Risk Factors of Advanced Adenoma in Small and Diminutive Colorectal Polyp

The aims of this study were to review the clinicopathological characteristics of diminutive (≤ 5 mm) and small polyps (> 5 mm but 65 years), a male gender, and a polyp size of > 5 mm were risk factors of advanced adenoma. The incidence of advanced adenoma in polyps of 65 years are independent risk factors of advanced adenoma.

Pólipos diminutos: ¿qué hacer con ellos? / Small polyps: what to do about them?

La extirpación de pólipos diminutos con características endoscópicas no neoplásicas sin estudio histológico o la no resección de los mismos son alternativas planteadas para minimizar riesgos y costos. Determinar la presencia de pólipos diminutos (5 mms. de diámetro o menos) y su naturaleza histológica para evaluar el impacto clínico de extirparlos o dejarlos in situ, o extirparlos y no enviarlos a estudio histológico. Con éste fin se evaluaron 217 colonoscopias practicadas consecutivamente, con resección y estudio histológico de los pólipos evidenciados. 26/63 pólipos diminutos (41,26%) presentaron riesgo carcinogénico para el paciente de haberse dejado in situ, con información inapropiada para determinar tiempo de seguimiento en caso de haberse resecados y descartados sin estudio histológico (entre ellos 2 displasias de alto grado). 1. Un alto porcentaje de pólipos diminutos presenta potencial carcinogénico y su estructura microscópica debe ser evaluada con fines pronósticos, de seguimiento o para determinar conductas a seguir. 2. Nuevas tecnologías pueden contribuir a una mejor selección de pólipos que no requieran ser resecados o estudiados histológicamente, pero mientras no sean adecuadamente validadas es prudente continuar con la estrategia de resecar y estudiar histológicamente

Several strategies have been proposed recently to diminish risks and costs such as the extirpation of diminutive polyps without histologic study, or leaving them in situ when their endoscopic characteristics allow to predict their non-neoplastic potential. To determine the nature of diminutive (5 mm diameter or less) polyps in a number of colonoscopies and the clinical impact of resecting them without histologic study or to leave them in situ without resection. 271 colonoscopies were performed consecutively, with resection and histopathological study of all the polyps detected. 26/63 diminutive polyps (41,26%) presented carcinogenic potential, with the inherent risk for the patient if they were leaved in situ, or with inapropiate information to determine the time of surveillance in case of having resected and discarded the polyps without histologic evaluation (2 high grade dysplasia between them). 1. A high percentage of diminutive polyps have a carcinogenic potential and its microscopic structure must be adequately evaluated. 2. The progress of high resolution endoscopy with magnification and chromoendoscopy, may contribute to the application of policies such as resect and discard