Surgical management of colorectal polyps
Ahmed Mahmoud Afify Zahy;
Abstract
A colorectal polyp is an abnormal protrusion of the mucosa into the bowel lumen that is classified by histopathological examination. Adenomas are a common finding during colonoscopy in symptomatic patients and in asymptomatic individuals undergoing screening. It is estimated that the prevalence of large-bowel adenoma is 21–28% in 50–59-year-old subjects, increasing to 40–45% in 60–69-year-old subjects and rising further to 53–58% in people over the age of 70.
The most common general classification is: hyperplastic, neoplastic (adenomatous and malignant), hamartomatous and, inflammatory.
Colorectal polyps are not usually associated with symptoms. When they occur, symptoms include rectal bleeding, bloody stools, abdominal pain and fatigue. A change in bowel habits may occur including constipation and diarrhoea. Occasionally, if a polyp is big enough to cause a bowel obstruction, there may be nausea, vomiting and severe constipation.
Colorectal polyps can be detected using a faecal occult blood test, flexible sigmoidoscopy, colonoscopy, virtual colonoscopy, digital rectal examination, barium enema or a pill camera.
Polyps can be removed during a colonoscopy or sigmoidoscopy using a wire loop that cuts the stalk of the polyp and cauterises it to prevent bleeding. Many "defiant" polyps (large, flat, and otherwise laterally spreading adenomas) may be removed endoscopically by a technique called endoscopic mucosal resection (EMR), which involves injection of fluid underneath the lesion to lift it and thus facilitate surgical excision. These techniques may be employed as an alternative to a much-more-invasive colectomy.
The management of a colorectal polyp following endoscopic removal is difficult because the possibility of residual malignant cells within the bowel wall or positive regional lymph nodes varies from patient to patient, depending on a number of prognostic factors. The evidence base for management of these lesions is poor and is mostly based on data from symptomatic patients.
The most common general classification is: hyperplastic, neoplastic (adenomatous and malignant), hamartomatous and, inflammatory.
Colorectal polyps are not usually associated with symptoms. When they occur, symptoms include rectal bleeding, bloody stools, abdominal pain and fatigue. A change in bowel habits may occur including constipation and diarrhoea. Occasionally, if a polyp is big enough to cause a bowel obstruction, there may be nausea, vomiting and severe constipation.
Colorectal polyps can be detected using a faecal occult blood test, flexible sigmoidoscopy, colonoscopy, virtual colonoscopy, digital rectal examination, barium enema or a pill camera.
Polyps can be removed during a colonoscopy or sigmoidoscopy using a wire loop that cuts the stalk of the polyp and cauterises it to prevent bleeding. Many "defiant" polyps (large, flat, and otherwise laterally spreading adenomas) may be removed endoscopically by a technique called endoscopic mucosal resection (EMR), which involves injection of fluid underneath the lesion to lift it and thus facilitate surgical excision. These techniques may be employed as an alternative to a much-more-invasive colectomy.
The management of a colorectal polyp following endoscopic removal is difficult because the possibility of residual malignant cells within the bowel wall or positive regional lymph nodes varies from patient to patient, depending on a number of prognostic factors. The evidence base for management of these lesions is poor and is mostly based on data from symptomatic patients.
Other data
| Title | Surgical management of colorectal polyps | Other Titles | الاتجاهات الحديثة فى علاج سرطان الشرج | Authors | Ahmed Mahmoud Afify Zahy | Issue Date | 2015 |
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