Pedunculated Colon Polyps Research Articles

Tu1503 Morphometric Analysis of the Blood Supply to the Stalk of Pedunculated Colon Polyps: What Level Is Appropriate for Polypectomy?

Bleeding after colonoscopic resection of pedunculated polyp occurs infrequently but is unpredictable. Anecdotally, polypectomy is recommended in the middle of the stalk, but it is not clear what level of the stalk is best for preventing hemorrhage. To address this issue, we conducted a morphometric study on blood supply to the stalk of pedunculated colon polyps.

Early stage colon cancer

Evidence has now accumulated that colonoscopy and removal of polyps, especially during screening and surveillance programs, is effective in overall risk reduction for colon cancer. After resection of malignant pedunculated colon polyps or early stage colon cancers, long-term repeated surveillance programs can also lead to detection and removal of asymptomatic high risk advanced adenomas and new early stage metachronous cancers. Early stage colon cancer can be defined as disease that appears to have been completely resected with no subsequent evidence of involvement of adjacent organs, lymph nodes or distant sites. This differs from the clinical setting of an apparent "curative" resection later pathologically upstaged following detection of malignant cells extending into adjacent organs, peritoneum, lymph nodes or other distant sites, including liver. This highly selected early stage colon cancer group remains at high risk for subsequent colon polyps and metachronous colon cancer. Precise staging is important, not only for assessing the need for adjuvant chemotherapy, but also for patient selection for continued surveillance. With advanced stages of colon cancer and a more guarded outlook, repeated surveillance should be limited. In future, novel imaging technologies (e.g., confocal endomicroscopy), coupled with increased pathological recognition of high risk markers for lymph node involvement (e.g., "tumor budding") should lead to improved staging and clinical care.

Long-Term Follow-Up of Patients with Malignant Pedunculated Colon Polyps after Colonoscopic Polypectomy

Previously published studies have suggested that patients with resected colon cancer have an increased risk for early metachronous colon cancer. Current screening guidelines recommend intense surveillance by colonoscopy for the initial five years after the initial colon cancer has been resected. Information regarding endoscopically removed malignant polyps is limited. In the present study, 25 consecutive patients (14 male, 11 female) with malignant pedunculated colon polyps treated with snare cautery polypectomy were followed for more than one decade up to 20 years. Five patients required an additional resection to ensure that removal of the original cancer was complete. Annual colonoscopies were planned for five years. If an adenoma was detected in the fifth year, colonoscopy was performed annually until no adenomas were detected. Otherwise, colonoscopy was planned every three years after five years. In the present study, there was no mortality from colon cancer and no patient developed either recurrent colon cancer or an early metachronous colon cancer during the initial five-year period of surveillance. Two patients (one male, one female) ultimately developed late cecal cancers almost one decade after the original colon cancers were resected. One had an early stage cancer that was resected, while the other had an infiltrating mucinous carcinoma complicating a small tubulovillous adenoma with extension to a single lymph node. After surgical removal and adjuvant chemotherapy, no further neoplastic disease has been detected. Overall, patients with malignant pedunculated polyps do extremely well if appropriately managed at the time of the initial polypectomy. Short-term outcomes after removal of a malignant polyp(s) appear to be similar to those with a nonmalignant polyp. However, late metachronous colon cancer may still occur. Long-term follow-up should be considered in each patient, assuming reasonable life expectancy, because risk of additional adenomas and metachronous colon cancer persists even after the initial five years of currently recommended surveillance. Patients with resected malignant polyps may represent a special patient subgroup that requires surveillance for more extended periods than current guidelines have recommended.

Autoamputation of a large pedunculated colon polyp

Autoamputation of a large pedunculated colon polyp

Extremity Leiomyosarcoma Metastasizing to the Large Bowel As a Pedunculated Colon Polyp

Extremity Leiomyosarcoma Metastasizing to the Large Bowel As a Pedunculated Colon Polyp

Endoscopic Resection of Giant Infracted Colonic Inflammatory Fibroid Polyp Mimicking Colonic Neoplasm

Purpose: Inflammatory fibroid polyp (IFP) is an uncommon non-neoplastic lesion more frequently involving the stomach and the small intestine and they are rarely described in the esophagus or the colon. The colonic IFP are usually asymptomatic, however, when they become very large, they may present with colicky pain, weight loss, diarrhea, bleeding, anemia, and intussusceptions. We report a case of giant infracted colonic IFP causing chronic intermittent abdominal pain and hematochezia treated successfully with endoscopic resection. Case: Our patient is an 83 year old male with past medical history of diabetes mellitus, coronary artery disease and end stage renal disease treated with hemodialysis, presented with one week history of hematochezia, chronic intermittent abdominal cramps, and anemia. Physical exam was unremarkable. He was scheduled for colonoscopy which revealed a giant polypoid mass, nearly obstructing the lumen of the descending colon. The mass was pedunculated, had a wide stalk, and measured 7.0 cm in size. Biopsies obtained with forceps revealed acutely inflamed stroma with granulation tissue but no epithelium was present for evaluation. Serum CEA was 1.3. CT scan of abdomen was done and revealed hypodense and heterogeneous mass within the proximal descending colon with somewhat low internal density corresponding to fat density which may represent lipoma, however, malignancy could not be excluded. Surgical option was declined by the patient. Colonoscopy was repeated and endoscopic polypectomy was performed. The mass was removed in a piecemeal fashion on two sessions. Pathology reported a 7.0 x 4.0 x 3.0 cm polyp with extensive infarction and necrosis with some areas of benign inflammatory fibrosis with scattered eosinophils. Immunostain was positive for CD34 and negative for S 100 and desmin. Patient's symptoms resolved completely after polypectomy. Conclusion: Although large benign colonic polyps can be difficult to differentiate from malignant polyps prior to resection, (even with abdominal imaging and direct endoscopic visualization), carefully selected cases can be accurately and safely diagnosed and treated endoscopically. This report is distinct to demonstrate that endoscopic resection of a giant infracted and symptomatic colonic IFP still remains a safe and effective option of therapy when it is performed by experienced endoscopists at the tertiary centers. To our knowledge this is the largest reported pedunculated colonic inflammatory fibroid polyp successfully treated by endoscopic polypectomy.

Novel use of combined Dual Knife and endoloop for resection of a large pedunculated colon polyp

Novel use of combined Dual Knife and endoloop for resection of a large pedunculated colon polyp

Synchronous cecal adenocarcinoma and multiple colonic in situ carcinomas in hamartomatous polyps in a case of isolated Peutz–Jeghers syndrome

Synchronous cecal adenocarcinoma and multiple colonic in situ carcinomas in hamartomatous polyps in a case of isolated Peutz–Jeghers syndrome Yahia Z Gad1, Doaa H Bakr1, Mohammad G El-Ebeidy21Department of Internal Medicine, 2Department of Surgery, Mansoura Specialized Medical Hospital, Mansoura University, Mansoura, EgyptBackground: Peutz–Jeghers syndrome (PJS) is a rare autosomal dominant disease characterized by mucocutaneous pigmentation and hamartomatous polyps of the entire gastrointestinal tract. A Peutz–Jeghers polyp (PJP) in a patient without pigmentation or a family history of the disease is called an isolated or solitary PJP. Individuals with PJS carry a very high risk of developing gastrointestinal (GI) as well as extra-GI malignancies. This case report documents lesion multiplicity and their malignant potential in a young patient with PJS presenting in a serious condition for the first time.Case report: An 18-year-old female Egyptian patient was admitted with hematochezia and remarkable anemia. After appropriate resuscitation and consent, colonoscopic evaluation revealed seven pedunculated colonic polyps at the ascending and the transverse colon, and numerous variable-sized sessile polyps were scattered all over the colon. To establish hemostasis, endoscopic polypectomy for pedunculated polyps and argon plasma photocoagulation for the bleeding sessile polyps were performed. Histopathological examination revealed cecal adenocarcinoma in one specimen and two simultaneous in situ carcinoma at the transverse and the sigmoid colon in the mucosae of the excised histologically proven hamartomatous polyps. Additionally, one focal in situ carcinoma in the resected colon was detected.Conclusions: When considering the family history, serious GI neoplastic lesions may be unmasked in young patients with PJS who present with hematochezia, even in the absence of its characteristic mucocutaneous pigmented lesions. GI endoscopic surveillance programs should be adopted for diagnosed cases of PJS and their families. Genetic prenatal screening for early detection is the best option for primary prevention.Keywords: isolated, Peutz–Jeghers syndrome, hematochezia

Colitis cystica profunda presenting with a mucus pool within the stalk of a pedunculated colon polyp

Colitis cystica profunda presenting with a mucus pool within the stalk of a pedunculated colon polyp

Endoscopic resection of large pedunculated colonic polyps and risk of postpolypectomy bleeding with adrenaline injection versus endoloop and hemoclip: a prospective, randomized study

Postpolypectomy bleeding is a major complication, especially in large pedunculated colonic polyps. Several endoscopic techniques have been evolved for prevention of bleeding episodes. The aim of this study is to evaluate postpolypectomy bleeding rates in large (>2 cm) pedunculated colonic polyps using either adrenaline injection alone or loop and clip application as prophylactic methods. Patients with one pedunculated colonic polyps (>2 cm) were included in a double-blind study and studied prospectively. Exclusion criteria were coexistence of other large polyps, antiplatelet, nonsteroidal anti-inflammatory drugs or aspirin. In group A (n = 32), adrenaline (1:10,000) was injected in the base of the stalk followed by conventional polypectomy using mixed coagulation and cutting current. In group B (n = 32), a detachable snare was placed at the base of the stalk followed by conventional polypectomy and clip application in the residual stalk above the snare. We evaluate the efficacy of combined endoscopic methods in early and late postpolypectomy bleeding rate in large pedunculated colonic polyps, severity of bleeding, days of hospitalization, and required transfusions. Overall, bleeding complications occurred in 5/64 patients (7.81%). In group A (adrenaline injection alone), four patients (12.5%) had a bleeding episode: two (6.25%) occurred during the first 24 h and two (6.25%) between days 7 and 14 from the procedure. In group B only one patient (3.12%) had a late bleeding episode (p = 0.02). Severity of late bleeding in group B patients (one moderate bleeding) versus group A patients (one moderate and one severe bleeding) and need for transfusions (1 versus 5 blood units) were lower (p = 0.02). Hospitalization days did not differ between the two groups, but colonoscopy time was significantly higher in group B versus group A (p = 0.04). Combined endoscopic techniques seem to be more effective in preventing postpolypectomy bleeding in large pedunculated colonic polyps.

POLYPOID COLONIC HAMARTOMATOUS INVERTED POLYP

We herein present a unique polyp diagnosed as polypoid colonic hamartomatous inverted polyp. Colonoscopic examination revealed a clover-like submucosal tumor about 30 mm in size with a long stalk at the mid-transverse colon. The polyp consisted of elongated crypts with cystic dilatation located in the submucosal layer. To the best of our knowledge, there have been no previous reports of the same type of pedunculated colonic polyp, similar in appearance to inflammatory myoglandular polyps but covered with a layer of normal mucosa possessing the muscularis mucosae at the uppermost surface of the polyp.

A large inflammatory fibroid polyp of the colon treated by endoclip-assisted endoscopic polypectomy: A case report

Inflammatory fibroid polyp is a rare benign polypoid lesion of the gastrointestinal tract. Histologically, inflammatory fibroid polyp is characterised by an admixture of numerous small vessels, fibroblasts and oedematous connective tissue, accompanied by marked inflammatory infiltration by eosinophils. A 40-year-old man visited our hospital for the purpose of colorectal screening due to a positive faecal occult blood test. A pedunculated and reddish polyp was found endoscopically in the ascending colon. The polyp was large but was resected endoscopically without any problems. Histologically, the abnormal tissue of the polyp was located in the submucosal and mucosal layer. Proliferation of spindle cells and infiltration of inflammatory cells, such as plasma cells and eosinophils, were observed. Immunohistochemically, the spindle cells were positive for CD34, which was localised in the cytoplasm. These cells were also positive for S100 protein but were negative for c-kit and muscle markers. These findings are compatible with the histological diagnosis of inflammatory fibroid polyp. The surgical margin of the polyp was free of the tumour. Inflammatory fibroid polyp is more commonly found in the stomach or small intestine, and rarely in the colon, and therefore our case is a rare example of large and pedunculated colonic inflammatory fibroid polyp, which was treated successfully by endoscopic polypectomy.

7085 Preventive clipping following bipolar snare removal of pedunculated colonic polyps.

PURPOSE : Bipolar snares minimize tissue damage, but are not used generally for colonic polypectomy in Japan, probably because increased risk of bleeding reflecting insufficient coagulation is suspected. Since clipping has been reported to be useful in preventing bleeding after monopolar snare polypectomy, we sought to determine whether clipping can prevent bleeding in removal of pedunculated polyps using the bipolar snare. METHODS: We studied patients whose colonic lesions were pedunculated polyps=5 mm in diameter and endoscopically appeared confined to the mucosal layer.We performed bipolar snare polypectomy and added preventive clipping to clamp the stump immediately after polypectomy even when no bleeding was encountered.We assessed retrospectively the histologic diagnosis of the resected specimen, the completeness of polypectomy, and the occurrence of bleeding and perforation. RESULTS : Between April 1997 and March 1999, we evaluated 11 lesions in 10 patients. 11 pedunculated polyps (diameter of head, 10.0 ± 4.1 mm) were resected completely. Histologically, 10 lesions were purely adenoma while 1 contained focal admocarcinoma that arose in the adenoma but was confined to the mucosa. Technical success with clipping was achieved in all cases. No postpolypectomy bleeding, perforation, or complications from dipping occurred. CONCLUSIONS :We found clipping to be effective in preventing bleeding after bipolar snare removal of pedunculated colonic polyps. A bipolar snare which has the advantage of shallow tissue damage can be employed safely by using preventive clipping.

Endoclip-assisted resection of large pedunculated colon polyps

Background: Large pedunculated colorectal polyps are often difficult to remove endoscopically. Methods: Four patients with giant pedunculated polyps (>3 cm) underwent an endoscopic procedure in which the polyp stalk was ligated with multiple clips and resected with a needle-knife papillotome. Results: No complications occurred either during or immediately after the procedure. Mean size of the resected polyps was 4.8 ± 1.2 cm (range 3 to 6 cm). Mean time for the entire procedure was 31 ± 5 minutes (range 25 to 45). No bleeding was found after a mean follow-up period of 4.3 ± 1.1 months (range 3 to 6 months). Conclusions: Although technical refinements are necessary to make the procedure easier and faster, this approach might represent the only option for selected patients who would otherwise need surgical resection of large pedunculated colonic polyps.

Metastasis from a pedunculated adenomatous colonic polyp with focally invasive carcinoma

A patient who had metastasis from a focus of invasive carcinoma confined to the head of an otherwise benign pedunculated adenomatous polyp of the sigmoid colon is described. That only 20 such cases have been reported previously attests to the rarity of this phenomenon. Because the morbidity and mortality of radical surgery far outweigh the liklihood of metastasis from such foci of invasive carcinoma in pedunculated adenomatous colonic polyps, local removal is recommended.