Small colorectal polyps. Are they worth treating?

The histology of small (less than or equal to 0.5 cm.) colorectal polyps removed during total colonoscopy in 303 patients was reviewed to determine their clinical significance. There were 178 male patients and 125 females, with a median age of 64 years (range, 26 to 97 years). A total of 766 polyps were treated, 60 percent being adenomatous and 22 percent hyperplastic. Hyperplastic polyps were more common in the rectum (71 percent) while adenomas were more common in the colon (63 percent). Hyperplastic polyps in the colon were associated with adenomas in 75 percent of cases and hyperplastic rectal polyps were associated with proximal adenomas in 63 percent. There were six mixed hyperplastic/adenomatous polyps. Of the 458 adenomas, 449 were tubular, eight were tubulovillous, and one was villous. Moderate dysplasia was noted in 23 (5 percent) and severe dysplasia in four (0.9 percent). There were associated large adenomas in 84 patients. Small colonic polyps are usually adenomatous and should be destroyed. Biopsy may be important if no other neoplasm has been identified. Small rectal polyps are usually hyperplastic but may be associated with proximal adenomas. Because of the uncertain significance of hyperplastic polyps they should also be treated, and are a relative indication for total colonoscopy.