Colonic Polyps – What A Surgeon Needs to Know!
DOI:
https://doi.org/10.48111/2021.04.07Keywords:
Polyp, Colonoscopy, Polypectomy, Adenoma, Endoscopic mucosal resectionAbstract
IMPORTANCE Colorectal polyps are protuberance of the tissue mass into the colonic lumen arising from the colonic mucosal layer. Although mostly benign, some types of colorectal polyps (especially adenoma) are considered to follow a histological pathway called adenoma-carcinoma transition sequence, which leads to the development of colorectal cancer. Up to 80% of colorectal cancers develop from initially benign adenomatous polyps that subsequently undergo such transition. Colonoscopy is considered to be an efficient method of detecting and removing polyps, thus reducing the incidence of colorectal cancer. Several important characteristics of a polyp can be assessed during endoscopies such as the gross morphology, superficial glandular pattern, vascular pattern, and appearance under chromoendoscopy, which help decide the most suitable type of polypectomy technique and subsequent surveillance examination. This article reviews the histological characteristics and classifications of colorectal polyps and discusses the traditional and modern endoscopic polypectomy techniques in light of recent scientific data.
References
Zauber AG, Winawer SJ, O’Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366(8):687-696. doi:10.1056/NEJMOA1100370
Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69-90. doi:10.3322/CAAC.20107
Ferlay J, Pisni M PD. GLOBOCAN 2002: Cancer incidence, mortality and prevalence worldwide. IARC Cancer Base No.5 version 2.0 Lyon France: IARC press 2004, American Cancer Society,Atlanta. www.cancer.org.
Seeff L, Ahmed F, King JB, Coughlin SS. Colorectal cancer incidence in the United States, 1999-2004?: an updated analysis of data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results Program. Cancer. 2009;115(9):1967-1976. doi:10.1002/CNCR.24216
Sung JJ, Lau JY, Goh K, Leung W. Increasing incidence of colorectal cancer in Asia: implications for screening. Lancet Oncol. 2005;6(11):871-876. doi:10.1016/S1470-2045(05)70422-8
Pourhoseingholi MA. Increased burden of colorectal cancer in Asia. World J Gastrointest Oncol. 2012;4(4):68-70. doi:10.4251/WJGO.V4.I4.68
Cho KR, Vogelstein B. Genetic alterations in the adenoma--carcinoma sequence - PubMed. Cancer. 1992;70(6Suppl):1727-1731. Accessed September 3, 2021. https://pubmed.ncbi.nlm.nih.gov/1516027/
Cummings OW. Pathology of the adenoma-carcinoma sequence: from aberrant crypt focus to invasive carcinoma. Semin Gastrointest Dis. 2000;11(4):229-237.
Leslie A, Carey FA, Pratt NR, Steele RJ. The colorectal adenoma-carcinoma sequence. Br J Surg. 2002;89(7):845-860. doi:10.1046/J.1365-2168.2002.02120.X
Palma FD, D’Argenio D, Jonathan G, et al. The Molecular Hallmarks of the Serrated Pathway in Colorectal Cancer. Cancers (Basel). 2019;11(7):1017. doi:10.3390/CANCERS11071017
Thiis-Evensen E, Hoff GS, Sauar J, Langmark F, Majak BM VM. [Population-based surveillance by colonoscopy: effect on the incidence of colorectal cancer. Telemark Polyp Study I]. Scand j Gastroenterol. 1999;34(4):414-420. Accessed September 3, 2021. https://www.kreftregisteret.no/Forskning/Prosjekter/prosjektarkiv/NordICC/Publikasjoner/NordICC-publikasjoner/Population-based-surveillance-by-colonoscopy-effect-on-the-incidence-of-colorectal-cancer-Telemark-Polyp-Study-I/
Citarda F, Tomaselli G, Caposaccia R, Barcherini S, Crespi M. Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut. 2001;48(6):812-815. doi:10.1136/GUT.48.6.812
Mönkemüller K, Neumann H, Malfertheiner, Fry LC. Advanced colon polypectomy. Clin Gastroenterol Hepatol. 2009;7(6):641-652. doi:10.1016/J.CGH.2009.02.032
Bhatt A, Abe S, Kumaravel A, Vargo J, Saito Y. Indications and Techniques for Endoscopic Submucosal Dissection. Am J Gastroenterol. 2015;110(6):784-791. doi:10.1038/AJG.2014.425
Delavari A, Mardan F, Salimzadeh H, et al. Characteristics of Colorectal Polyps and Cancer; a Retrospective Review of Colonoscopy Data in Iran. Middle East J Dig Dis. 2014;6(3):144-150. Accessed September 3, 2021. /pmc/articles/PMC4119671/
Sano Y. Narrow Band Imaging (NBI). Clin Gastroenterol. 2009;24:47-52.
Rex DK, Kahi C, O'Brien M, et al. The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc. 2011;73(3):419-422. doi:10.1016/J.GIE.2011.01.023
Tanaka S, Sano Y. Aim to unify the narrow band imaging (NBI) magnifying classification for colorectal tumors: current status in Japan from a summary of the consensus symposium in the 79th Annual Meeting of the Japan Gastroenterological Endoscopy Society. Dig Endosc. 2011;23 Suppl 1(SUPPL. 1):131-139. doi:10.1111/J.1443-1661.2011.01106.X
Kandel P, Wallace MB. Should We Resect and Discard Low Risk Diminutive Colon Polyps. Clin Endosc. 2019;52(3):239-246. doi:10.5946/CE.2018.136
Liljegren A, Lindblom A, Rotstein S, Nilsson B, Rubio C, Jaramillo E. Prevalence and incidence of hyperplastic polyps and adenomas in familial colorectal cancer: correlation between the two types of colon polyps. Gut. 2003;52(8):1140-1147. doi:10.1136/GUT.52.8.1140
Shussman N, Wexner SD. Colorectal polyps and polyposis syndromes. Gastroenterol Rep. 2014;2(1):1-15. doi:10.1093/GASTRO/GOT041
Taherian M, Lotfollahzadeh S, Daneshpajouhnejad P, Arora K. Tubular Adenoma. Cutan Adnexal Neoplasms. Published online July 25, 2021:127-136. Accessed September 3, 2021. https://www.ncbi.nlm.nih.gov/books/NBK553180/
Myers DJ AK. Villous Adenoma - StatPearls - NCBI Bookshelf. Stat Pearls Publishing. Accessed September 3, 2021. https://www.ncbi.nlm.nih.gov/books/NBK470272/
Ferlitsch M, Reinhart K, Pramhas S, et al. Sex-Specific Prevalence of Adenomas, Advanced Adenomas, and Colorectal Cancer in Individuals Undergoing Screening Colonoscopy. JAMA. 2011;306(12):1352-1358. doi:10.1001/JAMA.2011.1362
Fairley KJ, Li J, Komar M, Steigerwalt N, Erlich P. Predicting the risk of recurrent adenoma and incident colorectal cancer based on findings of the baseline colonoscopy. Clin Transl Gastroenterol. 2014;5(12):64. doi:10.1038/CTG.2014.11
Hayashi T, Yatani R, Apostol J, Stemmermann GN. Pathogenesis of Hyperplastic Polyps of the Colon: A Hypothesis Based on Ultrastructure and in vitro Cell Kinetics. Gastroenterology. 1974;66(3):347-356. doi:10.1016/S0016-5085(74)80133-2
Nusko G, Mansmann U, Kirchner T, Hahn EG. Risk related surveillance following colorectal polypectomy. Gut. 2002;51(3):424. doi:10.1136/GUT.51.3.424
Rex DK. Serrated Polyps in the Colon. Gastroenterol Hepatol (N Y). 2014;10(10):671. Accessed September 3, 2021. /pmc/articles/PMC4988225/
The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003;58(6 Suppl). doi:10.1016/S0016-5107(03)02159-X
Kudo S, Rubio CA, Teixeira CR, Kashida H, Kogure E. Pit pattern in colorectal neoplasia: endoscopic magnifying view. Endoscopy. 2001;33(4):367-373. doi:10.1055/S-2004-826104
Kato S, Fujii T, Koba I, et al. Assessment of colorectal lesions using magnifying colonoscopy and mucosal dye spraying: Can significant lesions be distinguished? Endoscopy. 2001;33(4):306-310. doi:10.1055/S-2001-13700
Kang H, Thoufeeq MH. Size of colorectal polyps determines time taken to remove them endoscopically. Endosc Int open. 2018;6(5):E610-E615. doi:10.1055/A-0587-4681
Tolliver KA, Rex DK. Colonoscopic polypectomy. Gastroenterol Clin North Am. 2008;37(1):229-251. doi:10.1016/J.GTC.2007.12.009
Eberth JM, Josey MJ, Mobley LR, et al. Who Performs Colonoscopy? Workforce Trends Over Space and Time. J Rural Health. 2018;34(2):138-147. doi:10.1111/JRH.12286
Mehran A, Jaffe P, Efron J, Vernava A, Liberman MA. Colonoscopy: why are general surgeons being excluded? Surg Endosc. 2003;17(12):1971-1973. doi:10.1007/S00464-003-8806-5
Williams MR, Crossett JR, Cleveland EM, et al. Equivalence in colonoscopy results between gastroenterologists and general surgery residents following an endoscopy simulation curriculum. J Surg Educ. 2015;72(4):654-657. doi:10.1016/J.JSURG.2015.01.018
Patel NM, Terlizzi JP, Trooskin SZ. Gastrointestinal endoscopy training in general surgery residency: what has changed since 2009? J Surg Educ. 2014;71(6):846-850. doi:10.1016/J.JSURG.2014.05.014
Rex DK. Detection Measures for Colonoscopy: Considerations On the Adenoma Detection Rate, Recommended Detection Thresholds, Withdrawal Times, and Potential Updates to Measures. J Clin Gastroenterol. 2020;54(2):130-135. doi:10.1097/MCG.0000000000001301
Lee TJ, Rutter MD, Blanks RG, et al. Colonoscopy quality measures: experience from the NHS Bowel Cancer Screening Programme. Gut. 2012;61(7):1050-1057. doi:10.1136/GUTJNL-2011-300651
Pace D, Borgaonkar M, Evans B, et al. Annual colonoscopy volume and maintenance of competency for surgeons. Surg Endosc. 2017;31(6):2630-2635. doi:10.1007/S00464-016-5275-1
Petersen BT. Quality assurance for endoscopists. Best Pract Res Clin Gastroenterol. 2011;25(3):349-360. doi:10.1016/J.BPG.2011.05.003
Singh N, Harrison M, Rex DK. A survey of colonoscopic polypectomy practices among clinical gastroenterologists. Gastrointest Endosc. 2004;60(3):414-418. doi:10.1016/S0016-5107(04)01808-5
Tolliver KA, Rex DK. Colonoscopic polypectomy. Gastroenterol Clin North Am. 2008;37(1):229-251. doi:10.1016/J.GTC.2007.12.009
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(10):860-863. doi:10.1055/S-2004-825801
Hogan RB, Hogan RB 3rd. Epinephrine volume reduction of giant colon polyps facilitates endoscopic assessment and removal. Gastrointest Endosc. 2007;66(5):1018-1022. doi:10.1016/J.GIE.2007.03.1078
Jung YS, Park JH, Kim HJ, et al. Complete biopsy resection of diminutive polyps. Endoscopy. 2013;45(12):1024-1029. doi:10.1055/S-0033-1344394
Peluso F, Goldner F. Follow-up of hot biopsy forceps treatment of diminutive colonic polyps. Gastrointest Endosc. 1991;37(6):604-606. doi:10.1016/S0016-5107(91)70863-8
Kim JS, Lee BI, Choi H, et al. Cold snare polypectomy versus cold forceps polypectomy for diminutive and small colorectal polyps: a randomized controlled trial. Gastrointest Endosc. 2015;81(3):741-747. doi:10.1016/J.GIE.2014.11.048
Repici A, Hassan C, Vitetta E, et al. Safety of cold polypectomy for. Endoscopy. 2012;44(1):27-31. doi:10.1055/S-0031-1291387
Muniraj T, Sahakian A, Ciarleglio MM, Deng Y, Aslanian HR. Cold snare polypectomy for large sessile colonic polyps: a single-center experience. Gastroenterol Res Pract. 2015;20(15):175-959. doi:10.1155/2015/175959
Uraoka T, Ramberan H, Matsuda T, Fujii T, Yahagi N. Cold polypectomy techniques for diminutive polyps in the colorectum. Dig Endosc. 2014;26 Suppl 2:98-103. doi:10.1111/DEN.12252
Ichise Y, Horiuchi A, Nakayama Y, Tanaka N. Prospective randomized comparison of cold snare polypectomy and conventional polypectomy for small colorectal polyps. Digestion. 2011;84(1):78-81. doi:10.1159/000323959
Holt BA, Jayasekeran V, Sonson R, Bourke MJ. Topical submucosal chromoendoscopy defines the level of resection in colonic EMR and may improve procedural safety (with video). Gastrointest Endosc. 2013;77(6):949-953. doi:10.1016/J.GIE.2013.01.021
Iishi H, Tatsuta M, Iseki K, et al. Endoscopic piecemeal resection with submucosal saline injection of large sessile colorectal polyps. Gastrointest Endosc. 2000;51(6):697-700. doi:10.1067/MGE.2000.104652
Tamura S1, Nakajo K, Yokoyama Y, et al. Evaluation of endoscopic mucosal resection for laterally spreading rectal tumors. Endoscopy. 2004;36(4):306-312. doi:10.1055/S-2004-814204
Kaltenbach T, Soetikno R. Endoscopic resection of large colon polyps. Gastrointest Endosc Clin N Am. 2013;23(1):137-152. doi:10.1016/J.GIEC.2012.10.005
Kedia P, Waye JD. Colon polypectomy: a review of routine and advanced techniques. J Clin Gastroenterol. 2013;47(8):657-665. doi:10.1097/MCG.0B013E31829EBDA7
Larghi A, Waxman I. State of the art on endoscopic mucosal resection and endoscopic submucosal dissection. Gastrointest Endosc Clin N Am. 2007;17(3):441-469. doi:10.1016/J.GIEC.2007.05.012
Burgess NG, Bahin FF, Bourke MJ. Colonic polypectomy (with videos). Gastrointest Endosc. 2015;81(4):813-835. doi:10.1016/J.GIE.2014.12.027
Fujishiro M, Yahagi N, Kakushima N, et al. Successful nonsurgical management of perforation complicating endoscopic submucosal dissection of gastrointestinal epithelial neoplasms. Endoscopy. 2006;38(10):1001-1006. doi:10.1055/S-2006-944775
Zauber AG, Winawer SJ, O’Brien MJ, et al. Colonoscopic Polypectomy and Long-Term Prevention of Colorectal-Cancer Deaths. N Engl J Med. 2012;366(8):687. doi:10.1056/NEJMOA1100370
62. Heldwein W, Dollhopf M, Rösch T, et al. The Munich Polypectomy Study (MUPS): prospective analysis of complications and risk factors in 4000 colonic snare polypectomies. Endoscopy. 2005;37(11):1116-1122. doi:10.1055/S-2005-870512
Rabeneck L, Paszat LF, Hilsden RJ, et al.. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology. 2008;135(6):1899-1906. doi:10.1053/J.GASTRO.2008.08.058
Watabe H, Yamaji Y, Okamoto M, et al.. Risk assessment for delayed hemorrhagic complication of colonic polypectomy: polyp-related factors and patient-related factors. Gastrointest Endosc. 2006;64(1):73-78. doi:10.1016/J.GIE.2006.02.054
Dobrowolski S, Dobosz M, Babicki A, G?owacki J, Na?ecz A.. Blood supply of colorectal polyps correlates with risk of bleeding after colonoscopic polypectomy. Gastrointest Endosc. 2006;63(7):1004-1009. doi:10.1016/J.GIE.2005.11.063
Rabeneck L, Saskin R, Paszat LF. Onset and clinical course of bleeding and perforation after outpatient colonoscopy: a population-based study. Gastrointest Endosc. 2011;73(3):520-523. doi:10.1016/J.GIE.2010.10.034
Vormbrock K, Mönkemüller K. Difficult colon polypectomy. World J Gastrointest Endosc. 2012;4(7):269. doi:10.4253/WJGE.V4.I7.269
Boustière C, Veitch A, Vanbiervliet G, et al. Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2011;43:445-458. doi:10.1055/s-0030-1256317
Hui AJ, Wong RM, Ching JY, et al.. Risk of colonoscopic polypectomy bleeding with anticoagulants and antiplatelet agents: analysis of 1657 cases. Gastrointest Endosc. 2004;59(1):44-48. doi:10.1016/S0016-5107(03)02307-1
Lee TJ, Rutter MD, Blanks RG, et al. Colonoscopy quality measures: experience from the NHS Bowel Cancer Screening Programme. Gut. 2012;61(7):1050-1057. doi:10.1136/GUTJNL-2011-300651
Stock C, Ihle P, Sieg A, et al. Adverse events requiring hospitalization within 30 days after outpatient screening and nonscreening colonoscopies. Gastrointest Endosc. 2013;77(3):419-429. doi:10.1016/J.GIE.2012.10.028
Benson BC, Myers JJ, Laczek JT. Postpolypectomy Electrocoagulation Syndrome: A Mimicker of Colonic Perforation. Case Rep Emerg Med. 2013;2013:1-3. doi:10.1155/2013/687931
Shin YJ, Kim YH, Lee KH, et al. CT findings of post-polypectomy coagulation syndrome and colonic perforation in patients who underwent colonoscopic polypectomy. Clin Radiol. 2016;71(10):1030-1036. doi:10.1016/J.CRAD.2016.03.010
Pohl H, et al. Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study. Gastroenterology. 2013;144(1):74-80. doi:10.1053/J.GASTRO.2012.09.043
Robertson DJ, Greenberg ER, Beach M, et al. Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology. 2005;129(1):34-41. doi:10.1053/J.GASTRO.2005.05.012
Buchner AM, Guarner-Argente C, Ginsberg GG. Outcomes of EMR of defiant colorectal lesions directed to an endoscopy referral center. Gastrointest Endosc. 2012;76(2):255-263. doi:10.1016/J.GIE.2012.02.060
Furnari M, Voiosu T, Ahmed I et al. Approaching polyps in the time of discrimination. Rev Gastroenterol Hepatol Nutr. 2015;2:28-38. doi:10.11138/RGHN/2015.2.1.028
Anderloni A, Jovani M, Hassan C, Repici A. Advances, problems, and complications of polypectomy. Clin Exp Gastroenterol. 2014;7(1):285-296. doi:10.2147/CEG.S43084
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