RATIONAL APPROACH TO SMALL POLYPS FOUND ON SIGMOIDOSCOPY

Most colorectal cancers are thought to develop from benign adenomas. B ecause adenomas are found in a large proportion of asymptomatic indivi duals, most adenomas must re main benign. Current guidelines suggest t hat colonoscopy is not necessary when hyperplastic polyps are found at screening sigmoidoscopy. Existing data suggest that small adenomatous polyps may also not be associated with substantial risk of current or future malignancy. We suggest that small polyps seen on flexible sigm oidoscopy require neither biopsy nor subsequent colonoscopy. Such an a pproach requires further study, but could result in substantial cost s avings, with modest risk to patients.