From the Guidelines
Hyperplastic polyps generally do not require specific treatment as they are typically benign and have minimal malignant potential. The management approach involves complete removal of the polyp during colonoscopy using polypectomy techniques, followed by histological examination to confirm the diagnosis. For small hyperplastic polyps (less than 5mm) located in the rectosigmoid region, no further intervention is usually necessary after removal and confirmation. However, larger hyperplastic polyps (greater than 10mm), those located in the right colon, or those with concerning features may warrant surveillance colonoscopy in 3-5 years due to a slightly increased risk of synchronous advanced neoplasia, as suggested by the US Multi-Society Task Force recommendations 1. Patients with multiple or large hyperplastic polyps should be evaluated for hyperplastic polyposis syndrome, which carries a higher risk of colorectal cancer and requires more intensive surveillance. No specific medications are indicated for hyperplastic polyps, though general colorectal cancer prevention strategies including maintaining a healthy weight, regular exercise, limiting alcohol consumption, avoiding smoking, and consuming a diet rich in fruits, vegetables, and fiber may be beneficial. The benign nature of most hyperplastic polyps is due to their cellular architecture, which shows elongated crypts with serrated luminal patterns but without the dysplastic changes seen in adenomatous polyps. Some key points to consider in the management of hyperplastic polyps include:
- Complete removal of the polyp during colonoscopy
- Histological examination to confirm the diagnosis
- Surveillance colonoscopy in 3-5 years for larger or concerning polyps
- Evaluation for hyperplastic polyposis syndrome in patients with multiple or large polyps
- General colorectal cancer prevention strategies for all patients. It's worth noting that the guidelines for the management of hyperplastic polyps are dynamic and based on the evidence currently in the literature, understanding of the adenoma carcinoma sequence, and expert opinion, as stated in the guidelines for colonoscopy surveillance after polypectomy 1. However, the most recent and highest quality study, published in 2020, provides the most up-to-date recommendations for follow-up after colonoscopy and polypectomy 1.
From the Research
Management and Treatment of Hyperplastic Polyps
- Hyperplastic polyps are typically small and sessile, and are often found in the rectosigmoid area of the colon 2.
- Large hyperplastic polyps are rare, but can be found in any part of the colon, and may be associated with synchronous neoplastic polyps or polyposis 2, 3.
- The management of hyperplastic polyps typically involves removal of the polyp by endoscopic polypectomy, which can be done on an outpatient basis without complications 2.
- Patients with hyperplastic polyps may need to be followed with successive endoscopies to monitor for metachronous polyps 2.
- Some studies suggest that hyperplastic polyps may be a precursor to colorectal cancer, particularly in the proximal colon, and that patients with these polyps may be at increased risk of malignant transformation 4.
- In some cases, prophylactic colectomy may be considered for patients with hyperplastic polyposis, particularly if there is a high risk of malignant transformation 5.
Surveillance and Follow-up
- The need for surveillance and follow-up after removal of a hyperplastic polyp depends on the individual patient's risk assessment, and may involve colonoscopy at regular intervals 6.
- Patients with small hyperplastic polyps (< 0.5 cm) may not require surveillance, while those with larger polyps or a history of neoplastic polyps may require more frequent follow-up 6.
- The interval between follow-up colonoscopies can be increased to 5 years after one negative result, but patients with a high risk of malignant transformation may require more frequent surveillance 6.