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The Turkish Journal of Gastroenterology
2001, Volume 12, No 1, Page(s) 49-52
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Colorectal polyps "The Yüksek Ihtisas experience"
Altıparmak Emin, Sezgin Orhan, Parlak Erkan, Altıntaş Engin
Yuksek Ihtisas Hospital, Department of Gastroenterology, Ankara
Keywords: Colorectal polyp, colorectal cancer, polypectomy.
Summary
Background/aims: Colonoscopy is considered to be the gold standard in the diagnosis and treatment of colon polyps. As the majority of colorectal cancers originate from adenomas, such lessions should be diagnosed and treated early. The aim of this study, carried out between July 1995 and 1998, was to investigate the anatomic location of polyps and their types, size and appearance in conjunction with synchronous carcinomas during colonoscopy performed in our clinic. Methods: In 2,568 colonoscopic examinations carried out in our clinic between July 1995 and 1998, 428 (230 males, mean age: 43.2 years, range: 12-84) cases with polyps were found. A standard colonoscopy diet (low fiber, liquid diet) was given to the patients for three days prior to the procedure and twelve hours before, 80 gr-100 gr. of huile de ricine was given orally. On the morning prior to colonoscopy, cleansing was performed by fleet enema. Results: Of the 657 endoscopic polypectomies performed, 76.7% were in the left colon (splenic flexure, distal colon) and 23.3% in the right colon (segment proximal to the splenic flexure). In 28 cases (6%), synchronous cancer was found. Histopathological examination was performed in 350 cases,of which 227 (64.8%) were adenomatous, 78 (22.7%) hyperplastic and 13 (3.7%) juvenile polyps and in 32 cases (9.1%), malignant degeneration was detected. Since 1997, only 22 of these patients have attended follow-up. Conclusion: Preliminary results from a 12 month follow up period of these 22 cases followed up six monthly by our therapeutic endoscopy team showed polyp reccurence rates to be 59% and 27% in the first and second six month follow up periods respectively. The high recurrence rate found in the first six month period was thought to be related to the polyps missed in the first colonoscopic examination
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  • Introduction
    Colonoscopy is considered to be the gold standard in the diagnosis and treatment of colon polyps. As the majority of colorectal cancers originate from adenomas, these lesions should be diagnosed and treated early. Furthermore, patients on whom polypectomy has been performed need to be followed up periodically evaluate new polyp development and malignant degeneration (1-2).

    The aim of this study, carried out between July 1995 and 1998 was to investigate the anatomic location of polyps and their histologic types, size and appearance in conjunction with synchronous carcinomas of the polyps found during colonoscopy performed in our clinic. In addition, the polyp recurrence rates in six month periods of long term follow up by the therapeutic endoscopy team was evaluated.

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  • Summary
  • Introduction
  • Materials And Methods
  • Results
  • Discussion
  • References
  • Materials And Methods
    Colonoscopy was performed on 2,568 patients admitted to our hospital and a total of 428 cases with polyps were diagnosed. At colonoscopy, Olympus CFL 10 and 20 colonoscopes were used and in colonoscopic polypectomy processes, Olympus electrosurgery unit and Olympus polypectomy snares were used. The mean age of the patients was 43.2 years (range 12-84). A standard colonoscopy diet was given to the patients for three days prior to the procedure. Twelve hours before, 80 gr-100 gr. of castor oil was given orally and on the morning prior to colonoscopy, rectum a cleansing enema was administered. Premedication of 0.03 mg/kg of midazolam and 25 mg-50 mg (25 mg. for <50 years and 50 mg. for >50 years) of meperidine was given. All patients on whom polypectomy was performed over a one-year period were recalled for follow-up at six monthly intervals. Colonoscopy was performed at these six-monthly appointments.

    Table 1: Anatomic location of polyps removed by polypectomy

    Table 2: Sizes of polyps removed by polypectomy

    Table 3: Histopathological classification of polyps removed by polypectomy

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  • Materials And Methods
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  • Results
    Six hundred and fifty-seven endoscopic polypectomies were performed on 428 patients with polyps. The anatomic locations, sizes and histopathological characteristics of the polyps were as follows : 505 (76.7%) of the polyps were found in the left colon (splenic flexure and distal colon) and 152 (23.3%) in the right colon (segments in the proximal section of the splenic flexure). In 28 (6%) of the 428 cases with polyps, synchronous cancer was also detected. Histopathological examination was performed in 350 cases, of which 227 (64.8%) were adenomatous, 78 (22.7%) hyperplastic, and 13 (3.7%) juvenile polyps and in 32 cases (9.1%), malignant degeneration was detected. Sizes of the 657 polyps were as follows: 473 (71.9%) were smaller than 1 cm, 96 (14.6%) 1-3 cm and 88 (13.3%) larger than 3 cm.

    Results from a 12 month follow up period, where 22 cases were followed up six-monthly by the therapeutic endoscopy team, showed recurrence rates of 59% (13 cases) and 27% (six cases) in the first and second six month period respectively. The results are shown in tables I, II, and III

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  • Summary
  • Introduction
  • Materials And Methods
  • Results
  • Discussion
  • References
  • Discussion
    Colon polyps may be classified into two main groups: neoplastic and non-neoplastic. Neoplastic polyps consist of adenomas and carcinomas, with adenomas being divided into three groups (tubuler, tubulovillous and villous) histopathologically. The non-neoplastic group include hyperplastic polyps, juvenile polyps, Peutz Jeghers polyps and inflammatory polyps (3).

    Adenomas are considered to be precancerous lesions. Although the incidence of adenomas in the general population ranges from 4-10% (4), it increases with age (5,6).

    There is a positive corelation between the size of the adenoma and risk of the carcinoma development. The risk of malignant degeneration is higher in polyps greater than 1 cm in size.

    In general, the location of adenomas is similar to carcinomas. Several surgical and colonoscopic series have shown that adenomas tend to be located in the rectum, sigmoid colon and the left colon. In our study, the majority (76.7%) of the adenomas were at the splenic flexure and distal colon. 12.1% were at the transverse colon and only 10.8% at the hepatic flexure and proximal to the hepatic flexure.

    Histopathological examination of the polyps revealed that 77.5% were tubular, 16.7% tubulovillous and 5.7% villous. In the literature, these rates are reported as 60-80%, 15-25% and 3-10% respectively (7,8). Our findings conformed with the ratios indicated in literature. In another study from Turkey, the rate of villous adenoma was determined as 15.82% and that of tubuler adenoma 55.07% (9).

    In our series, malignant degeneration was detected in 32 cases (9.1%), which was similar to the literature, where the frequency of carcinoma in situ and invasive cancer is reported as 5-10% (7,8). In our study, 78 of 350 polyps where polypectomy and histopathological examination were performed were hyperplastic, which are known to be non-neoplastic and benign lesions. The risk of cancer development in hyperplastic polyps is very low.

    However, in recent years it has been suggested that hyperplastic polyps can be indicators of adenomatous polyps (10-11). In another retrospective study from Turkey, 31 hyperplastic polyps (31.6%) amongst 228 colonoscopically removed lesions observed in 22 patients (27.2%) were found to occur along with proximal synchronous adenomas. It was concluded that hyperplastic polyps may have clinical significance as marker lesions for adenomas elsewhere in the colon (12). In our study, 78 hyperplastic polyps were found in the splenic flexure, 65 in the distal colon (83%), eight (10.2%) in the transverse colon and five (6.4%) in the hepatic flexura and the proximal colon. Our findings are similar to those of other studies (9,12).

    In the 22 cases followed up by the therapeutic endoscopy team, the recurrence rates of polyps were found to be 59% (13 cases) and 27.2 % (six cases) in the first and second six month periods respectively. In the literature, the recurrence rate for the first year is reported to be 5-15% (13-15). However, in some reports these rates are as high as 55% (16). It is considered that the high rate of 59% for the first six months in this study was not related to real recurrence but was probably due to polyps missed on initial colonoscopy.Further studies with a larger number of cases may produce more accurate results.

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  • Summary
  • Introduction
  • Materials And Methods
  • Results
  • Discussion
  • References
  • References

    1) Webb WA , Mc. Daniel L, Jones L. Experience with 1000 colonoscopic polypectomies. Ann Surg 1985; 20: 626-31.

    2) Fenoglio C, M,Pascal RR. Colorectal adenomas and cancer. Cancer 1982; 50 :2601-8.

    3) Boland CR, Hzkowitz SH, Kim YS. Colonic polyps and gastrointestinal polyposis syndromes. Gastrointestinal disease, Sleisenger MH, Fordran JSS, Philadelphia, WB Saunders Company 1989; 2: 1483-1518.

    4) Langer J C, Cohen Z,Taylor B R. Management of patients with polyps containing malignancy removed by colonoscopic polypectomy. Dis Colon Rectum 1984;27:6-9.

    5) Coode PE, Chan KW, Chan YT. Polyps and diverticula of the large intestine: a necrospy survey in Hong Kong. Gut 1985; 26: 1045-8.

    6) Eide TJ, Stalsberg H. Polyps of the large intestine in northern Norway. Cancer 1978; 42: 2839-48.

    7) Muto T, Bussoy HJR ,Morson BC. The evaluation of cancer of colon and rectum. Cancer 1975;36:2251-70.

    8) Shinya H, Wolff W I. Morphology, anatomic distribution and cancer potential of colonic polyps. Ann Surg 1979; 190: 679-83.

    9) Caner E, Dolar ME, Ate¾ KB et al. Kolonoskopik polipektomi sonuçlar›m›z. Turk J Gastroenterol 1992; 3: 342-7.

    10) Achkar E, Carey W. Small polyps found during fiberoptic sigmoidoscopy in asymptomatic patients. Ann Intern Med 1988; 109: 880-3.

    11) Ansher AF, Lewis JH, Fleischer DE. Hyperplastic colonic polyps as a marker for adenomatous colonic polyps. Am J Gastroenterol 1989; 84: 113-7.

    12) Tankurt E, Tözün N, Dire¾keneli H, et al. Hyperplastic polyps of the large bowel: A possible marker role for adenomas. Turk J Gastroenterol 1991; 2: 99-101.

    13) Kirsner JB, Rider JA , Moeller HC. Polyps of the colon and rectum: Statistical analysis of a long term follow-up study. Gastroenterology 1960; 39: 178.

    14) Kronborg O, Hage E, Adamson S. Follow-up after colorectal polypectomy. Repeated examinations of the colon every 6 months after removal of sessile adenomas and adenomas with the highest degree of dysplasia. Scand J. Gastroenterol 1983; 18: 1095.

    15) Dehyle P. Results of endoscopic polypectomy in the gastrointestinal tract. Endoscopy 1980; 12: 35.

    16) Neugut A I, Johnsen C M, Forde K A. Recurrence rates for colorectal polyps. Cancer 1985; 55:1586.

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  • Summary
  • Introduction
  • Materials And Methods
  • Results
  • Discussion
  • References
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