Dysplasia and Malignancy in Colonic Polyps: Preparing for a Resect and Discard Strategy in Canada

Background/Aims

Colonoscopies are commonly performed to evaluate and remove polyps. Currently, at most centers in Canada, all resected polyps are submitted for histologic examination. A resect and discard strategy has not been widely adopted in the Canadian population. The objective of this study was to characterize polyps and their rates of dysplasia.

Methods/Results

Colonoscopies and pathology reports were analyzed at a tertiary care hospital. We recorded polyp size, histology, and the presence of high-grade dysplasia (HGD)/cancer. Out of a total of 2218 colonoscopies, 2945 polyps were removed. In descending order, tubular adenomas, hyperplastic, sessile serrated, tubulovillous, and inflammatory polyps represented 67.4%, 16.2%, 9.9%, 5.6%, and 0.8% of all polyps, respectively. Regarding size, 1703 polyps were between 1 and 5 mm, with only 2 (0.12%) showing HGD. Similarly, in the 6–9 mm group, there were 699 polyps, with only 3 (0.43%) showing HGD. Neither of these groups had evidence of cancer. In contrast, the > 10 mm group had 543 polyps, of which 87 (16.02%) showed HGD, and 15 (2.76%) exhibited cancer. In our patient population, only 0.04% of patients would have a change in their screening interval due to HGD in polyps that were < 5 mm in size.

Conclusions

Based on these findings, a resect and discard strategy should be further evaluated for diminutive polyps in this population. While current recommendations for post-polypectomy screening include pathological assessment, further research on screening intervals based on size, location, and optical diagnosis may reduce resource utilization without compromising outcomes.