Review
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2017; 23(9): 1541-1551
Published online Mar 7, 2017. doi: 10.3748/wjg.v23.i9.1541
Pseudopolyps in inflammatory bowel diseases: Have we learned enough?
Dimitrios S Politis, Konstantinos H Katsanos, Epameinondas V Tsianos, Dimitrios K Christodoulou
Dimitrios S Politis, Konstantinos H Katsanos, Epameinondas V Tsianos, Dimitrios K Christodoulou, Department of Gastroenterology, University Hospital of Ioannina, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
Author contributions: All authors have made equally substantial contributions to the conception and design of the review, drafting of the article or revising it critically for important intellectual content, and providing final approval of the version to be submitted.
Conflict-of-interest statement: All authors declare no potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dimitrios K Christodoulou, MD, PhD, Associate Professor, Department of Gastroenterology, University Hospital of Ioannina, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece. dchristo@uoi.gr
Telephone: +30-2651-007501 Fax: +30-2651-007016
Received: November 12, 2016
Peer-review started: November 13, 2016
First decision: December 19, 2016
Revised: January 20, 2017
Accepted: February 16, 2017
Article in press: February 17, 2017
Published online: March 7, 2017
Processing time: 113 Days and 14.9 Hours
Abstract

Pseudopolyps are a well described entity in the literature and even though the exact pathogenesis of their formation is not completely understood, they are considered non-neoplastic lesions originating from the mucosa after repeated periods of inflammation and ulceration associated with excessive healing processes. Their occurrence is less common in Crohn's disease than in ulcerative colitis, and their overall prevalence ranges from 4% to 74%; moreover, they are found more often in colon but have been detected in other parts of the gastrointestinal tract as well. When their size exceeds the arbitrary point of 1.5 cm, they are classified as giant pseudopolyps. Clinical evaluation should differentiate the pseudopolyps from other polypoid lesions, such as the dysplasia-associated mass or lesion, but this situation represents an ongoing clinical challenge. Pseudopolyps can provoke complications such as bleeding or obstruction, and their management includes medical therapy, endoscopy and surgery; however, no consensus exists about the optimal treatment approach. Patients with pseudopolyps are considered at intermediate risk for colorectal cancer and regular endoscopic monitoring is recommended. Through a review of the literature, we provide here a proposed classification of the characteristics of pseudopolyps.

Keywords: Pseudopolyps; Inflammatory polyps; Post-inflammatory polyps; Giant pseudopolyps; Ulcerative colitis; Inflammatory bowel disease; Crohn's disease; Classification; Dysplasia-associated mass or lesion

Core tip: In inflammatory bowel disease patients, pseudopolyps are formed at the bowel wall during the inflammatory process. Published reports have begun to elucidate the mechanism of pseudopolyp formation and prevalence; however, the clinical challenge in distinguishing these entities from other dysplastic lesions remains and there is scarce data about their complications and management. In this review, we aimed to condense the published reports about their prevalence and to present a classification of their distinct characteristics based on endoscoping and histologic criteria, in order to facilitate their recognition. Moreover, available methods for confronting their complications and long-term management are presented.