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Diagnosis and Treatment of Diminutive Polyps in the Colon

  • Endoscopy (P Siersema, Section Editor)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Abstract

Purpose of review

Colonoscopy and polypectomy reduce the incidence and mortality of colorectal cancer (CRC) by detecting and removing colorectal adenomas. Diminutive polyps (1–5 mm) account for 75% of all polyps found but rarely contain or progress to CRC. Although a high adenoma detection rate (ADR) is associated with improved cancer prevention, the increase in detection of diminutive polyps also increases costs associated with CRC prevention programs. This review provides an update on endoscopic management and considerations related to diminutive colorectal polyps.

Recent findings

Recent studies show that only 0–4.3% of diminutive polyps show advanced features and progression into CRC is extremely rare. Advances in endoscopic imaging have improved the ADR for screening colonoscopy, mostly as a result of greater detection of diminutive and hyperplastic polyps. A resect and discard strategy for these low-risk diminutive polyps could reduce the need for pathologic assessment and is included in society guidelines with recommendations on imaging modalities, classification, and endoscopist benchmarks. To ensure complete resection, cold snare polypectomy is emerging as the most efficient and safest method of removal. A recent guideline review showed that fecal immunochemical testing is generally the preferred first-line screening test in average-risk adults. Post-polypectomy surveillance intervals may increase in the future as evidence on the management and outcomes of diminutive polyps which is assimilated.

Summary

High detection rates of diminutive polyps result in more surveillance colonoscopies and higher healthcare costs, with unclear benefit for CRC prevention. Optical diagnosis and strategies such as resect and discard may help to reduce costs. The performance of high-quality colonoscopies and strict adherence to recommended surveillance intervals will also optimize the effectiveness of screening programs.

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Abbreviations

ADR:

Adenoma detection rate

AI:

Artificial intelligence

ASGE:

American Society for Gastrointestinal Endoscopy

CRC:

Colorectal cancer

CSP:

Cold snare polypectomy

CTC:

Computed tomography colonoscopy

ESGE:

European Society of Gastrointestinal Endoscopy

FICE:

Flexible spectral imaging color enhancement

FIT:

Fecal immunochemical test

HGD:

High-grade dysplasia

NBI:

Narrow-band imaging

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Authors and Affiliations

  1. Division of Internal Medicine, Montreal University Hospital Center (CHUM), Montreal, Canada

    Iness Soltani MD

  2. Montreal University Hospital Research Center (CRCHUM), Montreal, Canada

    Iness Soltani MD & Daniel von Renteln MD

  3. Department of Medicine, Division of Gastroenterology, Montreal University Hospital Center (CHUM) and Montreal University Hospital Research Center (CRCHUM), 900 Rue Saint-Denis, Montreal, QC, H2X 0A9, Canada

    Daniel von Renteln MD

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Contributions

Iness Soltani: acquisition of data, analysis and interpretation of data, drafting of the manuscript, and critical revision of the manuscript for important intellectual content. Daniel von Renteln: analysis and interpretation of data, drafting of the manuscript, and critical revision of the manuscript for important intellectual content.

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Correspondence to Daniel von Renteln MD.

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Conflict of Interest

Daniel von Renteln is supported by a “Fonds de Recherche du Québec Santé” career development award. He has also received research funding from ERBE, Ventage, Pendopharm, and Pentax, and is a consultant for Boston Scientific and Pendopharm. Iness Soltani has no conflict of interest to declare.

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Soltani, I., von Renteln, D. Diagnosis and Treatment of Diminutive Polyps in the Colon. Curr Treat Options Gastro 18, 175–187 (2020). https://doi.org/10.1007/s11938-020-00281-3

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