| Theme | Update on Management of Colorectal Polyp | |
|---|---|---|
| Title | Clinical Management of Diminutive Colorectal Polyps | |
| Publish Date | 2019/08 | |
| Author | Takashi Hisabe | Department of Gastroenterology, Fukuoka University Chikushi Hospital |
| Author | Akikazu Hirano | Department of Endoscopy, Fukuoka University Chikushi Hospital |
| Author | Kenshi Yao | Department of Endoscopy, Fukuoka University Chikushi Hospital |
| Author | Toshiharu Ueki | Department of Gastroenterology, Fukuoka University Chikushi Hospital |
| Author | Ken Kinjyo | Department of Pathology, Fukuoka University Chikushi Hospital |
| Author | Akinori Iwashita | Department of Pathology, Fukuoka University Chikushi Hospital |
| [ Summary ] | There is no consensus concerning whether patients with diminutive colorectal polyps should be endoscopically resected or followed‒up in Japan. Follow‒up may be acceptable for several reasons: (1) The cancer rate of the diminutive neoplastic lesions is low, at 0.2 to 2.6 %; (2) Rapid increase in tumor size and canceration are not observed within three years; and (3) There is no significant difference in the metachronous advanced adenoma or neoplasia cumulative incidence rate in 3‒year follow‒up of patients with clean colon and semi‒clean colons. Therefore, follow‒up observation, without immediate endoscopically resection, is considered to be sufficient for the treatment of diminutive adenomas. Surveillance colonoscopy of semi‒clean colon is recommended one year after endoscopic resection to identify previously overlooked lesions. Another surveillance colonoscopy after three years is considered to be reasonable in clinical practice. Further, patients with risk factors (e.g. ≥3 baseline adenomas, villous features, and high‒grade dysplasia) for metachronous advanced adenoma or neoplasia should receive more detailed surveillance colonoscopy. | |