Endoscopic characteristics and clinical management of cap polyposis: Insights from seven cases

Abstract Cap polyposis (CP) is an uncommon benign condition affecting the colorectal region. This study aimed to examine endoscopic features, therapeutic responses, and clinical outcomes of CP, with particular emphasis on the variable response to Helicobacter pylori eradication. This retrospective case series evaluated seven patients diagnosed with CP at Tianjin Union Medical Center between February 2018 and April 2023. The diagnosis was established based on distinctive endoscopic and histological findings, with clinical exclusion of other conditions such as ulcerative colitis (UC) and solitary rectal ulcer syndrome. Clinical data, endoscopic characteristics, treatments, and outcomes were systematically reviewed. This case series included seven patients (six males, one female) with a median age of 36 years. Four patients were H. pylori-positive. All patients exhibited characteristic sessile or semi-pedunculated polyps covered by a whitish fibrinopurulent cap, predominantly located in the rectosigmoid region with normal intervening mucosa. Treatment outcomes varied. Two H. pylori-positive patients with short disease duration achieved complete remission following eradication therapy combined with polypectomy. Two other H. pylori-positive patients showed only initial improvement after eradication, with subsequent recurrences; one ultimately required total colectomy due to disease progression. In contrast, one H. pylori-negative patient achieved remission through polypectomy and medical therapy alone. CP poses significant diagnostic challenges and demonstrates heterogeneous responses to treatment. Eradication of H. pylori may prove effective in certain patients with early-stage disease. Therefore, timely diagnosis and personalized treatment strategies, including endoscopic resection, are essential for achieving favorable outcomes.