Rational approach to small polyps found on sigmoidoscopy

Most colorectal cancers are thought to develop from benign adenomas. Because adenomas are found in a large proportion of asymptomatic individuals, most adenomas must remain benign. Current guidelines suggest that 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 sigmoidoscopy require neither biopsy nor subsequent colonoscopy. Such an approach requires further study, but could result in substantial cost savings, with modest risk to patients.