Post written by Jasper L.A. Vleugels from the Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

This study explored the natural history of diminutive polyps that were left without resection and were followed up. At a certain point, I was in the endoscopy room, and the patient undergoing colonoscopy asked why these diminutive polyps were removed. The patient also asked why we did not leave these diminutive polyps in situ as the performing endoscopists said that these polyps never harbored cancer and had a very low chance to progress to cancer. These were very relevant questions asked by this patient. Especially as current focus on quality and improvements in endoscopic imaging increase the number of diminutive polyps detected. The detection, removal, and surveillance of these diminutive polyps lead to a considerable workload for the endoscopists performing colonoscopy. At that moment, I asked myself what was known about leaving diminutive polyps in situ. After, I started searching Pubmed for articles that described the natural history of these diminutive polyps. The articles I found were very interesting, and I prepared an overview to present the outcomes of these studies to our research group at the AMC. Everyone reacted enthusiastically and thought it was a nice idea to perform a systematic review to present this overview on this important topic.

Based on the very limited evidence from the available studies we found in our literature search, the estimated progression rates to advanced adenomas or colorectal cancer (CRC) were very low. The results of our literature overview seem to support suggestions that, overall, removal of diminutive and small polyps at colonoscopy may do more harm than good because the increased risk of adverse events and increased burden of histologic examinations and surveillance may be too high compared with the expected minimal gain in protection from CRC. The results of this study may add to the discussion on whether resection of diminutive polyps is necessary at all.

The results of the current study may also be considered as further support for the proposed “optical diagnosis” strategy. In this strategy, a high-confidence endoscopic diagnosis of diminutive polyps based on the use of advanced endoscopic imaging techniques can replace histopathological analysis. This proposed strategy would reduce risks associated with unnecessary polypectomy of nonneoplastic polyps in the rectum and sigmoid. Furthermore, diminutive polyps throughout the colon can be resected and discarded without histopathological analysis and their endoscopic appearance can be used to guide future surveillance.

Find the article abstract here.

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