Majority Of Polyps Research Articles

Efficacy and Safety of Endoscopic Mucosal Resection for Large Non-ampullary Duodenal Adenomas: A Single U.S. Center Experience

Introduction: Duodenal adenomas have potential for malignant transformation. Hence, surgical or endoscopic removal is recommended. Due to the high morbidity associated with surgical resection, EMR is being increasingly used, but there are no guidelines for endoscopic management of duodenal adenomas. There is also a lack of long-term follow-up data after endoscopic removal. Reported complication and recurrence rates from western data range between 25-33% and 24-37%. This is in comparison to Asian data showing 0-13% complications and 0-13% recurrence rate. The purpose of our study was to evaluate the safety and efficacy of EMR for non-ampullary duodenal adenomas. Methods: Retrospective IRB-approved study of patients with biopsy-proven duodenal adenomas from 2006 and 2013. Ampullary and periampullary adenomas were excluded. Patients had their first follow-up endoscopy at 3-6 months and then yearly. The main outcome measures were complete resection, complications, and incidence of residual and recurrent adenomas. Results: Twenty-nine patients underwent EMR using submucosal lift injection and hot snare technique. The mean age of patients was 65.1 years, and 51.7% were females. Majority of polyps were sessile (93%) and in the second duodenum (79.3%), with a mean size of 23.1 mm (range 10-50 mm). Sixty-nine percent of adenomas were resected in piecemeal fashion while only 9 (31%) were resected en-bloc. Thermal therapy was used in 55.2% adenomas for tissue destruction at the margins, and clips were placed in 82.8% of the patients. Three patients (10.3%) developed bleeding requiring hospitalization and endoscopic hemostasis. No perforations were noted, and none of the patients required any surgical intervention. Histology showed 82.8% of patients had tubular adenomas, while 5 patients (17.2%) had villous features. Follow-up data was available for 19 patients (65.5%), and the mean follow-up duration was 23.2 months. Three patients (15.8%) had residual adenoma at the first follow-up endoscopy, while 4 patients (21%) had recurrent adenomas (diagnosed if at least one priorendoscopic exam with biopsies negative for residual adenoma) at the site of resection after a mean follow-up period of 36.5 months (range 8-60 months). Conclusion: EMR is a safe and effective treatment for large duodenal adenomas. The adenoma size in our study was larger compared to previously published data, likely due to the referral-based nature of our practice. Despite removal of larger sized adenomas, our data showed good long-term outcomes and a low rate of complications. The recurrence rate in our study is comparable to previously published data, and recurrences can be successfully managed endoscopically. These patients require close follow-up with surveillance endoscopies, and surveillance guidelines are needed.

Management of Duodenal–Jejunal Polyps in Children With Peutz‐Jeghers Syndrome With Single‐Balloon Enteroscopy

Children with Peutz-Jeghers syndrome (PJS) have increased risk of polyp-related complications and emergency laparotomies. The aim of the present study was to assess the efficacy and the safety of endoscopic therapy of small bowel polyps using single-balloon enteroscopy (SBE) in children affected by PJS. Between January 2010 and December 2011, prospectively consecutive PJS children with polyps >15 mm or polyps actively bleeding previously identified using video capsule endoscopy and magnetic resonance imaging underwent therapeutic SBE. The main outcome measurements were the feasibility, the technical performance, and the safety. A total of 10 children (6 boys; median age 13.7 years, range 5.6-15.6) underwent 23 SBE procedures. Four patients had a history of abdominal surgery. A total of 53 polyps were removed, and 23 of them were >15 mm. The majority of polyps were found in jejunum (85%). The mean insertion depths for antegrade and retrograde approach were 200 ± 80 and 100 ± 50 cm beyond the ileal valve, respectively. The mean procedure time was 75 ± 25 minutes. Mild abdominal pain was reported after 3 procedures. In 1 patient a postpolypectomy perforation occurred. In conclusion, SBE is an effective endoscopic tool for treating small bowel polyps in children with PJS, and well-timed polypectomy may optimize patients' care, preventing polyp-related complications and emergency laparotomy. Further larger multicenter studies are warranted to accurately determine the safety of therapeutic SBE in children.

Risk Factors Associated with the Malignant Changes of Symptomatic and Asymptomatic Endometrial Polyps in Premenopausal Women.

This study aimed to evaluate the prevalence of premalignant and malignant lesions of symptomatic and asymptomatic endometrial polyps among premenopausal women and to verify whether different clinical parameters, and polyp volume and number are associated with a more precise estimate of malignancy. One hundred and fifty women aged 29-52years and with certain diagnosis of endometrial polyp were enrolled in a prospective observational study. The recruited patients underwent hysteroscopic polypectomy based on saline infusion sonohysterography and diagnostic hysteroscopy. Pathologic report was the main outcome. Among women with endometrial polyps, 62% had asymptomatic polyps. The prevalence of premalignant and malignant polyps comprised 4.6% of cases (3.3% hyperplasia with atypia and 1.3% carcinomatous polyps). The presence of abnormal uterine bleeding was not a predictor of premalignant and malignant changes in the polyp. On logistic regression analysis, the premalignant and malignant lesions were influenced by polycystic ovary syndrome (p<0.001; OR 4.61; CI 1.9-27), polyp volume >10ml (p<0.001; OR 5.83; CI 4.31-9.17), and multiple polyps (p=0. 01; OR 2.05; CI 1.09-3.76). Notably, the odds ratio of polyp volume >10ml was 5.83. This additional risk confirms the importance of polyp volume in the detection of malignant transformation rather than associating bleeding in premenopausal women. Polycystic ovary syndrome, polyp volume greater than 10ml, and increased polyp number represent the markers of risk for premalignant and malignant transformation of endometrial polyps in premenopausal women. Nonetheless, the majority of polyps are asymptomatic, and the risk of malignancy is very low. Therefore, for women with polyp volume ≤10ml and no risk factors, a more expectant approach may be warranted in order to reduce surgical risks and costs.

Conservative Management for Vocal Fold Polyps

IMPORTANCE Classically, surgery has been the mainstay of management for vocal fold (VF) polyps. However, a significant portion of patients experience spontaneous regression and may not require surgery. OBJECTIVES To report the results of conservative management for VF polyps, identify patients with polyps that are more likely to resolve, and describe the time course of resolution. DESIGN, SETTING, AND PARTICIPANTS In this case series of 248 patients with VF polyps conducted presenting to a tertiary referral center, 94 patients were treated conservatively with at least 3 months of follow-up. All laryngoscopy photodocumentation and medical records were reviewed retrospectively. INTERVENTIONS Conservative management with close follow-up. MAIN OUTCOMES AND MEASURES Time course and resolution of VF polyps. RESULTS Of 94 VF polyps, 43 (46%) showed a clinically significant reduction in size, and 36 (38%) resolved completely without requiring surgery. Multivariate analysis showed that VF polyps were most likely to resolve in female patients and in those with small-sized polyp and shorter symptom duration. Of the resolved polyps, 44% and 81% were resolved at 3 months and 8 months, respectively. CONCLUSIONS AND RELEVANCE Selected patients with VF polyp may benefit from conservative management, especially female patients and those with small, recent-onset polyps. The majority of polyps that resolve do so within 8 months, which can assist clinical decision making and counseling.

Improving quality measures in colonoscopy and its therapeutic intervention

Colonoscopy with polypectomy has been shown to reduce the risk of colon cancer. The critical element in the quality of colonoscopy in terms of polyp detection and removal continues to be the performance of the endoscopist, independent of patient-related factors. Improved results in terms of polyp detection and complete removal have implications regarding the development of screening and surveillance intervals and the reduction of interval cancers after negative colonoscopy. Advances in colonoscopy techniques such as high-definition colonoscopy, hood-assisted colonoscopy and dye-based chromoendoscopy have improved the detection of small and flat-type colorectal polyps. Virtual chromoendoscopy has not proven to improve polyp detection but may be useful to predict polyp pathology. The majority of polyps can be removed endoscopically. Available polypectomy techniques include cold forceps polypectomy, cold snare polypectomy, conventional polypectomy, endoscopic mucosal resection and endoscopic submucosal dissection. The preferred choice depends on the polyp size and characteristics. Other useful techniques include colonoscopic hemostasis for acute colonic diverticular bleeding, endoscopic decompression using colonoscopic stenting, and transanal tube placement for colorectal obstruction. Here we review the current knowledge concerning the improvement of quality measures in colonoscopy and colonoscopy-related therapeutic interventions.

Gallbladder Polyps: Sixty Patients and Literature Review

OZET Results: The average age of patients was 45.7. In 26 patients, the diagnosis was made incidentally during ultrasound imag- ing performed for some other reason. The mean diameter of polyps was 7.3 mm as measured by ultrasonography. In 24 patients only one polyp existed while the remainders had two or more polyps determined by ultrasonography. In the order of frequency, the majority of polyps were located in the gall- bladder corpus, fundus and the neck. Relevant studies have identified some risk factors for polyps. These may be listed as follows: Polyps 10 mm or greater in size, those single or sessile, those accompanied by irregularity or the thickening of adjacent gallbladder wall, rapid growth during follow-up and patient age over 50. Cholecystectomy is recommended in symptomatic patients as well as in those patients with one or more risk factors. For asymptomatic patients with no risk fac- tors, surveillance by ultrasonographic follow-up is adequate. Conclusion: Before making a decision for surgery, all patients should be sought for risk factors to reduce unnecessary chole- cystectomies and surgery related complications.

Epidemiology and Clinical Characteristics of Colorectal Polyps in Asian Americans

Purpose: Colon polyps are a known risk factor for colorectal cancers (CRCs). Most CRCs arise from adenomas, many of which are polyps that progress from small to large (>1 cm) and then to cancer. Most of the current data regarding colon polyps focus primarily on the Western population. Asian Americans (South Asian & Southeast Asian/East Asian) comprise ˜6% of the U.S. population and are one of the fastest growing populations in the U.S. Furthermore, Asian Americans have one of the lowest screening rates when compared with other ethnic groups due to various reasons. Additionally, there is an increasing incidence of CRCs among Asian Americans which may be partly due to adoption of Western habits and lifestyle. Currently, there are not many studies evaluating the epidemiology of polyps in the Asian American. The goal of our study is to define the epidemiology and clinical characteristics of colorectal polyps in Asian Americans undergoing screening colonoscopy. Methods: We conducted a retrospective chart review of 1,300 Asian patients who underwent screening colonoscopy at a New York City hospital from Jan 2006 to Dec 2010. Patient demographics and polyp features were recorded from our Clinical Outcome Research Initiative (CORI) database. Patients without polyps were excluded. All colonoscopies and polypectomies were performed by board certified gastroenterologists. The patient charts were reviewed to evaluate the polyp characteristics including location, size, and pathological features. Results: Out of 1,300 patients, polyps were detected in 311 patients (24%). The mean age of the population was 60.8 ± 7.3 (49-82). There were 173 males and 138 females, with M:F ratio of 1.3:1. The majority of the polyps were found in males (56%). The location of the polyp was left sided in 49%, right sided in 41%, & bilateral in 10%. The majority of the polyps were <5 mm in size (55%), 31% had intermediate (5-9 mm) polyps & 14% had polyps ≥1 cm. Pathologically, tubular adenoma was the most common type of polyp (74%), followed by hyperplastic polyp (11%) & villous polyp (11%); the least common pathology being high grade dysplasia/colorectal cancer (4%). Conclusion: Our study showed an adenoma prevalence rate of 21% on screening colonoscopy in Asian Americans. This detection rate is slightly lower than the estimated prevalence of adenoma in the general population in U.S. (25-30%). Large sized polyps were associated with advanced histology. The proportion of polyp according to pathology and size was similar to the general population. Majority of colon polyps and CRC were seen on the left side. Large multicenter studies are needed to confirm our results. Our findings suggest that we need to intensify efforts to increase colorectal cancer screening in Asian Americans.

CHARACTERISTICS AND DISTRIBUTION OF POLYPS FOUND IN BOWEL CANCER SCREENING COLONOSCOPY

IntroductionBowel Cancer Screening Programme (BCSP) in the UK achieved nationwide coverage in 20101. We collected data from a local endoscopy unit that performs bowel cancer screening colonoscopy between 2010 and...

Characteristics and Risk Stratification of Colon Polyps among Asymptomatic Hispanic Patients Undergoing First Time Screening Colonoscopy: A Retrospective Study

Goals: To determine characteristics of polyps in Hispanic patients undergoing first-time screening colonoscopy and to risk stratify them based on findings. Background: Current guidelines recommend screening colonoscopy beginning at age 50 in the average-risk population. Race has been shown to influence the risk of colorectal cancer, thus leading to the recommendation of initiating screening in blacks at the age of 45. Few data exist on the prevalence and characteristics of colon polyps among U.S. Hispanics. Study: Retrospective study at a community hospital in Brooklyn, NY serving large Hispanic population including patients >50 undergoing first-time screening colonoscopy who met inclusion and exclusion criteria. Results: Our final data analysis of 192 Hispanic patients showed that the majority of polyps (56%) were tubular adenomas with 17% showing dysplastic features. In a risk stratification analysis, 52.6% of patients fell into the low risk category while 47.4% of patients had adenomas with at least one high risk feature for progression to colon cancer. Conclusions: We found that Hispanic patients undergoing first-time screening colonoscopy have increased risk for malignancy based on the features of their polyps. There is need for further, race-specific studies determining the cause of increased progression to neoplasia and the possible need for earlier screening.

Risk Factors Associated with Premalignant and Malignant Endometrial Polyps

Endometrial polyps are a common gynecologic condition that affects up to 25% of the general population, most frequently periand postmenopausal women. These lesions are defined as localized overgrowths of endometrial tissue that contain a variable amount of glands, stroma, and blood vessels, covered by pseudostratified epithelium. Endometrial polyps are frequently associated with abnormal uterine bleeding and are often asymptomatic, incidentally detected during routine gynecologic examinations. Although the majority of polyps are benign, a small proportion may become malignant. The prevalence of endometrial cancer in polyps has been reported to range from 0-4.8%, depending on the selection of patients and resection methods used. With the expanding use of ultrasonography in outpatient clinics, the diagnosis of endometrial polyps has increased. Once polyps have been detected, operative hysteroscopy ISSN 1226-8704 http://dx.doi.org/10.6118/jksm.2013.19.2.74 J Korean Soc Menopause 2013;19:74-80

Colectomy for Endoscopically Unresectable Polyps

Colonoscopy has an established role in reducing the burden of colorectal cancer through early detection and removal of polyps. For endoscopically unresectable polyps, colectomy is generally indicated to prevent malignant transformation or to remove cancer already present. This study aimed to determine the incidence of malignancy and the factors predictive of malignancy in surgically resected benign polyps. DESIGN/PATIENTS/SETTING: This study was a retrospective chart review of patients undergoing a colectomy for a colonic polyp (no preoperative diagnosis of cancer) in 4 hospitals within the Mayo Clinic Health System. Patient characteristics, endoscopic location and size, and preoperative and operative polyp pathology were tabulated. Correlations between these features and the finding of invasive carcinoma on surgical pathology were assessed. A total of 750 patients met our inclusion criteria. Patients were predominantly male (55.2%) with an average age of 69.4 ± 9.8 years. A majority of polyps were located in the right colon (70.9%). Invasive cancer was identified in 133 patients (17.7%). Multivariate analysis revealed polyps in the left colon (adjusted OR 2.13, 95% CI (1.22-3.72)), and those with high-grade dysplasia (adjusted OR 4.60, 95% CI (2.91-7.27)) were more likely to harbor carcinoma. Age, sex, polyp dimension, and villous features were not predictive of malignancy. Of the patients with cancer, 31 (23.3%) had nodal disease. This study is limited by its retrospective nature, the change in terminology and technique over time, and the partially subjective nature of an endoscopically unresectable polyp. The finding that polyp size and villous features do not strongly predict malignancy differs from previous endoscopic studies. This study confirms that polyps located in the left colon or with high-grade dysplasia are more likely to harbor cancer. The results of this study suggest that endoscopically unresectable polyps are best treated by radical oncologic resection.

Immunohistochemical testing of conventional adenomas for loss of expression of mismatch repair proteins in Lynch syndrome mutation carriers: a case series from the Australasian site of the colon cancer family registry

AbstractDebate continues as to the usefulness of assessing adenomas for loss of mismatch repair protein expression to identify individuals with suspected Lynch syndrome. We tested 109 polyps from 69 proven mutation carriers (35 females and 34 males) belonging to 49 Lynch syndrome families. All polyps were tested by immunohistochemistry for four mismatch repair proteins MLH1, MSH2, MSH6 and PMS2. Detailed pathology review was performed by specialist gastrointestinal pathologists. The majority of polyps (86%) were conventional adenomas (n=94), with 65 tubular and 28 tubulovillous adenomas and a single villous adenoma. The remaining 15 lesions (14%) were serrated polyps. Overall, loss of mismatch repair expression was noted for 78/109 (72%) of polyps. Loss of mismatch repair expression was seen in 74 of 94 (79%) conventional adenomas, and 4 of 15 (27%) serrated polyps from mismatch repair gene mutation carriers. In all instances, loss of expression was consistent with the underlying germline mutation. Mismatch repair protein expression was lost in 27 of 29 adenomas with a villous component compared with 47 of 65 adenomas without this feature (93 vs 73%; P=0.028). A strong trend was observed for high-grade dysplasia. Mismatch repair deficiency was observed in 12 of 12 conventional adenomas with high-grade dysplasia compared with 60 of 79 with low-grade dysplasia (100 vs 76%; P=0.065). We were unable to demonstrate a significant association between conventional adenoma size or site and mismatch repair deficiency. All (4/4 or 100%) of the serrated polyps demonstrating mismatch repair deficiency were traditional serrated adenomas from a single family. Diagnostic testing of adenomas in suspected Lynch syndrome families is a useful alternative in cases where cancers are unavailable. The overwhelming majority of conventional adenomas from mutation carriers show loss of mismatch repair protein expression concordant with the underlying germline mutation.

Incidental Para-Nasal Polyps on Brain MRI Images in a Cameroonian Population

Rationale: Paranasal polyp is a soft tissue pear-shaped mass seen in the sinuses around the nostril. Allergy and inflammations are the major implicating factors. Small polyps could be of no concern to patients but large size could be a disturbance with perennial nasal obstruction and rhinorrhea. MRI with its superlative soft tissue contrast and multi-planarity facilitates the detection of paranasal polyps in brain MRI even when the referral is un-related to otorrhinolarygological features.Objective: To evaluate the prevalence and regional localisation of incidental polyps seen in brain MRI. Design and equipments: Prospective pioneer study using 0.3Tesla Hitachi AIRIS 11 MRI equipment. Setting: Polyclinic Bonanjo, Douala, Cameroon, a Specialist Hospital. Patients: 103 Patients referred for brain MRI from June 2009- Jan 2010 with only neurological symptomatology. Main outcome measured: Paranasal sinus was evaluated for polyps using T1W, T2W, FLAIR in different acquisitions. Results: 103 Patients were studied, 20 Patients had paranasal polyps with 14 (70%) males and 6 (30%) females forming a ratio of 2.33:1. Peak age range was 20-29years with 7 polyps (30%) followed by 50-59years with 25%. Polyps were rare in extremes of age. These 20 patients had 23 polyps due to 2 cases of bilateral maxillary polyps and single case of multiple polyps. The highest number of paranasal polyps 17 (73.91%) were in the maxillary sinus, followed by sphenoidal and frontal sinuses. Majority of polyps were pedunculated and < 2cm. Conclusion: Paranasal polyps are easily detected by MRI. The highest location is in the maxillary sinus with male preponderance.

Kolorektale Adenome: Pro konventionelle/laparoskopische Resektion

The knowledge that due to the adenoma-cancer sequence polyps will develop sooner or later into invasive cancer demands the complete removal of colorectal polyps. The majority of polyps can be endoscopically removed. The indications for surgical removal of polyps are a previous incomplete endoscopic resection, location not amenable to endoscopic removal and lesions which are macroscopically highly suspicious for malignancy and cannot be detached by submucosal saline injection. If a surgical approach is indicated minimally invasive surgery in the hands of an experienced laparoscopic surgeon is a suitable option. Adenomas suspicious for malignancy in the lower two thirds of the rectum should not be treated by time-consuming endoscopic submucosal dissection (ESD) and can be quickly and safely removed transanally, conventionally or by transanal endoscopic microsurgery (TEM) by a full thickness én bloc resection. This allows the pathologist to determine the depth of invasion and the completeness of resection in terms of the circumferential margin and a definitive radical surgical approach is only necessary in high risk situations.

Gastric polypectomies in our department. Analysis of 198 specimens from 166 patients

Background: 1–4% of patients who undergo gastric biopsy have gastric polyps. The two most common gastric polyps are the hyperplastic polyps which arise in patients with underlying gastritis and the fundic-gland polyps which are associated with long term PPI therapy. It has been reported that the risk of gastric polyp is increased in various colonic polyposis syndromes. The risk of colorectal adenocarcinoma increases significantly in patients with gastric cancer. Aims: To analyze the frequency of gastric polypoid lesions in our patient population and to evaluate association of gastric polyps with colon polyps. Materials and methods: Gastric polypectomies performed in our endoscopic department between January 2008 and December 2010 were analyzed restrospectively. We made 198 endoscopic polypectomies in 166 patients. Polypoid lesions were totally removed after infiltration with diluted epinephrine by loop, electrocauter or by hot biopsy forceps. In our patient population prevailed the female gender (116 females and 50 males). In some cases more than one polyp were removed in the same session, or subsequent polypectomies were performed at the controll gastroscopy in the same patient. The polyps were analyzed in many aspects (location, shape, size, histologic subtypes). It was also looked for that colonoscopy has ever made in these patients and the results of it were assessed. Results: The majority of polyps were located in the body of the stomach (105/198, 53%) and were sessile in form (178/198, 90%). More than half of the polyps were less than 5mm (105/198, 53%). The most common histology were hyperplastic polyp and fundic gland polyp (both 74/198, 37%). Other findings were chronic gastritis in 11 (6%), foveolar hyperplasia in 10 (5%), adenoma in 6 (3%), inflammatory polyp in 5 (3%) and neuroendocrine tumor in 7 (4%) cases. The histology were negative in 9 (5%) cases and in 2 patients histology sample was not taken. Colonoscopy was performed in 106 patients (63.9%) and colonic polyps were revealed in 29 patients (27.6%), colon cancers in 6 cases (5.7%). Conclusion: In our cases the hyperplastic and fundic gland polyps were most and equally frequent gastric polyps. We found in about one third of patients synchronous colonic polyps or tumors. In case of gastric polyp performing colonoscopy is mandatory.

Large Colorectal Polyps

High rate of malignancy has been reported in large colorectal polyps. However, studies were limited by including surgically resected polypoid lesions, only polyp ≥3 cm, only sessile polyps or carcinoma in situ. The aim of the study was to define the prevalence of invasive carcinoma among colorectal polyps ≥2 cm in diameter detected by colonoscopy and also to study the success of endoscopic resection.All polypectomies of ≥2 cm colorectal polyps were identified from our endoscopy and pathology database and patients' medical records were reviewed for gross features, techniques of resection, complications, histology, and follow-up. Standard statistical tests were applied for calculating the rates, prevalence, and difference in proportions.Colonoscopic resection of 183 large polyps was performed in 174 patients over a period of 6 years (55% men and 45% women), mean age 64 years (median 67 y and range 25-91 y). The majority of polyps were sessile (84%). Fifty-six percent were located in the right colon. Invasive cancer was found in 10% of polyps. Endoscopic resection was successful in 89% of patients. Postpolypectomy bleeding and perforation was noted in 5% and 2% of patients, respectively. No death was observed. Seventy-eight percent of patients completed >1 year of follow-up after initial polypectomy. Recurrence of adenoma was noted in 12%, which was managed successfully by colonoscopic polypectomy techniques.The rate of invasive cancer is low among endoscopically resected large colorectal polyps and most of these polyps can be resected successfully via colonoscopy with minimal morbidity and no mortality. A close endoscopic follow-up is required to monitor for recurrence.

CT Colonography Fails To Detect Hyperplastic Polyposis Syndrome

Purpose: Hyperplastic Polyposis Syndrome (HPS) patients carry an increased risk of colorectal cancer (CRC), likely through a serrated pathway recently described in the literature. The current management options are frequent endoscopic surveillance to detect and remove all polyps, to prevent malignant progression, versus prophylactic surgical resection. CT colonography was developed as a noninvasive method for CRC screening. Subsequent studies have shown its limitations, particularly in detecting smaller flat polyps. We report a patient diagnosed with HPS where a CT colonography failed to show multiple sessile polyps. Case Presentation: A 52 year-old Caucasian male with no family history of CRC or polyps, underwent a surveillance colonoscopy that showed multiple large right sided hyperplastic polyps, and coexisting tubular adenomas. The following year a repeat colonoscopy showed multiple right and left sided hyperplastic polyps and tubular adenomas. Three years later a colonoscopy showed three flat polyps one of which was 1 cm and was a sessile serrated polyp. The exam was limited due to a torturous long colon and poor preparation. It was decided to reschedule the patient for a same day CT colonography followed by an optical colonoscopy under deep sedation. The CT colonography was reported as showing no polyps. The subsequent colonoscopy on the same day showed 12 flat polyps ranging in size from 5 to 8 mm including proximal large polyps that were hyperplastic. The patient was offered prophylactic surgical resection, but preferred to undergo frequent endoscopic surveillance due to comorbidities. Six months later a repeat colonoscopy showed multiple hyperplastic and tubular adenomas up to 1.2 cm. Discussion: Patients with HPS are at increased risk of CRC. CT colonography has limited sensitivity for detecting small flat polyps, which are the majority of polyps seen in HPS. Our case represents the failure of CT colonography in detecting HPS, which further questions its reliability as a modality of CRC screening especially in patients with flat polyps including hyperplastic, tubular adenomas and sessile serrated polyps.

Gallenblasenpolypen: Prävalenz und Risikofaktoren

The objective of the present study was to investigate the prevalence of gallbladder polyps and possible risk factors in a random population sample of an urban population. A total of 2099 subjects (1072 women, 1027 men; aged 19 - 65 years, mean age 42.1 (SD ± 12.8 years) were prospectively examined using ultrasound, a standardized questionnaire and laboratory studies. Gallbladder polyps were identified in 6.1 % (128 / 2099) of all subjects (women: 6.1 % [63 / 1027]); men: 6.1 % [65 / 1072]). Solitary polyps were found in 52.4 % (65 / 124), two polyps in 16.1 % (20 / 124), three polyps in 6.5 % (8 / 124), several polyps in 22.6 % (28 / 124) and multiple polyps in 2.4 % (3 / 124) of subjects. The mean polyp diameter was 4.7 mm (SD ± 2.2; range 2 - 20 mm). The polyp diameter was ≤ 7 mm in 94.5 % of subjects. The polyps were described as pedunculate in 82.3 % (102 / 124). The polyps were broad-based in 11.3 % of subjects (14 / 124; men: 18 % women: 4.8 %). The polyps were homogeneously echogenic in 100 % of cases and with irregular contours in only one male subject. Multiple logistic regression failed to demonstrate an influence on the increased occurrence of gallbladder polyps for the risk factors of male sex, age, body-mass index (BMI), alcohol, nicotine or caffeine consumption or diabetes mellitus. The prevalence of gallbladder polyps reported in the present study (6.1 %) is higher than figures previously published for populations in Germany or Europe. The majority of polyps were pedunculate and solitary. A typical risk factor profile for gallbladder polyps could not be identified in the present population sample.

Endoscopic therapy of small-bowel polyps by double-balloon enteroscopy in patients with Peutz-Jeghers syndrome

Peutz-Jeghers syndrome (PJS) is a hereditary disorder characterized by mucocutaneous pigmentations and hamartomatous polyps mainly in the small bowel. These polyps may cause complications such as intussusception. To assess therapeutic efficacy and safety of double-balloon enteroscopy (DBE) for detection and treatment of small-bowel polyps in patients with PJS. Prospective cohort study. Tertiary-care referral center. This study involved 13 patients with PJS, defined as a proven STK11 gene mutation or according to international diagnostic criteria. DBE with enteroscopic removal of pedunculated polyps of > or =10 mm. Location, number and size of small-bowel polyps, polypectomy data, and complications and long-term complications associated with development of small-intestine polyps. Thirteen patients with PJS (8 male, mean age 31 years) underwent 29 DBE procedures. Ten patients (77%) had a history of partial small-bowel resection because of small-bowel polyps. Small-bowel polyps were found in all 13 patients. The majority of polyps (94%) were located in the proximal jejunum. A total of 82 polyps of > or =10 mm were detected, and 79 (96%) were endoscopically removed without complications. After the introduction of DBE, no small-intestine-polyp-related complications occurred during a follow-up period of 356 person-months. Small number of patients. DBE is clinically useful and safe for diagnosis and therapy of small-bowel polyps in patients with PJS, even in patients with a history of extensive abdominal surgery. DBE may decrease the need for laparotomy in patients with PJS.

Clinical, Endoscopic and Pathologic Findings of Colonic Polyposis in Korean Children

Purpose: Colonic polyposis is less common in children than in adults. The clinical data pertaining to colonic polyposis in children are limited. Children with colonic polyposis have complications associated with numerous polyps, malignant transformation of the polyps, and extraintestinal neoplasms. We studied the clinical spectrum, endoscopic characteristics, and histologic findings of colonic polyposis in Korean children. Methods: We reviewed the clinical data of 37 children with multiple colonic polyps between 1987 and 2009. The mean age at the time of diagnosis of colonic polyposis was 8.0±3.2 years. Results: Peutz-Jeghers syndrome, juvenile polyposis syndrome, familial adenomatous polyposis (FAP), and lymphoid polyposis was diagnosed in 22, 7, 6, and 2 children, respectively. The most common clinical presentation in children with colonic polyposis was hematochezia. A family history of colonic polyposis was noted in 7 children. The colonoscopic findings of colonic polyposis varied with the size and number of polyps. The majority of polyps were multi-lobulatd and pedunculated in children with Peutz-Jeghers syndrome. The polyps in children with juvenile polyposis syndrome were primarily round and pedun- culated. For the children with FAP, the colon was carpeted with small, sessile polyps. There were multiple sessile polyps in the patients with lymphoid polyposis. Surgical polypectomy was performed in 14 children (38%). Intestinal segmental resection was performed in 13 children (35%). Four patients with FAP underwent total colectomy. Four children with Peutz-Jeghers syndrome had extraintestinal neoplasms. No malignant transformation of polyp was identified. Conclusion: Children with colonic polyposis should undergo a careful initial evaluation and require periodic re-evaluation. (Korean J Pediatr Gastroenterol Nutr 2010; 13: 154∼163)