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PubMed2003

Experience in the endoscopic management of large colonic polyps.

BACKGROUND: Large colonic polyps present a particular challenge to endoscopists because of the risks of significant haemorrhage, perforation, inadequate polypectomy, or trying to snare an unrecognized cancer. The alternative to endoscopic therapy of large polyps is surgical resection and although minimally invasive techniques are available, risks are significant. Although neither surgery nor endoscopy is a perfect way of treating large colonic polyps, endoscopic resection is usually tried first. Most series of endoscopic polypectomies are small, include both rectal and colonic polyps and have varying size and shape criteria. The purpose of the present study is to describe a large consecutive series of colonic polyps evaluated endoscopically, to determine the chances of performing a safe, effective endoscopic polypectomy. METHODS: All colonic polyps>20 mm in maximum dimension assessed during colonoscopy from 1989 to 2002 were reviewed. Rectal polyps were excluded. Demographic data for the patients were abstracted, as were data regarding the outcomes of polyp assessment and treatment. Primary end-points were: the need for surgical resection, the incidence of postpolypectomy complications and the persistence of the index polyp at follow up. Independent variables included the endoscopically assessed size of the polyps, the year in which the polypectomy took place, the shape of the polyps and their location within the colon. RESULTS: During the period under review 311 large polyps were removed from 252 different patients. Of these, 263 polyps were removed endoscopically and 48 polyps were removed surgically. An additional 18 endoscopically removed polyps ultimately needed surgery for recurrence or malignancy. There were no deaths but 19 complications of endoscopic polypectomy (17 late haemorrhage and two postpolypectomy syndrome). At first follow up, 22% of polyps had persisted, this decreased to 14% at second follow up and 7% at third. Complications were more common in right sided polyps and in flat or sessile lesions. Pedunculated polyps never persisted or recurred and had the lowest rate of surgery. Larger polyps had higher rates of advanced histology, complications, polyp persistence and the need for surgery. CONCLUSIONS: Polyp size, location and shape influence the results of endoscopic resection of large colonic polyps. Polyps>30 mm in maximum diameter are significantly more advanced histologically but also significantly more difficult to treat successfully than those <30 mm. However, size alone is rarely a contraindication to endoscopic resection.

Aged↗
PubMed1987

[Are stomach polyps an indicator of colonic carcinoma and colonic polyps an indicator of stomach carcinoma?].

Over a period of six years a total of 407 patients with polyps of the gastrointestinal tract were examined by gastroscopy and coloscopy and the findings analysed retrospectively. Among patients with colon polyps 10.5% were found also to have polypoid gastric lesions, among those with adenoma of the colon the prevalence was 11.7%. Only 2.4% of simultaneously diagnosed gastric lesions were found to be malignant or premalignant, a figure similar to the population average. But in patients with more than ten polyps of the colon both the prevalence of polypoid gastric changes and the significance of polyps with respect to precancerous lesions were clearly increased. On the other hand, in patients with epithelial polyps and/or glandular cysts colon polyps were found in 45%, in 42% with precancerous changes (adenoma). Thus patients with epithelial gastric polyps and glandular cysts probably constitute a group with a real additional risk of colon carcinoma. Regular coloscopy will thus reveal precancerous changes (adenoma) in the colon of 42% of such patients; coloscopic polypectomy will be an effective prophylactic measure against carcinoma of the colon.

Adenomatous Polyposis Coli↗
PubMed1996

High-resolution chromoendoscopy for the diagnosis of diminutive colon polyps: implications for colon cancer screening.

BACKGROUND & AIMS: A visual, nonbiopsy technique that could reliably determine the histology of diminutive colorectal polyps could greatly reduce the cost of colon cancer screening. This study was designed to report our experience using a high-resolution colonoscope combined with indigo carmine dye to diagnosis diminutive colorectal polyps. METHODS: Colonoscopy using a Fujinon EC-400 HM/HL was performed in 36 patients with polyps <10mm in diameter. Polyps from the first 12 patients (phase 1) were sprayed with 10 mL of 0.2% indigo carmine dye, and a biopsy was performed or a specimen removed and submitted for histological analysis. The morphological data were used to predict polyp histology in the subsequent 24 patients (phase 2). RESULTS: Hyperplastic polyps had a characteristic surface "pit pattern" of orderly arranged "dots" that resembled the surrounding, nonpolypoid mucosa. Adenomatous polyps had surface "grooves" or "sulci." Sensitivity and specificity of our techniques in distinguishing adenomatous from nonadenomatous colorectal polyps were 93% and 95% respectively. CONCLUSIONS: High-resolution chromoendoscopy provides morphological detail of diminutive colorectal polyps that correlates well with polyp histology. If incorporated into colon cancer screening, these techniques may limit the need for biopsy and/or subsequent colonoscopy and ultimately decrease costs.

Adult↗
PubMed1999

Laparoscopic surgery in the treatment of colonic polyps.

BACKGROUND: Benign colonic polyps that are impossible to remove with the aid of the flexible colonoscope because of their size or location must be removed surgically. METHODS: Twenty patients with colonic adenomatous polyps that could not be resected by colonoscopy because of size or difficult location (n = 18) or polyps in combination with diverticulitis (n = 2) underwent polyp removal through a small 'assisted' incision in the abdominal wall using a standard 'dissection-facilitated' laparoscopic approach to the affected colonic segment. RESULTS: In six patients the polyp was removed through a colotomy, in three through a limited resection (two ileocaecal and one limited sigmoid resection) and in 11 through a standard colectomy (four right hemicolectomy, one left hemicolectomy, four sigmoid and two anterior resections) because of suspicion of cancer. In only one patient could the polyp not be found during laparoscopy, resulting in a second conventional surgical intervention. In four patients carcinoma was diagnosed in the specimen. CONCLUSION: Precise preoperative localization of the polyp and the use of dissection-facilitated laparoscopic colonic surgery make laparoscopic removal of benign colonic polyps an alternative to an open procedure.

Aged↗
PubMed1983

Skin tags: a cutaneous marker for colonic polyps.

The relation between adenomatous colonic polyps and the development of adenocarcinoma of the colon is well established. An association between skin tags and colonic polyps in patients with acromegaly has also been reported. To ascertain if skin tags are a cutaneous marker for colonic polyps independent of the presence of acromegaly, 100 men referred for colonoscopy were studied. Forty-six patients had colonic polyps and 37 also had skin tags; the correlation was highly significant (p less than 0.005). The sensitivity and specificity of the presence of skin tags serving as a cutaneous marker for adenomatous colonic polyps were both greater than 75%. Thus, at least in this population, skin tags may serve as a means for identifying patients at increased risk for having colonic polyps.

Colonic Neoplasms↗
PubMed2002

Prolapsing mucosal polyps: an underrecognized form of colonic polyp--a clinicopathological study of 15 cases.

OBJECTIVE: Prolapsing intestinal mucosa occurs in many forms throughout the GI tract. We describe 15 patients with polypoid masses in the sigmoid colon and histological features of mucosal prolapse. METHODS: Fifteen patients with colon polyps demonstrating endoscopic and histological features of mucosal prolapse were retrospectively identified from our database. RESULTS: Twelve patients presented with signs and symptoms that were nonspecific, but consistent with mucosal prolapse, such as occult or gross intestinal bleeding and lower abdominal pain. Three patients were asymptomatic. The polyps occurred in the sigmoid colon, usually in association with diverticular disease, and appeared more often in men. Endoscopically, the polyps appeared to be well-circumscribed, hyperemic masses that contrasted sharply with normal-appearing adjacent mucosa. Histological features include glandular crypt abnormalities, fibromuscular obliteration of the lamina propria, and thickened and splayed muscularis mucosa. CONCLUSIONS: Prolapsing mucosal polyps of the colon are histologically similar to other mucosal prolapsing conditions in the GI tract, such as the solitary rectal ulcer syndrome, inflammatory cloacogenic polyps, inflammatory "cap" polyps, and gastric antral vascular ectasia, and should therefore be designated as part of the "mucosal prolapse syndrome."

Adult↗
PubMed1987

Patterns of inheritance of colonic polyps.

While the inheritance pattern of familial polyposis coli is established as an autosomal dominant pattern, the expression of the various extracolonic manifestations associated with the neoplastic polyposis is less well understood. The discrete polyp cancer syndrome may not be recognized unless both polyps and colon cancer are considered in the inheritance pattern. The hamartomatous polyps follow a Mendelian-dominant inheritance pattern for the Peutz-Jeghers syndrome, while the inheritance pattern for the juvenile polyposis syndromes is less clear. Cowden's disease appears in a Mendelian dominant pattern, but the occurrence of colonic polyps is less well documented. The ganglioneuromas follow a mendelian dominant inheritance pattern, while the relationship and occurrence of colonic polyps in association with Torre's syndrome is uncertain. The Mendelian dominant inheritance pattern for the cancer family syndrome is documented; the role of colon polyps in this syndrome is less well understood. A further understanding of the inheritance patterns of these various colon polyps will lead to more understanding of the basic disease and help in prevention and early detection for treatment and cure.

Adenomatous Polyposis Coli↗
PubMed1986

Treatment of colonic polyps--practical considerations.

The adenomatous colonic polyp, a neoplastic lesion, is the precursor of most if not all carcinomas of the colon and rectum. Confirmatory evidence is derived from epidemiological, histological and clinical data demonstrating a close parallelism between adenomas and cancer of the colon. Based on current knowledge, all colonic polyps should be removed to prevent the development of colonic cancer. However, since the risk of malignancy within an adenoma is related to its size, histology and the degree of dysplasia, practical considerations dictate that all polyps 1 cm in diameter or larger should be removed upon their detection by barium enema or colonoscopy since such adenomas are the ones most likely to contain malignancy. The endoscopic removal of colon polyps can be efficiently and safely accomplished when established principles of colonoscopy and electrosurgery are followed. This technique requires the proper equipment, a skilled endoscopy assistant, and an experienced endoscopist with the ability to adeptly perform colonoscopy, an understanding of the basic concepts of electrocautery and knowledge of the various structural configurations of colonic polyps. Colonoscopic polypectomy will avoid the need for surgical resection in most instances. Management of the malignant colonic polyp remains controversial. The patient with a sessile or pseudo-pedunculated polyp containing invasive cancer should undergo colonic resection. Surgery is not necessary for the majority of patients whose pedunculated adenomas contain invasive cancer, unless the malignancy is poorly differentiated, the cancer invades lymphatics or vascular channels, or tumour is seen at or near the resection margin. Surveillance colonoscopy after endoscopic polypectomy should be performed in most instances within one year to look for recurrent tumour, missed polyps or a metachronous adenoma. Subsequently, colonoscopy should be performed every two years in patients with multiple index polyps, and every three years after removal of a single index adenoma.

Adenoma↗
PubMed2000

Significance of rectosigmoid polyp as a predictor of proximal colonic polyp.

The association between rectosigmoid polyps and polyps in the more proximal colon is still a matter of debate, and the need for colonoscopy in patients with rectosigmoid polyps that are detected by flexible sigmoidoscopy is controversial. The aim of this study was to determine whether or not certain characteristics of rectosigmoid polyps are associated with the presence and characteristics of proximal colonic polyps. Seven hundred and twenty-eight patients who underwent total colonoscopy between October 1995 and June 1998 and who had colorectal polyps were retrospectively analyzed. Patients with inflammatory bowel diseases, familial adenomatous polyposis, or any advanced cancer were excluded. The odds ratio (OR) and 95% confidence interval (CI) of prevalence of proximal colonic polyps according to the patients age and sex, as well as the characteristics of rectosigmoid polyps, were calculated. Advanced adenoma was defined as an adenoma larger than 10 mm or an adenoma of any size with villous component, high-grade dysplasia or invasive carcinoma. Among 728 patients with colorectal polyps, 356 patients (48.9%) had polyps only in the rectosigmoid region, 193 patients (26.5%) had polyps only in the proximal colon, and 179 patients (24.6%) had polyps in both the rectosigmoid and proximal colon. In 535 patients with rectosigmoid polyps, the prevalence of proximal colonic polyps, neoplastic polyps and advanced adenomas were 33.4%, 27.3% and 2.9%, respectively. The prevalence of proximal colonic polyps in patients with rectosigmoid polyps was found to be significantly related to the male gender and elderly patients, in addition to the neoplastic histology of the rectosigmoid polyps. However, the prevalence of the proximal colonic polyps was not related to the size, number and shape of rectosigmoid polyps. In 179 patients with both rectosigmoid and proximal colonic polyps, the characteristics of proximal colonic polyps such as size, number and shape were similar to those of rectosigmoid polyps. We recommend total colonoscopic examination in all patients with rectosigmoid adenomas, regardless of the size, number, and shape, especially in elderly males.

Adult↗
PubMed1986

Changing concepts of colonic polyps: clinical and radiographic implications.

The relationship of colonic polyps to carcinoma of the colon provides a basis for their importance. Recent advances in the detection of colonic polyps, including double contrast barium examination and colonoscopy, have provided a method for more extensive study of colonic polyps. Studies using these newer techniques indicate that many traditional concepts of colonic polyps were inaccurate. The relationships of polyp size to histology, polyp location to age, and the phenomenon of colon polyp clustering are important to both the immediate treatment of the polyp and to the long-term follow-up of the patient. The use of hemoccult stool screening as a technique for screening for colonic pathology is also of significance to the radiologist. The changing relationships of various parameters of colon polyps bring into question the utility of many of the currently recommended screening procedures for colon pathology. Undoubtedly, this will impact on the practice of radiology.

Aged↗
PubMed2006

[Clinical usefulness of fecal occult blood test as a screening method for asymptomatic patients with colon polyps].

BACKGROUND/AIMS: Detection of asymptomatic benign colon polyp is increasing because colonoscopy is widely used as a screening and diagnostic method. Fecal occult blood test is usually performed for the selection of patients requiring colonoscopy as well as mass screening for colon cancer. The aim of this study was to investigate the usefulness of fecal occult blood test performed prior to colonoscopy as a screening method of benign colon polyps. METHODS: Clinical characteristics of patients with polyps were evaluated according to the fecal occult blood test results in patients who underwent one-day fecal occult blood test and colonoscopic polypectomies from May 2003 to October 2004, retrospectively. RESULTS: A total of 942 colonoscopic polypectomies in 288 patients were evaluated. Fecal occult blood tests were positive only in 32 patients (11.1%). In univariate analysis, there was a significant difference in polyp size (p=0.02) and location (p=0.03) according to the presence of positive fecal occult blood tests. In addition, age of the patient (p=0.046), polyp size (mean, p=0.04; largest, p<0.01) and the number of polyps (p=0.045) were significantly different. However, in multivariate analysis, only polyp size larger than 20 mm was significantly related with positive fecal occult blood test with estimated odds ratio of 4.71. CONCLUSIONS: Fecal occult blood test has limitations as a screening test in asymptomatic patients with colon polyps, except for colon polyps larger than 20 mm in size.

Colonic Neoplasms↗
PubMed1975

Arteriographic diagnosis of a juvenile colon polyp.

A juvenile colon polyp was demonstrated by inferior mesenteric arteriography in a 21-year old man with recurrent, massive, unexplained gastrointestinal bleeding. The arteriogram demonstrated a mucosal blush at the tip of the polyp along with a solitary prominent draining vein in the stalk and a nest of draining veins at the base of the stalk.

Adult↗
PubMed2003

Correlation of the morphology and size of colonic polyps with their histology.

BACKGROUND: Colonic adenomatous polyps are premalignant lesions; early recognition and use of a polypectomy for these polyps can reduce the occurrence of colorectal cancer. The purposes of this study were to evaluate the complications of polypectomy and the relationship between the morphology and size of colonic polyps and their histology. METHODS: Data on colonic polyps from 324 patients who received a polypectomy between April 1998 and December 2001 were collected. These included 207 men and 117 women, ranging in age between 17 and 86 years old, and who had had a colonoscopy or sigmoidoscopic examination. A polypectomy was performed on those colonic polyps discovered, and their morphology, size, and histology were analyzed. RESULTS: The histological findings of these polyps included adenoma, carcinoma, hyperplastic, and inflammatory polyps. One and a half percent (n = 6) were carcinomas, all of which belonged to the Yamada III or IV polyp group and were more than 1 cm in size, except for 1 polyp which was 0.7 cm. One case was complicated by colon perforation, and 2 cases experienced mild bleeding with no need for a blood transfusion or hospitalization. CONCLUSIONS: Morphology and size are closely related to the malignant change in colonic polyps. Colonic polyps with a size greater than 1 cm and classified as Yamada type III or IV have a higher potential for malignant change, and a polypectomy should be considered when they are discovered. A polypectomy is a safe procedure with only minor complications.

Adenomatous Polyps↗