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Endoscopic resection of large colorectal polyps Resección endoscópica de pólipos difíciles de colon  [cached]
F. Pérez Roldán,P. González Carro,M. L. Legaz Huidobro,M. C. Villafá?ez García
Revista Espa?ola de Enfermedades Digestivas , 2004,
Abstract: Backgrounds: endoscopic polypectomy is a common technique, but there are discrepancies over which treatment -surgical or endoscopic- to follow in case of polyps of 2 cm or larger. Objectives: to analyse the efficacy and complications of colonoscopic polypectomy of large colorectal polyps. Patients and methods: 147 polypectomies were performed on 142 patients over an eight-year period. The technique used was that of submucosal adrenaline 1:10000 or saline injection at the base of the polyp, followed by resection of the polyp using a diathermic snare in the smallest number of fragments. Remnant adenomatous tissue was fulgurated with an argon plasma coagulator. Lately, prophylactic hemoclips have been used for thick-pedicle polyps. Complete removal was defined as when a polyp was completely resected in one or more polypectomy sessions. Polypectomy failure was defined as when a polyp could not be completely resected or contained an invasive carcinoma. Results: the mean patient age was 67.9 years (range, 4-90 years), with 68 men and 79 women. There were 74 sessile polyps, and the most common location was the sigmoid colon. The most frequent histology was tubulovillous. Most of the polyps (96.6%), were resected and cured. This was not achieved in four cases of invasive carcinoma, and a villous polyp of the cecum. All pedunculated polyps were resected in one session, whereas the average number of colonoscopies for sessile polyps was 1.35 ± 0.6 (range, 1-4). The polypectomy was curative in all of the in situ carcinomata except one. As for complications, 2 colonic perforations (requiring surgery) and 8 hemorrhages appeared, which were controlled via endoscopy. There was no associated mortality. Conclusions: endoscopic polypectomy of large polyps (≥ 2 cm) is a safe, effective treatment, though it is not free from complications. Complete resection is achieved in a high percentage, and there are few relapses. It should be considered a technique of choice for this type of polyp, except in cases of invasive carcinoma. Antecedentes: existen discrepancias sobre qué tratamiento realizar en pólipos de 2 o más centímetros, si quirúrgico o polipectomía endoscópica. Objetivos: analizar la eficacia y complicaciones de la polipectomía endoscópica en pólipos difíciles de colon. Pacientes y métodos: durante 8 a os se han realizado 147 polipectomías en 142 pacientes. La técnica utilizada fue la inyección submucosa de adrenalina 1:10.000 o de suero fisiológico en la base del pólipo, seguida de resección con asa de diatermia en el menor número de fragmentos. Si quedaba remanente de
Micronucleus analysis in patients with colorectal adenocarcinoma and colorectal polyps  [cached]
Ali Karaman, Do?an Nas?r Binici, Mehmet E?ref Kabalar, Züleyha ?al?ku?u
World Journal of Gastroenterology , 2008,
Abstract: AIM: To determine, by counting micronucleus (MN) frequencies, whether chromosomal or DNA damage have an effect on the pathogenesis of early colorectal adenocarcinoma (CRC).METHODS: We analyzed MN frequencies in 21 patients with CRC, 24 patients with colon polyps [10 neoplastic polyps (NP) and 14 non-neoplastic polyps (NNP)] and 20 normal controls.RESULTS: MN frequency was significantly increased in CRC patients and in NP patients compared with controls (3.72 ± 1.34, 3.58 ± 1.21 vs 1.97 ± 0.81, P < 0.001). However, there was no difference in the MN frequency between CRC patients and NP patients (P > 0.05). Similarly, there was no difference in the MN frequency between NNP patients (2.06 ± 0.85) and controls (P > 0.05).CONCLUSION: Our results suggest increased chromosome/DNA instabilities may be associated with the pathogenesis of early CRC.
Endoscopic resection of large colorectal polyps
Pérez Roldán,F.; González Carro,P.; Legaz Huidobro,M. L.; Villafá?ez García,M. C.; Soto Fernández,S.; Pedro Esteban,A. de; Roncero García- Escribano,O.; Ruiz Carrillo,F.;
Revista Espa?ola de Enfermedades Digestivas , 2004, DOI: 10.4321/S1130-01082004000100006
Abstract: backgrounds: endoscopic polypectomy is a common technique, but there are discrepancies over which treatment -surgical or endoscopic- to follow in case of polyps of 2 cm or larger. objectives: to analyse the efficacy and complications of colonoscopic polypectomy of large colorectal polyps. patients and methods: 147 polypectomies were performed on 142 patients over an eight-year period. the technique used was that of submucosal adrenaline 1:10000 or saline injection at the base of the polyp, followed by resection of the polyp using a diathermic snare in the smallest number of fragments. remnant adenomatous tissue was fulgurated with an argon plasma coagulator. lately, prophylactic hemoclips have been used for thick-pedicle polyps. complete removal was defined as when a polyp was completely resected in one or more polypectomy sessions. polypectomy failure was defined as when a polyp could not be completely resected or contained an invasive carcinoma. results: the mean patient age was 67.9 years (range, 4-90 years), with 68 men and 79 women. there were 74 sessile polyps, and the most common location was the sigmoid colon. the most frequent histology was tubulovillous. most of the polyps (96.6%), were resected and cured. this was not achieved in four cases of invasive carcinoma, and a villous polyp of the cecum. all pedunculated polyps were resected in one session, whereas the average number of colonoscopies for sessile polyps was 1.35 ± 0.6 (range, 1-4). the polypectomy was curative in all of the in situ carcinomata except one. as for complications, 2 colonic perforations (requiring surgery) and 8 hemorrhages appeared, which were controlled via endoscopy. there was no associated mortality. conclusions: endoscopic polypectomy of large polyps (≥ 2 cm) is a safe, effective treatment, though it is not free from complications. complete resection is achieved in a high percentage, and there are few relapses. it should be considered a technique of choice for this type of polyp,
Association between Obesity, Serum Lipids, and Colorectal Polyps in Old Chinese People  [PDF]
Wen Yang,Yan Chang,Haiyan Huang,Yuzhu Wang,Xiaohong Yu
Gastroenterology Research and Practice , 2013, DOI: 10.1155/2013/931084
Abstract: Background. Colorectal cancer mostly arises from the polyps of colon. The aim of our study was to examine the association of body mass index (BMI) and serum lipids with the colorectal polyps in old Chinese people. Methods. The risk of developing colorectal polyps was studied in 244 subjects (212 men and 32 women, 74.63 ± 11.63 years old) who underwent colonoscopy for the first time from January 2008 to July 2012 at the Navy General Hospital, Beijing, China. According to the results of colonoscopy, all the subjects were divided into 112 normal control, 38 right colorectal polyps, 53 left colorectal polyps, and 41 both right and left colorectal polyps groups. The total plasma cholesterol, plasma triglyceride, plasma creatinine concentration, blood urinary nitrogen, and fasting glucose were determined using a multichannel analyzer. Results. There were significant differences among normal control, right colorectal polyps, left colorectal polyps, and both right and left polyps groups, which were the BMI, total cholesterol, triglycerides, creatinine, and urinary nitrogen. In binary logistic regression analysis, there were two risk factors associated with the occurrence of colorectal polyps, which included BMI and systolic blood pressure. Conclusions. Colorectal polyps were significantly associated with increased BMI, total cholesterol, and triglycerides levels. 1. Introduction According to a report of the World Health Organization, cancer was the leading cause of death in 2007, accounting for 7.9 million deaths, or 13% of the total amount. The same report stated that colorectal cancer was the fourth most common fatal cancer, after lung, stomach, and liver cancers [1]. Epidemiological evidence has shown that obesity is associated with an increased risk of mortality from cancers [2, 3]. In some studies, serum triglyceride [4–7] and cholesterol [8–10] levels are positively related to an increased risk of colorectal adenoma, while several investigators report an insignificant or even inverse relationship between serum lipids and colorectal adenoma [11–13]. The prevalence of obesity and dyslipidemia is rising dramatically in both developed and developing countries. Therefore, we examined the association between body mass index (BMI), serum lipids, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and colorectal polyps in relatively immobile resident of old Chinese people, hoping to provide useful information for preventing colorectal cancer. 2. Methods 2.1. Study Population The subjects comprised 244 individuals who underwent a routine screening
Malignant colorectal polyps  [cached]
Luis Bujanda, Angel Cosme, Ines Gil, Juan I Arenas-Mirave
World Journal of Gastroenterology , 2010,
Abstract: Nowadays, the number of cases in which malignant colorectal polyps are removed is increasing due to colorectal cancer screening programmes. Cancerous polyps are classified into non-invasive high grade neoplasia (NHGN), when the cancer has not reached the muscularis mucosa, and malignant polyps, classed as T1, when they have invaded the submucosa. NHGN is considered cured with polypectomy, while the prognosis for malignant polyps depends on various morphological and histological factors. The prognostic factors include, sessile or pedunculated morphology of the polyp, whether partial or en bloc resection is carried out, the degree of differentiation of the carcinoma, vascular or lymphatic involvement, and whether the polypectomy resection margin is tumor free. A malignant polyp at T1 is considered cured with polypectomy if it is a pedunculated polyp (Ip of the Paris classification), it has been completely resected, it is not poorly differentiated, the resection edge is not affected by the tumor and there is no vascular or lymphatic involvement. The sessile malignant polyp (Is of the Paris classification) at T1 is considered not cured with polypectomy. Only in some cases (e.g. older people with high surgical risk) local excision (polypectomy or endoscopic submucosal dissection or conventional endoscopic mucosal resection) is considered the definitive treatment.
Confocal Endomicroscopy of Colorectal Polyps
Vivian M. Ussui,Michael B. Wallace
Gastroenterology Research and Practice , 2012, DOI: 10.1155/2012/545679
Abstract: Confocal laser endomicroscopy (CLE) is one of several novel methods that provide real-time, high-resolution imaging at a micron scale via endoscopes. CLE has the potential to be a disruptive technology in that it can change the current algorithms that depend on biopsy to perform surveillance of high-risk conditions. Furthermore, it allows on-table decision making that has the potential to guide therapy in real time and reduce the need for repeated procedures. CLE and related technologies are often termed “virtual biopsy” as they simulate the images seen in traditional histology. However, the imaging of living tissue allows more than just pragmatic convenience; it also allows imaging of living tissue such as active capillary circulation, cellular death, and vascular and endothelial translocation, thus extending beyond what is capable in traditional biopsy. Immediate potential applications of CLE are to guide biopsy sampling in Barrett's esophagus and inflammatory bowel disease surveillance, evaluation of colorectal polyps, and intraductal imaging of the pancreas and bile duct. Data on these applications is rapidly emerging, and more is needed to clearly demonstrate the optimal applications of CLE. In this paper, we will focus on the role of CLE as applied to colorectal polyps detected during colonoscopy.
Analysis of mtDNA sequence variants in colorectal adenomatous polyps
Sharifeh Mehrabi, Joyce A Akwe, Gregory Adams, William Grizzle, Xuebiao Yao, Felix O Aikhionbare
Diagnostic Pathology , 2010, DOI: 10.1186/1746-1596-5-66
Abstract: Adenomatous polyps are histologically divided into tubular adenomas, villous adenomas, and mixed or tubulo-villous adenomas [1,2]. There is considerable clinicopathological evidence that support adenomatous polyp to be a precursor lesion in most of colorectal cancers. Colorectal malignancy risk correlate with the transformation of a polyp from low risk tubular adenomas to high pure villous adenomas, while the tubulo-villous have an intermediate risk of malignant transformation [2]. At molecular level, changes from tubular to villous through tubulo-villous adenomas may be due to accumulation in mutations of oncogenes, tumor suppressor genes [3-5] and mitochondrial DNA variants within a specific cell and haplogroups [6-8]. These mutations may be adenomatous polyp specific and could potentially be employed as polyp predictors. It is not known, however, whether these mutations are needed to initiate and/or promote tumorigenesis or whether they result from the genomic instability inherent in the resulting colorectal adenocarcinoma [7]. This study examined the possibility of using mitochondrial DNA variants to differentiate the three adenomatous polyps of colon and their matched surrounding paracancerous normal tissues. The mitochondrial genome is particularly susceptible to mutation because of its high local level of reactive oxygen species (ROS) [9,10]. Variants in mtDNA may cause subtle changes in the protein subunits comprising the complexes involved in mitochondrial oxidative phosphorylation (OXPHOS) activity and lead to even higher levels of ROS [11] (ROS are a by product of normal OXPHOS). The accumulation of ROS and oxidative DNA damage during the course of a lifetime may be deleterious and could lead to specific mitochondrial genome markers that may be involved in the development and progression of colorectal cancer [7,12], since colorectal cancer usually occurred in older individuals. In addition, mutant mtDNA may also play a role in tumorigenesis because mutant
Correlation between location, size and histologic type of colorectal polyps at the presence of dysplasia and adenocarcinoma
Valarini, Sandra Beatriz Marion;Bortoli, Vinícius Tomadon;Wassano, Noelle Suemi;Pukanski, Maiara Fontes;Maggi, Dariana Carla;Bertollo, Lucas Amadeu;
Journal of Coloproctology (Rio de Janeiro) , 2011, DOI: 10.1590/S2237-93632011000300003
Abstract: adenocarcinoma represents 96-98% of colorectal neoplasms, and neoplastic polyps (adenomas) are their precursors. the aim of this study is to correlate size, location and histologic type of colorectal polyps at the presence of dysplasia and adenocarcinoma. methods: colonoscopies from january/2007 to december/2008 were retrospectively studied, in order to evaluate the characteristics of the polyps. results and discussion: out of the 2,401 analyzed colonoscopies, 583 (24.3%) presented polyps. due to the lack of histopathologic data, 139 exams were excluded. mean age of the patients was 58±12 years, and 60% were females. polyps were prevalent in the left colon (38.5%) and rectum (32.5%). out of the 850 polyps which were histologically examined, 55.17% were tubular adenomas; 21.88%, hyperplastic; 17.05%, serrated; 5.4%, tubulovillous; and 0.47%, villous. as to polyps £1.0 cm, dysplasia was observed in 16.0% and adenocarcinoma in 1.9%. those >1.0 cm, 72.0% (p<0.001) presented dysplasia, and 25.3% (p<0.001) presented adenocarcinoma. polyps in the right and transverse colon were strongly associated with dysplasia (17.8% and 16.7%). adenocarcinomas were prevalent in the left colon (2.5%) and rectum (2.1%). conclusion: polyps were more frequent in the left colon and rectum. the right and transverse colons were strongly correlated with dysplasia. those of the left colon and rectum were associated with adenocarcinoma. lesions >1.0 cm were positively related to dysplasia and neoplasm.
Colorectal Polyps in Sharykia, Egypt: Clinico-Pathological Study of Our Experience with Endoscopy  [PDF]
Tarik Zaher,Magid Bahgat,Amany Ibrahim,Mostafa Ahmady
Journal of Medical Sciences , 2008,
Abstract: In the present study, manifestation, location, histopathological features and complications of endoscopic excision of different colorectal polyps were studied. Data were collected prospectively during colonoscopic examination performed on 592 subjects in Endoscopy Units, Zagazig University Hospitals, Sharkyia, Egypt. The study was performed from April 2003 till July 2007. Colorectal polyps were found in 112 patients (18.9%). Sixty patients (53.6%) were males and 52 patients (46.4%) were females. The age of the patients ranged from 3.5 to 68 years. Seventy one patients (63.4%) were children and adolescents. Bleeding per rectum presented in 84 patients (75%), hypochromic microcytic anaemia in 5 patients (4.5%) and bowel disturbances in 20 patients (17.8%). Screening colonoscopy was performed on 3 patients (2.7%). Polyps were located in the proximal colon in 23 patients (20.5%), distal colon in 83 patients (74.1%) and diffuse involvement in 6 patients (5.35%). One patient (0.89%) had bleeding after polypectomy necessitating admission and blood transfusion. Fifty three patients (48.2%) had juvenile polyps, 22 (20%) had adenomatous polyps, 20 (18.2%) had inflammatory polyps, 5 (4.5%) had bilharzial polyps, 4 (3.6%) had pseudopolyps of ulcerative colitis, 3 (2.7%) had familial polyposis coli, one (0.9%) had malignancy inside adenomatous polyp, one (0.9%) was associated with rectal prolapse and one (0.9%) was associated with sutures of previous operation of rectal prolapse. Histopathological specimens were not available in 2 patients. We concluded that juvenile polyps were the most frequent polyps in our study. Also the low number of bilharzial polyps points to the decreasing prevalence of bilharziasis in Egypt nowadays. As well as Polyps are located mainly in the distal colon and endoscopic polypectomy had few complications.
Endoscopic mucosal resection of colorectal polyps in typical UK hospitals  [cached]
Teegan R Lim, Venkat Mahesh, Salil Singh, Benjamin HL Tan, Mohamed Elsadig, Nerukav Radhakrishnan, Phil Conlong, Chris Babbs, Regi George
World Journal of Gastroenterology , 2010,
Abstract: AIM: To evaluate the outcomes of endoscopic mucosal resection (EMR) for colorectal polyps, with particular regard to procedural complications and recurrence rate, in typical United Kingdom (UK) hospitals that perform an average of about 25 colonic EMRs per year.METHODS: A total of 239 colorectal polyps (≥ 10 mm) resected from 199 patients referred to Rochdale Infirmary, Salford Royal Hospital and Royal Oldham Hospital for EMR between January 2003 and January 2009 were studied.RESULTS: The mean size of polyps resected was 19.6 ± 12.4 mm (range 10-80 mm). The overall major complication rate was 2.1%. Complications were less frequent with non-adenomas compared with the other groups (Pearson’s χ2 test, P < 0.0001). Resections of larger-sized polyps were more likely to result in complications (unpaired t-test, P = 0.021). Recurrence was associated with histology, with carcinoma-in-situ more likely to recur compared with low-grade dysplasia [hazard ratio (HR) 186.7, 95% confidence interval (95% CI): 8.81-3953.02, P = 0.001]. Distal lesions were also more likely to recur compared with right-sided and transverse colon lesions (HR 5.93, 95% CI: 1.35-26.18, P = 0.019).CONCLUSION: EMR for colorectal polyps can be performed safely and effectively in typical UK hospitals. Stricter follow-up is required for histologically advanced lesions due to increased recurrence risk.
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