Follow-up for a 5 millimeter hyperplastic polyp in the rectum

From the Guidelines

For a 5 mm hyperplastic polyp in the rectum, follow-up colonoscopy is recommended in 10 years, assuming you have no other risk factors for colorectal cancer. Hyperplastic polyps in the rectum are generally considered non-neoplastic lesions with minimal malignant potential, especially when they are small (less than 10 mm) and located in the rectum 1. No specific medication or treatment is needed for the polyp itself since it was already removed during the colonoscopy. However, you should maintain a healthy lifestyle with regular physical activity, a diet rich in fruits, vegetables, and fiber, and limited red meat and processed foods to reduce colorectal cancer risk.

Key Considerations

• The American Family Physician guidelines suggest that patients with small colorectal hyperplastic polyps should have their next follow-up colonoscopy in 10 years, unless they have a hyperplastic polyposis syndrome 1.
• The American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer also recommend a 10-year follow-up interval for patients with small rectal hyperplastic polyps 2, 3, 4.
• If you have a family history of colorectal cancer, Lynch syndrome, or other risk factors, your follow-up interval might need to be shorter.
• Report any new symptoms such as rectal bleeding, change in bowel habits, or abdominal pain to your doctor promptly, as these might warrant earlier evaluation.

Lifestyle Recommendations

• Regular physical activity
• A diet rich in fruits, vegetables, and fiber
• Limited red meat and processed foods
• Avoid smoking and excessive alcohol consumption

Follow-up Interval

• 10 years for patients with small rectal hyperplastic polyps and no other risk factors
• Shorter intervals for patients with a family history of colorectal cancer, Lynch syndrome, or other risk factors, as determined by clinical judgment.

From the Research

Follow-up for a 5 millimeter hyperplastic polyp in the rectum

• The management of a 5 millimeter hyperplastic polyp in the rectum is guided by current guidelines, which recommend screening colonoscopy at 10-year intervals in average-risk individuals who had baseline screening colonoscopy with no polyps or only hyperplastic polyps ≤5 mm in the recto-sigmoid colon 5.
• A study published in 2017 found that the yield of repeat screening colonoscopy at 10 years is unknown, but the adenoma detection rate at the second screening examination was 36.1% and 56.8% in the groups with no polyp at baseline and with only distal hyperplastic polyps, respectively 5.
• However, another study published in 2020 found that individuals with proximal 5- to 9-mm hyperplastic polyps are at an increased risk for metachronous large serrated polyps, suggesting that close surveillance intervals may be appropriate for these patients 6.
• The diagnostic criteria for serrated polyposis syndrome (SPS) include having serrated polyps proximal to the rectum, all being ≥5 mm in size, with at least two being ≥10 mm in size, and a more distal phenotype that presents with greater than 20 SPs of any size throughout the large bowel with five being proximal to the rectum 7.
• Hyperplastic polyps are typically small sessile polyps (5 mm) located in the rectosigmoid area, but large hyperplastic polyps can occur and should be removed with a standard technique, with patients needing to be followed with successive endoscopies 8.
• Adenomatous polyps, on the other hand, can undergo malignant degeneration, and size and histologic type are useful in predicting the likelihood of malignancy, with biopsy required to distinguish small adenomas from hyperplastic polyps 9.