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PubMed1985

Colonic lipomas: clinical significance and management.

Colonic lipomas are uncommon tumors but do constitute the most common nonepithelial tumor of the gastrointestinal tract. They tend to occur in an older population and rarely cause symptoms. However, if a lipoma discovered by barium enema or colonoscopy is causing symptoms of obstruction or bleeding, the tumors may require surgical removal. Rarely, as in our patient, the bleeding lipoma may be sufficiently pedunculated to allow safe colonoscopic removal. In general, lipomas of the colon are curiosities that must be distinguished from adenomatous polyps.

Aged↗
PubMed1974

Routine proctosigmoidoscopy: how often?

The cost-yield performance of routine proctosigmoidoscopy can be improved by far fewer examinations limited to the higher-risk patients. Since patients with diminutive polyps are at greater risk but diminutive polyps are rarely malignant and the doubling rate of colon cancer is slow, proctosigmoidoscopic examination of these higher-risk patients every 2 years is safe and more productive. Over 35 percent of those with original negative proctosigmoidoscopy demonstrate a new polyp on a second examination within 6 years. This significant shift into the higher-risk population warrants repeat proctosigmoidoscopy at least every 6 years in those without polyps.

Colonic Diseases↗
PubMed1990

Invasive colorectal adenomas: surgery versus colonoscopic polypectomy.

Of 6,426 colonoscopies performed in 1978-1987, 66 invasive colorectal adenomatous polyps were removed in 58 examinations. The study group included 36 (62%) men and 22 (38%) women with an age range of 42-96 years. Forty-three patients had invasive pedunculated polyps and 15 had invasive sessile polyps. Following the colonoscopic polypectomy, secondary surgical resection was done in 19 patients with pedunculated polyps and in 13 patients with sessile polyps. The operative specimens showed that the colonoscopic polypectomy removed the entire cancerous focus in all patients with pedunculated polyps, including those with stalk invasion. In contrast, most cases with sessile polyps turned out on operation to be Dukes' B or C carcinoma. Follow-up (mean 4.4 years) was available for 53 (93%) patients: none of 24 unoperated patients with pedunculated polyps suffered from local recurrence. We conclude that colonoscopic polypectomy is sufficient for invasive pedunculated polyps, provided that histology shows that the resection margins are free of tumoral cells. Surgery is recommended for all invasive sessile polyps.

Adult↗
PubMed1984

Is there a safe interval between diagnostic invasive procedure and the barium enema study of the colorectum?

In an attempt to define the optimal interval of safety when a barium enema study of the colon follows a planned injury of the bowel by local treatment or biopsy (or both), we studied a group of 833 patients who were seen at the Mayo Clinic during 1978. In the study group, 886 polyps were destroyed by fulguration, 258 lesions were both sampled and fulgurated, and 126 areas were sampled for biopsy study. One hundred ninety-four patients had multiple lesions; in 193 of these, 2-18 diminutive polyps were fulgurated. Of the 846 barium studies in the 833 patients, 5 were done on the same day as the planned injury, 543 within 24 hours, and 174 within 72 hours. Four patients demonstrated extravasation of barium, but none had signs or symptoms of acute perforation nor did the resected surgical specimen demonstrate communication with site of injury.

Barium Sulfate↗
PubMed1993

Antioxidant vitamins or lactulose for the prevention of the recurrence of colorectal adenomas. Colorectal Cancer Study Group of the University of Modena and the Health Care District 16.

Colonic adenomas represent the natural precursor lesions of most colorectal cancers. The treatment of choice is endoscopic polypectomy. However, after endoscopic removal, polyps recur in a large fraction of cases. Thus, we evaluated the effect of antioxidant vitamins or lactulose on the recurrence rate of adenomatous polyps. After polypectomy, 255 individuals were randomized into three groups. Group 1 was given vitamin A (30,000 IU/day), vitamin C (1 g/day), and vitamin E (70 mg/day); Group 2 was given lactulose (20 g/day); Group 3 received no treatment. Forty-six subjects had to be excluded because the histologic diagnosis was not consistent with adenoma. The remaining 209 individuals were included in the analysis according to the "intention to treat" criterion, though 34 did not adhere to the scheduled treatment or were lost during the follow-up. Subjects were followed at regular intervals for an average of 18 months. Polyps recurring before one year from index colonoscopy were considered missed by the endoscopist. In the 209 evaluable subjects, the percentages of recurrence of adenomas were 5.7 percent, 14.7 percent, and 35.9 percent in the vitamins, lactulose, and untreated groups, respectively. The fraction of subjects remaining free of adenomas, estimated by Kaplan-Meier survival curves, was significantly different among the three groups (log-rank chi-squared = 17.138; P < 0.001). Using Cox's regression analysis, treatment was the only variable that significantly contributed to the model (regression coefficient = 0.905; P < 0.001). In conclusion, either antioxidant vitamins or, to a lesser extent, lactulose lower the recurrence rate of adenomas of the large bowel and can be proposed as chemopreventive agents, at least in high-risk individuals.

Adenoma↗
PubMed2006

Endoscopic mucosal resection of large sessile colorectal polyps with submucosal injection of hypertonic 50 percent dextrose-epinephrine solution.

PURPOSE: Before endoscopic mucosal resection of large sessile colorectal polyps, injection of solution into submucosa cushions and isolates the tumor, although there is little information as to which solution with optimal effect should be used. This study investigated the effectiveness of endoscopic mucosal resection by use of a hypertonic dextrose plus epinephrine solution for large sessile colorectal polyps. METHODS: We removed 59 large sessile colorectal polyps in 59 patients by introducing an endoscopic submucosal hypertonic dextrose plus epinephrine injection technique. Endoscopic evaluations were repeated at 3, 6, and 12 months or longer. If no residual tumor was observed endoscopically and histologically at one year or more, the patient was considered to be "cured." The main outcome measurements were the mean amount of solution injected, mean disappearance time of solution, safety, complications, and recurrence at follow-up. RESULTS: Of the 59 large sessile colorectal polyps, 23 (39 percent) were resected en bloc and 36 (61 percent) piecemeal. The mean amount of hypertonic dextrose plus epinephrine solution injected was 24.42 +/- 17.52 ml, and its mean disappearance time was 13.61 +/- 5.21 (range, 7-21) minutes. Of the 36 patients treated with piecemeal resection, 18 (50 percent) required additional endoscopic interventions. In patients who entered the follow-up surveillance protocol for one year or longer, the cure rate by en bloc resection was 100 percent (23/23) and that by piecemeal intervention was 96.78 percent (30/31). Four patients (6.8 percent) had local bleeding after endoscopic mucosal resection that was mainly controlled endoscopically. CONCLUSIONS: Endoscopic mucosal resection after submucosal hypertonic dextrose plus epinephrine solution injection, with an intensive follow-up program, seems to be a safe and effective treatment for large sessile colorectal polyps.

Aged↗
PubMed1992

Colorectal cancer: the case for barium enema.

Both colonoscopy and barium enema are important techniques for examining the colon for polyps and cancer. They are approximately equally sensitive in detecting polypoid lesions of 7 to 10 mm or larger. A major limitation of colonoscopy is that the cecum cannot be visualized in 10 to 36% of cases. The comparable accuracy for detecting significant lesions, greater safety, and greater cost-effectiveness of barium enema favor its use in most patients.

Barium Sulfate↗
PubMed2001

[Colonoscopic follow-up of patients undergoing curative resection of colorectal cancer].

AIM: To investigate the role of colonoscopy in the follow-up of patients undergoing curative resection of colorectal cancer. MATERIAL AND METHODS: A prospective study was performed of 102 patients with colorectal cancer who underwent surgery with curative intention. Postoperative colonoscopic follow-up was a minimum of 5 years. RESULTS: There were 62 males and 40 females. The mean duration of follow-up was 73.4 months. Synchronous polyps were found in 44.1% (114 in 45 patients) and metachronous polyps in 33.4% (64 in 34 patients). Synchronous carcinoma was detected in 7.8% (9 in 8 patients), metachronous carcinoma in 1.9% (2 in 2 patients) and suture recurrence in 4.9% (5 in 5 patients). Metachronous polyps developed in 55.5% of the patients with synchronous polyps and in only 15.8% of those with no synchronous polyps (p < 0.00005); the odds ratio was 6.67. Colonoscopy diagnosed 92 synchronous polyps and 64 metachronous polyps; of these, 34 were found to be significant(in 22 patients). Colonoscopy diagnosed 5 synchronous carcinomas; in 3 of these (polyps with non-invasive carcinoma) polypectomy constituted definitive therapy and in the remaining 2, curative resection was achieved. Colonoscopy diagnosed 2 stage C2 metachronous carcinomas at 63 and 94 months. Curative resection was achieved in both cases. Colonoscopic follow-up diagnosed 2 suture recurrences and resection was potentially curative. CONCLUSIONS: Colonoscopy was found to play an essential role in 30% of the patients. The technique allowed the early diagnosis of synchronous carcinomas and curative treatment of metachronous carcinomas and demonstrated that the presence of synchronous polyps increases the risk of developing metachronous polyps.

Adenomatous Polyps↗
PubMed2003

[Endoscopic Therapy of Early Colorectal Cancer (pT1) - A Prospective Study].

INTRODUCTION: In a prospective study initiated in 1982, we have been investigating the question as to whether - and if so, which - pT1 carcinomas of the colorectum can be treated exclusively via the endoscope. METHOD: In the period between February 1, 1982 and April 30, 2001, a total of 5,470 polyps were removed endoscopically at the Medical Department I of the Klinikum Ludwigsburg. Among these lesions, a total of 144 (2.6 %) pT1 carcinomas were found in 141 patients. We were able to follow 120 patients with 123 pT1 carcinomas over a mean follow-up period of 46 months (range: 1-60). In low-risk situations (definitive removal in healthy tissue, G1-G2, no lymphatic involvement), endoscopic treatment alone usually represented sufficient treatment. In high-risk cases (removal in healthy tissue uncertain or negative, and/or lymphatic vessel involvement, and/or G3/G4), subsequent surgical resection was carried out. RESULTS: 64 cases were classified as high-risk, 59 as low-risk. Nevertheless, 9 patients with 10 low-risk carcinomas were submitted to surgery (young age, patient's own request). In none of these 10 cases was residual tumour or lymph node metastasis detected in the surgical specimen. 47 patients with 49 low-risk carcinomas were treated solely by endoscopic polypectomy using the diathermy snare, and 45 patients with 47 carcinomas remained recurrence-free during the follow-up period. In a single case, a local recurrence was detected 2 months after polypectomy and underwent curative resection. In another case, peritoneal carcinosis with tumour infiltrating into the colon developed 8 months after initial treatment; this, however, was most probably a recurrence of a previously operated carcinoma of the uterus. Among the high-risk cases, 10 were not submitted to surgery on account of advanced age and/or rejection of an operation by the patient; all remained recurrence-free. Among the surgically treated high-risk carcinomas, 3 surgical specimens contained residual tumour, while 2 revealed a lymph node metastasis. In our group of patients, no tumour-related mortality was seen among endoscopically treated patients. DISCUSSION: In the light of the fact that the reported mortality rate associated with open surgery for colorectal carcinoma is 3 % as compared with about 1 % risk of lymph node metastasis and 0,1 % mortality rate for the endoscopic modality, endoscopic removal of a pT1 tumour in a low-risk situation followed by appropriate surveillance can be considered as adequate treatment.

Adenoma↗
PubMed2004

[Endoscopic removal of large colorectal polyps].

BACKGROUND: Due to the potential risk of malignancy and technical difficulties in achieving complete removal, large colorectal polyps represent a special problem for the endoscopist. The aim of this study was to evaluate the capabilities and risks of endoscopy in complete removal of large colorectal polyps. METHODS: Endoscopic polypectomy of 189 colorectal polyps (141 sessile, 48 pedunculated) larger than 3 cm in diameter (range 3-13 cm) was carried out. Sessile polyps were removed using the piecemeal technique. RESULTS: Histology showed an adenoma in 173 cases, and invasive carcinoma was present in the adenoma in 16 patients. Complete endoscopic removal was achieved in one session in 129 sessile polyps and all pedunculated polyps; the other patients required two to ten sessions. Bleeding occurred in 20 patients during polypectomy, and after polypectomy in four. Except for two cases, definitive hemostasis was immediately achieved by endoscopic treatment. Perforation occurred in four patients. 3 were treated conservatively, in one patient who showed an invasive carcinoma of the cecum, resection was performed. There was no mortality due to polypectomy. During a median follow-up period of 77 months (6-107 months), six patients presented with recurrence of a benign adenoma, which was treated endoscopically, and one patient presented with a recurrent invasive carcinoma, which was treated surgically. CONCLUSIONS: Endoscopic polypectomy is a safe and effective method of treating large colorectal polyps, associated with a low complication rate, reduced hospital stay and lower costs in comparison to surgical procedure.

Adult↗
PubMed2002

Diagnostic accuracy of forceps biopsy versus polypectomy for gastric polyps: a prospective multicentre study.

AIMS: To determine whether an adequate histological diagnosis of gastric polyps can be attained on the basis of forceps biopsy. PATIENTS AND METHODS: In a prospective multicentre study, 194 patients with 222 endoscopically removable gastric polyps (>or=5 mm) underwent forceps biopsy and complete polypectomy. Patients with fundic gland polyps and polyposis syndrome were not included. Specimens were evaluated by primary and reference pathologists, and the complication rate of gastric polypectomy was also determined. RESULTS: Of the 222 polyps, histological examination of the polypectomy specimens revealed tumour-like lesions in 77% (10% focal foveolar hyperplasia, 59% hyperplastic polyps, 4% inflammatory fibroid polyps, 4% other polyps) and neoplasia in 19% (10% tubular adenoma, 2% tubulovillous adenoma, 1% high grade intraepithelial neoplasia, 6% adenocarcinoma). When biopsy results were compared, complete agreement was found in 124 cases (55.8%) and, in an additional 77 cases (34.7%), the clinically important differentiation between tumour-like lesions and neoplasia was possible. However, relevant differences were found by the reference pathologist in six cases (2.7%), the most common reason being failure of biopsy to reveal foci of carcinoma in hyperplastic polyps. Bleeding was observed after polypectomy in 16 patients (7.2%), in 15 of whom it was managed conservatively. CONCLUSIONS: We recommend complete removal by an experienced endoscopist of all epithelial gastric polyps larger than 5 mm after thorough individualised risk-benefit analysis.

Adult↗