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Natural history of diminutive colorectal polyps: L ong‐term prospective observation by colonoscopy
Author(s) -
Mizuno Kenichi,
Suzuki Yutaka,
Takeuchi Manabu,
Kobayashi Masaaki,
Aoyagi Yutaka
Publication year - 2014
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12263
Subject(s) - diminutive , medicine , colonoscopy , natural history , term (time) , prospective cohort study , general surgery , colorectal cancer , gastroenterology , cancer , astronomy , philosophy , linguistics , physics
Background and Aim Endoscopic removal of colorectal adenomatous polyps effectively prevents cancer. However, the treatment strategy for diminutive polyps (diameter ≤5 mm) remains controversial. Understanding the natural history of diminutive polyps is a prerequisite to their effective management. We prospectively examined the natural history of diminutive polyps by long‐term surveillance colonoscopy. Methods A total of 207 polyps detected in 112 patients from D ecember 1991 through M arch 2002 were studied. To avoid potential effects on size and morphological characteristics, all polyps were selected randomly and were followed without biopsy. Polyp size was estimated by comparing the lesion with the diameter of a biopsy forceps. Results Mean follow up was 7.8 years ( SD , 4.8; range, 1.0–18.6; median, 7.5; interquartile range 3.4–11.2). Twenty‐four polyps were resected endoscopically, and the histopathological diagnosis was mucosal high‐grade neoplasia ( C ategory 4) for one polyp, and mucosal low‐grade neoplasia ( C ategory 3) for 23 polyps. Mean linear size of the polyps was 3.2 mm ( SD , 1.0; range, 1.3–5.0) at initial colonoscopy and 3.8 mm ( SD 1.6; range 1.3–10.0) at final colonoscopy ( P < 0.01). Left‐sided polyps showed a higher growth rate than right‐sided polyps, and a type III L2 pit pattern was associated with a lower growth rate than a type III L1 pattern. Conclusion We clarified the natural history of diminutive polyps by long‐term follow‐up colonoscopy. The benign course of diminutive polyps should be considered in the design of treatment strategies.