Daily colonoscopies are finding more and more patients with colon polyps. Colon polyps are detected by colonoscopy screening in about 1/3 of first-time patients. Is it true that the incidence has increased due to a change in diet? Or is it simply an increase in detection due to clearer instruments and better physician skills? Many patients panic when they hear “polyps found” because everyone seems to know that polyps can become cancerous. The vast majority of patients will opt for immediate endoscopic removal. However, some patients ask, “Can polyps be treated non-surgically? My answer to this question is that not every polyp needs to be removed, but there are no medications that can treat polyps either. The term polyp is a generalized colonoscopic description of a lesion that originates from the mucosa of the large intestine and rises above the mucosal surface. Polyps can be divided into two main categories: non-adenomatous polyps and adenomatous polyps. An experienced colonoscopist can accurately determine the type of polyp without relying on pathology by carefully observing the pattern of glandular openings on the surface of the polyp. Non-adenomatous polyps include: 1. Inflammatory polyps: polyps left over after healing of inflammatory bowel diseases (commonly tuberculosis and ulcerative colitis); 2. Juvenile polyps: commonly found in small children (usually retention polyps) and detected due to blood in the stool; 3. Hyperplastic polyps: often found in the rectal region, most are small (about 0.3 cm), flat, and white in color. All the above three types are not cancerous, so there is no need to worry. Juvenile polyps need to be removed because they often have symptoms of blood in the stool; if the primary disease of inflammatory polyps is still active, we need to treat the primary disease with appropriate medication rather than treating the polyps. Particularly common hyperplastic polyps are neither cancerous nor symptomatic, and some people even consider them to be equivalent to normal colon mucosa, so it is really a mistake to remove them surgically (colonoscopically). Of course, there is no drug that can make it subside or prevent its regeneration, so if you are really unsure, you can review the colonoscopy once every 5-10 years to observe whether there is any change. 4, misconfigured polyps: most of them are seen in polyposis nigricans syndrome (P-J syndrome), also belongs to non-adenomatous polyps, but there is a certain rate of cancer. Regular colonoscopic removal of polyps is required. Adenomatous polyps: These include tubular adenomas, villous adenomas, and serrated adenomas, which are the polyps that we focus on, need to be removed, and are at risk for cancer. If multiple adenomas are found at the same time, any adenoma with a diameter greater than or equal to 1.0 cm, pathology suggesting a villous structure, high-grade intraepithelial neoplasia, or serrated changes, we call it a high-risk polyp. Because of their high risk of cancer, they need to be treated promptly. Colonic polyposis: It refers to multiple polyps in the colon up to 50 or even 100 or more polyps of different sizes in a dense pattern. The cancer rate of familial adenomatous polyposis (FAP) is 100%, and some doctors even believe that total colectomy is the best way to prevent future cancer. Some patients with colonic polyposis have so many large polyps that the doctor can only remove up to a dozen at a time to ensure safety. When the next resection reveals that the polyps have not been reduced, but are even larger, it is frustrating to even think: remind the patient to remove the whole colon, otherwise cancer or even metastasis will occur sooner or later. There have been attempts to use non-steroidal anti-inflammatory drugs (such as aspirin and celecoxib) to prevent the occurrence of colonic adenomas or adenocarcinomas. The final conclusions are: 1. Small doses of NSAIDs (including COX-2 inhibitors) are not effective in preventing familial adenomatous polyposis FAP (familial adenomatous polyposis) and colonic adenomas; 2. High doses of COX-2 inhibitors are effective in preventing familial adenomatous colonic disease FAP; 3. High doses of COX-2 inhibitors increase mortality from cardiovascular disease. Therefore, the United States (U.S. Preventive Service Task Force) does not yet recommend NSAIDs as a preventive measure for routine colonic adenoma and colonic adenocarcinoma. The final conclusion is that non-surgical treatment of colon polyps is not useful, but not every polyp needs surgical treatment either.