Do polyps smaller than 6 mm have a different prognosis depending on their macroscopic, topographical or histological characteristics?

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Aims The natural history of small polyps is not well established. This study was conducted to describe the diagnostic and prognostic characteristics of the small colonic polyp less than 6 mm. Methods This is a cross-sectional study extended over a period of 3 years from 2022 to 2024 including patients with colonic polyps. The data sources used were the anatomo-pathological reports. For each patient, the following parameters were included: sex, age, size and location of the polyp during colonoscopy. The anatomo-pathological characteristics were also determined. Results 124 patients were included in our study. The average age was: 61.30 years±11.36. The majority of the population was male (n=86; 67.7%). Among 124 polyps 54 were diminutive (42.5%). Polyps less than 6 mm were adenomatous in 51.9% of the cases (n=28). Seven polyps (25%) were of advanced histological nature: with scalloped component (n=1; 3.5%), in high-grade dysplasia (n=5;17.8%) with adenocarcinoma lesions (n=1; 3.5%). Of the polyps≥6mm, 41 were of adenomatous type (58.1%): 17 polyps were advanced histological nature :14 polyps (20%) were with high-grade dysplasia, 2 polyps (2,9%) were scalloped, adenocarcinoma n=1 (1.4%). High-grade dysplasia is more frequent according to the size of the polyp. Non-diminutive polyps have a frequency of DHG which rises to 3% compared to diminutive polyps with a significant difference (P<0.001). In the rectum, the great majority of polyps less than 6 mm are of hyperplastic nature (n=22; 40.7%) or in low-grade dysplasia (n=20; 37%) apart from the rare cases of high-grade dysplasia (n=6; 11.1%) and a single case of adenocarcinoma n=1 (1.9%). Conclusions Diminutive polyps, defined by a size less than 6 mm, are the most frequent polyps, whether they are adenomas in more than half of the cases (> 51%) of scalloped polyps or adenocarcinomas in some cases of rectal polyps. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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