BACKGROUND AND AIMS: Diminutive (1-5 mm) and small (6-9 mm) polyps comprise 90% of detected lesions during colonoscopy and rarely contain advanced histology or colorectal cancer (CRC). Routine removal of these lesions results in a significant burden to colonoscopy programs. At the same time, the risk for progression of these polyps to CRC is unclear. We performed a systematic review to explore the natural history of diminutive and small colorectal polyps. METHODS: We searched MEDLINE and EMBASE for studies investigating the natural history of colorectal polyps. Studies were considered eligible when they assessed patients with 1- to 9-mm polyps that were not treated with polypectomy and that underwent follow-up. We excluded studies in patients with inflammatory bowel disease, polyposis syndromes, and previously diagnosed CRC. We independently extracted study characteristics and evaluated CRC and advanced adenoma (size ≥ 10 mm, containing high-grade dysplasia or villous features) as outcome parameters. RESULTS: Of 8775 retrieved studies, 9 studies with 721 patients were included that prospectively evaluated the evolution of 1- to 9-mm polyps. In 7 studies the average duration of observation was 2 to 3 years. There was only 1 study in which 1 small polyp might have progressed to cancer. Of 1034 adenomas sized 1 to 9 mm in those studies, 6% progressed to advanced adenomas over time. CONCLUSIONS: Based on this systematic review, it appears that some 1- to 9-mm adenomas progress to advanced adenomas within 2 to 3 years. No information on long-term CRC transition rates was found. Defining the biologic significance of these polyps is needed to balance between benefits and harm of polypectomy. (PROSPERO database registration number: CRD42016036577.).
BACKGROUND AND AIMS: Diminutive (1-5 mm) and small (6-9 mm) polyps comprise 90% of detected lesions during colonoscopy and rarely contain advanced histology or colorectal cancer (CRC). Routine removal of these lesions results in a significant burden to colonoscopy programs. At the same time, the risk for progression of these polyps to CRC is unclear. We performed a systematic review to explore the natural history of diminutive and small colorectal polyps. METHODS: We searched MEDLINE and EMBASE for studies investigating the natural history of colorectal polyps. Studies were considered eligible when they assessed patients with 1- to 9-mm polyps that were not treated with polypectomy and that underwent follow-up. We excluded studies in patients with inflammatory bowel disease, polyposis syndromes, and previously diagnosed CRC. We independently extracted study characteristics and evaluated CRC and advanced adenoma (size ≥ 10 mm, containing high-grade dysplasia or villous features) as outcome parameters. RESULTS: Of 8775 retrieved studies, 9 studies with 721 patients were included that prospectively evaluated the evolution of 1- to 9-mm polyps. In 7 studies the average duration of observation was 2 to 3 years. There was only 1 study in which 1 small polyp might have progressed to cancer. Of 1034 adenomas sized 1 to 9 mm in those studies, 6% progressed to advanced adenomas over time. CONCLUSIONS: Based on this systematic review, it appears that some 1- to 9-mm adenomas progress to advanced adenomas within 2 to 3 years. No information on long-term CRC transition rates was found. Defining the biologic significance of these polyps is needed to balance between benefits and harm of polypectomy. (PROSPERO database registration number: CRD42016036577.).
Authors: Lucinda Bertels; Sientje van der Heijden; Maartje Hoogsteyns; Evelien Dekker; Kristel van Asselt; Henk van Weert; Bart Knottnerus Journal: BJGP Open Date: 2019-03-20
Authors: N C A Vermeer; M P M de Neree Tot Babberich; P Fockens; I D Nagtegaal; C J H van de Velde; E Dekker; P J Tanis; K C M J Peeters Journal: BJS Open Date: 2019-07-30
Authors: Philippe Willems; Roupen Djinbachian; Saskia Ditisheim; Sinan Orkut; Heiko Pohl; Alan Barkun; Mickael Bouin; Bernard Faulques; Daniel von Renteln Journal: Endosc Int Open Date: 2020-04-17