Cap Polyposis Research Articles

"Cap polyposis", refractory to drug treatment, including infliximab.

Cap polyposis is a rare disease characterized by the presence of inflammatory polyps with an adherent fibrin sheath ("cap"), in variable number and size, in the rectum and sigmoid. It presents with tenesmus, mucous stools and rectorrhagia. There is currently no standardized treatment, having been treated empirically with aminosalicylates, oral or rectal steroids, metronidazole, H. pylori eradication therapy and infliximab with variable results. In refractory cases, endoscopic resection of polyps may be used and surgery may even be necessary. We present the case of a 36-year-old patient diagnosed in our center with cap polyposis, refractory to both pharmacological and endoscopic treatment, and therefore treatment with infliximab was decided out of indication. The case we present is the fourth case of cap polyposis treated with infliximab available in the current literature and highlights the difficulty of achieving a clinical response with pharmacological treatment, including biologic drugs such as infliximab.

Clinical, endoscopic, pathological characteristics and management of cap polyposis: experience from a Tertiary Hospital in China.

Cap polyposis (CP) is a rare kind of benign disease, and the majority of previously published relevant articles involve a small number of patients. Hence, we summarized our experience to contribute additional data, hoping to raise awareness of this disease. From 1 January 2017 to 1 November 2021, consecutive patients diagnosed with CP were retrospectively reviewed. Their medical histories, and laboratory, imaging, endoscopic, and pathology results were analyzed. We made telephone calls to the patients and searched for the information in our electronic medical records to obtain the follow-up results. Forty-one patients were chosen for analysis. The median age of the patients was 20years old, and 90.24% (37 patients) of the patients were male. The majority of the patients presented with hematochezia. The rectum was the most commonly affected site, and the Helicobacter pylori infection rate was high. There were multiple and combined treatments for these patients. These treatments can be divided into 3 main categories: medical therapy, endotherapy and surgery. Medical therapy helped to diminish the size of but the polyps were difficult to resolve; however, the patients' symptoms could be diminished. Twenty-three patients underwent surgical resection, and 12 patients received endotherapy. We further compared the two methods of polyp resection. Both endotherapy and surgery were safe, and the recurrence risk was not significantly different between the two kinds of therapy (p = 0.321). The clinical improvement of medical treatments was not satisfactory, and endotherapy or surgical resection could remove the polyposis and provide temporary relief, but the recurrence rates were high.

Clinical characteristics and treatments of cap polyposis: a single center case series.

Clinical characteristics and treatments of cap polyposis: a single center case series.

Cap Polyposis: An Elusive Diagnosis in a Pediatric Patient Successfully Managed With Endoscopic Treatment

Cap polyposis is a rare condition of the rectum or sigmoid colon manifested by inflammatory polyps covered by a thick layer of fibrinopurulent mucus. This condition typically presents as mucoid diarrhea and rectal bleeding, and patients are often prescribed antibiotics (such as those for Helicobacter pylori), steroids, infliximab, or aminosalicylates. Surgical management is an option for unresponsive disease, but endoscopic management has been rarely reported. For cases of cap polyposis in which conservative medical management fails, wide-field endoscopic mucosal resection is a viable option.

S1987 Cap Polyposis: A Rare Condition in a Pediatric Patient Successfully Treated With Endoscopic Treatment

Introduction: Cap polyposis is a rare condition of the rectum or sigmoid colon manifested by inflammatory polyps covered by a thick layer of fibrinopurulent mucus. This condition typically presents as mucoid diarrhea and rectal bleeding, and patients are often prescribed antibiotics (such as those for Helicobacter pylori), steroids, infliximab, or aminosalicylates. Surgical management is an option for unresponsive disease, but endoscopic management has been rarely reported. Case Description/Methods: A 16-year-old boy had a 10-year history of mucoid diarrhea and occasional rectal bleeding and incontinence. Previous endoscopy revealed pseudopolyps in the rectum that appeared inflammatory with granulation tissue. Initial laboratory evaluation revealed mild iron deficiency, anemia, and hypoalbuminemia. The patient was treated with limited polypectomy, topical steroids, and diphenoxylate-atropine, which did not resolve his symptoms. A full workup for inflammatory bowel disease with an upper endoscopy, colonoscopy, and magnetic resonance enterography showed indications of marked polyposis in the rectum that was suggestive of “cap polyposis”. Tests for H. pylori were negative. There was no improvement with metronidazole or with treatments to reduce straining during bowel movements. Repeat sigmoidoscopy showed diffuse 1–4-cm multilobulated polypoid lesions in the rectum. Initially ESD was considered but deemed unsuitable due to poor lifting of the lesions. Thus, wide field endoscopic mucosal resection (WEMR) was performed, Approximately 40 band ligations with snare endoscopic submucosal resection were performed with near complete removal of all of the lesions. There was no post-procedure bleeding, pain, or other adverse effects. The resected tissue specimen had signs of high-grade dysplasia away from the resection margins. The patient’s symptoms resolved, and a second-look procedure 3.5 months later revealed only a slightly nodular area with no signs of dysplasia or cap polyposis. Discussion: Patients with cap polyposis typically report mucoid stools and rectal bleeding, and evaluations reveal a characteristic pattern on colonoscopy and pathology. For cases of cap polyposis in which conservative medical management fails, wide-field endoscopic mucosal resection is a viable option.

Solitary rectal ulcer transformation to cap polyposis in a 15-year-old child

BackgroundCap polyposis (CP) is a benign, non-malignant inflammatory disease that affects the rectum. It usually occurs during the 5th decade of life, but children could also be affected. Its specific pathology is unknown. Due to the clinical, endoscopic, and histologic similarities with other disorders such as inflammatory bowel disease, a thorough histologic evaluation is critical to avoid unnecessary interventions. This study presents a 15-year-old child with a previously reported case of solitary rectal ulcer (SRU) that developed into CP determined by colonoscopy and histologic findings.Case presentationA 15-year-old boy who was previously diagnosed with SRU presented to our office with rectal bleeding, mucoid discharge, and abdominal pain. Additional colonoscopy evaluation revealed multiple polyposes varying in size and shape limited to the rectum. Histologic examination revealed a characteristic cap of granulation tissue covering tortuous nondysplastic crypts in the inflamed stroma, indicating that SRU had transformed into CP. Based on the assessments, we planned to perform endoscopic mucosal resection of the lesions in multiple sessions.ConclusionsDespite the rarity of CP, the transformation from SRU may be one of its etiologies. Thus, thorough serial histologic evaluation is critical in children with rectal bleeding to avoid unnecessary or harmful interventions.

Benefits of Helicobacter pylori Eradication on Extragastric Diseases

Helicobacter pylori (H. pylori) eradication can reduce the risk of gastric diseases such as gastritis, gastric ulcer, and gastric adenocarcinoma. Since H. pylori was discovered more than 30 years ago, many studies have reported associations between H. pylori infection and extragastric diseases such as immune thrombocytopenia and iron-deficiency anemia. Thus, recent guidelines recommended H. pylori eradication in patients with those diseases. In contrast, although the role of H. pylori eradication in other extragastric diseases remains controversial, there is growing evidence of its benefit on them, especially cardiovascular (ischemic heart disease and stroke), metabolic (dyslipidemia, diabetes mellitus, and non-alcoholic fatty liver disease), neurodegenerative (Parkinson’s disease and Alzheimer’s disease), autoimmune (Graves’ disease, Hashimoto’s thyroiditis, Raynaud’s syndrome, rosacea, and chronic urticaria), and other (cap polyposis, colorectal mucosa-associated lymphoid tissue lymphoma, periodontal disease, hyperemesis gravidarum, and osteoporosis) conditions. A recent prospective randomized study reported that H. pylori eradication improved insulin resistance and dyslipidemia. These findings were consistent with the results of a recent meta-analysis. Therefore, well-designed prospective interventional studies are needed to examine the effects of H. pylori eradication on various extragastric diseases.

Cap polyposis treated with laparoscopic-assisted total proctocolectomy and ileal J-pouch anal anastomosis: a case report

BackgroundCap polyposis (CP) is extremely rare in Japan, and there is no established cure. We report a case in which CP was improved by surgical treatment.Case presentationA 48-year-old man was investigated at a local hospital because of diarrhea and bloody stools in 2018. The patient was treated with metronidazole for suspected amoebic dysentery, but his symptoms did not improve. Subsequent close examination revealed possible CP, but treatment with 5-aminosalicylic acid and a steroid enema had no effect. The patient was then referred to our hospital. The bloody stools, diarrhea, and abdominal pain worsened despite medical treatment, so laparoscopic-assisted total proctocolectomy and ileal J-pouch anal anastomosis with ileostomy were performed. CP has no known cause or established treatment, but Helicobacter pylori (HP) infection has been reported in many CP cases in Japan, and HP eradication is often successful. This patient was HP-negative and did not improve with antimicrobial treatment, but the symptoms improved after surgery.ConclusionsEven after surgery, CP recurrence reportedly occurs within a short period in many cases. However, our patient has had no signs of CP recurrence during 1 year of follow-up.

Vascular Malformation and CAP Polyposis: A New Insight into Pathophysiology or Fortuitous Association?

Introduction: CAP polyposis is a benign colorectal process presenting with multiple colorectal polyps with a “CAP” of inflammatory granulation tissue whose etiology has remained largely unknown. Case: A 24-year-old male presented with a long-standing history of repeated multiple sessile colonic polyps over a period of 17 years. Results: The numerous polyps showed consistent histologic features of superficial erosion with a surface “CAP” of granulation tissue with minimal submucosa to evaluate over this period. A left hemicolectomy disclosed an extensive vascular malformation. Conclusion: The underlying vascular malformation may have an etiologic correlation to the overlying CAP polyps in this patient. Future cases may benefit from an evaluation of the underlying submucosa for the presence of possible vascular malformation likely to be missed on superficial polypectomy.

Cap Polyposis in a Child

Inflammatory cap polyposis (CP) is a uncommon, non-malignant condition characterized by the presence of sessile and pedunculated polyps in the colon and rectum. The histology of these polyps reveals a “cap” of inflammatory granulation tissue with fibrinopurulent exudate that covers the polyps, hence the name “inflammatory cap polyposis”. The pathogenesis of this non-malignant condition is poorly understood and while several associations have been made, causality has yet to be elucidated. The mainstay of initial treatment is conservative, however complicated and refractory cases usually benefit from endoscopic or surgical intervention followed by close surveillance for disease recurrence and progression. We present a 12 yr old girl with a large cap polyposis which was resected successfully by EMR and literature review.

Inflammatory Cap Polyposis of the Rectum: A Rare Entity in an 11-year-old Male Child.

Inflammatory Cap Polyposis of the Rectum: A Rare Entity in an 11-year-old Male Child.

Rectal cap polyposis: a rare cause of rectal bleeding, anaemia and mucoid diarrhoea

Rectal cap polyposis: a rare cause of rectal bleeding, anaemia and mucoid diarrhoea

Successful laparoscopic resection for cap polyposis: case report, literature review

BackgroundCap polyposis is a rare gastrointestinal disease with endoscopically and pathologically distinctive features. Its exact etiology has not been fully elucidated. In a few cases, there was recurrence after inadequate treatment. Efficacy of Helicobacter pylori eradication therapy, however, has been shown in some published research.Case presentationA 70-year-old female patient developed intermittent mucous diarrhea with loss of body weight and visited a physician. Total colonoscopy showed multiple sessile polyps which were partially coadunated from the rectum to the sigmoid colon. Histopathological finding was tubular adenoma with mild atypia. The patient stayed for observation. Worsening symptoms following protein-losing enteropathy demanded surgical treatment because malignancy could not be ruled out. Laparoscopic resection was performed, and the surgical specimens revealed that the polypoid lesion mainly consisted of mild adenomatous glands which were covered with purulent granulation tissues. We made final diagnosis of cap polyposis and saw rapid improvement of her symptoms. Long-term observation is required after surgery.ConclusionsWe reported a case of successful laparoscopic resection of cap polyposis with protein-losing enteropathy (170 words).

A case of cap polyposis with cytomegalovirus colitis

A case of cap polyposis with cytomegalovirus colitis

Cap Polyposis in a Patient with Ulcerative Colitis

Cap Polyposis in a Patient with Ulcerative Colitis

A case of cap polyposis masquerading as inflammatory bowel disease

A case of cap polyposis masquerading as inflammatory bowel disease

Cap Polyposis (CP) was cured by eradication of <i>H. pylori</i>

Cap Polyposis (CP) was cured by eradication of <i>H. pylori</i>

Cap polyposis and colitis cystica profunda: a rare association

: Cap polyposis and colitis cystica profunda (CCP) are two rare, benign and distinct colorectal conditions whose etiology remains unclear. A rare association between cap polyposis and CCP has already been described. In those cases, cystic glands were present in the submucosal layer of the cap polyps.(1,2) Interestingly, in the present case, lesions of CCP were not intermingled with cap polyps, but were distant from them. This article is protected by copyright. All rights reserved.

Cap Polyposis of Colon Due to Helicobacter pylori Infection Masquerading as Inflammatory Bowel Disease

Purpose: Cap polyposis is a rare disorder characterized by the presence of inflammatory colonic polyps in patients with underlying constipation. The etiopathogenesis is unclear, and H. pylori has been suggested as a causative organism. Only six cases of cap polyposis associated with H. pylori have been reported so far. We report a case that was misdiagnosed as Crohn's disease, but further work-up revealed cap polyposis in the setting of H. pylori infection and chronic constipation. A 59-year-old female was referred to our clinic for management of Crohn's disease. She had a history of chronic constipation, and presented to an outside facility with intermittent lower abdominal pain and hematochezia. Colonoscopy had revealed multiple ulcerated polyps from the sigmoid colon to hepatic flexure. Pathology showed polypoid fragments of ulcerated and inflamed granulation tissue with prolapse or hamartomatous features. She was diagnosed with Crohn's disease and initiated on prednisone. The patient presented to our institution for evaluation of persistent symptoms. Colonoscopy revealed multiple 2-20 mm polyps with overlying ulceration and exudate (Figure) in the entire colon, with rectal sparing. The interposed colonic mucosa and terminal ileum appeared normal. Pathology revealed erosions on the polyp surface, cystically dilated crypts with mucoid exudate and inflammatory cells. The diagnosis of cap polyposis was made based on clinical, endoscopic and pathologic features. Esophagogastroduodenoscopy was normal, but H. Pylori immunostatin was positive on gastric biopsies. The patient was initiated on H. pylori eradication treatment and prednisone was recommended to be tapered. The patient reported clinical improvement and a follow-up colonoscopy has been planned.Figure: Ulcerated polyps.Conclusion: Cap polyposis is a rare and benign disorder characterized by the presence of inflammatory polyps, which are covered by a “cap” of granulation tissue. Thirty cases have been reported in the literature, and, similar to our case, were initially misdiagnosed as Crohn's disease or ulcerative colitis. The exact etiology of cap polyposis remains unknown. Treatment regimen is not standardized, but H. pylori eradication has been reported. Review of further cases is necessary to establish a common pathophysiology and standardize the treatment regimen.

Inflammatory “Cap” Polyposis

Inflammatory cap polyposis (ICP) is a rare nonneoplastic polyposis of the colon of unknown etiology that can be confused with prolapse-induced polyps and hyperplastic polyposis. We contribute a case of ICP from a 59-year-old woman who was affected by severe constipation and hematochezia. Numerous sessile and semipedunculated polyps were found in the colon, all with cap of whitish fibrin. Histology revealed erosion of the surface, superficial dilated crypts filled with mucoid inflammatory exudate, and minimal crypt serration, all findings typical of ICP. Only the largest polyps had smooth muscle in the mucosa. Ki-67 showed modest expansion and irregular distribution of the crypts proliferative areas. Low-degree positivity for p16, similar to that of hyperplastic polyps, was found. CK20 was expressed as in normal mucosa. Distinguishing between ICP and other polyposis is important because of difference in management.