Polyps colonic Endoscopic finding power point.pptx

polyp

1. Colonic polyps By dr . Zaid aldabbagh S upervised by dr . Abdulla Alyozbaki

2. Colonic Polyps Colonic polyps are slow-growing overgrowths of the colonic mucosa that carry a small risk (< 1%) of becoming malignant. However, because colonic polyps are highly prevalent in the general population (especially with increasing age), they confer an important predisposition to colon cancer and are therefore removed when detected

3. Symptoms Most patients with colonic polyps are asymptomatic. In symptomatic patients, the most common presenting symptom is rectal bleeding; chronic bleeding from colonic polyps may cause iron deficiency anemia. Other symptoms of polyps include diarrhea or constipation, often with decreased stool caliber By examination Distal rectal polyps can be detected by digital rectal examination. Otherwise, physical examination findings are typically normal.

4. Diagnosis Stool occult blood test A stool occult blood test can detect a proportion (20%-40%) of colonic polyps that are larger than 10 mm in diameter, but this test also suggests the presence of other causes of gastrointestinal blood loss. Flexible sigmoidoscopy Flexible sigmoidoscopy is a good screening test for colonic polyps and is the only procedure or imaging modality to be validated by studies that document a decrease in colorectal cancer mortality.[1]However, this procedure does not examine the entire colon. Studies indicate that the majority of large adenomatous polyps in women will be missed by using flexible sigmoidoscopy alone.

5. Colonoscopy Colonoscopy is the preferred test to detect colonic polyps, obtain biopsies, and/or perform endoscopic resection.[2]Sensitivities for large colonic polyps in the 80%-90% range have been reported. Although flexible sigmoidoscopy and stool tests for occult blood have been the mainstays of screening to prevent colon cancer, some clinicians now favor colonoscopy as a primary screening tool.

6. Capsule endoscopy An ingestible, camera-equipped capsule developed as a means of exploring the gastrointestinal tract received approval by the US Food and Drug Administration (FDA) in February 2014 for the detection of colon polyps in patents who have had an incomplete optical colonoscopy.[4, 5] Stool DNA Tests have been developed that detect mutant, fragmented, and/or methylated deoxyribonucleic acid (DNA) from exfoliated colon tumor cells in stool. This test was approved by the FDA in August 2014.

7. Management Polypectomy In patients with a solitary or a few pedunculated or sessile polyps, colonoscopic removal can be performed concurrently with the search for other lesions. Colonic resection
In the case of multiple intestinal polyps associated with familial adenomatous polyposis (FAP), colon resection remains the only feasible option (see the image below). Surgical resection may be advocated for large, sessile polyps that are difficult to remove endoscopically or for advanced colonic polyps that recur despite adequate initial endoscopic treatment.

8. Familial adenomatous polyposis, total colectomy specimen. The colonic mucosa is studded with innumerable sessile and small pedunculated polyps, which involve the entire length of the specimen.

9. Colonic polyps are curable if removed. If not treated, the patient may develop complications, such as bleeding, and the condition may even be fatal if malignant transformation occurs. Fortunately, colonic polyps grow slowly; cancer development is estimated to usually occur about 10 years after the formation of a small colonic polyp. Hereditary nonpolyposis colorectal cancer (HNPCC) is an exception. Progression to cancer appears to be more rapid because of increased genetic instability in the lesion. Patients with HNPCC should undergo screening for colonic polyps at more frequent intervals (every 1-2 y) than patients at average risk.

10. Complications Complications of colonic polyps include bleeding, obstruction, diarrhea, and the development of cancer. Complications of polypectomy are uncommon but include bleeding and, rarely, intestinal perforation.

11. POLYP REMOVAL TECHNIQUES There are two primary goals of colonic polyp removal:
●To completely remove all neoplastic tissue
●To provide a tissue specimen that can be evaluated histologically Biopsies alone are inadequate for establishing or excluding the presence of malignancy (figure 3). Only complete excision of the polyp permits accurate histologic diagnosis.

12. :There are a number of techniques for endoscopic excision of large colon polyps [26,27]. The approach chosen will depend on the characteristics and location of the polyp and the endoscopist’s preference 1. Snare polypectomy – Large pedunculated polyps can be removed by transecting the stalk of the polyp with a snare, usually with electrocautery .

13. 2. Endoscopic mucosal resection (EMR) – Large sessile polyps (laterally spreading tumors) are removed using EMR

14. Endoscopic submucosal dissection (ESD) – An alternative to EMR is ESD. ESD is a variant of EMR in which a specialized needle knife is used to dissect lesions from the submucosa. The advantage of ESD is that it often permits removal of large sessile polyps en bloc ( eg , in one piece), whereas EMR often removes the polyp piecemeal. However, the technique requires specialized training. ESD is typically not required for colon polyps because the majority of colon polyps are benign, so they can be removed piecemeal with a low recurrence risk

15. Resources 1.MEDSCAPE 2.UPTODATE