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Characteristics of Clinically Significant Hyperplastic Polyps: Distinctions Between Microvesicular and Goblet

Osamu Toyoshima¹, Toshihiro Nishizawa^1,2, Shuntaro Yoshida¹

¹Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan.

Journal of Gastroenterology and Hepatology

|March 3, 2025

Summary

Clinically significant microvesicular hyperplastic polyps (CS-MVHPs) are larger, more common, and found in younger females, similar to sessile serrated lesions (SSLs). This suggests CS-MVHPs may precede SSL development.

Keywords:

colonoscopy colorectal neoplasm goblet cell‐rich hyperplastic polyp microvesicular sessile serrated lesion

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Area of Science:

Gastroenterology
Colorectal Cancer Prevention
Pathology

Background:

Clinically significant serrated polyps (CSSPs) encompass sessile serrated lesions (SSLs), SSLs with dysplasia, traditional serrated adenomas (TSAs), and specific hyperplastic polyps (HPs).
HPs are subclassified into microvesicular (MVHPs) and goblet cell-rich (GCHPs) types.
This study focuses on clinically significant MVHPs (CS-MVHPs) and clinically significant GCHPs (CS-GCHPs) within the CSSP category.

Purpose of the Study:

To compare the distinct characteristics of CS-MVHPs, CS-GCHPs, and SSLs.
To investigate potential precursor relationships among these serrated polyp types.

Main Methods:

A retrospective analysis of 14,065 patients undergoing colonoscopy at Toyoshima Endoscopy Clinic (March 2021 - April 2024).
Comparison of age, sex, polyp count, detection rates, and polyp size across CS-MVHPs, CS-GCHPs, and SSLs.
Inclusion of all removed adenomas and CSSPs for diagnosis.

Main Results:

Detection rates were 5.24% for CS-MVHPs, 1.22% for CS-GCHPs, and 6.36% for SSLs.
Patients with CS-MVHPs or SSLs were younger and more frequently female compared to those with CS-GCHPs.
CS-MVHPs and SSLs were significantly larger than CS-GCHPs; CS-GCHP detection increased with age, unlike CS-MVHPs and SSLs.

Conclusions:

CS-MVHPs are larger, more frequent, and detected in younger females, sharing traits with SSLs.
These findings support the hypothesis that CS-MVHPs may serve as precursors to SSLs.
Understanding these differences aids in risk stratification and targeted surveillance for colorectal neoplasia.