SMALL COLORECTAL POLYPS: IS A SYSTEMATIC HISTOPATHOLOGICAL ASSESSMENT JUSTIFIED?

Aims:

Small polyps constitute the vast majority of colorectal polyps. The prevalence of advanced adenomas in this group of lesions is low. The "Detect-and-leave" strategy is discussed for diminutive polyps (≤5 mm), given the induced costs and the high proportion of non adenomatous lesions. The aim of this study is to determine the histopathological nature of resected diminutive (≤5 mm) colorectal polyps and to evaluate the interest of a systematic histopathological assessment.

Methods:

Consecutive patients who underwent polypectomy for small colorectal polyps during a 12-month period (2017), were included in this retrospective study.

Two groups were defined: Group 1 for small polyps [range 6 – 10 mm] and group 2 for diminutive polyps. Endoscopic and histopathological data were analyzed.

Results:

During the year of the study, 116 colorectal polypectomies were performed for 74 patients with a mean age of 62 years [22 – 87 years] and a sex ratio (M/F) of 2.08. A single polyp was detected in forty-six patients (39.6%). Polyps sat mainly in the rectum (29.3%). They were sessile in 81.1% (n = 94), pedunculated in 10.3% (n = 12) and flat in 8.6% of cases (n = 10). The average size of polyps was 4.59 mm [2 – 10]. Diminutive polyps were prevailing (71.5% of cases, n = 83). In the first group; 28 polyps (84.8%), were adenomatous polyps referring to histopathological assessment. In the second group; 50 polyps (60.2%) were adenomatous and 30 (36.1%) were hyperplastic. The diagnosis of adenomas was less frequent in the group of diminutive polyps with a statistically significant difference (p = 0.001).

Conclusions:

Our serie shows a significant rate of adenomas among diminutive polyps. Thus, the "detect-and-leave" strategy must be reserved for expert endoscopists with a high level of confidence using high definition endoscopy and chromoendoscopy techniques.