Implementation and Implication of Ignoring Small Polyps at Colonoscopy

Background and Aim: CT colonography has promoted a new paradigm, that up-to 2 polyps ≤5mm can be left in-situ and followed. In contrast, endoscopists identify and remove all colorectal polyps, regardless of size. We evaluated whether and how endoscopists might implement a plan of ignoring small polyps in clinical practice. Methods: We prospectively queried endoscopists as they encountered small polyps with a hypothetical question: “If you accepted and believed in a new paradigm that a polyp ≤5mm does not need to be endoscopically removed, would you remove this polyp?” We assessed how the new paradigm would be implemented by gastroenterologists and the pathologic impact of ignoring polyps' ≤5mm.