From the Guidelines
The management of a hyperplastic polyp in the sigmoid colon typically involves polypectomy during colonoscopy followed by surveillance colonoscopy based on polyp characteristics. For a single small hyperplastic polyp in the sigmoid colon, routine screening colonoscopy can be resumed in 10 years for average-risk individuals, as stated in the guidelines for colonoscopy surveillance after polypectomy 1. No specific medications or treatments are needed after removal as these polyps are considered non-neoplastic with minimal malignant potential. However, if multiple hyperplastic polyps are found, or if they are large or located in the right colon, more frequent surveillance may be warranted, typically in 3-5 years, as these findings may suggest serrated polyposis syndrome which carries higher cancer risk. During colonoscopy, complete removal of the polyp with clear margins is important, and histopathological examination should confirm the hyperplastic nature of the polyp to rule out serrated adenomas which have greater malignant potential, as noted in guidelines for colonoscopy surveillance after polypectomy 1. Hyperplastic polyps in the sigmoid colon are common findings and generally considered benign, representing a metaplastic response to local irritation rather than true precancerous lesions. Some key points to consider in the management of hyperplastic polyps include:
- The size and location of the polyp
- The presence of multiple polyps
- The histological characteristics of the polyp
- The patient's family history and risk factors for colorectal cancer
- The need for complete removal and surveillance, as for typical adenomas, in cases of serrated adenomas or hyperplastic polyposis syndrome. It is essential to follow the guidelines for colonoscopy surveillance after polypectomy to ensure appropriate management and minimize the risk of colorectal cancer.
From the Research
Management Approach for Hyperplastic Colon Polyp in Sigmoid Colon
The management approach for a patient with a hyperplastic colon polyp in the sigmoid colon involves several considerations, including the size and location of the polyp, as well as the patient's overall health and risk factors.
- Removal of the polyp is often recommended, even if it is hyperplastic, as it can serve as a marker for adenomatous polyps in the proximal colon 2.
- The use of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen has been shown to be associated with a decreased risk of colorectal adenomas and hyperplastic polyps 3.
- Large hyperplastic polyps, although rare, should be removed using a standard technique, and patients should be followed with successive endoscopies 4.
- The decision to perform a colectomy depends on various factors, including the presence of malignancy, lymphatic or vascular invasion, and the patient's overall health 5.
Risk of Malignant Transformation
There is evidence to suggest that hyperplastic polyps may serve as precursors to colorectal cancer, particularly in the proximal colon, through a novel pathway involving DNA methylation and deficient DNA mismatch repair 6.
- This highlights the need to define the genetic steps involved in the evolution of colorectal cancer from hyperplastic polyps and to identify biomarkers for hyperplastic polyps that are prone to malignant conversion.
- Screening can then be targeted more selectively toward patients who are at significantly increased risk of malignant transformation of hyperplastic polyps.
Recommendations
Based on the available evidence, it is recommended that:
- Hyperplastic colon polyps in the sigmoid colon be removed, even if they are small, as they can serve as a marker for adenomatous polyps in the proximal colon.
- Patients with hyperplastic polyps be followed with successive endoscopies to monitor for any changes or development of new polyps.
- The use of NSAIDs such as aspirin and ibuprofen be considered as a potential chemopreventive measure to reduce the risk of colorectal adenomas and hyperplastic polyps 3.