ISSN: 1859 - 2872
Update in management of small colorectal polyps
Main Article Content
Keywords
Small colorectal polyp, colorectal cancer, colonoscopy, polypectomy
Abstract
Colorectal polyps are strongly associated with colorectal cancer. More than 90% of colorectal polyps are small (< 10mm), with only a small proportion of neoplastic lesions. As a result, polypectomies of these polyps exposed patients to the hazards of bleeding and perforation, as well as increased unnecessary pathology expenses. Management and monitoring strategies for small colorectal polyps should be based on white light endoscopic characteristics, enhanced imaging, and histological findings. During a colonoscopy, the majority of small polyps may be easily removed. Furthermore, cold snare polypectomy is recommended because of its modest post-polypectomy complication rate and high en bloc resection rate. Endoscopic mucosal resection and endoscopic submucosal dissection are recommended if polyps have signs of a superficial invasion.
Article Details
References
1. Shaukat A, Kahi CJ, Burke CA, Rabeneck L, Sauer BG, Rex DK (2021) ACG Clinical Guidelines: Colorectal Cancer Screening 2021. The American journal of gastroenterology 116(3): 458-479. doi:10.14309/ajg.0000000000001122.
2. Vleugels JLA, Hazewinkel Y, Fockens P, Dekker E (2017) Natural history of diminutive and small colorectal polyps: A systematic literature review. Gastrointestinal endoscopy 85(6): 1169-1176.. doi:10.1016/j.gie.2016.12.014.
3. Tanaka S, Saitoh Y, Matsuda T et al (2021) Evidence-based clinical practice guidelines for management of colorectal polyps. J Gastroenterol 56(4): 323-335. doi:10.1007/s00535-021-01776-1.
4. Ang TL, Lim JF, Chua TS et al (2020) Clinical guidance on endoscopic management of colonic polyps in Singapore. Singapore Med J doi:10.11622/smedj.2020108.
5. Kaltenbach T, Anderson JC, Burke CA et al (2020) Endoscopic Removal of Colorectal Lesions: Recommendations by the US Multi-Society Task Force on Colorectal Cancer. The American journal of gastroenterology 115(3): 435-464. doi:10.14309/ajg.0000000000000555.
6. Ferlitsch M, Moss A, Hassan C et al (2017) Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 49(3):270-297. doi:10.1055/s-0043-102569.
7. John J, Garber DCC (2021) Colonic Polyps and Polyposis Syndromes. In: Madk Feldman LSF, Lawrence J. Brandt, ed. Sleisenger and Fordtran’s gastrointestinal and liver disease. Elsevier 2021: 2077 - 2107.
8. Chaptini L, Chaaya A, Depalma F, Hunter K, Peikin S, Laine L (2014) Variation in polyp size estimation among endoscopists and impact on surveillance intervals. Gastrointestinal endoscopy 80(4): 652-659. doi:10.1016/j.gie.2014.01.053.
9. Nagtegaal ID, Odze RD, Klimstra D et al (2020) The 2019 WHO classification of tumours of the digestive system. Histopathology 76(2): 182-188. doi:10.1111/his.13975.
10. Shaukat A, Kaltenbach T, Dominitz JA et al (2020) Endoscopic Recognition and Management Strategies for Malignant Colorectal Polyps: Recommendations of the US Multi-Society Task Force on Colorectal Cancer. The American journal of gastroenterology 115(11): 1751-1767. doi:10.14309/ajg.0000000000001013.
11. Huynh TM, Le QD, Le NQ, Le HM, Quach DT (2023) Utility of narrow-band imaging with or without dual focus magnification in neoplastic prediction of small colorectal polyps: A Vietnamese experience. Clin Endosc 56(4): 479-489. doi:10.5946/ce.2022.212.
12. Lê ĐQ, Lê QN, Quách TĐ (2020) Giá trị của phân loại NICE trong tiên đoán mô bệnh học của polyp đại trực tràng. Y học thành TP. Hồ Chí Minh 24(6), tr. 152-159.
13. Jeong YH, Kim KO, Park CS, Kim SB, Lee SH, Jang BI (2016) Risk factors of advanced adenoma in small and diminutive colorectal polyp. J Korean Med Sci 31(9): 1426-1430. doi:10.3346/jkms.2016.31.9.1426.
14. Ponugoti PL, Cummings OW, Rex DK (2017) Risk of cancer in small and diminutive colorectal polyps. Digestive and liver disease: Official journal of the Italian Society of Gastroenterology and the Italian. Association for the Study of the Liver 49(1): 34-37. doi:10.1016/j.dld.2016.06.025.
15. Mason SE, Poynter L, Takats Z, Darzi A, Kinross JM (2019) Optical technologies for endoscopic real-time histologic assessment of colorectal polyps: A Meta-Analysis. The American journal of gastroenterology 114(8): 1219-1230. doi:10.14309/ajg.0000000000000156.
16. Hewett DG, Kaltenbach T, Sano Y et al (2012) Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology 143(3): 599-607. doi:10.1053/j.gastro.2012.05.006.
17. Hamada Y, Tanaka K, Katsurahara M et al (2021) Utility of the narrow-band imaging international colorectal endoscopic classification for optical diagnosis of colorectal polyp histology in clinical practice: a retrospective study. BMC Gastroenterology 21(1): 336. doi:10.1186/s12876-021-01898-z.
18. JE IJ, Bastiaansen BA, van Leerdam ME et al (2016) Development and validation of the WASP classification system for optical diagnosis of adenomas, hyperplastic polyps and sessile serrated adenomas/polyps. Gut 65(6): 963-970. doi: 10.1136/gutjnl-2014-308411.
19. Kobayashi S, Yamada M, Takamaru H et al (2019) Diagnostic yield of the Japan NBI Expert Team (JNET) classification for endoscopic diagnosis of superficial colorectal neoplasms in a large-scale clinical practice database. United European Gastroenterol J 7(7): 914-923. doi:10.1177/2050640619845987.
20. Le NQ, Huynh TM, Vo DTN et al (2024) Diagnostic performance of the Japanese Narrow-band imaging expert team classification system using dual focus magnification in real-time Vietnamese setting. Medicine (Baltimore) 103(27):e38752. doi:10.1097/md.0000000000038752.
21. Sano Y, Tanaka S, Saito Y (2021) The Japan narrow-band imaging expert team (JNET) classification for the characterization of colorectal lesion using magnifying endoscopy. In: Chiu PWY, Sano Y, Uedo N, Singh R, eds. Endoscopy in Early Gastrointestinal Cancers: Diagnosis. Springer Singapore: 75-80.
22. Rex DK (2009) Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps. Gastroenterology 136(4): 1174-81. doi:10.1053/j.gastro.2008.12.009.
23. Kandel P, Wallace MB (2019) Should we resect and discard low risk diminutive colon polyps. Clinical endoscopy 52(3): 239-246. doi:10.5946/ce.2018.136.
24. Houwen B, Hassan C, Coupe VMH et al (2022) Definition of competence standards for optical diagnosis of diminutive colorectal polyps: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 54(1): 88-99. doi:10.1055/a-1689-5130.
25. Dekker E, Houwen B, Puig I et al (2020) Curriculum for optical diagnosis training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 52(10): 899-923. doi:10.1055/a-1231-5123.
26. Huynh TM, Le QD, Le NQ, Le HM, Quach DT (2024) Implementing narrow banding imaging with dual focus magnification for histological prediction of small rectosigmoid polyps in Vietnamese setting. JGH Open 8(5):13058. doi:10.1002/jgh3.13058.
27. Messmann H, Bisschops R, Antonelli G et al (2022) Expected value of artificial intelligence in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 54(12): 1211-1231. doi:10.1055/a-1950-5694.
28. Đào Việt Hằng, Lâm Ngọc Hoa, Nguyễn Phúc Bình, Đinh Duy Hải, Nguyễn Thanh Tùng, Đào Văn Long (2022) Kết quả ứng dụng nội soi đại tràng có hỗ trợ trí tuệ nhân tạo trong phát hiện polyp đại tràng gần. Tạp chí Y học Việt Nam. 519(2). doi:10.51298/vmj.v519i2.3630.
2. Vleugels JLA, Hazewinkel Y, Fockens P, Dekker E (2017) Natural history of diminutive and small colorectal polyps: A systematic literature review. Gastrointestinal endoscopy 85(6): 1169-1176.. doi:10.1016/j.gie.2016.12.014.
3. Tanaka S, Saitoh Y, Matsuda T et al (2021) Evidence-based clinical practice guidelines for management of colorectal polyps. J Gastroenterol 56(4): 323-335. doi:10.1007/s00535-021-01776-1.
4. Ang TL, Lim JF, Chua TS et al (2020) Clinical guidance on endoscopic management of colonic polyps in Singapore. Singapore Med J doi:10.11622/smedj.2020108.
5. Kaltenbach T, Anderson JC, Burke CA et al (2020) Endoscopic Removal of Colorectal Lesions: Recommendations by the US Multi-Society Task Force on Colorectal Cancer. The American journal of gastroenterology 115(3): 435-464. doi:10.14309/ajg.0000000000000555.
6. Ferlitsch M, Moss A, Hassan C et al (2017) Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 49(3):270-297. doi:10.1055/s-0043-102569.
7. John J, Garber DCC (2021) Colonic Polyps and Polyposis Syndromes. In: Madk Feldman LSF, Lawrence J. Brandt, ed. Sleisenger and Fordtran’s gastrointestinal and liver disease. Elsevier 2021: 2077 - 2107.
8. Chaptini L, Chaaya A, Depalma F, Hunter K, Peikin S, Laine L (2014) Variation in polyp size estimation among endoscopists and impact on surveillance intervals. Gastrointestinal endoscopy 80(4): 652-659. doi:10.1016/j.gie.2014.01.053.
9. Nagtegaal ID, Odze RD, Klimstra D et al (2020) The 2019 WHO classification of tumours of the digestive system. Histopathology 76(2): 182-188. doi:10.1111/his.13975.
10. Shaukat A, Kaltenbach T, Dominitz JA et al (2020) Endoscopic Recognition and Management Strategies for Malignant Colorectal Polyps: Recommendations of the US Multi-Society Task Force on Colorectal Cancer. The American journal of gastroenterology 115(11): 1751-1767. doi:10.14309/ajg.0000000000001013.
11. Huynh TM, Le QD, Le NQ, Le HM, Quach DT (2023) Utility of narrow-band imaging with or without dual focus magnification in neoplastic prediction of small colorectal polyps: A Vietnamese experience. Clin Endosc 56(4): 479-489. doi:10.5946/ce.2022.212.
12. Lê ĐQ, Lê QN, Quách TĐ (2020) Giá trị của phân loại NICE trong tiên đoán mô bệnh học của polyp đại trực tràng. Y học thành TP. Hồ Chí Minh 24(6), tr. 152-159.
13. Jeong YH, Kim KO, Park CS, Kim SB, Lee SH, Jang BI (2016) Risk factors of advanced adenoma in small and diminutive colorectal polyp. J Korean Med Sci 31(9): 1426-1430. doi:10.3346/jkms.2016.31.9.1426.
14. Ponugoti PL, Cummings OW, Rex DK (2017) Risk of cancer in small and diminutive colorectal polyps. Digestive and liver disease: Official journal of the Italian Society of Gastroenterology and the Italian. Association for the Study of the Liver 49(1): 34-37. doi:10.1016/j.dld.2016.06.025.
15. Mason SE, Poynter L, Takats Z, Darzi A, Kinross JM (2019) Optical technologies for endoscopic real-time histologic assessment of colorectal polyps: A Meta-Analysis. The American journal of gastroenterology 114(8): 1219-1230. doi:10.14309/ajg.0000000000000156.
16. Hewett DG, Kaltenbach T, Sano Y et al (2012) Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology 143(3): 599-607. doi:10.1053/j.gastro.2012.05.006.
17. Hamada Y, Tanaka K, Katsurahara M et al (2021) Utility of the narrow-band imaging international colorectal endoscopic classification for optical diagnosis of colorectal polyp histology in clinical practice: a retrospective study. BMC Gastroenterology 21(1): 336. doi:10.1186/s12876-021-01898-z.
18. JE IJ, Bastiaansen BA, van Leerdam ME et al (2016) Development and validation of the WASP classification system for optical diagnosis of adenomas, hyperplastic polyps and sessile serrated adenomas/polyps. Gut 65(6): 963-970. doi: 10.1136/gutjnl-2014-308411.
19. Kobayashi S, Yamada M, Takamaru H et al (2019) Diagnostic yield of the Japan NBI Expert Team (JNET) classification for endoscopic diagnosis of superficial colorectal neoplasms in a large-scale clinical practice database. United European Gastroenterol J 7(7): 914-923. doi:10.1177/2050640619845987.
20. Le NQ, Huynh TM, Vo DTN et al (2024) Diagnostic performance of the Japanese Narrow-band imaging expert team classification system using dual focus magnification in real-time Vietnamese setting. Medicine (Baltimore) 103(27):e38752. doi:10.1097/md.0000000000038752.
21. Sano Y, Tanaka S, Saito Y (2021) The Japan narrow-band imaging expert team (JNET) classification for the characterization of colorectal lesion using magnifying endoscopy. In: Chiu PWY, Sano Y, Uedo N, Singh R, eds. Endoscopy in Early Gastrointestinal Cancers: Diagnosis. Springer Singapore: 75-80.
22. Rex DK (2009) Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps. Gastroenterology 136(4): 1174-81. doi:10.1053/j.gastro.2008.12.009.
23. Kandel P, Wallace MB (2019) Should we resect and discard low risk diminutive colon polyps. Clinical endoscopy 52(3): 239-246. doi:10.5946/ce.2018.136.
24. Houwen B, Hassan C, Coupe VMH et al (2022) Definition of competence standards for optical diagnosis of diminutive colorectal polyps: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 54(1): 88-99. doi:10.1055/a-1689-5130.
25. Dekker E, Houwen B, Puig I et al (2020) Curriculum for optical diagnosis training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 52(10): 899-923. doi:10.1055/a-1231-5123.
26. Huynh TM, Le QD, Le NQ, Le HM, Quach DT (2024) Implementing narrow banding imaging with dual focus magnification for histological prediction of small rectosigmoid polyps in Vietnamese setting. JGH Open 8(5):13058. doi:10.1002/jgh3.13058.
27. Messmann H, Bisschops R, Antonelli G et al (2022) Expected value of artificial intelligence in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 54(12): 1211-1231. doi:10.1055/a-1950-5694.
28. Đào Việt Hằng, Lâm Ngọc Hoa, Nguyễn Phúc Bình, Đinh Duy Hải, Nguyễn Thanh Tùng, Đào Văn Long (2022) Kết quả ứng dụng nội soi đại tràng có hỗ trợ trí tuệ nhân tạo trong phát hiện polyp đại tràng gần. Tạp chí Y học Việt Nam. 519(2). doi:10.51298/vmj.v519i2.3630.