Clin Endosc.  2014 Sep;47(5):404-408. 10.5946/ce.2014.47.5.404.

Diminutive and Small Colorectal Polyps: The Pathologist's Perspective

• Kang YK

• KMID: 2165370
• DOI: http://doi.org/10.5946/ce.2014.47.5.404

Abstract

Recent progress in advanced endoscopic imaging and electronic chromoendoscopy allows the real-time endoscopic estimation of the histologic type of polyps, mainly for the differentiation of adenomas from hyperplastic polyps. Accordingly, a "resect-and-discard" strategy applied to diminutive colorectal polyps is now one of the emerging issues among gastroenterologists. The strategy has a practical advantage in terms of the potential cost savings. However, it has a number of limitations in the medical, academic, and legal aspects. The major pitfalls include the endoscopic investigation of colorectal polyps with a wide variety of histogenetic origins, including serrated polyps, and the lack of a standardized method for polyp size measurement. Another issue is the importance of the pathologic diagnosis for legal purposes and medical research. Moreover, it is not certain whether the implementation of the strategy has economic benefit in countries with an undervalued reimbursement system for pathologic examination. There is no doubt that a highly confident optical diagnosis of polyp type is a novel valuable tool. It can provide a more steady symbiosis between gastroenterologists and pathologists to allow a more evident diagnosis and management of patients with colorectal polyps.

Keyword

Colorectum; Diminutive polyp; Adenoma; Serrated polyp; Pathologic diagnosis

MeSH Terms

Adenoma
Cost Savings
Diagnosis
Humans
Jurisprudence
Polyps*
Symbiosis

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