting and removing these polyps before they have a chance to grow larger or potentially develop into cancer.
Removal of Diminutive Polyps
- Cold snare polypectomy is the recommended removal method
- High complete resection rates and safety profile
- Removed tissue is sent for pathological examination to determine its exact nature
- Regular colonoscopy screenings are important for early detection and removal
From the Research
Definition of Diminutive Polyp
- A diminutive polyp is a type of colorectal polyp that measures between 1 and 5 mm in size 2.
- Diminutive polyps represent the vast majority of colorectal polyps encountered during screening colonoscopy 2.
Characteristics of Diminutive Polyps
- The chance of harboring advanced adenoma or neoplastic cells in diminutive polyps is low 2.
- Despite their small size, diminutive polyps can still be clinically significant and should not be ignored 3.
- Small adenomas, including diminutive polyps, can have unfavorable histologic features, such as villous architecture or severe dysplasia 3.
Management of Diminutive Polyps
- Cold biopsy polypectomy is indicated for resection of polyps measuring 1-3 mm, while cold snare polypectomy is recommended for removal of 4-5 mm polyps 2.
- The resect and discard strategy and the diagnose and disregard strategy should be performed only by expert endoscopists, who should use validated scales and document the polyp features by storing several endoscopic images 2.
- Complete resection of diminutive polyps, following the most appropriate technique, is recommended in clinical practice 2, 4.