From the Guidelines
Hyperplastic polyps are common, accounting for approximately 25-30% of all colonic polyps, and are generally considered benign with minimal malignant potential. They are most frequently found in the rectosigmoid region and are typically small (less than 5mm), pale, and sessile. Management primarily involves endoscopic removal during colonoscopy, with polypectomy using cold snare or forceps being the standard approach for smaller lesions. For hyperplastic polyps less than 5mm in the rectosigmoid, some guidelines suggest that removal is not mandatory, though many practitioners still remove them for histological confirmation.
Key Points
- Surveillance recommendations depend on the size, number, and location of polyps.
- For patients with small rectosigmoid hyperplastic polyps only, routine screening intervals are typically recommended (10 years for average-risk individuals) 1.
- However, patients with larger (>10mm) hyperplastic polyps, multiple hyperplastic polyps, or those located in the proximal colon may require shorter surveillance intervals of 3-5 years.
- The development of hyperplastic polyps is associated with factors such as smoking, alcohol consumption, obesity, and possibly low-fiber diets, so lifestyle modifications addressing these factors may help reduce recurrence risk.
- While hyperplastic polyps themselves rarely cause symptoms, their importance lies in distinguishing them from adenomatous polyps, which have greater malignant potential.
Recommendations
- Patients with small rectosigmoid hyperplastic polyps should be considered to have normal colonoscopies, and therefore the interval before the subsequent colonoscopy should be 10 years 1.
- Patients with larger hyperplastic polyps or those with multiple polyps may require more frequent surveillance.
- Lifestyle modifications, such as quitting smoking, reducing alcohol consumption, and increasing fiber intake, may help reduce the risk of developing hyperplastic polyps.
From the Research
Prevalence of Hyperplastic Polyps
- Hyperplastic polyps are the most frequent nonneoplastic lesions of the colon, typically small and sessile, located in the rectosigmoid area 2, 3.
- The majority of hyperplastic polyps are found in the distal colo-rectum, with a site distribution corresponding to the site distribution for colorectal carcinomata 3.
- Large hyperplastic polyps are rare, with a study finding only four cases over a 9-year period 2.
Management of Hyperplastic Polyps
- Hyperplastic polyps should be removed with a standard technique, and patients need to be followed with successive endoscopies 2.
- The discovery of hyperplastic polyps on screening sigmoidoscopy should not prompt colonoscopy, as patients with distal hyperplastic polyps do not exhibit an increased risk for proximal neoplasia or proximal advanced neoplasia compared to those with no distal polyps 4.
- However, multiple large hyperplastic polyps may be coincident with adenomatous polyps and carcinoma of the colon, and it is recommended that patients found to have large hyperplastic polyps undergo removal of all polyps for histologic study 5.
Characteristics of Hyperplastic Polyps
- Hyperplastic polyps can show misplaced epithelium within the submucosa, simulating an adenoma with pseudoinvasion or even an adenocarcinoma 6.
- Hyperplastic polyps with misplaced epithelium probably occur secondary to trauma-induced protrusion of glands through breaks in the muscularis mucosae 6.
- The prevalence of proximal neoplasia and advanced neoplasia was compared among patients with distal hyperplastic polyps, distal adenomas, and no distal polyps, with results showing no increased risk for proximal neoplasia or proximal advanced neoplasia in patients with distal hyperplastic polyps 4.