No data to support leaving small colon polyps in place

The American Gastroenterological Association (AGA) Institute is eager to increase the number of patients who receive screening for colon cancer. There are a variety of established screening methods that are widely available, and emerging technologies, such as computed tomography colonography (CT colonography), that are under investigation. As the medical community evaluates CT colonography, the AGA Institute offers the following comments regarding the study by Pickhardt et al published in Cancer on the cost-effectiveness of colorectal cancer screening with CT colonography and the impact of not reporting diminutive lesions.

To date, there are no long-term, adequately controlled studies that define whether leaving small polyps is truly safe. The science is not there, and only anecdotal conclusions can currently be made, says John I. Allen, MD, MBA, AGAF, incoming chair of the AGA Institute Clinical Practice & Quality Management Committee. We are especially concerned as more literature emerges about small, flat, right-sided polyps. These were traditionally called hyperplastic polyps but now are recognized to be sessile serrated polyps that have a malignant potential. Radiologic imaging would not be expected to detect these polyps. This should remind us all of the need for meticulous evaluation, slow withdrawal and inspection of the proximal colon during optical colonoscopy.

The AGA has asked the National Institutes of Health to pursue a study to establish the clinical significance of diminutive polyps (<5mm) using adequate controls and long term follow up.

The need to define the natural history and biological significance of small polyps is central to refining colorectal cancer screening, irrespective of modality, says Joel V. Brill, MD, AGAF, incoming chair of the AGA Institute Practice Management & Economics Committee. We support any technology that helps more patients get screened for colorectal cancer. However, in the rush

Contact: Aimee Frank
American Gastroenterological Association

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