• Paul E. Wise


Polyps are defined as pathologic epithelial elevations of the aerodigestive and genitourinary tracts. This term serves to describe any of the types of abnormal growths identified on or involving the colonic mucosa that protrude into the bowel lumen. Polyps are of concern to clinicians due to their malignant potential depending on the histologic type of the polyp identified. The primary histologic colonic polyp types include the following: adenomas, serrated polyps (including hyperplastic polyps and sessile serrated adenomas (SSAs)), hamartomas, and inflammatory polyps. Because some of these polyps are neoplastic, they are the target of screening modalities (including colonoscopy, computed tomography (CT) colonography, etc.) to remove them prior to their malignant degeneration. Other polyp-like lesions, usually submucosal rather than mucosal in nature, such as carcinoids, leiomyomas, and lipomas will be described and discussed in Chap.  49.


  1. 1.
    Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58(3):130–60.PubMedGoogle Scholar
  2. 2.
    Turner JR. The gastrointestinal tract. In: Kumar V, Abbase AK, Fausto N, Aster JC, editors. Robbins and Cotran pathologic basis of disease, Professional edition. 8th ed. Philadelphia, PA: Saunders Elsevier; 2009.Google Scholar
  3. 3.
    Winawer SJ, Fletcher RH, Miller L, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology. 1997;112:594–642.PubMedGoogle Scholar
  4. 4.
    Simons BD, Morrison AS, Lev R, et al. Relationship of polyps to cancer of the large intestine. J Natl Cancer Inst. 1992;84:962–6.PubMedGoogle Scholar
  5. 5.
    Gschwantler M, Kriwanek S, Langner E, et al. High-grade dysplasia and invasive carcinoma in colorectal adenomas; a multivariate analysis of the impact of adenoma and patient characteristics. Eur J Gastroenterol Hepatol. 2002;14:183–8.PubMedGoogle Scholar
  6. 6.
    Patel K, Hoffman NE. The anatomical distribution of colorectal polyps at colonoscopy. J Clin Gastroenterol. 2001;33(3):222–5.PubMedGoogle Scholar
  7. 7.
    Bond JH. Polyp guideline: diagnosis, treatment, and surveillance for patients with nonfamilial colorectal polyps. The Practice Parameters Committee of the American College of Gastroenterology. Ann Intern Med. 1993;119:836–43.PubMedGoogle Scholar
  8. 8.
    Schoenfeld P, Cash B, Flood A, et al. Colonoscopic screening of average-risk women for colorectal neoplasia. N Engl J Med. 2005;352(20):2061–8.PubMedGoogle Scholar
  9. 9.
    Boursi B, Halak A, Umansky M, et al. Colonoscopic screening of an average-risk population for colorectal neoplasia. Endoscopy. 2009;41(6):516–21.PubMedGoogle Scholar
  10. 10.
    Giacosa A, Frascio F, Munizzi F. Epidemiology of colorectal polyps. Tech Coloproctol. 2004;8 Suppl 2:s243–7.PubMedGoogle Scholar
  11. 11.
    Farraye FA, Wallace M. Clinical significance of small polyps found during screening with flexible sigmoidoscopy. Gastrointest Endosc Clin North Am. 2002;12:41–51.Google Scholar
  12. 12.
    Winawer SJ, Stewart ET, Zauber AG, et al. A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group. N Engl J Med. 2000;342:1766–72.PubMedGoogle Scholar
  13. 13.
    Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329:1977–81.PubMedGoogle Scholar
  14. 14.
    Davila RE et al. ASGE guideline: colorectal cancer screening and surveillance. Gastrointest Endosc. 2006;63:546–57.PubMedGoogle Scholar
  15. 15.
    Blachar A, Sosna J. CT colonography (virtual colonoscopy): technique, indications, and performance. Digestion. 2007; 76:34–41.PubMedGoogle Scholar
  16. 16.
    Landeras LA, Aslam R, Yee J. Virtual colonoscopy: technique and accuracy. Radiol Clin North Am. 2007;45:333–45.PubMedGoogle Scholar
  17. 17.
    Villavicencio RT, Rex DK. Colonic adenomas: prevalence and incidence rates, growth rates, and miss rates at colonoscopy. Semin Gastrointest Dis. 2000;11:185–93.PubMedGoogle Scholar
  18. 18.
    Lieberman DS, Smith FW. Screening for colon malignancy with colonoscopy. Am J Gastroenterol. 1991;86:946–51.PubMedGoogle Scholar
  19. 19.
    Foutch PG, Mai H, Pardy K, et al. Flexible sigmoidoscopy may be ineffective for secondary prevention of colorectal cancer in asymptomatic, average-risk men. Dig Dis Sci. 1991;36:924–8.PubMedGoogle Scholar
  20. 20.
    Johnson DA, Gurney MS, Volpe RJ, et al. A prospective study of the prevalence of colonoscopic neoplasms in asymptomatic patients with an age-related risk. Am J Gastroenterol. 1990;85:969–74.PubMedGoogle Scholar
  21. 21.
    Rex DK, Lehman GA, Ulbright TM, et al. Colonic neoplasia in asymptomatic persons with negative fecal occult blood tests: inf1uence of age, gender and family history. Am J Gastroenterol. 1993;88:825–31.PubMedGoogle Scholar
  22. 22.
    Marshall JR. Prevention of colorectal cancer: diet, chemoprevention, and lifestyle. Gastroenterol Clin North Am. 2008;37:73–82.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Leiberman DA, Weiss DG, Bond JH, et al. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med. 2000;343:162–8.Google Scholar
  24. 24.
    Brenner H, Hoffmeister M, Stegmaier C, et al. Risk of progression of advanced adenomas to colorectal cancer by age and sex: estimates based on 840, 149 screening colonoscopies. Gut. 2007;56:1585–9.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Pariente A, Milan C, Lafon J, et al. Colonoscopic screening in first-degree relatives of patients with “sporadic” colorectal cancer: a case-control study. The Association Nationale des Gastroenterologues des Hopitaux and Registre Bourguinon des Cancers Digestifs (INSERM CRI 9505). Gastroenterology. 1998;115:7–12.PubMedGoogle Scholar
  26. 26.
    Gaglia P, Atkin WS, Whitelaw S, et al. Variables associated with the risk of colorectal adenomas in asymptomatic patients with a family history of colorectal cancer. Gut. 1995;36:385–90.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Menges M, Fischinger J, Gärtner B, et al. Screening colonoscopy in 40- to 50-year-old first-degree relatives of patients with colorectal cancer is efficient: a controlled multicentre study. Int J Colorectal Dis. 2006;21(4):301–7.PubMedGoogle Scholar
  28. 28.
    Rex DK. Co1onoscopy: a review of its yield for cancers and adenomas by indication. Am J Gastroenterol. 1995;90:353–65.PubMedGoogle Scholar
  29. 29.
    Schatzkin A, Lanza E, Corle D, et al. Lack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas. Polyp Prevention Trial Study Group. N Engl J Med. 2000;342:1149–55.PubMedGoogle Scholar
  30. 30.
    Triantafyllou K, Papatheodoridis GV, Paspatis GA, et al. Predictors of the early development of advanced metachronous colon adenomas. Hepatogastroenterology. 1997;44:533–8.PubMedGoogle Scholar
  31. 31.
    Alberts DS, Martinez ME, Roe DJ, et al. Lack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas. Phoenix Colon Cancer Prevention Physicians’ Network. N Engl J Med. 2000;342:1156–62.PubMedGoogle Scholar
  32. 32.
    Martínez ME, Baron JA, Lieberman DA, et al. A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy. Gastroenterology. 2009;136(3):832–41.PubMedGoogle Scholar
  33. 33.
    Noshirwani KC, van Stolk RU, Rybicki LA, et al. Adenoma size and number are predictive of adenoma recurrence: implications for surveillance colonoscopy. Gastrointest Endosc. 2000;51(4 Pt 1):433–7.PubMedGoogle Scholar
  34. 34.
    Holtzman R, Poulard JB, Bank S, et al. Repeat colonoscopy after endoscopic polypectomy. Dis Colon Rectum. 1987;30:185–8.PubMedGoogle Scholar
  35. 35.
    Woolfson IK, Eckholdt GJ, Wetzel CR, et al. Usefulness of ­performing colonoscopy one year after endoscopic polypectomy. Dis Colon Rectum. 1990;33:389–93.PubMedGoogle Scholar
  36. 36.
    Winawer SJ, Zauber AG, Fletcher RH, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. 2006;130:1872–85.PubMedGoogle Scholar
  37. 37.
    Rex DK, Cutler CS, Lemmel GT, et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology. 1997;112:24–8.PubMedGoogle Scholar
  38. 38.
    Hoff G, Vatn M. Epidemiology of polyps of the rectum and sigmoid colon. Endoscopic evaluation of size and localization of polyps. Scand J Gastroenterol. 1985;20:356–60.PubMedGoogle Scholar
  39. 39.
    Kronborg O, Hage E, Deichgraeber E. A prospective, partly randomized study of the effectiveness of repeated examination of the colon after polypectomy and radical surgery for cancer. Scan J Gastroenterol. 1981;16:879–84.Google Scholar
  40. 40.
    Hixson LS, Fennerty MB, Sampliner RE, et al. Prospective study of the frequency and size distribution of polyps missed by colonoscopy. J Natl Cancer Inst. 1990;82:1769–72.PubMedGoogle Scholar
  41. 41.
    Kudo S, Lambert R, Allen JI, et al. Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc. 2008;68(4 Suppl):S3–47.PubMedGoogle Scholar
  42. 42.
    Winawer SJ. Appropriate intervals for surveillance. Gastrointest Endosc. 1999;49(3 Pt 2):S63–6.PubMedGoogle Scholar
  43. 43.
    Rex DK, Cummings OW, Helper DJ, et al. Five-year incidence of adenomas after negative colonoscopy in asymptomatic average-risk persons. Gastroenterology. 1996;111:1178–81.PubMedGoogle Scholar
  44. 44.
    Tolliver KA, Rex DK. Colonoscopic polypectomy. Gastro­enterol Clin North Am. 2008;37(1):229–51.PubMedGoogle Scholar
  45. 45.
    Leung K, Pinsky P, Laiyemo AO, et al. Ongoing colorectal cancer risk despite surveillance colonoscopy: the Polyp Prevention Trial Continued Follow-up Study. Gastrointest Endosc. 2010;71(1):111–7.PubMedGoogle Scholar
  46. 46.
    Winawer SJ et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. CA Cancer J Clin. 2006;56:143–59.PubMedGoogle Scholar
  47. 47.
    Knoernschild HE. Growth rate and malignant potential of colonic polyps: early results. Surg Forum. 1963;14:137–8.PubMedGoogle Scholar
  48. 48.
    Carroll RLA, Klein M. How often should patients be sigmoidoscoped? A mathematical perspective. Prev Med. 1980;9:741–6.PubMedGoogle Scholar
  49. 49.
    Stryker SJ, Wolff BG, Culp CE, et al. Natural history of untreated colonic polyps. Gastroenterology. 1987;93:1009–13.PubMedGoogle Scholar
  50. 50.
    Eide TJ. Risk of colorectal cancer in adenoma-bearing individuals within a defined population. Int J Cancer. 1986;38:173–6.PubMedGoogle Scholar
  51. 51.
    Brenner H, Hoffmeister M, Stegmaier C, et al. Risk of progression of advanced adenomas to colorectal cancer by age and sex: estimates based on 840, 149 screening colonoscopies. Gut. 2007;56:1585–9.PubMedPubMedCentralGoogle Scholar
  52. 52.
    Lamlum H, Papadopoulou A, Ilyas M, et al. APC mutations are sufficient for the growth of early colorectal adenomas. Proc Natl Acad Sci USA. 2000;97:2225–8.PubMedGoogle Scholar
  53. 53.
    Cappell MS. Pathophysiology, clinical presentation, and management of colon cancer. Gastroenterol Clin North Am. 2008;37(1):1–24. v.PubMedGoogle Scholar
  54. 54.
    Konishi M, Kikuchi-Yanoshita R, Tanaka K, et al. Molecular nature of colon tumors in hereditary nonpolyposis colon cancer, familial polyposis, and sporadic colon cancer. Gastroenterology. 1996;111:307–17.PubMedGoogle Scholar
  55. 55.
    Harvey NT, Ruszkiewicz A. Serrated neoplasia of the colorectum. World J Gastroenterol. 2007;13(28):3792–8.PubMedPubMedCentralGoogle Scholar
  56. 56.
    Vakiani E, Yantiss RK. Pathologic features and biologic importance of colorectal serrated polyps. Adv Anat Pathol. 2009;16(2):79–91.PubMedGoogle Scholar
  57. 57.
    East JE, Saunders BP, Jass JR. Sporadic and syndromic hyperplastic polyps and serrated adenomas of the colon: classification, molecular genetics, natural history, and clinical management. Gastroenterol Clin North Am. 2008;37(1):25–46. v.PubMedGoogle Scholar
  58. 58.
    Tsuga K, Haruma K, Fujimura J, et al. Evaluation of the colorectal wall in normal subjects and patients with ulcerative colitis using an ultrasonic catheter probe. Gastrointest Endosc. 1998;48:477–84.PubMedGoogle Scholar
  59. 59.
    Waye JD. Endoscopic mucosal resection of colonic polyps. Gastrointest Endosc Clin North Am. 2001;11:537–48. vii.Google Scholar
  60. 60.
    Zlatanic J, Waye JD, Kim PS, et al. Large sessile colonic adenomas: use of argon plasma coagulator to supplement piecemeal snare polypectomy. Gastrointest Endosc. 1999;49:731–5.PubMedGoogle Scholar
  61. 61.
    Uno Y, Munakata A. The non-lifting sign of invasive colon cancer. Gastrointest Endosc. 1994;40:485–9.PubMedGoogle Scholar
  62. 62.
    Dellon ES, Hawk JS, Grimm IS, Shaheen NJ. The use of carbon dioxide for insufflation during GI endoscopy: a systematic review. Gastrointest Endosc. 2009;69(4):843–9.PubMedGoogle Scholar
  63. 63.
    Winter H, Lang RA, Spelsberg FW, et al. Laparoscopic colonoscopic rendezvous procedures for the treatment of polyps and early stage carcinomas of the colon. Int J Colorectal Dis. 2007;22(11):1377–81.PubMedGoogle Scholar
  64. 64.
    Franklin Jr ME, Portillo G. Laparoscopic monitored colonoscopic polypectomy: long-term follow-up. World J Surg. 2009;33(6):1306–9.PubMedGoogle Scholar
  65. 65.
    Wilhelm D, von Delius S, Weber L, et al. Combined laparoscopic-endoscopic resections of colorectal polyps: 10-year experience and follow-up. Surg Endosc. 2009;23(4):688–93.PubMedGoogle Scholar
  66. 66.
    Bond JH. Colorectal cancer update. Prevention, screening, treatment and surveillance for high-risk groups. Med Clin North Am. 2000;84:1163–82. viii.PubMedGoogle Scholar
  67. 67.
    Bond JH. Colon polyps and cancer. Endoscopy. 2003;35:27–35.PubMedGoogle Scholar
  68. 68.
    Atkin WS, Morson BC, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med. 1992;326:658–62.PubMedGoogle Scholar
  69. 69.
    Spencer RJ, Melton III LJ, Ready RL, et al. Treatment of small colorectal polyps: a population based study of risks of subsequent carcinoma. Mayo Clin Proc. 1984;59:305–10.PubMedGoogle Scholar
  70. 70.
    Ko C, Hyman NH. Practice parameter for the detection of colorectal neoplasms: an interim report (revised). Dis Colon Rectum. 2006;49:299–301.PubMedGoogle Scholar
  71. 71.
    Ferrucci LM, Sinha R, Graubard BI, et al. Dietary meat intake in relation to colorectal adenoma in asymptomatic women. Am J Gastroenterol. 2009;104(5):1231–40.PubMedPubMedCentralGoogle Scholar
  72. 72.
    Weingarten MA, Zalmanovici A, Yaphe J. Dietary calcium supplementation for preventing colorectal cancer and adenomatous polyps. Cochrane Database Syst Rev. 2008;(1):CD003548.Google Scholar
  73. 73.
    Bertagnolli MM, Eagle CJ, Zauber AG, et al. Five year efficacy and safety analysis of the adenoma prevention with celecoxib (APC) trial. Cancer Prev Res. 2009;2(4):310–21.Google Scholar
  74. 74.
    Dubois R. New, long-term insights from the adenoma prevention with celecoxib trial on a promising but troubled class of drugs. Cancer Prev Res. 2009;2(4):285–7.Google Scholar
  75. 75.
    Kruskal JB, Sentovich SM, Kane RA. Staging of rectal cancer after polypectomy: usefulness of endorectal US. Radiology. 1999;211(1):31–5.PubMedGoogle Scholar
  76. 76.
    García-Aguilar J, Hernández de Anda E, Rothenberger DA, et al. Endorectal ultrasound in the management of patients with malignant rectal polyps. Dis Colon Rectum. 2005;48(5):910–6. discussion 916–7.PubMedGoogle Scholar
  77. 77.
    Nivatvongs S, Nicholson JD, Rothenberger DA, et al. Villous adenomas of the rectum: the accuracy of clinical assessment. Surgery. 1980;87:549–51.PubMedGoogle Scholar
  78. 78.
    Nusko G, Mansmann U, Partzsch U, et al. Invasive carcinoma in colorectal adenomas: multivariate analysis of patient and adenoma characteristics. Endoscopy. 1997;29:626–31.PubMedGoogle Scholar
  79. 79.
    Ramirez M, Schierling S, Papaconstantinou HT, Scott Thomas J.Management of the malignant polyp. Clin Colon Rectal Surg. 2008;21(4):286–90.PubMedPubMedCentralGoogle Scholar
  80. 80.
    Nivatvongs S. Complications in colonoscopic polypectomy: an experience with 1, 555 polypectomies. Dis Colon Rectum. 1986;29:825–30.PubMedGoogle Scholar
  81. 81.
    Seitz U, Bohnacker S, Seewald S, et al. Is endoscopic polypectomy an adequate therapy for malignant colorectal adenomas? Presentation of 114 patients and review of the literature. Dis Colon Rectum. 2004;47(11):1789–96.PubMedGoogle Scholar
  82. 82.
    Nivatvongs S. Surgical management of malignant colorectal polyps. Surg Clin North Am. 2002;82:959–66.PubMedGoogle Scholar
  83. 83.
    Haggitt RC, Glotzbach RE, Soffer EE, et al. Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology. 1985;89:328–36.PubMedGoogle Scholar
  84. 84.
    Kyzer S, Begin LR, Gordon PH, et al. The care of patients with colorectal polyps that contain invasive adenocarcinoma: endoscopic polypectomy or colectomy. Cancer. 1992;70:2044–50.PubMedGoogle Scholar
  85. 85.
    Nivatvongs S, Rojanasakul A, Reiman ME, et al. The risk of lymph node metastases in colorectal polyps with invasive adnenocarcinoma. Dis Colon Rectum. 1991;34:323–8.PubMedGoogle Scholar
  86. 86.
    Nascimbeni R, Burgart LG, Nivatvongs S, et al. Risk of lymph node metastases in T1 carcinoma of colon and rectum. Dis Colon Rectum. 2002;45:200–6.PubMedGoogle Scholar
  87. 87.
    Cooper HS, Deppisch LM, Gourley WK, et al. Endoscopically removed malignant colorectal polyps: clinical patholologic correlations. Gastroenterology. 1995;108:1657–65.PubMedGoogle Scholar
  88. 88.
    Coverlizza S, Risio M, Ferrari A, et al. Colorectal adenomas containing invasive carcinoma: pathologic assessment of lymph node metastatic potential. Cancer. 1989;64:1937–47.PubMedGoogle Scholar
  89. 89.
    Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy. 1993;25:455–61.PubMedGoogle Scholar
  90. 90.
    Kikuchi R, Takano M, Takagi K, et al. Management of early invasive colorectal cancer: risk of recurrence and clinical guidelines. Dis Colon Rectum. 1995;38:l286–95.Google Scholar
  91. 91.
    Blumberg D, Paty PB, Guillem JG, et al. All patients with small intramural rectal cancers are at risk for lymph node metastases. Dis Colon Rectum. 1999;42:881–5.PubMedGoogle Scholar
  92. 92.
    Brodsky JT, Richard GK, Cohen AM, et al. Variables correlated with the risk of lymph node metastases in early rectal cancer. Cancer. 1992;69:322–6.PubMedGoogle Scholar
  93. 93.
    Tanaka S, Harouma K, Teixeira CR, et al. Endoscopic treatment of submucosal invasive colorectal carcinoma with special reference to risk factors for lymph node metastases. J Gastroenterol. 1995;30:710–7.PubMedGoogle Scholar
  94. 94.
    Goldstein NS, Hart J. Histologic features associated with lymph node metastases in stage T1 and superficial T2 rectal adenocarcinomas in abdominoperineal resection specimens. Identifying a subset of patients for whom treatment with adjuvant therapy or completion abdominoperineal resection should be considered after local excision. Am J Clin Pathol. 1999;111:51–8.PubMedGoogle Scholar
  95. 95.
    Boenicke L, Fein M, Sailer M. The concurrence of histologically positive resection margins and sessile morphology is an important risk factor for lymph node metastasis after complete endoscopic removal of malignant colorectal polyps. Int J ­Colorectal Dis. 2010;25(4):433–8.Google Scholar
  96. 96.
    The National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology, colon cancer and rectal cancer, v.1.2010. Accessed 8 Feb 2010.
  97. 97.
    Garcia-Aguilar J, Mellgren A, Sirivongs P, et al. Local excision of rectal cancer without adjuvant therapy: a word of caution. Ann Surg. 2000;231:345–51.PubMedPubMedCentralGoogle Scholar
  98. 98.
    Chakravarti A, Compton CC, Shellito PC, et al. Long-term follow-up of patients with rectal cancer managed by local excision with and without adjuvant irradiation. Ann Surg. 1999;230:49–54.PubMedPubMedCentralGoogle Scholar
  99. 99.
    Reinacher-Schick A, Schmiegel W. Surveillance strategies in patients after polypectomy. Dig Dis. 2002;20:61–9.PubMedGoogle Scholar
  100. 100.
    Lambert R, Kudo SE, Vieth M, et al. Pragmatic classification of superficial neoplastic colorectal lesions. Gastrointest Endosc. 2009;70(6):1182–99.PubMedGoogle Scholar
  101. 101.
    Muto T, Kamiya J, Sawada T, et al. Small “flat adenoma” of the large bowel with special reference to its clinicopathologic features. Dis Colon Rectum. 1985;28:847–51.PubMedGoogle Scholar
  102. 102.
    Jaramillo E, Watanabe M, Slezak P, et al. Flat neoplastic lesions of the colon and rectum detected by high-resolution video endoscopy and chromoscopy. Gastrointest Endosc. 1995;42:l14–22.Google Scholar
  103. 103.
    Rembacken BJ, Fujii T, Cairns A, et al. Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK. Lancet. 2000;355:1211–4.PubMedGoogle Scholar
  104. 104.
    Saitoh Y, Waxman I, West AB, et al. Prevalence and distinctive biologic features of flat colorectal adenomas in the North American population. Gastroenterology. 2001;120:1657–65.PubMedGoogle Scholar
  105. 105.
    Smith GA, Oien KA, O’Dwyer PJ. Frequency of early colorectal cancer in patients undergoing colonoscopy. Br J Surg. 1999;86:1328–31.PubMedGoogle Scholar
  106. 106.
    Estrada RG, Spjut HJ. Hyperplastic polyps of the large bowel. Am J Surg Pathol. 1980;4(2):127–33.PubMedGoogle Scholar
  107. 107.
    Jass JR. Pathogenesis of colorectal cancer. Surg Clin North Am. 2002;82:891–904.PubMedGoogle Scholar
  108. 108.
    Hawkins NJ, Bariol C, Ward RL. The serrated neoplasia pathway. Pathology. 2002;34:548–55.PubMedGoogle Scholar
  109. 109.
    Rembacken BJ, Trecca A, Fujii T. Serrated adenomas. Dig Liver Dis. 2001;33:305–12.PubMedGoogle Scholar
  110. 110.
    Norfleet RG, Ryan ME, Wyman JB. Adenomatous and hyperplastic polyps cannot be reliably distinguished by their appearance through the fiberoptic sigmoidoscope. Dig Dis Sci. 1988;33:1175–7.PubMedGoogle Scholar
  111. 111.
    Axelrad AM, Fleischer DE, Geller AJ, et al. High resolution chromoendoscopy for the diagnosis of diminutive colon polyps: implications for colon cancer screening. Gastroenterology. 1996;110:1253–8.PubMedGoogle Scholar
  112. 112.
    Bensen SP, Cole BF, Mott LA, et al. Colorectal hyperplastic polyps and risk of recurrence of adenomas and hyperplastic polyps. Polyp Prevention Study (Letter). Lancet. 1999;354:1873–4.PubMedGoogle Scholar
  113. 113.
    Bond JH. Polyp guidelines: diagnosis, treatment, and surveillance for patients with colorectal polyps: Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol. 2000;95:3053–63.PubMedGoogle Scholar
  114. 114.
    Longacre TA, Fenoglio-Preiser CM. Mixed hyperplastic adenomatous polyps/serrated adenomas. A distinct form of co1orectal neoplasia. Am J Surg Pathol. 1990;14:524–37.PubMedGoogle Scholar
  115. 115.
    Matsumoto T, Mizuno M, Shimizu M, et al. Clinicopathological features of serrated adenoma of the colorectum: comparison with traditional adenoma. J Clin Pathol. 1999;52:513–6.PubMedPubMedCentralGoogle Scholar
  116. 116.
    Ober WB. Selected items from the history of pathology: Eugen Albrecht, MD (1872-1908): hamartoma and choristoma. Am J Pathol. 1978;91(3):606.PubMedPubMedCentralGoogle Scholar
  117. 117.
    Chen HM, Fang JY. Genetics of the hamartomatous polyposis syndromes: a molecular review. Int J Colorectal Dis. 2009;24:865–74.PubMedGoogle Scholar
  118. 118.
    Calva D, Howe JR. Hamartomatous polyposis syndromes. Surg Clin North Am. 2008;88(4):779–817.PubMedPubMedCentralGoogle Scholar
  119. 119.
    Zbuk KM, Eng C. Hamartomatous polyposis syndromes. Nat Clin Pract Gastroenterol Hepatol. 2007;4(9):492–502.PubMedGoogle Scholar
  120. 120.
    Mesiya S, Ancha HB, Ancha H, Lightfoot S, Kida M, Guild R, et al. Sporadic colonic hamartomas in adults: a retrospective study. Gastrointest Endosc. 2005;62(6):886–91.PubMedGoogle Scholar
  121. 121.
    Brahim EB, Jouini R, Khayat O, et al. Adenomatous transformation in hamartomatous polyps cases of two patients with Peutz–Jeghers Syndrome. Int J Colorectal Dis. 2009;24:1361–3.PubMedGoogle Scholar
  122. 122.
    Pidala MJ, Slezak FA, Hlivko TJ. Delayed presentation of an inflammatory polyp following colonic ischemia. Am Surg. 1993;59(5):315–8.PubMedGoogle Scholar
  123. 123.
    Kosugi I, Tada T, Tsutsui Y, Sato Y, Mitsui T, Itazu I. Giant inflammatory polyposis of the descending colon associated with a Crohn’s disease-like colitis. Pathol Int. 2002;52(4):318–21.PubMedGoogle Scholar
  124. 124.
    Esaki M, Matsumoto T, Fuyuno Y, Maehata Y, Kochi S, Hirahashi M, et al. Giant inflammatory polyposis of the cecum with repeated intussusception in ulcerative colitis: report of a case. Am J Gastroenterol. 2009;104(11):2873–4.PubMedGoogle Scholar
  125. 125.
    Buck JL, Dachman AH, Sobin LH. Polypoid and pseudo­polypoid manifestations of inflammatory bowel disease. Radiographics. 1991;11(2):293–304.PubMedGoogle Scholar

Copyright information

© ASCRS (American Society of Colon and Rectal Surgeons) 2011

Authors and Affiliations

  • Paul E. Wise
    • 1
  1. 1.Department of General SurgeryVanderbilt University Medical CenterNashvilleUSA

Personalised recommendations