Approach to a colorectal polyp

Polyps are defined as well delimited lesions that pro-trude in the intestinal lumen from the mucosa. From amorphological point of view, they may be sessile or pe-dunculated. They are presented as isolated, multiple ordiffuse lesions. The appearance of multiple or diffuse le-sions characterize polyposis syndromes, which are here-ditary and constitute well-defined entities that exceed thepurpose of this review (1).Colorectal polyps are classified as neoplastic (adeno-matous) and non-neoplastic. Non-neoplastic polyps donot have malignant potential and include hyperplastic,hamartomas and inflammatory polyps. Once they havebeen removed and histologically analyzed, these types ofpolyps do not require endoscopic follow-up. Adenomasare a result of the abnormal proliferation of the epithe-lium of the intestinal mucosa, for which they have malig-nant potential. Adenomas are classified as tubular, tu-bulovillous or villous, depending on the presence andgrade of the papillary component. Approximately 70% ofthe polyps surgically removed by colonoscopy are adeno-mas (2). Of these, 70-85% correspond to tubular adeno-mas, 10-25% to tubulovillous adenomas and less than5% to villous adenomas.At present, the adenoma-carcinoma sequence is fullyaccepted. The National Poly Study Workgroup (3) establi-shed that the adenoma or adenomatous polyp is a prema-lignant lesion that precedes, in most cases, the appearan-ce of colorectal cancer (CRC); therefore, excision of theadenoma reduces or even eliminates the risk of develo-ping this tumor. Colonoscopy is considered the most effi-cient strategy for CRC prevention. The low and high-gra-de dysplasia classification (4) reduces the interobservervariation. High-grade dysplasia includes the term