Diagnosis and Treatment of Diminutive Polyps in the Colon
AbstractPurpose of reviewColonoscopy and polypectomy reduce the incidence and mortality of colorectal cancer (CRC) by detecting and removing colorectal adenomas. Diminutive polyps (1 –5 mm) account for 75% of all polyps found but rarely contain or progress to CRC. Although a high adenoma detection rate (ADR) is associated with improved cancer prevention, the increase in detection of diminutive polyps also increases costs associated with CRC prevention programs. This review pr ovides an update on endoscopic management and considerations related to diminutive colorectal polyps.Recent findingsRecent studies show that only 0 –4.3% of diminutive polyps show advanced features and progression into CRC is extremely rare. Advances in endoscopic imaging have improved the ADR for screening colonoscopy, mostly as a result of greater detection of diminutive and hyperplastic polyps. A resect and discard strategy for these low-r isk diminutive polyps could reduce the need for pathologic assessment and is included in society guidelines with recommendations on imaging modalities, classification, and endoscopist benchmarks. To ensure complete resection, cold snare polypectomy is emerging as the most efficient and safest method of removal. A recent guideline review showed that fecal immunochemical testing is generally the preferred first-line screening test in average-risk adults. Post-polypectomy surveillance intervals may increase in the future as evidence on the management a...
A 64-year-old man presented with large colon polyp detected by screening colonoscopy. The colonoscopy showed a 20-mm pedunculated polyp with a thick and bulging stalk in the sigmoid colon (Figure A). Endoscopic ultrasonography revealed that the stalk consisted of a low echoic structure in the submucosa, considering of a cystic component (Figure B, arrows). Although the polyp was suspected of an invasive cancer, biopsies from the polyp head revealed tubular adenoma. Endoscopic resection was performed for pathological diagnosis and local treatment at the patient ’s request.
Conclusion Incomplete polyp resection was frequent after polypectomy in routine clinical practice. Serrated histology and proximal location were independent risk factors for incomplete resection. The performance of board-certified gastroenterologists was not superior to that of trainees. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, GermanyArticle in Thieme eJournals: Table of contents | Abstract | Full text
Postpolypectomy bleeding and incomplete polyp removal are important complication and quality concerns of colonoscopy for colon cancer prevention. Endoscopic mucosal stripping (EMS) is a modified extension of traditional cold snare polypectomy to avoid submucosal injury during removal of non-pedunculated colon polyps. We previously demonstrated EMS could potentially eliminate postpolypectomy bleeding, especially for advanced colon polyps, and facilitate complete polyp removal based on polypectomy site biopsy and short-term follow-up colonoscopy (1,2).
We reported retrospective data that compared with CO2 insufflation, water exchange (WE) colonoscopy significantly reduced rAMR (17.5% vs. 33.8%, P=0.034) (BMC Gastroenterol 2019;19:143). We performed a prospective randomized controlled trial (RCT) of WE and CO2 insufflation to determine whether WE with near-complete removal of infused water during insertion could reduce rAMR and rAMR combined with right colon hyperplastic polyp miss rate (rHPMR).
Colonoscopy is considered to be the preferred modality for colo-rectal cancer (CRC) screening because it has both diagnostic and therapeutic capabilities. Current consensus dictates that colonoscopy be performed with rapid passage of the instrument through the loops and bends of the colon to the cecum. The time taken for this is called cecal intubation time (CIT). This is then followed by thorough evaluation for and removal of all polyps during a slow deliberate withdrawal, the time taken for which is called withdrawal time.
CONCLUSION: Second inspection of the whole colon leads to increased adenoma detection with no differences between SFV and RFV. Hence, increased detection is most likely a feature of the second inspection itself but not of the inspection mode. PMID: 32390706 [PubMed - in process]
Abstract The development of colorectal cancer (CRC) is a multistep process initiated by a benign polyp that has the potential to evolve into in situ carcinoma through the interactions between environmental and genetic factors. CRC incidence rates are constantly increased for young adult patients presenting an advanced tumor stage. The majority of CRCs arise from colonic adenomas originating from aberrant cell proliferation of colon epithelium. Endoscopic polypectomy represents a tool for early detection and removal of polyps, although the occurrence of cancers after negative colonoscopy shows a significant inciden...
ConclusionsPatients with advanced colorectal polyps have poor knowledge of personal and familial CRC risk and recommendations. Endoscopists who remove advanced polyps are in an ideal position to educate their patients about their personal risk and the risk and recommendations for first-degree family members.
CONCLUSION: This is the first case of an adult UC patient with a solitary juvenile polyp at the 12-year follow-up. The correlation between juvenile polyps and the activity of IBD needs further study. PMID: 32148384 [PubMed - in process]
Colonoscopy with polypectomy is frequently performed in pediatric patients based on symptoms, with the majority of polyps identified being benign juvenile pedunculated polyps with a vascular stalk. This is in distinction to adults where polypectomy is often performed as part of a colon cancer screening and prevention strategy and a higher fraction of polyps are sessile and or dysplastic. In adults, polypectomy techniques emphasize a need for deeper resection to ensure complete resection of adenomas or potential carcinoma in situ. Adenomatous polyps can occur in the pediatric age group and may be associated with an underlyi...