From the Guidelines
Finding Hyperplastic Polyps (HP) during a Colonoscopy has limited implications for colorectal cancer risk.
Implications of Hyperplastic Polyps
- Hyperplastic polyps are not currently considered precancerous lesions, unlike sessile serrated polyps (SSPs) and traditional serrated adenomas 1.
- However, some studies suggest that large (≥1 cm) hyperplastic polyps may represent an increased risk group, although the evidence is limited and inconclusive 1.
- The management of patients with hyperplastic polyps only is generally the same as for average-risk patients, with no increased risk for colorectal cancer 1.
Surveillance Recommendations
- For patients with small distally located hyperplastic polyps, surveillance is recommended as for average-risk patients 1.
- For patients with large (≥1 cm) hyperplastic polyps, consideration of management similar to SSPs may be warranted, particularly if they have not been reviewed by an expert gastrointestinal pathologist 1.
- Surveillance intervals assume complete resection, adequate bowel preparation, and complete examination 1.
Important Considerations
- The differentiation between hyperplastic polyps and SSPs can be challenging, with poor interobserver agreement between pathologists 1.
- Hyperplastic polyposis, a syndrome characterized by multiple hyperplastic polyps, may be associated with an increased risk of colorectal cancer, although the magnitude of this risk is unclear 1.
From the Research
Implications of Finding Hyperplastic Polyps (HP) during a Colonoscopy
- The presence of hyperplastic polyps may indicate a higher likelihood of having adenomas, with 93.6% of patients with hyperplastic polyps also having concomitant adenomas 2.
- Patients with hyperplastic polyps in the rectosigmoid area are more likely to have proximal adenomas, with 64.7% of patients having proximal adenomas compared to 29.4% of those without rectosigmoid hyperplastic polyps 2.
- Hyperplastic polyps may serve as a precursor to colorectal cancer (CRC) with DNA methylation and deficient DNA mismatch repair, particularly in the proximal colon 3.
- Large hyperplastic polyps (>20 mm) are rare and can be difficult to distinguish from other types of polyps, but they should be removed and patients should be followed with successive endoscopies 4.
- Hyperplastic polyps identified during screening endoscopy may be reclassified as serrated polyps with neoplastic potential, including sessile serrated adenoma (SSA) and traditional serrated adenoma (TSA) 5.
- Polyps >10 mm are more likely to be found in the proximal colon and tend to harbor neoplastic components, with some having BRAF or KRAS mutations 5.
- The reclassification of hyperplastic polyps into traditional hyperplastic polyp (THP), sessile serrated lesions (SSL), and other lesions may help identify patients at higher risk of developing colorectal cancer, with 16% of patients with SSL subsequently developing a neoplastic lesion 6.