Do all colon polyps have to be removed? Do all hyperplastic polyps in the colon need to be removed?

  Colonoscopic detection and removal of polyps is an effective means of reducing the incidence of colorectal cancer. It is generally accepted that adenomatous polyps need to be removed and hyperplastic polyps may not. If they appear to be hyperplastic polyps but have the characteristics of a clot-free serrated polyp/adenoma, they may also need to be treated. The latest WASP classification of colorectal polyps can help determine which polyps need to be removed.  Serrated polyps are subdivided into hyperplastic polyps, non-tipped serrated polyps / adenomas and conventional serrated adenomas, the latter two of which can progress to cancer by some route. Small polyps (6-9 mm) and microscopic polyps (1-5 mm) generally do not carry the characteristics of progressive adenomas compared to larger polyps (≥10 mm).  If small polyps and micropolyps can be accurately identified endoscopically, they can be removed and discarded without evaluation by a pathologist. And it has been demonstrated that it is safe and cost-effective to leave benign microproliferative polyps of the sigmoid colon and rectum untreated. Therefore, there is an urgent need for a classification method that can accurately identify all non-tipped serrated polyps/adenomas at colonoscopy and remove them completely.  Current endoscopic polyp classification methods are based on narrow band imaging (NBI) and do not include non-tipped serrated polyps. For this reason, a number of experts, including Prof. IJspeert from the Netherlands, formed the WASP working group and proposed a new classification, which was published in a recent issue of Gut.  The experts integrated the existing NICE classification with the diagnostic principles proposed by Hazewinkel et al. for non-tipped serrated polyps and devised a new classification for the endoscopic diagnosis of small/microadenomas, hyperplastic polyps and non-tipped serrated polyps/adenomas, the WASP classification.  After evaluation by 10 consultants, it was concluded that the use of this classification significantly improved the optical diagnosis of intestinal polyps, especially for non-tipped serrated polyps.  Therefore, this classification will provide a better reference for the endoscopic management of colorectal polyps by identifying and endoscopically removing non-tipped serrated polyps/adenomas from hyperplastic polyps.