Small colonic polyps: a reappraisal of their significance.

Abstract

With the advent of fiberoptic endoscopy and modern radiographic techniques, the majority of detected polyps are < 1 cm. During a 7-mo. period, 140 patients who had radiographically demonstrated colonic polyps that were confirmed by pathologic study were studied. Tissue specimens were obtained by proctoscopy, colonoscopy or surgery. There were 222 polyps of which 144 (65%) were 1 cm or less in size, with the preponderance (80%) of these being adenomatous. Of the 82 polyps that ranged in size from 6-10 mm, 68 (83%) were adenomas, including 1 carcinoma and 5 villous adenomas. Forty-seven (72%) of the diminutive polyps (.ltoreq. 5 mm) were adenomatous, including 2 with atypia. These results correspond to those of several recent endoscopic studies, reporting that a small colonic polyp is most likely to be adenomatous, and that it possesses the potential for growth and malignant transformation. The detection of small polyps during Ba enema examination is thus warranted, particularly in the proximal colon where the majority are adenomatous. The clinical management of polyps is becoming more aggressive, and the removal of even small lesions (.ltoreq. 5 mm) is now performed if they are found incidentally during colonoscopy.