Risk of villous histology or high grade dysplasia in patients with diminutive polyps: influence of number of polyps

INTRODUCTION/OBJECTIVES: Current recommendations on post-polypectomy surveillance recommend shorter intervals in case of 3 or more polyps, irrespectively of histological findings (see reference below). These recommendations doesn't differentiate between diminutive (1-5 mm) polyps and polyps of larger size (>5 mm). AIMS & METHODS: Aim of the present study was to assess, in a group of patients with "isolated" diminutive polyps, i.e. without associated polyps of larger size, if the presence of 3 or more diminutive polyps is associated with higher number of polyps with villous histology (VH) or high grade dysplasia (HGD). Retrospective examination of endoscopical records and of histopathological records of patients with diminutive polyps. RESULTS: 315 patients with "isolated" diminutive polyps were identified; 171 patients showed neoplastic (i.e.adenomatous) histology, while remaining showed hyperplastic histology or absence of polypoid features at histology. Data on prevalence of villous component at histology according to number of polyps detected are shown in the table. N\ub0 of patients VH HGD TOT N\ub0 of polyps (%) 1 polyp 97 6 1 7 (7.2) 97 2 polyps 43 9 0 9 (20.5) 86 >2 polyps 31 1 0 1 (3.0) 112 Prevalence of villous histology or HGD according to number of diminutive polyps was 16/140 (11.4%) in patients with one or two diminutive polyps and 1 /112 (0.8%) in patients with 3 or more polyps. CONCLUSION: Number of diminutive polyps found in a single patient does not seem to affect risk of villous histology or high grade dysplasia in diminutive polyps. Further studies are needed to assess if current recommendations on 3-year intervals of surveillance for patients with 3 or more polyps can apply to patients with "isolated" diminutive polyps

Clinical Significance Of Isolated Diminutive Colonic Polyps

INTRODUCTION/OBJECTIVES: Several reports have assessed clinical significance of diminutive (1-5 mm) polyps; here we report on the prevalence of advanced histology in patient with "isolated" diminutive polyps, i.e. without associated polyps of larger size. AIMS & METHODS: Retrospective examination of endoscopy records and of histopathology records of patients with polyps of any size. Advanced histology was defined as the presence of high grade dysplasia (HGD) or in situ carcinoma. Polyps were categorized into three groups: diminutive (1-5 mm); small (6-10 mm) and large (11 mm or more). Diminutive Small Large Advanced Carcinoma Number 315 89 67 84 Male (%) 205 (62) 57 (64) 46 (68) 52 (62) Mean age 62.0 67.2 68.7 70.1 % HGD 0.9 11.2 32.8 Not appropriated RESULTS: Data on 2176 consecutive colonoscopies were evaluated; biopsies were performed in 895 (41%); 555 (61%) biopsies evaluated polyps of various size; 315 patients (61%) showed "isolated" diminutive polyps, 89 (16%) patients had small polyps and 67 (12%) had large polyps. Advanced carcinoma was present in 84 (15%) patients. Mean age and prevalence of high grade dysplasia are shown in the table. CONCLUSION: "Isolated" diminutive polyps are at very low risk of advanced histology; small polyps carry a significant risk of advanced histological features. Difference in mean age between groups at different risk of HGD and with patients with advanced carcinoma suggests that progression from diminutive polyps to polyps of larger size and with significant HGD risk might need several (5 or 6) years