Media Backgrounder

Frequently Asked Questions: Flat Polyps

Is a flat polyp a new kind of polyp?
No, flat polyps are not a new type of polyp. The well-publicized Journal of the American Medical Association (JAMA) study from March 5, 2008, regarding flat polyps in the colon is a significant study, as these flat polyps are more difficult to detect and have more aggressive pathology than the typical polyp detected during colorectal cancer screening. While this study is important, flat polyps in the colon are not a new type of polyp and any expertly-trained gastrointestinal endoscopist already looks for these flat polyps (which are also referred to as sessile polyps) just as they look for the more typical raised type of colorectal polyp frequently found during a colonoscopy.

How are flat polyps found?
Flat polyps are identified through colonoscopy screening. While colonoscopy is not a perfect test, it is the best method for colorectal cancer prevention and early detection of colorectal cancer because of its high sensitivity rate for identifying polyps in the colon. It is the only procedure that has the ability to both detect and remove polyps from the colon at the same time.

Do patients need to undergo another colonoscopy to find flat polyps?

Patients who are concerned about flat polyps do not need to repeat their colonoscopy.

This study highlights the importance of quality colonoscopy screening. The American Society for Gastrointestinal Endoscopy (ASGE), as the standard-setting society for endoscopy, has issued quality indicators for colorectal cancer screening that define measures for improving quality in colonoscopy to ensure the best care possible for patients.

Among the issues stressed in these quality indicators are thorough bowel preparation and adequate withdrawal time – two important steps in completing a thorough examination of the colon to identify flat and raised polyps. In addition, the physician performing the colonoscopy should have received specific training in endoscopy and be board certified.

  • Patients must take the full bowel preparation as directed by their physician before the colonoscopy. Proper bowel preparation is important so that the physician can clearly see the entire colon.
  • According to ASGE guidelines, your physician should have an average withdrawal time of six minutes or more in order to ensure adequate time for viewing and detection of abnormalities.
  • Physicians performing colonoscopy should receive formal endoscopy training. This is usually part of a gastroenterology fellowship or a surgical residency. The physician should also be board certified.

Are there any new technologies that are better at identifying flat polyps?
In the JAMA study, a special dye was used to help identify flat polyps during the colonoscopy, however, use of this dye is not the only way to find these lesions; a proper bowel preparation and thorough examination of the colon will also find flat polyps.

It is important to note that currently this dye is only used in select centers under special circumstances and is not widely available. The special dye is not a substitute for a careful examination. Also of note, this study was done on an elderly male veteran population, so the results may not be representative of a general population. While new technologies and methods garner press attention, there are often additional studies that need to be done until these new techniques become a standard of care.

The ASGE recommends that patients speak to their physician about colorectal cancer screening and ask questions about the new technologies available.

For more information about colorectal cancer screening and to find a qualified doctor in your area, log on to the ASGE’s colorectal cancer awareness Web site

Reviewed August 2014