Colorectal schistosomiasis

The role of colonoscopic polypectomy for schistosomal polyps was studied. The results showed that, in spite of the large number of polyps, a total of 404 polyps were removed from 20 patients. The procedure is feasible with minimal complications. A marked reduction of rectal bleeding occurred in half the patients, and the remaining half had minimal symptoms. Colonoscopic polypectomy gives equal results to colonic excision for schistosomal polyps.     

Avoiding Surgery in Patients With Colorectal Polyps

PURPOSE: Colonic polyps are sometimes difficult to remove endoscopically and are referred for surgical resection. This study was performed to determine how many polyps referred for surgery could actually be managed endoscopically. METHODS: An endoscopic database with data entered prospectively and consecutively was used to identify patients referred for surgery for a colonic polyp. Rectal polyps were excluded. All patients underwent colonoscopy before surgery to see if the polyp could be managed endoscopically. Cases were reviewed to see the method and outcome of treatment. RESULTS: The study population consists of 58 patients referred for surgical resection of a colorectal polyp. Endoscopic polypectomy was initially successful in 48. Five of the 48 needed surgery later for a final success rate of 43/58 avoiding surgery. There were no deaths, four complications of endoscopic polypectomy (three bleeds, one post-polypectomy syndrome) and two patients had complications of surgery (one splenic injury, one ventral hernia). Polyps ranged in size from 1.5 cm to 8.0 cm. Seven polyps contained invasive cancer (three needing surgical resection), eight contained intramucosal cancer (one operated) and 11 had severe dysplasia (three operated). Rate of persistent polyp was 16/37 at first follow up, 7/23 at second, 1/14 at third and 0/8 at fourth. CONCLUSION: Most polyps referred for surgical resection were successfully managed endoscopically. Patients with colonic polyps that are difficult or potentially dangerous to remove endoscopically should be sent for a second opinion before surgery is performed.     

Follow-up Study of Early Colorectal Cancer After Endoscopic Resection

Abstract: This study was conducted to determine the significance of long-term follow-up observation of early colorectal cancer following endoscopic resection. The subjects included 100 patients who had undergone early colorectal cancer resection by endoscopic polypectomy with prior injection of the base (73 patients with mucosal carcinoma (m cancer), 24 Patients with submucosal carcinoma (sm cancer), and 3 patients with multiple early colorectal cancers. Posttherapeutic observation was carried out by endoscopy. The results were, briefly, as follows: 1) No cases of local recurrence or metastasis were observed during the follow-up observation period for up to a period of 14 years. 2) 3 cases (3%) of metachronous carcinoma were detected, 2 of these patients had early carcinoma and 1 had advanced carcinoma. The mean period which elapsed before the detection of metachronous cancers was 35.0 ± 15.3 months. 3) The incidence of adenoma during the follow-up period was 40%, the frequency of newly detected adenoma was relatively high among the patients with coexisting adenoma at the time of treatment for early carcinoma and among the elderly patients aged 60 years or over, 4) No cancer was detected after establishing a clean colon, and the incidence of adenoma in such cases was relatively low, i. e., 14.5%. The mean period of time which elapsed until the detection of the adenoma was 24.4 ± 18.0 months. The results of this study indicated that endoscopic examination is necessary and useful for surveillance of local recurrence or metachronous carcinoma as well as the detection of adenoma.     

Malignancy Risk of Small Polyps and Related Factors

The aim of this study was to determine the risk of polyps <6 and between 6 and 10 mm in terms of progression to malignancy and to evaluate the influence of age, gender, and colonic localization on malignancy development. Thirteen hundred sixty-nine polyps <10 mm identified in 680 patients were retrospectively evaluated. Sixty-seven and two-tenths percent of polyps <10 mm were of a neoplastic nature. The incidence of neoplasia was higher in left-sided and small polyps than diminutive polyps. In patients older than 60 years, small polyps showed a higher rate of high-risk histology than diminutive polyps,while the same relationship did not exist in other age groups. In male patients over 60 years of age, the rate of high-risk histology was higher in small polyps than in diminutive polyps.     

Macroscopic versus Microscopic Appearance of Colorectal Polyps

Small light-red sessile colorectal polyps, 1-5 mm in diameter, are generally believed to be hyperplastic (non-neoplastic), whereas polyps that are dark-red in contrast to the surrounding mucosa are thought to be adenomas. This hypothesis was tested prospectively in a series of 209 polyps removed by one endoscopist in a 6-month period. A ‘blinded’ pathologist provided the histopathological diagnosis. Twenty-two per cent of polyps described as hyperplastic by the endoscopist were adenomas, whereas 40% of those believed to be adenomas, 1-5 mm in diameter, were hyperplastic. The diagnostic effectivity of the endoscopist increased with increasing size of the polyps. In conclusion, all colorectal polyps must be removed to prevent possible precancerous lesions from being left behind and to define a group of patients with increased risk of new adenomas, in whom follow-up examinations should be considered.     

Advances in the removal of diminutive colorectal polyps

Diminutive polyps (<5 mm in diameter) represent the majority of polyps found during colonoscopy; about a half of them are adenomatous, with low risk of advanced neoplasia. Recent studies have demonstrated that cold polypectomy should be considered the recommended approach for resecting diminutive polyps and that cold snaring may be superior to cold forceps biopsy, at least for polyps of 4–5 mm. Recently, electronic chromoendoscopy has been applied to characterization of diminutive polyps to discriminate adenomatous from nonadenomatous lesions. Optical diagnosis of polyp histology could potentially exert huge cost savings by the ‘resect and discard’ strategy for diminutive polyps and ‘leaving-in’ for diminutive hyperplastic polyps in the recto-sigmoid colon. These policies represent the mainstay for adopting endoscopy-directed post-polypectomy surveillance strategies, endorsed by both American and European Endoscopy Societies. Accuracy of both histology and surveillance intervals predictions from academic centers have been encouraging, although the same performance has not been replicated in community practices.     

Prospective Study Comparing Multislice CT Colonography With Colonoscopy in the Detection of Colorectal Cancer and Polyps

PURPOSE: Multislice CT colonography is an alternative to colonoscopy. The purpose of this study was to compare multislice CT colonography with colonoscopy in the detection of colorectal polyps and cancers. METHODS: Between June 2000 and December 2001, 45 males and 35 females (median age, 68 (29–83) years) with symptoms of colorectal disease were studied prospectively. All patients underwent multislice CT colonography and colonoscopy, and the findings were compared. RESULTS: Colonoscopy was incomplete in 18 (22 percent) patients because of obstructing lesions or technical difficulty, and multislice CT colonography was unsuccessful in 4 (5 percent) because of fecal residue. Colonoscopy was normal in 26 patients and detected 29 colorectal cancers and 33 polyps in 35 patients, diverticulosis in 16 patients, and colitis in 3 patients. Multislice CT colonography identified 28 of 29 colorectal cancers with one false negative and one false positive (sensitivity, 97 percent; specificity, 98 percent; positive predictive value, 96 percent; negative predictive value, 98 percent). Multislice CT colonography identified all 12 polyps measuring 10 mm in diameter (sensitivity, 100 percent), 5 of 6 measuring 6 to 9 mm in diameter (sensitivity, 83 percent), 8 of 15 polyps 5 mm (sensitivity, 53 percent), and false-positive for 8 polyps. The overall sensitivity was 74 percent and specificity 96 percent. The positive predictive value for polyps was 88 percent, and the negative predictive value was 90 percent. Multislice CT colonography also detected 5 of 16 patients with diverticulosis (sensitivity, 31 percent; specificity, 98 percent) and colitis in 2 of 3 patients (sensitivity, 67 percent; specificity, 100 percent). In ten (13 percent) patients, extracolonic findings on multislice CT colonography altered management and included five patients with colorectal liver metastases. In 15 (19 percent) patients, there were incidental findings that did not demand further investigation. CONCLUSIONS: The results from this study indicate that the efficacy of multislice CT colonography in the detection of colorectal cancers and polyps 6 mm is similar to colonoscopy. Multislice CT colonography allows clinical staging of colorectal cancers, outlines the whole length of the colon in obstructing carcinoma when colonoscopy fails, and can identify extracolonic causes of abdominal symptoms.     

Endoscopic Treatment of Colorectal Polyps and Early Cancer

To analyze the efficacy and outcome of colonoscopic resection for colorectal neoplastic lesions, we retrospectively reviewed 338 colorectal lesions from 232 patients regarding the clinical profiles, colonoscopic findings, histological findings, complications, and outcome. Morphologically, these lesions were classified into three categories: pedunculated (n = 140), sessile (n = 176); and flat (n = 22). Histological findings of lesions included adenoma (n = 248), carcinoma in situ (n = 17), submucosal carcinoma (n = 2), hyperplastic polyp (n = 57), and inflammatory polyp (n = 14). Neoplastic lesions are generally larger than nonneoplastic lesions (² test, P < 0.05). The incidence of carcinoma was 5.6% of 338 resected lesions. The rate of cancer or high-grade dysplasia in flat polyps was greater than in pedunculated and sessile polyps (13.6 vs 4.54 vs 5.71%; P < 0.05). There were no perforations or deaths after colonoscopic treatment, and only mild bleeding occured in two patients. To date, 19 patients with early colorectal cancer were treated successfully by endoscopy with no recurrence or metastasis. To reduce the incidence and mortality of colorectal cancer, colonoscopic resection is a simple and safe procedure for removing neoplastic lesions. Detailed histological examinations are essential to decide the indications of surgery.     

Growth of Colorectal Polyps: Recovery and Evaluation of Unresected Polyps of Less Than 10 mm, 1 Year after Detection

Hofstad B, Vatn M, Larsen S, Osnes M. Growth of colorectal polyps: recovery and evaluation of unresected polyps of less than 10 mm, 1 year after detection. Scand J Gastroenterol 1994;29:640-645

Background and Methods: Colonoscopic 1-year control of polyps of less than 10 mm left in situ was carried out in 103 (89%) of 116 originally examined patients.

Results: Analysis showed an 85% recovery: 91% and 81% for polyps of 5-9 mm and <5 mm, respectively. The recovery was significantly related to size and localization, whereas the growth rate was inversely correlated to the originally measured diameter. A linear relationship was demonstrated between anus-to-polyp distances 1 year apart, with a normalized agreement index of 0.70. In only 1 of 189 polyps, an increase of diameter to > 10 mm was demonstrated. The 79 new polyps in 52 (50%) of the patients were significantly smaller, more often right-sided, and related to multiplicity of polyps at the initial examination but not to growth of recovered polyps or cleansing status.

Conclusion: An acceptable recovery and growth rate of polyps <10mm seems to justify the continuation of the study for the remaining 2 years.     

冷圈套切除术治疗老年结直肠息肉的临床效果研究

目的 探究冷圈套切除术治疗老年结直肠息肉的临床效果,为治疗老年结直肠息肉提供方法.方法 回顾性分析2017年1月～2019年12月期间安徽医科大学第三附属医院消化内科住院治疗的211例老年结直肠息肉患者的临床资料,依据不同治疗方法分为观察组(n=110)和对照组(n=101).观察组息肉回收样本238粒,对照组息肉回收...     

Adenomatous Colorectal Polyps in Patients Referred for Colonoscopy in a Regional Hospital in Kuwait

Background/Aim:

Adenomatous colorectal polyps (ACPs) are known to be the precursor lesions for colorectal cancer. The aim of the study was to determine the prevalence, endoscopic and pathological features of ACPs in patients referred for colonoscopy.

Patients and Methods:

The endoscopic and histological reports of adult patients who underwent complete colonoscopy in the gastroenterology unit of a regional Kuwaiti hospital between January 2008 and December 2008 were retrospectively studied. The specimens of polyps were reviewed by an experienced pathologist who was blinded to the clinical or endoscopic information. Non-neoplastic polyps were not included in the analysis.

Results:

Of 530 eligible patients (mean age, 45 years; male-female ratio, 2:1), 54 (10%) had 103 ACPs. Of the patients with ACPs (mean age, 57 years), 43 (80%) were males and 36 (67%) were Kuwaitis. Histopathological examination of the most significant polyp in each patient revealed that 40 (74%) polyps were tubular adenomas (TAs); 11 (20%), tubulovillous (TV) adenomas; and 3 (6%), villous adenomas. High-grade dysplasia was noticed in 4 (10%) adenomas. Fifteen (2.8%) of the 530 patients had advanced ACPs. Logistic regression analysis of some variables and their association with ACPs found that age (P<0.001; OR, 1.9; CI, 1.5-2.3), history of adenoma (P=0.001; OR, 6.4; CI, .2.1-19.4) and being Kuwaitis (P=0.029; OR, 2.1; CI, 1.1-4.1) to be independently associated with ACPs.

Conclusion:

The most common histological type of ACPs was tubular adenoma. Advancing age, being Kuwaiti nationals and prior removal of ACPs were significantly associated with the occurrence of ACPs.     

Cellular and Structural Atypia of the Early Colorectal Cancers

Cellular and structural gland atypia in lesions of early colorectal cancer removed by endoscopic polypectomy in 101 patients were histopathologically studied. The following results were observed. Cellular atypia was frequently found in lesions with a high rate of nuclear polarity loss and multiple nuclear mitoses (99. 0%). The most frequent findings in the glands with structural atypia was intraglandular glands and crowding of neoplastic glands (85. 1%). Most of the appearances of the cellular and structural atypias showed no marked relationship with the sizes of the lesions, depth of invasion and association of adenoma components. Early cancer had both cellular and structural atypia in 95% of the patients and could be diagnosed by conventional histopathological criteria. However five patients with early cancer showed no structural atypia and were diagnosed as having cellular atypia. These cancers were early intramucosal cancer and four lesions were associated with adenoma components 20 mm or less in size. The loss of nuclear polarity and nuclear pleomorphism may be considered more important than nuclear stratification and mitoses in the diagnosis of early cancer.     

黏膜刀辅助切除术治疗结直肠带蒂息肉的初步研究（含视频）

目的探讨黏膜刀辅助息肉切除术（knife assisted polypectomy,KAP）治疗结直肠带蒂息肉（巴黎分型0-Ⅰp型）的安全性和有效性。方法回顾性分析2019年5月—2019年9月在复旦大学附属中山医院和徐汇区中心医院内镜中心行KAP治疗的42例结直肠带蒂息肉患者的临床资料,统计手术切除操作时间和术后并发症发生情况等,初步分析KAP的治疗效果。结果对42例患者共48枚息肉完成切除,息肉中位直径2.0 cm（0.8~3.5 cm）,操作时间（11.3±1.1）min。所有患者术中无严重出血和穿孔发生,术后无迟发性出血、迟发性穿孔及电凝综合征发生。术后病理显示手术完整切除率为100%。结论KAP治疗结直肠带蒂息肉操作安全高效。     

Endoscopic excision of a prolapsing malignant polyp which caused intermittent gastric outlet obstruction

A 69-year-old male with chronic lymphocytic leukemia presented with iron deficiency anemia and post-prandial abdominal fullness. Endoscopy showed a large polyp on a stalk, protruding through the pylorus into the duodenum causing intermittent gastric outlet obstruction. While prolapsing gastric antral polyps are usually benign and hyperplastic, inflammatory or regenerative in type, excisional snare polypectomy here led to complete resolution of his symptoms, but showed a malignant polyp.     

Small bowel perforation caused by thermal injury during colonic polypectomy: A case report and literature review

Rationale:Iatrogenic gastrointestinal perforation is a known uncommon complication of colonoscopy. The perforation usually occurs in the colon itself. Rarely, colonoscopic procedures can also cause the perforations of the small intestine.Patient concerns and diagnoses:We describe the case of a 70-year-old man who experienced abdominal pain several hours after electrical polypectomy in the transverse colon. Urgent abdominal computed tomography scans showed a few bubbles on the frontal surface around the liver and a little extraluminal free air in the upper abdomen. Urgent exploratory laparotomy revealed a round perforation with a diameter of approximately 5 mm in the ileum 80 cm proximal to the ileocecal valve, accompanied by the outflow of intestinal contents. A small bowel perforation by thermal injury was diagnosed during colonic polypectomy.Interventions and outcomes:The ileal perforation was repaired primarily after debridement of the perforation site and abdominal cavity. The patient recovered well after surgery. Histopathological examination of the perforation site demonstrated inflammatory necrosis and infiltration of inflammatory cells.Lessons:Small bowel perforation should be considered after colonoscopic procedures although the incidence is exceedingly rare. Urgent exploratory laparotomy is warranted when a visceral perforation is identified after colonoscopy.     

Almost One-Third of Large Sessile Serrated Polyps Are Missed on CT Colonography

Background: Nearly one-third of colorectal cancers (CRC) arise via the serrated pathway. CT colonography (CTC) is a CRC screening examination. Endoscopic detection of sessile serrated polyps (SSPs) varies widely; it is unknown whether CTC effectively detects SSPs. The aim of this study is to determine whether CTC detects SSPs at an institution that performs a large volume of CTC.Methods: We conducted a search of pathology records to identify serrated polyps (SPs) from 2005 to 2012. We extracted demographic data from the electronic health records (EHRs) of subjects with an SSP and examined endoscopy reports for location and size of each SSP. We identified subjects with a CTC within 1 year prior to the colonoscopy that found an SSP, and determined if the CTC identified the SSP.Results: Our search found 3978 subjects with SP over the 7-year period. Seven hundred thirty-two subjects had at least 1 SSP. Eighty-two subjects had CTC done within 1 year prior to the colonoscopy that identified SSP. Seventy-nine subjects’ polyps were identified on CTC. CT colonography was done an average of 38 ± 54 days prior to colonoscopy. One hundred fifteen SSPs were identified endoscopically. A total of 48.7% of all SSPs were identified via CTC; larger SSPs were more likely to be seen on CTC (P < .001), and 69.6% of SSPs larger than 10 mm were found via CTC. Proximal SSPs were more often identified than distal SSPs (P = .005). Conclusion: Given the miss rate for SSPs on CTC, endoscopists should be vigilant about examining the proximal colon in subjects referred after CTC, even if the imaging does not reveal a proximal polyp.     

胆囊切除与结直肠息肉相关性的研究

背景：胆囊切除已被认为是结直肠癌的危险因素之一,但胆囊切除与结直肠息肉的关系一直未受到重视。目的：探讨胆囊切除与结直肠息肉的相关性。方法：连续收集经结肠镜排除恶性肿瘤、炎症性肠病、家族性腺瘤性息肉病等疾病的患者425例,根据既往有无胆囊切除史分为胆囊切除组（n=63）和对照组（n=362）,对两组患者结直肠息肉的发生率、内镜下息肉表现和组织学类型进行分析。结果：胆囊切除组结直肠息肉发生率高于对照组（46.0%对37.8%）,但差异无统计学意义（P=0.219）。两组患者息肉的部位和形态均无明显差异（P=0.753,P=0.127）;但胆囊切除患者腺瘤性息肉的发生危险显著高于对照组（OR=1.79,P=0.006）。亚组分析示胆囊切除史≥10年的结直肠息肉发生率与胆囊切除史〈10年无明显差异（P=0.11）。结论：胆囊切除并未增加结直肠息肉发生的危险性,但腺瘤性息肉的发生率显著增高,因此对胆囊切除患者应重视早期结直肠癌和腺瘤性息肉的筛查。