From the Guidelines
The recommended follow-up for patients with hyperplastic polyps is typically a routine screening colonoscopy in 10 years, assuming the patient has no other risk factors. Hyperplastic polyps are generally considered non-neoplastic and have minimal malignant potential, especially when they are small (less than 10mm) and located in the rectosigmoid region. However, certain situations warrant more frequent surveillance. Large hyperplastic polyps (>10mm), those located in the proximal colon, or multiple hyperplastic polyps may indicate a serrated polyposis syndrome, which requires more vigilant follow-up with colonoscopy every 1-3 years. Additionally, if the patient has a family history of colorectal cancer or other high-risk factors, the surveillance interval should be shortened accordingly. During follow-up colonoscopies, any newly discovered polyps should be removed and sent for histological examination to confirm their nature. The rationale for this approach is based on the understanding that most hyperplastic polyps have limited neoplastic potential, but certain variants, particularly sessile serrated lesions, can progress to colorectal cancer through the serrated neoplasia pathway 1.
Some key points to consider in the management of hyperplastic polyps include:
- The size and location of the polyps, with larger polyps or those located in the proximal colon potentially requiring more frequent surveillance
- The presence of multiple polyps, which may indicate a serrated polyposis syndrome
- The patient's family history of colorectal cancer or other high-risk factors, which may necessitate a shorter surveillance interval
- The importance of removing and examining any newly discovered polyps during follow-up colonoscopies to confirm their nature and guide further management.
It's worth noting that guidelines for the management of hyperplastic polyps are evolving, and the approach may vary depending on the specific clinical context and the presence of other risk factors 1. However, in general, a 10-year follow-up interval is recommended for patients with small distal hyperplastic polyps and no other risk factors.
From the Research
Hyperplastic Polyp Follow-up
The recommended follow-up for patients with hyperplastic polyps is based on several studies that have investigated the relationship between hyperplastic polyps and colorectal cancer.
- A study published in 1993 by the Practice Parameters Committee of the American College of Gastroenterology 2 suggests that a hyperplastic polyp found during proctosigmoidoscopy is not an indication for colonoscopy, and that follow-up surveillance after polypectomy should be tailored to the individual risk assessment for each patient.
- However, a study published in 2001 3 found that patients with hyperplastic polyps on initial colonoscopy had a rate of subsequent adenoma diagnoses twice that of patients with a clean initial colonoscopy, suggesting that patients with hyperplastic polyps may be at increased risk for adenomatous polyps.
- Another study published in 2004 4 suggests that hyperplastic polyps may serve as precursors to colorectal cancer, particularly in the proximal colon, and that it may be unsafe to ignore these polyps.
- A study published in 2000 5 describes four cases of large hyperplastic polyps and concludes that these polyps should be removed and patients should be followed with successive endoscopies.
Follow-up Recommendations
Based on these studies, the follow-up recommendations for patients with hyperplastic polyps are:
- Initial follow-up should be performed at 3 years for most postpolypectomy patients, as suggested by the 1993 study 2.
- Patients with hyperplastic polyps should be followed more closely, with consideration given to more frequent colonoscopies, as suggested by the 2001 study 3 and the 2004 study 4.
- Large hyperplastic polyps should be removed and patients should be followed with successive endoscopies, as described in the 2000 study 5.
- The use of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen may be associated with a decreased risk of colorectal adenomas and hyperplastic polyps, as suggested by a study published in 2010 6.