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colorectal polyp

Grossly visible protrusion from the colonic mucosal surface. Classification: 1) serrated polyp - hyperplastic polyp - sessile serrated polyp - serrated adenoma 2) adenomatous polyp - tubular adenoma - tubulovillous adenoma - villous adenoma 3) other - non neoplastic hamartoma (juvenile polyp) - inflammatory polyp [2] Etiology: - modifiable risk factors [2] - high dietary fat - red meat - low dietary fiber - smoking - excessive alcohol ingestion - obesity - type 2 diabetes - physical inactivity Pathology: 1) only adenomatous polyps are clearly premalignant* 2) only a minority of adenomatous polyps develop into cancer (< 1%) 3) most colorectal carcinomas begin as adenomatous polyps * hyperplastic polyps may be associated with colorectal cancers that show microsatellite instability [3] Clinical manifestations: - most polyps produce no symptoms Laboratory: 1) polyps are found on sigmoidoscopy or colonoscopy 2) occult blood in stool occurs in only 5% of patients with colonic polyps Complications: - colorectal cancer risk for non-advanced adenomas or small serrated polyps no different than no polyps [9] - patients with any polyps with higher colorectal cancer incidence - those with sessile serrated polyps, tubulovillous adenomas, or villous adenomas with higher colorectal cancer mortality [11] Management: 1) see colorectal adenomatous polyp 2) repeat colonoscopy in 10 years for rectosigmoid hyperplastic polyp < 10 m 3) 1-2 tubular adenomas < 10 mm, surveillance in 5-10 years 4) 3-4 tubular adenomas < 10 mm, surveillance in 3-5 years 5) any tubular adenoma > 10 mm, 5-10 tubular adenomas < 10 mm, villous adenoma, or high-grade dysplasia, surveillance in 3 years 6) > 10 tubular adenomas, surveillance in 3 years + investigate genetic cause 7) sessile serrated polyps all < 10 mm without dysplasia - 1-2 polyps: surveillance in 5-10 years - 3-4 polyps: surveillance in 3-5 years - 5-10 polyps: surveillance in 3-5 years [2] 8) sessile serrated polyp > 10 mm or with dysplasia, or serrated adenoma, surveillance in 3 years [2] 9) serrated polyposis syndrome, surveillance in 1 year [2] 10) endoscopic resection of solitary juvenile polyps* - endoscopic surveillance unnecessary [2] 11) surgical resection (rather than endoscopic polypectomy) of non-malignant colorectal polyps is associated with increased morbidity & mortality [10] 12) prevention: - aspirin or NSAIDs not recommended [2] * criteria for juvenile polyposis coli: - >= 3 juvenile colorectal polyps, juvenile polyps throughout the GI tract, juvenile polyp with family history of juvenile polyposis coli

Related

colonoscopy with polypectomy intestinal polyposis syndrome

Specific

colorectal adenomatous polyp; tubular adenoma; villous adenoma hyperplastic polyp serrated colorectal polyp; serrated adenoma

General

colorectal neoplasm intestinal polyp

References

  1. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1426
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2012, 2015, 2018, 2021.
  3. Journal Watch 21(19):151, 2001 Hawkins NJ, Ward RL. Sporadic colorectal cancers with microsatellite instability and their possible origin in hyperplastic polyps and serrated adenomas. J Natl Cancer Inst 93:1307, 2001 PMID: 11535705
  4. Martinez ME et al One-Year Risk for Advanced Colorectal Neoplasia: U.S. Versus U.K. Risk-Stratification Guidelines Ann Intern Med. 18 December 2012;157(12):856-864 PMID: 23247939 http://annals.org/article.aspx?articleid=1485310
  5. East JE, Saunders BP, Jass JR. Sporadic and syndromic hyperplastic polyps and serrated adenomas of the colon: classification, molecular genetics, natural history, and clinical management. Gastroenterol Clin North Am. 2008 Mar;37(1):25-46, v PMID: 18313538
  6. Miller HL, Mukherjee R, Tian J, Nagar AB. Colonoscopy surveillance after polypectomy may be extended beyond five years. J Clin Gastroenterol. 2010 Sep;44(8):e162-6. PMID: 20628313
  7. Rapuri S, Spencer J, Eckels D. Importance of postpolypectomy surveillance and postpolypectomy compliance to follow-up screening--review of literature. Int J Colorectal Dis. 2008 May;23(5):453-9. PMID: 18193238
  8. Lieberman DA, Rex DK, Winawer SJ et al Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012 Sep;143(3):844-57 PMID: 22763141 (corresponding NGC guideline withdrawn Feb 2018)
  9. He X, Hang D, Wu K et al. Long-term risk of colorectal cancer after removal of conventional adenomas and serrated polyps. Gastroenterology 2019 Jul 11 PMID: 31302144 https://www.gastrojournal.org/article/S0016-5085(19)41086-X/pdf
  10. Ma C, Teriaky A, Sheh S, et al. Morbidity and mortality after surgery for nonmalignant colorectal polyps: A 10-year nationwide analysis. Am J Gastroenterol 2019 Oct 11; PMID: 31634261
  11. Emilsson L, Bozorg SR et al Risk of colorectal cancer incidence and mortality after polypectomy: a Swedish record-linkage study. Lancet Gastroenterol Hepatol. 2020 Mar 16. PMID: 32192628 Free Article - Meester RGS, Ladabaum U Sessile serrated polyps and colorectal cancer mortality. Gastroenterology. 2020 Mar 18. PMID: 32199884