Localization and size of 1058 polyps detected in the lower gastrointestinal system and the approach used for their treatment
Localization and size of 1058 polyps detected in the lower gastrointestinal system and the approach used for their treatment
The occurrence of colon cancer typically depends on the presence or absence of adenomatous polyps. Hence, performing colonoscopy and polypectomy can aid in cancer prevention. This study aimed to retrospectively investigate demographic, endoscopic, and histopathological data of patients who presented with colorectal polyps and underwent endoscopic resection at our center. In this single-center retrospective study, we collected the data of 1058 colorectal polyps that were excised from 498 cases between September 2019 and September 2020. We reviewed patient’s information, including patient age and sex, indications for colonoscopy, polyp characteristics (localization, size, number, and histopathology), endoscopic resection techniques, and presence of related complications. Mean age of the 498 cases included in this study was 62.44 ± 11.77 years (21–90 years); among these patients, 296 (59.4%) were females. The age group of 60–69 years had the highest number of cases (150 cases) presenting with polyps (30.1%). The most common indication for colonoscopy was polyp surveillance in 100 cases (20.1%). The polyps were most commonly localized in the sigmoid colon (26%). Histopathologically, the most common type of polyp was tubular adenoma. Furthermore, 54.3% of the polyps were diminutive. Polyps with dysplasia were significantly different from those without dysplasia in terms of polyp size, polyp localization, and post-polypectomy complications (p < 0.001, p = 0.006, and p < 0.001, respectively). In people aged >50 years, colon polyps were more common in the left colon, especially in the rectosigmoid region. Endoscopic polypectomy is a safe method for resecting precancerous lesions. Polypectomy should be performed immediately after identifying polyps in colonoscopy screenings to determine their histology and prevent progression to malignancy. Additionally, these patients should be included in a polyp surveillance program.
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- Winawer SJ. The multidisciplinary management of gastrointestinal cancer. Colorectal cancer screening. Best Pract Res Clin Gastroenterol 2007;21:1031-48.
- Levin B, Lieberman DA, McFarland B, et al; American Cancer Society Colorectal Cancer Advisory Group; US Multi-Society Task Force; American College of Radiology Colon Cancer Committee. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58:130-60.
- Eddy DM. Screening for colorectal cancer. Ann Intern Med 1990;113:373- 84.
- Rex DK, Johnson DA, Anderson JC, et al. American College of Gastroenterology. American College of Gastroenterology guidelines for colorectal cancer screening 2009. Am J Gastroenterol 2009;104:739-50.
- Lau CF, Hui PK, Mak KL, et al. Gastric polypoid lesions illustrative cases and literature review. Am J Gastroenterol 1998;93:2559-64.
- Solakoğlu T, Atalay R, Köseoğlu H, et al. Analysis of 2222 colorectal polyps in 896 patients: A tertiary referreal hospital study. Turk J Gastroenterol 2014;25:175-79.
- Shinya H, Wolff WI. Morphology, anatomic distribution and cancer potential of colonic polyps. Ann Surg 1979;190:79.
- Ferlitsch M, Moss A, Hassan C, Bhandari P, Dumonceau J. et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 2017;49:270-97.
- Cha JM, Lim KS, Lee SH, et al. Clinical outcomes and risk factors of postpolypectomy coagulation syndrome: A multicenter, retrospective, case– control study. Endoscopy 2013;45:202-7.
- Risio M. The natural history of adenomas. Best Pract Res Clin Gastroenterol 2010;24:271-80.
- Paik JH, Jung EJ, Ryu CG, Hwang DY. Detection of polyps after resection of colorectal cancer. Ann Coloproctol 2015;31:182-86.
- Nouraie M, Hosseinkhah F, Brim H, et al. Clinicopathological features of colon polyps from African-Americans. Dig Dis Sci 2010;55:1442–49.
- Siegel RL, Ward EM, Jemal A. Trends in colorectal cancer incidence rates in the United States by tumor location and stage, 1992-2008. Cancer Epidemiol Biomarkers Prev. 2012;21:411–6.
- Corley DA, Jensen CD, Marks AR, et al. Variation of adenoma prevalence by age, sex, race, and colon location in a large population: implications for screening and quality programs. Clin Gastroenterol Hepatol. 2013;11:172- 80.
- Loeve F, Boer R, Zauber AG, et al. National Polyp Study data: Evidence for regression of adenomas. Int J Cancer. 2004;111:633-9.
- Korkmaz H, Kendir İC, Akkaya Ö. Evaluation of size, localization and histopathologic structures of colonic polyps Endoscopy Gastrointestinal 2016;24:13-7.
- Coşkun A, Kandemir A. Analysis of colonoscopic polypectomy results. Endoscopy Gastrointestinal. 2017;25:66-9.
- Temiz A, Kaya A. Histopathological results of colonoscopic polypectomy in a surgery unit. Endoscopy Gastrointestinal 2017;25:62-5.
- Yalçın MS, Sayın S, Bursalı B. Analysis of colonoscopic polypectomy results in Aksaray region. Ortadogu Tıp Derg. 2019;11:219-23.
- Başak F, Çalışkan YK, Tilev, SM, Şişik A. Lower gastrointestinal endoscopic polypectomy: Cross-sectional study with 7503 consecutive endoscopic procedures. J Surg Med. 2019;3:809-11.
- Shussman N, Wexner SD. Colorectal polyps and polyposis syndromes. Gastroenterol Rep (Oxf). 2014;2:1-15.
- Tan YJ, Wendy T, Chieng JY. Detection rate of colonic polyp among patients who had undergone colonoscopy at gastroenterology unit of Serdang Hospital, Malaysia. Med J Malaysia. 2019;74:20-4.
- Nam YJ, Kim KO, Park CS, Lee SH, Jang BI. Clinicopathological features of colorectal polyps in 2002 and 2012. Korean J Intern Med. 2019;34:65– 71.
- 2Nisihara R, Fudalli F, Turra MLM, et al. Pathological findings of colorectal polyps analyzed in Curitiba-Brazil. J Coloproctol. 2017;37:123-7.
- Rocha BP, Ferrari AP, Forones NM. Frequency of polyps in patients undergoing surgery for colorectal cancer. Arq Gastroenterol. 2000;37:31–4.
- Valarini SBM, Bortoli VT, Wassano NS, et al. Correlation between location, size and histologic type of colorectal polyps at the presence of dysplasia and adenocarcinoma. J Coloproctol. 2011;31:241–7.
- Smith RA, Cokkinides V, Eyre HJ. American Cancer Society. American Cancer Society guidelines for the early detection of cancer, 2003. CA Cancer J Clin. 2003;53:27-43.
- Bech K, Kronborg O, Fenger C. Adenomas and hyperplastic polyps in screening studies. World J Surg. 1991;15:7-13.
- Lieberman DA, Smith FW. Screening for colon malignancy with colonoscopy. Am J Gastroenterol. 1991;86:946-51.
- Winawer SJ, Zauber AG, Fletcher RH, et al. US Multi-Society Task Force on Colorectal Cancer; American Cancer Society. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. 2006;130:1872-85.
- Kamis F, Tanoglu A, Cetin EU, et al. Retrospective analysis of patients underwent colonoscopic polypectomy: A two-center study. Medicine. 2020;9:473-7.
- Vişovan II, Tanşau M, Ciobanu, et al. Increasing prevalence of right-sided colonic adenomas in a high-volume endoscopy department in Romania: implications for colorectal cancer screening. J Gastrointestin Liver Dis. 2014;23:147-51.
- Dave S, Hui S, Kroenke K, Imperiale TF. Is the distal hyperplastic polyp a marker for proximal neoplasia? J Gen Intern Med. 2003;18:128–37.
- Lewis JD, Ng K, Hung KE, et al. Detection of proximal adenomatous polyps with screening sigmoidoscopy: a systematic review and metaanalysis of screening colonoscopy. Arch Intern Med. 2003;163:413–20.
- Di Giorgio P, De Luca L, Calcagno G, et al. Detachable snare versus epinephrine injection in the prevention of postpolypectomy bleeding: a randomized and controlled study. Endoscopy. 2004;36:860-3.
- Burgess NG, Metz AJ, Williams SJ, et al. Risk factors for intraprocedural and clinically significant delayed bleeding after wide-field endoscopic mucosal resection of large colonic lesions. Clin Gastroenterol Hepatol. 2014;12:651-61.
- Dobrowolski S, Dobosz M, Babicki A, et al. Blood supply of colorectal polyps correlates with risk of bleeding after colonoscopic polypectomy. Gastrointest Endosc. 2006;63:1004-9.
- Muto T, Bussey HJ, Morson BC. The evolution of cancer of the colon and rectum. Cancer. 1975;36:2251-570.
- O'Brien MJ, Winawer SJ, Zauber AG, et al. The National Polyp Study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas. Gastroenterology. 1990; 98:371-9.
- Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993:30;329:1977-81.
- Williams AR, Balasoorriya BAW, Day DW. Polyp and cancer of the large bovel: A necropsy study in Liverpool. Gut 1982;23:835-42.
- Vatn MH, Staisberg H. The prevalence of polyps of the large intestine in Osio: An autopsy study. Cancer. 1982;49:819-25.
- Eminler AT, Sakallı M, Irak K, et al. Colonoscopic polypectomy results of our gastroenterology unit. Turk J Academic Gastroenterol. 2011;10:112-5.
- Weinberg DS. Large adenoma recurrence after polypectomy. Gastrointest Endosc. 2009;70:350-2.
- US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al. Screening for colorectal cancer: US preventive services task force recommendation statement. JAMA. 2016;315:2564–75.
- Dore MP, Tufano MO, Pes GM, et al. Tissue resonance interaction accurately detects colon lesions: a double-blind pilot study. World J Gastroenterol 2015;21:7851–9.
- Burgess NG, Pellise M, Nanda KS, et al. Clinical and endoscopic predictors of cytological dysplasia or cancer in a prospective multicentre study of large sessile serrated adenomas/polyps. Gut. 2016;65:437–46.