Fecal occult blood and flexible sigmoidoscopy screening for colorectal cancer: modeling the impact on colonoscopy requirements and cancer detection rates

AiM: The aim of this study was to estimate the colonoscopy requirements and the likely impact of fecal occult blood and flexible sigmoidoscopy screening on the detection of colorectal cancer by using previously published data. METHODS: Fecal occult blood and flexible sigmoidoscopy screening programs were applied to the 2.04 million subjects aged 50-65 years, at a participation rate of 40%. The following strategies were evaluated: Fecal occult blood testing with colonoscopy follow up of all positive tests; flexible sigmoidoscopy with colonoscopy follow up of all adenomatous polyps; and flexible sigmoidoscopy with colonoscopy follow up of all adenomatous polyps > 10 mm in size. RESULTS: The fecal occult blood program detected 5.6% of all colorectal cancer cases at a rate of 2,914 colonoscopies/percentage of detection of colorectal cancer. The flexible sigmoidoscopy program detected 14% of all colorectal cancer cases at a rate of 8,160 colonoscopies/percentage of detection of colorectal cancer. The flexible sigmoidoscopy program with follow up of adenomatous polyps > 10 mm in size detected 13% of all colorectal cancer cases at a rate of 1,230 colonoscopies/percentage of detection of colorectal cancer. CONCLUSIONS: Flexible sigmoidoscopy screening followed by colonoscopic follow up of adenomatous polyps > 10 mm in size is the most efficient screening strategy in terms of colonoscopies generated and cases of colorectal cancer detected.     

黏膜切除术治疗结直肠广基隆起性腺瘤性息肉98例临床研究

目的探讨内镜下黏膜切除术(endoscopic mucosal resection,EMR)治疗结直肠广基隆起性腺瘤性息肉患者的疗效。方法回顾性分析98例结直肠广基隆起性腺瘤性息肉(息肉直径0.6~2.0 cm)患者的临床资料并行EMR治疗。结果 98例均经电子结肠镜检查及术前病理诊断为腺瘤性息肉,均为广基隆起性病变,共120枚,行EMR,留取完整标本病理检查,创面均给予钛夹封闭。术后病理诊断为腺瘤性息肉113例,高级别瘤变4例,局部癌变3例,7例切缘均无癌细胞,未追加外科手术。1个月后复查见病变部位黏膜光滑,未见息肉及病变黏膜残留。高级别瘤变及局部癌变7例随访3年,未见肿瘤复发及它处转移。结论对于广基隆起性腺瘤性息肉行EMR较既往单纯的高频电灼或氩离子凝固术有助于发现早期癌,改善患者的预后。     

Cancer and adenomatous polyp distribution in the colorectum

Objective: To examine the possible role of adenomatous polyps in colorectal cancer development, this study focused on the relationship of the distribution between adenomatous polyps and cancer in the colorectum. Methods: The distribution of 753 adenomatous polyps was compared with that of 35 colorectal cancer lesions in 510 male patients ranging from 45 to 55 yr of age who underwent a total colonoscopy. Results: The incidence of cancer significantly increased with a distal shift in the colorectal sites in comparison with that of adenomatous polyps (   p < 0.02  ). Conclusion: The different distribution between adenomatous polyps and cancer thus suggested that adenomatous polyps at various colorectal sites appear to have a different malignant potential for cancer development.     

High frequency of colorectal adenoma in patients with duodenal adenoma but without familial adenomatous polyposis

BACKGROUND: Duodenal adenomas are extremely common in patients with familial adenomatous polyposis. However, it is uncertain whether patients with duodenal adenomas without familial adenomatous polyposis are at greater risk for colorectal neoplasia and, therefore, should routinely undergo surveillance colonoscopy. The aim of this study was to determine whether there is a correlation between non-papillary duodenal adenoma without familial adenomatous polyposis and colorectal adenoma. METHODS: Twenty-five patients with non-papillary duodenal adenomas without familial adenomatous polyposis, seen from January 1990 to April 2003, were retrospectively evaluated. RESULTS: Non-papillary duodenal polyps were diagnosed by endoscopy in the 25 patients. Of these, 21 underwent colonoscopy and one underwent proctoscopy. The mean age of these 22 patients (12 women, 10 men) was 69 years (range 50-83 years). Sixteen of the 22 patients (72.7%) with duodenal adenomas had associated colorectal adenomas. A total of 38 adenomas and one colorectal cancer were detected. The mean size of the polyps was 6.2 mm (range 3-15 mm). The adenomas were removed by snare excision or with a biopsy forceps. CONCLUSIONS: Based on the results of this uncontrolled, retrospective study, the frequency of colorectal adenomas in patients with duodenal polyps without familial adenomatous polyposis appears to be increased compared with the general population. All patients with duodenal polyps should undergo surveillance colonoscopy for colorectal adenomas. A prospective study to definitively establish the frequency of colorectal adenomas in these patients is warranted.     

下呼吸道痰痂分类及其清除术

探讨下呼吸道痰痂形态、治疗。通过支气管镜观察，探求４例开胸术后急性呼吸衰竭的病人在气管切开后，痰痂依形态可分为：扁平型和隆起型。依其与气道壁附着的牢固程度可分为：牢固型和非牢固型。纤维支气管镜直视下清除痰痂有三种方法：吸除，活检钳清除，弯止血钳取除。三种方法中以弯止血钳取除的效率最高，耗时最少。     

The relationship between cyclooxygenase-2 expression and characteristics of malignant transformation in human colorectal adenomas

BACKGROUND AND AIMS: Cyclooxygenase 2 (COX-2) is a target of aspirin and other non-steroidal anti-inflammatory drugs and is implicated in the pathogenesis of colorectal cancer. The objective of this study was to evaluate the extent of COX-2 in pre-malignant colorectal polyps and to assess the relationship between COX-2 and the level of dysplasia in these lesions. METHODS: Whole polypectomy specimens were retrieved from 123 patients by endoscopic or surgical resection. Following formalin fixation and paraffin embedding, the polyps were evaluated histologically for size, type and grade of dysplasia. The extent of COX-2 expression was measured by the avidin-biotin immunohistochemical technique using a monoclonal COX-2 antibody. The extent of COX-2 expression was graded according to percentage epithelial COX-2 expression. RESULTS: The polyps were of the following histological types: 10 hyperplastic, 35 tubular adenomas, 61 tubulovillous adenomas and 17 villous adenomas. Twenty showed mild dysplasia, 65 moderate dysplasia, and 28 focal or severe dysplasia (including eight with focal invasion). The average polyp size was 1.7 cm. Nine hyperplastic polyps were COX-2-negative and one was COX-2-positive. COX-2 expression was more extensive in larger polyps and in polyps with a higher villous component. There was a significant increase in the extent of COX-2 protein with increasing severity of dysplasia. Within a polyp, there was a focal corresponding increase in COX-2 expression within epithelium showing a higher grade of dysplasia. CONCLUSIONS: COX-2 expression is related directly to colorectal adenomatous polyp size, type and grade of dysplasia. This suggests that the role of COX-2 in colorectal cancer may be at an early stage in the adenoma-to-carcinoma sequence and supports the suggestion that inhibition of COX-2 may be useful chemoprevention for this disease.     

Colorectal polyps and cancers diagnosed by pathologists in Ile de France Region. Crisapif-Petri Study

OBJECTIVES: The aim of this study was to evaluate the histological characteristics of adenomatous polyps (AP), non adenomatous polyps (NAP), and colorectal cancers (CRC) diagnosed in the greater Paris area. MATERIAL AND METHODS: Pathologists filled out an identification and histological questionnaire for each biopsy or surgical specimen received between 20/09/02 and 20/12/02, which had at least one colorectal polyp or CRC, taken from a patient of the greater Paris area. RESULTS: The participation rate of pathologists was 73.3% and 10,396 patients with 16,681 lesions were included. Lesions consisted in 1,223 CRC among 1,107 patients, 9,280 AP and 6,178 NAP. Mean age of patients with CRC was 68 years, with at least one AP without CRC 62 years, and with at least one NAP without CRC or AP 58 years. The mean number of polyps per patient was 1.4, and increased with age. Average size of AP was larger than that of NAP and the size increased with age for AP but not NAP. pTNM staging of CRC was: pT0, 1% pT1, 4% pT2, 13% pT3, 63% pT4, 19% N0, 55% N1, 24% N2, 19% Nx, 2%. CONCLUSION: This study provides detailed data on colorectal polyps and colorectal cancers in the greater Paris region, which does not have a cancer registry. Repeated surveys could be helpful for evaluating the efficacy of screening programs in the general population.     

Frequency of colonic adenomatous polyps in a tertiary hospital in Mumbai

Introduction

Incidence of colorectal carcinoma is increasing all over world. There is limited data on colorectal polyps from India. We evaluated the histomorphological features of colorectal polyps and determined risk stratification in adenomatous polyps.

Methods

In 4970 consecutive colonoscopies, colorectal polyps were detected in 515 cases (10.3 %). Polyps were classified using standard histological criteria. Each polyp was evaluated for presence of dysplasia. Adenomatous polyps were classified as low-risk adenomas (1–2 tubular adenomas <10 mm) and high-risk adenomas characterized by villous histology, high-grade dysplasia, size ≥10 mm, or ≥3 adenomas.

Results

Of 515 colorectal polyps, 270 (52.4 %) were adenomatous, followed by 78 (15.1 %) inflammatory, 78 (15.1 %) hyperplastic, 32 (6.2 %) hamartomatous polyps, 25 (4.8 %) benign epithelial polyps, 5 (0.9 %) cap polyps, 5 (0.9 %) lipomatous polyps, 3 (0.5 %) angiomatous polyps, 4 (0.7 %) lymphoid, and 15 (2.9 %) cases with adenocarcinoma masquerading as polyps. Mean (SD) age with colorectal polyps was 54.8?(33.0)?years while for adenomatous polyps, 59.5?(14.8)?years with male to female ratio of 2:1. Majority of adenomatous polyps 124 (45.9 %) were tubular adenomas present in rectosigmoid. High-grade dysplasia was found in 38 (14 %) adenomas. One hundred and fifty-five (57.4 %) were high risk of which majority were villous adenomas and nine (7.2 %) tubular adenomas.

Conclusion

The most common colorectal polyps found during routine colonoscopy were 270 adenomatous (52.4 %) cases. Of these, 155 (57.4 %) adenomatous polyps were high-risk category. Population prevalence data of colonic polyps in general population beyond the age of 50 years needs to be obtained.

     

First-degree relatives of patients with advanced colorectal adenomas have an increased prevalence of colorectal cancer.

BACKGROUND & AIMS: The risk of colorectal cancer in relatives of patients with adenomatous colonic polyps is not well defined. This study assessed whether finding colonic neoplasia during screening colonoscopy was related to the family history of colorectal cancer among the participants' parents and siblings. METHODS: Self-reported family history of colorectal cancer was recorded for all participants in a screening colonoscopy study. The size and location of all polyps were recorded before their removal and histologic examination. Participants were grouped according to the most advanced lesion detected. RESULTS: Three thousand one hundred twenty-one patients underwent complete colonoscopic examination. Subjects with adenomas were more likely to have a family history of colorectal cancer than were subjects without polyps (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.09-1.70). The finding of a small (<1 cm) tubular adenoma as the most advanced lesion was associated with only a modest increase in the OR of colorectal cancer in family members (OR, 1.26; 95% CI, 0.99-1.61), but the presence of an advanced adenoma was associated with a higher OR (OR, 1.62;5% CI, 1.16-2.26). Younger age of adenoma diagnosis was not related to a higher prevalence of a family history of colorectal cancer. CONCLUSIONS: Relatives patients with advanced colorectal adenomas have an increased risk of colorectal cancer. Individuals with advanced colorectal adenomas should be counseled about the increased risk of colorectal cancer among their relatives.     

Genetic testing and phenotype in a large kindred with attenuated familial adenomatous polyposis

BACKGROUND & AIMS: An attenuated form of familial adenomatous polyposis has been described, but the phenotype remains poorly understood. METHODS: We performed genetic testing on 810 individuals from 2 attenuated familial adenomatous polyposis kindreds harboring an identical germline adenomatous polyposis coli gene mutation. Colonoscopy was performed on mutation-positive persons. RESULTS: The disease-causing mutation was present in 184 individuals. Adenomatous polyps were present in 111 of 120 gene carriers who had colonoscopy at an average age of 41 years. The median number of adenomas was 25 (range, 0-470), with striking variability of polyp numbers and a proximal colonic predominance of polyps. Colorectal cancer occurred in 27 mutation carriers (average age, 58 years; range, 29-81 years), with 75% in the proximal colon. The cumulative risk of colorectal cancer by age 80 was estimated to be 69%. An average of 3.4 recurrent polyps (range, 0-29) were found in the postcolectomy rectal remnant over a mean of 7.8 years (range, 1-34 years), with 1 rectal cancer. CONCLUSIONS: This investigation shows that attenuated familial adenomatous polyposis in the kindreds examined shows a much smaller median number of polyps than typical familial adenomatous polyposis, a wide variability in polyp number even at older ages, and a more proximal colonic location of polyps and cancer, yet it is associated with an extremely high risk of colon cancer. The phenotype of attenuated familial adenomatous polyposis mimics typical familial adenomatous polyposis in some cases but in others is difficult to distinguish from sporadic adenomas and colorectal cancer, thus making genetic testing particularly important.     

The appropriate use of colonoscopy in the curative management of colorectal cancer

A total of 175 patients who underwent a curative resection for a colonic (n = 130) or a rectal cancer (n = 45) between 1986 and 1992 were entered into a routine clonoscopy program. Colonoscopies were performed 1 year after the operation, and then at 2-year intervals. The findings at colonoscopy, as well as those of preoperative colonoscopy (when performed), were recorded. Eleven anastomotic recurrences were diagnosed at an asymptomatic stage, at a mean follow-up of 14 months. All of them were identified in patients with a stage B or C primary rectosigmoid cancer. Eight patients underwent another potentially curative re-operation. Only perioperative colonoscopy (preoperative colonoscopy; first postoperative colonoscopy in patients for whom the preoperative procedure was incomplete or not performed) allowed diagnosis of second cancers (n = 7) and adenomatous polyps greater than 10 mm (n = 17). Further colonoscopies detected only polyps less than 10 mm. Positive examination rates for successive follow-up colonoscopies were 15, 20 and 23%, respectively; they were significantly higher in patients who had previously had adenomatous polyps than in patients who had not: 30% versus 6% (P<0.025), 46% vs 5% (P<0.005) and 38% vs 11% (P<0.025), respectively. From these data, the following recommendations are made: (1) All colorectal cancer patients should have a total colonoscopy either before (whenever possible) or soon after operation; (2) Based on results of the perioperative colonoscopy, patients: should undergo their first follow-up colonoscopy only 3 yearly (presence of synchronous adenomatous polyps) or 5 yearly (absence of synchronous adenomatous polyps) after resection; (3) In patients with stage B or C primary rectosigmoid cancer, a surveillance of the suture line by rigid proctosigmoidoscopy should be added during the first 2 postoperative years: 6, 15 and 24 months after the operation.     

Effects of sulindac on sporadic colorectal adenomatous polyps.

BACKGROUND: Although sulindac is known to cause regression of colorectal adenomatous polyps in familial adenomatous polyposis, less is known about the effect of sulindac on sporadic adenomas. The precise mechanisms of these effects also remain to be determined. AIMS: Sulindac was given to patients with sporadic colorectal adenomatous polyps to evaluate its effects on them, and histological analysis was performed to elucidate the mechanism of the polyp regression, as well the kind of adenomatous polys that are susceptible to the agent. SUBJECTS: 20 adenomatous polyps in 15 patients were studied. METHODS: Sulindac (300 mg daily) was given for four months, followed by colonoscopy with removal of the residual polyps. Polyp size, degree of atypia, inflammatory cell infiltration in the polyps, and immunostaining for mutant p53 product were evaluated before and after treatment. RESULTS: 13 of the 20 polyps shrank or disappeared. Patient sex, polyp location, size, degree of atypia, or p53 mutation did not affect the response, but polyps in older patients were more sensitive to sulindac. The degree of atypia or inflammatory cell infiltration was not affected by the treatment. A polyp containing a focal cancer was unresponsive. CONCLUSIONS: Sulindac can cause regression of sporadic colorectal adenomatous polyps.     

上海松江区结直肠癌普查研究的初步结果

目的探讨粪便隐血试验结合大肠镜检查作为大肠癌普查方式的可行性。方法2006年9月至2007年5月,对上海市松江区无症状且结直肠癌普通危险度的≥50岁人群以及40～49岁志愿参加普查者行免疫组化法粪便隐血试验,连续3次排便中任意2次粪便标本送检,对任何1次粪便隐血阳性（包括弱阳性）的患者行全结肠镜检查。对息肉的数量、分布位置及病理结果进行统计。结果≥50岁受检者共2692例,粪便隐血试验阳性者184例,阳性率6．8％,共56例患者发现了64枚结肠息肉,包括腺瘤性息肉34枚、炎性息肉15枚、增生性息肉15枚,发现直肠癌1例。40～49岁志愿普查者共582例,隐血试验呈阳性者28例,阳性率4．8％,共6例患者发现了6枚息肉,包括腺瘤性息肉1枚、炎性息肉5枚,并发现肠癌2例。多数息肉分布于左半结肠。结论对无症状的结直肠癌普通危险度人群的普查能较早发现结肠息肉,对粪便隐血试验阳性的患者行全结肠镜检查可能较适合社区及广大农村地区结直肠癌的大规模普查。     

老年人大肠息肉与大肠癌

为了解老年人大肠息肉和大肠癌的临床特点，更好地预防老年人大肠肿瘤的发生和早期诊断大肠癌，对２４８例老年人大肠息肉和大肠癌的临床及病理作一回顾性分析。结果老年人大肠息肉和大肠癌的检出率分别为３３．３％和２３．３％，并有以下特点：（１）大肠息肉和大肠癌是老年人便血的主要原因，炎性息肉、腺瘤性息肉及大肠癌三者的便血率依次增高；（２）息肉检出率显著高于普通人群息肉检出率，且腺瘤性息肉占７３．８％；（３）多发性息肉比例较高，并以腺瘤性息肉为主，占８０．７％，且多发生于不同的肠段；（４）老年人大肠癌低恶性程度者多；（５）大肠腺瘤性息肉常与大肠癌并存，二者多发生于不同肠段。因此，我们认为便血是老年人大肠镜检查的有力指征；大肠镜检查时不应满足于远端大肠病变的诊断，应尽可能检查全大肠；对老年人大肠息肉，尤其是多发性息肉及直径大于１．０ｃｍ者应积极切除。     

Relationship of non‐alcoholic fatty liver disease to colorectal adenomatous polyps

Background and Aims: Metabolic syndrome and insulin resistance are associated with a higher risk of colon cancer. Non‐alcoholic fatty liver disease (NAFLD) is regarded as a manifestation of metabolic syndrome in the liver. This investigation was initiated to determine whether NAFLD has a relationship to colorectal adenomatous polyps. Methods: We examined the 2917 participants who underwent a routine colonoscopy at Kangbuk Samsung Hospital in 2007. We divided the 2917 subjects into the adenomatous polyp group (n = 556) and the normal group (n = 2361). Anthropometric measurements, biochemical tests for liver and metabolic function, and abdominal ultrasonographs were assessed. Results: The prevalence of NAFLD was 41.5% in the adenomatous polyp group and 30.2% in the control group. By multiple logistic regression analysis, NAFLD was found to be associated with an increased risk of colorectal adenomatous polyps (odds ratio, 1.28; 95% confidence interval, 1.03–1.60). An increased risk for NAFLD was more evident in patients with a greater number of adenomatous polyps. Conclusion: NAFLD was associated with colorectal adenomatous polyps. Further studies are needed to confirm whether NAFLD is a predictor for the development of colorectal adenomatous polyps and cancer.     

Colorectal cancer risk in first-degree relatives of patients with colorectal adenomatous polyp

BACKGROUND/AIMS: To evaluate any risk of colorectal cancer in first-degree relatives of patients with colorectal adenomatous polyp. METHODOLOGY: In a screening program-based cross-sectional study, 44821 subjects received an immunochemical fecal occult blood test using a 2-consecutive-day method. They were divided into two groups, according to the results of a self-completed questionnaire on family history of colorectal adenomatous polyps, and the positivity rate of an immunochemical fecal occult blood test as well as the positive predictive value for colorectal cancer were determined in these two groups. RESULTS: The fecal occult blood test was positive in 8.5% of subjects with family history and in 4.8% of subjects without family history, and the positive predictive value for colorectal cancer was 6.8% and 2.4% in subjects with and without family history of colorectal adenomatous polyps, respectively, indicating a significant difference in the positivity rate of the fecal occult blood test (P < 0.01) as well as the positive predictive value for colorectal cancer (P < 0.05) between these two groups. CONCLUSIONS: These results show that first-degree relatives of patients with colorectal adenomatous polyp have an increased risk for colorectal cancer, and that the subjects with family history of colorectal adenomatous polyps as well as cancers should be considered as a priority group for prevention of colorectal cancer.     

共聚焦激光显微内镜对结直肠腺瘤性息肉的诊断价值

目的 通过共聚焦激光显微内镜(CLE)分析结直肠息肉的镜下组织学特点,制定相应的诊断依据,探讨CLE诊断结直肠腺瘤性息肉和非腺瘤性息肉的价值.方法 2009年6月至12月间共计90例患者纳入本研究,其中包括已被病理证实为结直肠息肉的40例患者(48个结直肠息肉)和前瞻性研究的50例患者(106个结直肠息肉).同时选取10处正常黏膜作为对比.首先对48个经病理证实为结直肠息肉的病变(腺瘤性息肉22个,非腺瘤性息肉26个)进行CLE图像分析,制定CLE下鉴别腺瘤性息肉和非腺瘤性息肉的诊断依据.然后应用该依据对106个结直肠息肉进行前瞻性CLE诊断,最终将CLE诊断结果与病理诊断结果作比较,评价CLE的诊断效率.结果 在48个经病理证实为结直肠息肉中腺瘤性息肉22个,非腺瘤性息肉26个.CLE诊断腺瘤性息肉的敏感度94.0%、特异度92.9%、准确率93.4%、阳性预测值92.2%,阴性预测值94.5%;CLE诊断非腺瘤性息肉的敏感度92.9%、特异度94%、准确率93.4%、阳性预测值94.5%,阴性预测值92.2%.CLE与组织病理在诊断结直肠腺瘤性息肉时的一致性较好(Kappa=0.893).结论 CLE在结直肠腺瘤性息肉和非腺瘤性息肉的鉴别诊断中精度较高,与组织病理学诊断具有较好的一致性,为进一步及时发现结直肠癌前病变提供了经验基础.     

新疆沙湾地区大肠癌筛查研究的初步结果

目的探讨粪便隐血试验及结肠镜检查作为大肠癌筛查主要方式的临床价值。方法 2007～2009年对沙湾地区无症状及有下消化道症状自愿体检的患者,先行大便隐血试验阳性者进行结肠镜检查,对检查结果进行分析。结果≥40岁受检者共413例,粪便隐血试验阳性者69例,阳性率16.71%,共24例发现了58枚结肠息肉,包括腺瘤性息肉38枚,炎性息肉8枚,增生性息肉12枚;发现结肠癌13例,直肠癌5例,恶性淋巴瘤1例。〈40岁自愿体检者94例,粪便隐血试验阳性者6例,阳性率6.38%,3例患者发现了4枚结肠息肉,包括腺瘤性息肉1枚,炎性息肉2枚,增生性息肉1枚;发现直肠癌1例。结论对无症状自愿体检患者进行粪便及结肠镜检查能较早发现大肠息肉,对大便隐血试验阳性患者行全结肠镜检查更适合于对基层广大农牧民结直肠癌的筛查。     

Frequency of colorectal polyps in patients with sporadic adenomas or adenocarcinomas of the papilla of vater--an age-matched, controlled study

BACKGROUND: Epithelial tumors of the papilla of Vater are rare neoplasms of the gastrointestinal tract. The carcinogenesis of these tumors seems to be fairly analogous to the genetic mechanisms which have been described for colorectal carcinoma. Patients with familial adenomatous polyposis bear a particularly increased risk for periampullary tumors. Data on whether the prevalence of colorectal tumors is increased in patients with sporadic ampullary neoplasms are scarce. METHODS: 26 consecutive patients (16 women, 10 men; median age 59 years) with sporadic adenomas (n = 19) or adenocarcinomas (n = 7) of the ampulla of Vater were retrospectively evaluated. The study patients were compared with 104 age-matched asymptomatic controls. All patients had undergone total colonoscopy. RESULTS: Neoplastic colorectal polyps were present in a similar proportion (23%) of patients of the study group compared with 26% in the control group (p > 0.05). Overall, 16 polyps were found among patients with ampullary tumors and 40 in asymptomatic controls (p > 0.05). Colonoscopy detected rectal carcinoma in 2 patients (8%) of the study group. Patients with and without colorectal polyps differed neither significantly by age nor by ampullary histological findings. 50% of the colonic polyps in patients with ampullary neoplasms were located in the ascending colon. CONCLUSIONS: The frequency of colorectal polyps in patients with ampullary tumors did not exceed the risk in the control group. However, the finding of 2 rectal carcinomas among patients with ampullary neoplasms supports the place of screening colonoscopy for the diagnostic work-up of ampullary tumors. Prospective multicenter studies should address this issue to provide a broad basis for future recommendations.     

Polyps with an invasive degenerated focus

Advances in technology of flexible endoscopes have greatly changed the management of patients with adenomatous polyps of the colon and rectum. Some controversy still exists concerning the best treatment for invasive polyps. For some authors, invasive polyps need radical operation, while others think that unless cancer goes beyond the bounds of a removed polyp, endoscopic resection is an adequate procedure. We designed a study of 65 patients presenting an invasive carcinoma arising in adenomatous polyps and who underwent a colorectal resection thereafter, in order to determine which endoscopic and histological features correlated best with a curative treatment by polypectomy. When the group of "non-curative polypectomies", (carcinoma in the surgical specimen: 34 patients) was compared to the group of "curative polypectomies" (carcinoma in the surgical specimen: 31 patients), there was no significant difference in the number of pedunculated or sessile polyps but a polyp's size exceeding 30 mm was significantly more frequent in the group of "non-curative polypectomies" (P less than 0.005) as well as a tubulo-villous or villous histological type (P less than 0.001) and presence of vascular neoplastic invasion (P less than 0.01). In conclusion, a surgical resection after endoscopic polypectomy of a polyp containing an invasive carcinoma is necessary for a polyp's size exceeding 30 mm, for a villous or tubulo-villous type and in the presence of vascular neoplastic invasion in the pathological analysis of the removed polyp.