Colon Polyps

Overview

Colon polyps are a common and can affect up to 1 in 4 patients in their lifetime (1)

They're slightly more common in men than women and are most common in people over the age of 60.

Colon polyps are generally asymptomatic, but they can be picked up during investigations done for other reasons or as part of the bowel screening program.

Large polyps can cause the following symptoms:

• mucous or blood in the stool
• diarrhoea or constipation
• abdominal pain

Polyps can turn into cancer, particularly if they are larger (10mm diameter or bigger).

(1) NHS.uk website - Bowel Polyps. 

Who to refer

Most colon polyps will be picked up as part of investigations in endoscopy clinics (2WW, AQP, bowel screening) and managed appropriately using existing pathways (see British Society of Gastroenterology (BSG) pathway on Post-polypectomy and Post cancer resection Surveillance - 2019).

Sometimes polyps are picked up during other investigations in primary or secondary care and will need to be referred on appropriately if this has not happened automatically via existing pathways.

Some patients with polyps may not need to be referred if this is not likely to change management (e.g. if patient is too frail or has comorbidities that would prevent further invasive investigations or treatment).

For further details and how to refer see Referral section below.

Familial conditions

For patients with known cancer syndrome/gene mutation in family then please see the Family History of Colorectal Cancer page.

Red Flags

Symptomatic patients with who meet criteria for Lower GI - USC (2WW) referral should be referred if not already investigated appropriately.

Patient's with a polyp >10mm diameter and who have not already been referred for follow up, should also be referred via the 2WW pathway (direct to test or suspect cancer clinic as appropriate).

Before referral

Ensure patient is fit for colonoscopy and undertake bloods including:

• FBC
• Ferritin
• UE

Referral

Suspected cancer

If patients under surveillance present with new symptoms that meet Lower GI - USC (2WW) criteria then referrals should be made via usual pathways (direct to test on ICE or 2WW referral via eRS).

High Risk

If previous colonoscopy has shown High Risk findings then a one off surveillance colonoscopy 3 years later is indicated (unless exceptions apply).

High risk findings as follows:

Two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); 

or

Five or more premalignant polyps.

Referrals can be made as follows if not already under care of  local provider:

• AQP (Prime or EGTC) direct access colonoscopy via eRS  - See Endoscopy page
• Lower GI clinic via eRS or Advice and Guidance- for discussion/advice on management if direct access scope is not considered appropriate (e.g frailty or comorbidities).

Low Risk

If previous colonoscopy has not reported High Risk findings then colonoscopic surveillance is not usually required but patients should still be encouraged to engage with bowel screening when invited.

If more specific advice is required please request  Advice and Guidance.

Colon polyp surveillance

Surveillance colonoscopies for patients who have colon polyps is dependent on size and number of polyps. Providers should manage this process so GPs should not need to make follow up referrals for this purpose. However, it is advisable that GPs should add an alert to the patient's computer record to indicate when the next colonoscopy is due.

Patients moving from other areas or who have been lost to follow up or who wish to change provider can be referred for direct access colonoscopy at the appropriate time for local follow up if required. It is important to include previous endoscopic reports and histology with these referrals. 

Please also see British Society of Gastroenterology (BSG) pathway on Post-polypectomy and Post cancer resection Surveillance (2019)

See endoscopy page for details and referral form.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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