CAN WE APPLY THE "DETECT-AND-LEAVE" STRATEGY FOR DIMINUTIVE POLYPS OF THE RECTO-SIGMOID?

Aims:

The size of colorectal polyps is one of the factors that determine colorectal cancer risk.

The prevalence of advanced histological signs (villous contingent, or high grade dysplasia, or cancer) in small polyps is relatively low. ESGE recommends a "detect-and-leave" strategy for very small (≤5 mm) polyps of the recto-sigmoid and whose appearance is suggestive of a hyperplastic polyp.

The aim of our study is to evaluate the feasibility of this strategy by investigating the prevalence of advanced histological signs in diminutive polyps of the recto-sigmoid.

Methods:

A retrospective study of 222 patients in a Tunisian center between 2010 and 2017 was performed. Patients records who had a colonoscopy with polypectomy were collected.

The histological features of diminutive polyps of the recto-sigmoid have been specified.

Results:

We included 222 patients with 322 polyps. The mean age was 61 years [22 – 90] with male predominance (SR H/F = 1.46). Main indications for colonoscopy were: chronic constipation and/or diarrhea (n = 110), rectal bleeding (n = 63) and abdominal pain (n = 42).

The colonoscopy was complete in 60%. The preparation was considered sufficient (Boston score ≥7) in 41% of cases. Depending on the size, polyps were classified: diminutive (≤5 mm, n = 216), small and medium (6 – 9 mm, n = 51), large (10 – 19 mm, n = 42), giants (≥20 mm, n = 13). Forty-eight polyps were diminutive and located on the rectosigmoid. They were adenomatous (60%, including 17% tubulo-villous) or hyperplastic 26% or carcinomatous (4%). Dysplasia was found in 60% of cases including 7% of high grade.

Conclusions:

Advanced histological signs within diminutive polyps of the recto-sigmoid are frequent. The "detect-and-leave" strategy can only be applied in expert centers where advanced endoscopy techniques are mastered.