Adenomatous polyps of the colon and rectum.
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Adenomatous Polyps↗
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Audit of investigations in patients with iron deficiency anaemia.
BACKGROUND: Patients with iron deficiency anaemia (IDA) are commonly referred to the gastroenterologists for exclusion of gastrointestinal (GI) pathologies. The British Society of Gastroenterology (BSG) has published a guideline for management of IDA. As recommended by this guideline, all patients should have examinations of both upper and lower GI tract with the exception of pre-menopausal women younger than 45 years old. The primary aim of this audit was to determine how thoroughly patients referred to our unit at the Singapore General Hospital had been investigated. The secondary aim was to determine the yield rate of gastroscopy and lower gastrointestinal investigations (colonoscopy or barium enema) in our patients. METHODS: We reviewed the case notes of patients who underwent gastroscopy for indication of anaemia between the period from April to December 1999. We classified iron deficiency anaemia as having haemoglobin of lower than reference range with either low ferritin level or iron/ TIBC ratio of less than 10%. RESULTS: Of a total of 326 patients reviewed, 172 patients (65 men, 109 women) met the inclusion criteria of IDA. The median age for the group was 59 (Range 16 to 88) years old and there were 107 (62.2%) women. There were 31 female patients younger than 45 years old (group A) and 141 patients in group B which included all the males and females older than 45 years old. Due to the method of data retrieval, all of the patients in group A fulfilled the standard set by the BSG guideline in that they all underwent gastroscopy. In this group, few gastrointestinal pathologies were found (one patient with peptic ulcer and two patients with colonic cancer). In terms of finding potential gastrointestinal causes of IDA, the yield rate of gastroscopy and colonoscopy were 3.2% and 13.6% respectively. In group B, 96 patients (68%) underwent upper and lower gastrointestinal investigations. Evaluation with gastroscopy showed peptic ulcer disease in 31 patients (21.7%) and gastric cancer in 9 patients (6.3%). Only 96 patients (68.1%) in group B had lower gastrointestinal investigations. Twenty-six patients were found to have gastrointestinal disorders (12 patients with colon cancer, 10 colonic polyps, one Crohn's disease, one colonic tuberculosis and two haemorrhoids). The yield rate of gastroscopy and colonoscopy were 31.2% and 25% respectively. CONCLUSION: In this study of patients with confirmed IDA, we found much higher incidence of gastrointestinal disorders in the group of male and postmenopausal women than in the group with premenopausal women. Furthermore, over 30% of patients in this group did not undergo lower gastrointestinal tract investigations as recommended by the BSG guideline. We also found two cases of colonic cancer in the latter group. We would recommend bidirectional endoscopy for postmenopausal women and men with IDA. For premenopausal women, we would recommend similar approach unless there are clinical pointers to dietary iron deficiency or menorrhagia.
Adolescent↗
Acute and chronic management of lower gastrointestinal bleeding: cost-effective approaches.
This article is concerned with current diagnosis and treatment of patients with severe lower gastrointestinal (GI) bleeding. Our purposes were to discuss tests available for diagnosis and treatment and to present our approach and to discuss cost assessment of different approaches. We evaluated 100 consecutive patients who presented with severe and persistent lower GI bleeding. Patients were continually monitored and had polyethylene sulfate purge to cleanse the colon. Panendoscopy revealed an upper GI source in 11%. Presumed small bowel bleeding accounted for 9%, and no site was found in 6%. During emergency colonoscopy at the bedside, a definite colonic lesion was found in 74% of patients. Angiomata accounted for 30% of total or 41% of all colonic bleeding sites. Diverticula were the source of bleeding in 23%, ulcerated colonic polyps or cancers in 15% of colonic sites, focal colitis or ulceration in 12%, rectal lesions in 5%, and other colonic sources in 4%. Based on 1990 data and costs of services to the patients with severe ongoing hematochezia, we estimated that by using emergency colonoscopy rather than medical, angiographic, and surgical management, a mean of $10,065 per patient was saved.
Colonic Neoplasms↗
Impact of endoscopist withdrawal speed on polyp yield: implications for optimal colonoscopy withdrawal time.
BACKGROUND: In 2002, a U.S. Multi-Society Task Force on Colorectal Cancer recommended that the withdrawal phase for colonoscopy should average at least 6-10 min. This was based on 10 consecutive colonoscopies by two endoscopists with different adenoma miss rates. AIMS: To characterize the relationship between endoscopist withdrawal time and polyp detection at colonoscopy, and to determine the withdrawal time that corresponds to the median polyp detection rate. DESIGN: Procedural data from out-patient colonoscopies performed at the Mayo Clinic, Rochester during 2003 were reviewed. Endoscopists were characterized by their mean withdrawal time for a negative procedure and individual polyp detection rate. RESULTS: A total of 10 955 colonoscopies performed by 43 endoscopists were analysed. Median withdrawal time was 6.3 min (range: 4.2-11.9); polyp detection rate was 44.0% (all polyps), 29.8% (< or = 5 mm), 5.9% (6-9 mm), 6.7% (10-19 mm), 2.1% (> or = 20 mm). Longer withdrawal time was associated with higher polyp detection rate (r = 0.76; P < 0.0001); this relationship weakened for larger polyps (r = 0.19 for polyps 6-9 mm, r = 0.28 for polyps 10-19 mm, r = 0.02 for polyps > or = 20 mm). Overall median polyp detection rate corresponded to a withdrawal time of 6.7 min. CONCLUSION: Our findings support a colonoscopy withdrawal time of at least 7 min, which correlates with higher colon polyp detection rates.
Adenoma↗
Do gastroenterologists notify polyp patients that family members should have screening?
OBJECTIVE: The objective of this study was to determine whether patients found to have adenomatous polyps or cancer were notified that their relatives should have screening, due to an increased risk of developing colorectal cancer. METHODS: Consecutive (n = 121) colonoscopy patients from December of 1999 to October of 2001 found to have adenomatous colon polyps or colon cancer formed the study group. Charts were reviewed for documentation of relative notification, and when documentation was not present, study subjects were contacted by telephone. RESULTS: Overall, 71% had data that were able to be evaluated; the remaining 29% were unable to be contacted because of changes of address or phone numbers. Adenomatous polyps were seen in 95%, and cancer seen in 5%. Overall, 30% of the patients were notified: 23 of 82 (28%) in the polyp group and 3 of 4 (75%) in the cancer group. Advanced adenomas or multiple adenomas were noted in 28 of the 82 (34%). Of those, 8 of 28 (29%) were notified. CONCLUSIONS: Gastroenterologists should be aware of the need for increased attention to family notification, especially in those with advanced adenomas or multiple adenomas. Template notification letters may complement the polyp surveillance programs that many colonoscopists use.
Adult↗
Radiologic manifestations of the syndrome of neurocrest and colonic tumors.
This report describes the radiologic findings in the recently described syndrome of multiple colonic polyps and malignant tumors of neurocrest origin. One patient had multiple endocrine neoplasia syndrome type 11B with malignant medullary thyroid carcinoma, another had malignant pheochromocytoma, and the third had malignant carcinoid tumor. All patients had multiple colonic tubular or tubulovillous adenomas. In 2 patients, there were 8 sessile or pedunculated polyps distributed throughout the colon. In the patient with multiple endocrine neoplasia syndrome type 11B, the colon was carpeted with small polyps, 2-6 mm in size.
Adrenal Gland Neoplasms↗
[A descending colon tumour prolapsing from anus: case report].
Most colonic polyps are asymptomatic and the incidence rises during sixth and seventh decades. Symptoms and signs may vary with histological types and location. Clinical features include fresh rectal bleeding, mucoid diarrhea and prolapsus of stalked rectal polyps located near distal segment. Here we discuss a case with a rare clinical presentation, who had sessile malign villous adenoma located in the descending colon, which caused colocolic intussusception and prolapsed through the anus.
Adenoma, Villous↗
Gaucher's disease complicated by bleeding esophageal varices and colonic infiltration by Gaucher cells.
We report a 10-yr-old child with Gaucher's disease who developed upper gastrointestinal bleeding from esophageal varices, as well as hemorrhage from a colonic polyp infiltrated with Gaucher cells. Both the varices and polyp were treated endoscopically, and the outcome was successful. Although gastrointestinal hemorrhage due to portal hypertension is considered a rare complication of Gaucher's disease, colonic infiltration with Gaucher cells has not been recognized previously.
Biopsy↗
Reduction of false positives by internal features for polyp detection in CT-based virtual colonoscopy.
In this paper, we present a computer-aided detection (CAD) method to extract and use internal features to reduce false positive (FP) rate generated by surface-based measures on the inner colon wall in computed tomographic (CT) colonography. Firstly, a new shape description global curvature, which can provide an overall shape description of the colon wall, is introduced to improve the detection of suspicious patches on the colon wall whose geometrical features are similar to that of the colonic polyps. By a ray-driven edge finder, the volume of each detected patch is extracted as a fitted ellipsoid model. Within the ellipsoid model, CT image density distribution is analyzed. Three types of (geometrical, morphological, and textural) internal features are extracted and applied to eliminate the FPs from the detected patches. The presented CAD method was tested by a total of 153 patient datasets in which 45 patients were found with 61 polyps of sizes 4-30 mm by optical colonoscopy. For a 100% detection sensitivity (on polyps), the presented CAD method had an average FPs of 2.68 per patient dataset and eliminated 93.1% of FPs generated by the surface-based measures. The presented CAD method was also evaluated by different polyp sizes. For polyp sizes of 10-30 mm, the method achieved mean number of FPs per dataset of 2.0 with 100% sensitivity. For polyp sizes of 4-10 mm, the method achieved 3.44 FP per dataset with 100% sensitivity.
Biophysical Phenomena↗
Edge displacement field-based classification for improved detection of polyps in CT colonography.
Colorectal cancer can easily be prevented provided that the precursors to tumors, small colonic polyps, are detected and removed. Currently, the only definitive examination of the colon is fiber-optic colonoscopy, which is invasive and expensive. Computed tomographic colonography (CTC) is potentially a less costly and less invasive alternative to FOC. It would be desirable to have computer-aided detection (CAD) algorithms to examine the large amount of data CTC provides. Most current CAD algorithms have high false positive rates at the required sensitivity levels. We developed and evaluated a postprocessing algorithm to decrease the false positive rate of such a CAD method without sacrificing sensitivity. Our method attempts to model the way a radiologist recognizes a polyp while scrolling a cross-sectional plane through three-dimensional computed tomography data by classification of the changes in the location of the edges in the two-dimensional plane. We performed a tenfold cross-validation study to assess its performance using sensitivity/specificity analysis on data from 48 patients. The mean specificity over all experiments increased from 0.19 (0.35) to 0.47 (0.56) for a sensitivity of 1.00 (0.95).
Adult↗
[RADIODIAGNOSIS OF COLONIC AND RECTAL POLYPS].
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Colonic Neoplasms↗
Radiological evidence for the polyp/cancer sequence in the colon.
Three cases of frank malignancy developing in pre-existing colonic polyps are presented. Although this sequence of events is well recognised, it is rarely demonstrated radiologically. The cases illustrate the importance of identifying and appropriately treating polypoid colonic lesions.
Adenocarcinoma↗
Metaplastic polyp of the colon develops in response to inflammation.
BACKGROUND: The metaplastic polyp of the colon is a non-neoplastic lesion that is generally identified as white, flat and having a smooth surface. In general, this polyp is small, is less than 5 mm in diameter but is occasionally larger than 5 mm in diameter, and forms a swelling. The aims of the present study were to clarify the factors that determine the morphology of protruding metaplastic polyps. More specifically, we investigated whether the metaplastic polyp forms as a result of an abnormality in cell proliferation or inflammation of the region. METHODS: We examined 15 endoscopically resected metaplastic polyps of the colon having a longitudinal diameter of more than 5 mm. To study aspects of cell proliferation, we used proliferating-cell nuclear antigen (PCNA) staining. For examination of histological changes caused by inflammation, we used alpha-smooth muscle actin (alphaSMA) staining, in which myofibroblasts are specifically stained. RESULTS: Metaplastic polyps showed significantly higher expression of PCNA, not only in the deep layer, but also in the intermediate and superficial layers, compared with the normal mucosa of the colon. In the protruding metaplastic polyps, anti-alphaSMA staining revealed bundle-like myofibroblasts in the interstitium. CONCLUSIONS: The factors responsible for the formation of non-neoplastic metaplastic polyps larger than 5 mm with a protruding morphology are: an increased number of epithelial cells due to the movement of these cells toward the ductal epithelium in the proliferating zone; and expansion of interstitial tissues due to infiltration of myofibroblasts and other inflammatory cells in response to inflammation.
Actins↗
[Characteristics and risk factors of synchronous and metachronous polyp in colorectal cancer].
BACKGROUND/AIMS: Detection and removal of adenomatous polyps with colonoscopy is known to be the best preventive method for the colon cancer. With removal of synchronous colon polyps, the risk of metachronous cancer seems to be decreased effectively. However, the preoperative evaluation of entire colon is frequently impossible due to luminal obstructive lesion. Therefore, it is important to evaluate entire colon in postoperative period as earlier as possible. The aim of current study is to analyze the characteristics and risk factors of synchronous as well as metachronous polyps. METHODS: From Jan. 1998 to Dec. 2001, among the patients who received operative treatment for colon cancer in Yonsei University, Severance Hospital, 972 patients, who had underwent preoperative endoscopic evaluation and surveillance above one year after operation, were enrolled. RESULTS: In 617 patients who had completed total colonic evaluation within one year after operation, 45.93% of cases had synchronous polyps, 17.0% advanced polyps, and 5.8% synchronous cancer. The incidence of synchronous and advanced synchronous polyps was high in elderly (>or=60 year), male patients (p<0.05). In 166 patients who had underwent postoperative colonoscopy after one year, 25.3% had metachronous polyps, 3.0% advanced polyps, and 0.6% metachronous cancer. The presence of synchronous polyps was associated with the risk of metachronous polyps (p<0.05). CONCLUSIONS: Complete colonic evaluation during perioperative period should be recommended to identify precancerous lesions, which can contribute to reduce the development of colon cancer.
Adult↗
The histopathology of adenomatous polyps of the colon and rectum.
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Adenomatous Polyps↗
A small pedunculated adenomatous polyp of the colon found to contain the focus of invasive carcinoma extending to the serosa: report of a case.
A small pedunculated polyp was detected among other polyps in the transverse colon of a 64-year-old man, the resected specimen of which showed an adenomatous polyp 1 cm in diameter, containing the foci of adenocarcinoma invading the submucosa, muscularis, and serosa. This case report stresses the importance of performing careful pathologic examination of resected specimens obtained from endoscopic polypectomy, even for small pedunculated colon polyps.
Adenocarcinoma↗
Transabdominal transcolonic polypectomy.
Up until now, 2%-10% of colonic polyps larger than 2 cm have been considered colonoscopically unresectable. These were commonly treated by piecemeal resection and observation by colonoscopists and hemicolectomy by surgeons. Our minimally invasive "rural solution" in this situation is transcolonic resection through a mini-laparotomy. We present 7 patients with large colonic villous adenomas not amenable to colonoscopic resection. Laporoscopy determined the location of the muscle-splitting incision. The segment of bowel containing the polyp was exteriorized: antimesentric polyps were excised together with the corresponding colonic wall; polyps in mesenteric location were removed transmurally through an anterior colotomy. There was no surgical morbidity. Five of the 7 patients were discharged within 24 hours. Preoperative tattooing of the lesions and laparoscopic mobilization of the involved segment--when necessary--proved to be useful adjuncts. This seems to be an attractive option that may be superior to formal colectomy or repeated endoscopic piecemeal excision of large polyps. It provides colonoscopists with the option of avoiding having to resect very difficult polyps while not subjecting their patients to unnecessarily morbid operations.
Aged↗
Accuracy of pathologic interpretation of colorectal polyps by general pathologists in community practice.
BACKGROUND: The histologic features of colorectal polyps often guide colonoscopic surveillance and the need for surgical intervention. Our objective was to evaluate the pathologic interpretation of colorectal polyps by general pathologists in community practice. METHODS: Twenty histologic slides of colorectal polyps were reviewed by 20 randomly selected general pathologists in community practice. There were 5 malignant polyps, 9 adenomas, and 6 miscellaneous polyps. RESULTS: Cancer was correctly identified in 91% of readings and adenoma in 94%. The grade of differentiation of cancer was provided in 55% of readings, and comment regarding whether the resection margin was free of cancer was made by 50% of pathologists. Tubular adenoma was called tubulovillous or villous in 35% of readings, but tubulovillous or villous adenoma was seldom (2%) called tubular. High-grade dysplasia was correctly identified in 47% of 60 readings, was called invasive cancer in 22%, and was missed in 31%. Among miscellaneous polyps, hyperplastic polyp was correctly recognized in 75% of cases, and inflammatory polyp and juvenile polyp each were recognized by 16 of 20 pathologists (80%). Peutz-Jeghers hamartoma was identified by 4 of 20 pathologists (20%), and the polypoid phase of solitary rectal ulcer syndrome was recognized by 2 pathologists (10%). CONCLUSION: Areas of strength with regard to interpretation of colon polyps by general pathologists in community practice included identification of cancer, adenoma, and certain non-neoplastic polyps (e.g., inflammatory and juvenile polyps). Areas of weakness included lack of comment on cancer differentiation and proximity to the resection line, erroneous identification of high-grade dysplasia, and identification of rare lesions. The results of this study suggest areas on which to focus continuing education and continuous quality improvement efforts with regard to polyp interpretation.
Adenocarcinoma↗