Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Polyps”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 307 records · Page 17Linked to original sources
PubMedDate not supplied

Piroxicam-induced regression of intestinal adenomatous polyps in APC(delta474) mice.

Mutation of adenomatous polyposis coli (APC) gene results in incidence or development of polyps and colorectal cancer. It has been reported that nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit cell growth, cause cell cycle arrest, and induce apoptosis. The aims of this study are to investigate chemopreventive effects of piroxicam and elucidate its mechanism. All APC(delta474) mice have intestinal polyps. Thirty-five APC(delta474) mice were divided into three groups: 0.005% solution of piroxicam in tap water was given for P group (n = 15) and 0.001% solution for P' group (n = 5), and water without piroxicam for C group (n = 15) from 4 weeks of age to 12 weeks, respectively. All mice were sacrificed at the 12th week after birth. Hematoxylin-eosin staining for number and size of polyps, immunohistochemical staining for cyclooxygenase (COX)-1 and -2, proliferating cell nuclear antigen (PCNA), vascular endothelial growth factor (VEGF), TUNEL method, and Western blot analysis of COX-2 and VEGF were performed. Polyps were divided into two types of large polyps of >or=300 microm in diameter and small polyps of <300 microm. The number of large polyps in P group decreased significantly compared with C group (p <.0001), but without significant difference in small polyps. There were no significant differences in PCNA index in both of large and small polyps among the three groups. Apoptotic index of polyps in P group increased more than those in C group (p <.05). There was immunohistochemically no significant difference in COX-1 positivity of normal intestinal epithelia and adenomas among three groups. Both numbers of VEGF-positive cells and COX-2 positive cells in the stroma of the small intestine were significantly downregulated in P group (p <.05). COX-2 expression was inhibited in dose-dependent manner without significant difference. There were no significant differences in VEGF expression between P' and C groups. In conclusion, piroxicam suppressed the development of large polyps in APC(delta474) mice by inducing apoptosis and inhibiting VEGF expression in interstitial cells of polyps.

Adenomatous Polyposis Coli↗
PubMed2005

The association between cigarette smoking and colorectal polyp recurrence (United States).

OBJECTIVE: Although evidence exists linking smoking to precancerous colorectal adenomatous polyps, few studies have examined the association between cigarette smoking and recurrence of colorectal polyps. This association was investigated prospectively with data from the Polyp Prevention Trial. METHODS: Cigarette smoking data were collected through baseline interviews. The study was completed by 1872 men and women with presence of adenomas at baseline colonoscopy. Multiple logistic regression analysis was used to examine the association between cigarette smoking and polyp recurrence (adenomatous and hyperplastic) up to four years from baseline. RESULTS: Adenoma recurrence was not related to cigarette smoking. Current smokers had increased odds of hyperplastic polyps at follow-up compared to never smokers (OR 2.88, 95% CI 2.06-4.01). Current smoking was associated with subsequent distal (OR 3.44, 95% CI 2.38-4.95) and rectal (OR 3.53, 95% CI 2.15-5.78) hyperplastic polyps, but not subsequent proximal hyperplastic polyps. Cigarette smoking was associated with subsequent multiple and small size (4 mm) hyperplastic polyps. Significant linear trends were observed between development of subsequent hyperplastic polyps and all smoking variables. CONCLUSIONS: Although no association with recurrent adenomas was observed, cigarette smoking was significantly associated with hyperplastic polyp development, except for those in the proximal colon. This prospective study confirms that cigarette smoking has a significant effect on the development of hyperplastic colorectal polyps.

Adenoma↗
PubMed2004

Small early tubular adenomas and mixed colonic polyps found on screening flexible sigmoidoscopy do not predict proximal neoplasia in males.

BACKGROUND & AIMS: Distal colonic adenomas found on flexible sigmoidoscopy are associated with proximal neoplasias, thus requiring a complete colonoscopic examination, but data regarding the association of distal mixed polyps with proximal neoplasia are lacking. We conducted this study to elucidate the significance of distal mixed colonic polyps in predicting proximal neoplasia. METHODS: We retrospectively analyzed data from patients who underwent a flexible sigmoidoscopic examination for colorectal cancer screening and a follow-up colonoscopic examination because of distal colonic polyps. Distal index polyps were classified by a pathologist as early tubular adenoma (ETA), serrated, or true mixed categories. Index polyps also were immunostained with a monoclonal antibody, Adnab-9, a marker for the colorectal adenoma carcinoma sequence. RESULTS: In 636 patients with distal index polyps, 6% were malignant, 55% were adenomas, 13% were ETAs, 6% were serrated, 4% were true mixed, and 17% were hyperplastic. Compared with distal hyperplastic index polyps, distal malignant polyps (P = 0.0006) and adenomas (P = 0.001) were associated with a significantly increased number of synchronous proximal neoplasia, but the small distal mixed, serrated, or ETA did not predict the increased incidence of proximal neoplasia. Large distal polyps of each category were significantly associated with an increased number of synchronous proximal neoplasias. In support of these findings, immunostaining of distal polyps with Adnab-9 showed predictability for proximal neoplasia only in the adenoma category (P < 0.05). CONCLUSIONS: Small ETAs, serrated, or mixed polyps found on flexible sigmoidoscopic examination do not increase the probability of synchronous proximal neoplasia.

Adenomatous Polyps↗
PubMed1999

Does mutation of transforming growth factor-beta type II receptor gene play an important role in colorectal polyps?

Mutations in the transforming growth factor-beta type II receptor (RII) gene that remain uncorrected due to mutation and inactivation of mismatch repair genes play an important role in hereditary nonpolyposis colorectal cancer (HNPCC) and in a subset of sporadic colorectal cancers. Some colorectal cancers develop from colorectal polyps. To elucidate the role of the RII gene in the generation of colorectal polyps, we analyzed 137 colorectal polyps from 100 patients for RII mutations and microsatellite instability (MSI). MSI was detected in three of 36 polyps from 25 patients. For one of these three polyps, the mobilities of the PCR products between polyp and nonpolyp tissues was different for only one microsatellite marker, and for the other two polyps the mobilities were different for more than two markers. These two polyps were obtained from one patient with ascending colon carcinoma and suspected HNPCC based on his clinical profile and family history. An RII mutation was detected in only one of these two polyps. RII may play a minor role in sporadic colorectal polyps. RII gene analysis in colorectal polyps may be a useful screening measure for potential HNPCC patients.

Adult↗
PubMed2003

Expression of Ki-67 and cytokeratin 20 in hyperplastic polyps of the colorectum.

AIMS: To study the expression of Ki-67 and cytokeratin 20 (CK20) in a group of hyperplastic polyps (including a group with "atypical" features) with the aim of determining whether upper crypt Ki-67 staining and lower crypt CK20 staining correlated with these atypical features, as assessed by light microscopy. METHODS: Fifty seven formalin fixed, paraffin wax embedded hyperplastic colorectal polyps from 53 patients were selected on histological grounds; these comprised 26 typical polyps and 31 with atypical features, which included nuclear hyperchromatism, basal crowding, and increased mitotic activity. These polyps were examined using a standard immunohistochemical method with antibodies against CK20 and Ki-67. Comparisons were made with normal mucosa, adenomatous polyps, and carcinomas. RESULTS: Of the 26 typical polyps, 17 showed the usual pattern of lower crypt Ki-67 and upper crypt CK20 staining; one with upper crypt Ki-67 staining but normal surface CK20 staining; seven with Ki-67 confined to the lower half of crypts but with scattered lower crypt CK20; and one with both upper crypt Ki-67 staining, together with scattered CK20 basal staining. Of the 31 polyps with atypical features, 11 showed the usual staining pattern of lower crypt Ki-67 staining and surface staining with CK20; two showed Ki-67 staining extending into the upper half of crypts, but with a normal surface staining with CK20; 14 showed Ki-67 confined to the lower half of crypts, but scattered lower crypt staining with CK20; and four showed upper crypt Ki-67 staining together with scattered CK20 lower crypt staining. CONCLUSIONS: The normal pattern of lower crypt Ki-67 and upper crypt CK20 was seen in 28 of the 57 hyperplastic polyps and, in general, this corresponded with standard light microscopic appearances. Twenty one of the 57 polyps showed lower crypt mosaic CK20 staining, which in general corresponded with basal abnormalities on light microscopy, although seven specimens had normal appearances. Two smaller subsets emerged, one showing upper crypt Ki-67 staining in the presence of normal CK20 expression (three cases) and another in which a combination of lower crypt CK20 and upper crypt Ki-67 expression was seen (five cases). This last pattern was similar to that of neoplastic polyps and raises the possibility that a subgroup of hyperplastic polyps exists that may be a variant with malignant potential. Further studies with markers of mismatch repair genes and K-ras mutations may help to clarify this issue.

Adenomatous Polyps↗
PubMed2000

Comparison of time-efficient CT colonography with two- and three-dimensional colonic evaluation for detecting colorectal polyps.

OBJECTIVE: We compared the findings of time-efficient CT colonography with complete two-dimensional (2D) and three-dimensional (3D) CT colonography and conventional colonoscopy in detecting colorectal polyps. SUBJECTS AND METHODS: Forty-two patients undergoing colonoscopy screening were examined with CT colonography before endoscopy. Data were examined following one of two methods. In method 1, axial 2D data sets were examined in a cine mode. If findings were suggestive of abnormality, focal areas were examined with 3D CT colonography. In method 2, data sets were examined exactly as in method 1, and subsequent to that review, data sets were examined with simultaneous 3D "fly-through" CT colonography (surface-rendered images) and multiplanar reformatted images. The time required to examine CT colonography using each technique was recorded and abnormal findings were documented. Results of methods 1 and 2 were compared with findings on colonoscopy. RESULTS: Colonoscopy detected 16 polyps in 13 patients (polyp size, 2-10 mm). Ten polyps measured 5 mm or less, five measured between 6 and 9 mm, and one measured 10 mm or more. Using method 1, two of 10 polyps measuring less than 5 mm, three of five polyps measuring between 6 and 9 mm, and one polyp measuring 10 mm were detected. We noted no false-positive polyps. Average evaluation time was 16 min. With method 2, the same polyps were seen as with method 1. No additional polyps were detected, and the average evaluation time was 40 min. CONCLUSION: Axial 2D CT colonography can be performed quickly and is comparable with complete 2D and 3D CT colonography in detecting colorectal polyps.

Aged↗
PubMed2003

Correlation of the morphology and size of colonic polyps with their histology.

BACKGROUND: Colonic adenomatous polyps are premalignant lesions; early recognition and use of a polypectomy for these polyps can reduce the occurrence of colorectal cancer. The purposes of this study were to evaluate the complications of polypectomy and the relationship between the morphology and size of colonic polyps and their histology. METHODS: Data on colonic polyps from 324 patients who received a polypectomy between April 1998 and December 2001 were collected. These included 207 men and 117 women, ranging in age between 17 and 86 years old, and who had had a colonoscopy or sigmoidoscopic examination. A polypectomy was performed on those colonic polyps discovered, and their morphology, size, and histology were analyzed. RESULTS: The histological findings of these polyps included adenoma, carcinoma, hyperplastic, and inflammatory polyps. One and a half percent (n = 6) were carcinomas, all of which belonged to the Yamada III or IV polyp group and were more than 1 cm in size, except for 1 polyp which was 0.7 cm. One case was complicated by colon perforation, and 2 cases experienced mild bleeding with no need for a blood transfusion or hospitalization. CONCLUSIONS: Morphology and size are closely related to the malignant change in colonic polyps. Colonic polyps with a size greater than 1 cm and classified as Yamada type III or IV have a higher potential for malignant change, and a polypectomy should be considered when they are discovered. A polypectomy is a safe procedure with only minor complications.

Adenomatous Polyps↗
PubMedDate not supplied

Intestinal polyps in children and adolescents--a review of 103 cases.

Juvenile polyps are the most common tumors of the gastrointestinal tract in children and are the principal cause of hematochezia. A total of 103 children and adolescents with intestinal polyps have been treated in Veterans General Hospital-Taipei from March 1961 to March 1994. The diagnosis included 87 cases (84.5%) of juvenile polyps, 2 cases of isolated adenomatous polyp and 14 cases of inherited polyposis syndrome. Juvenile polyps most often occur in children between 2 to 10 years old, with a male-to-female ratio of 1.4:1. Rectal bleeding was the main symptom (97.7%). Of the 87 patients, 82.8% had isolated polyps and 83.3% of those were located in rectosigmoid colon. After extensive use of colonoscopy, the reported incidence of multiple polyps substantially increased, and more polyps were found proximal to the rectosigmoid colon. Most juvenile polyps were removed by colonoscopic polypectomy. The recurrent rate was 10.2%. One of the two cases of juvenile polyposis coli suffered from intussusception demanding partial colectomy. Recurrent polyps were found in the remaining colon and were removed by colonoscopic polypectomy. Seven patients of Peutz-Jeghers syndrome came from five families. At initial diagnosis, one case had no polyps and two presented with intussusception. A 19-year-old girl was found to have bilateral ovarian cysts. One of the three familial adenomatous polyposis had adenocarcinoma at initial evaluation. Two cases of Gardner's syndrome received sulindac treatment, and no evidence of malignancy was found after three years of follow-up.

Adenomatous Polyposis Coli↗
PubMed1993

NSAID effect on sporadic colon polyps.

UNLABELLED: In this study, our objective was to determine whether 6 months of open-label therapy with sulindac 400 mg/daily or piroxicam 20 mg/daily promote regression of adenomatous colonic polyps left in situ. Left-sided colonic polyps (size 3-12 mm) detected at colonoscopy were measured and left without being biopsied. The bowel wall opposite to the polyps was marked with India ink submucosally. Patients were assigned to drug therapy, and compliance was determined by pill count. Polyps were measured during sigmoidoscopy after 3 and 6 months of treatment; polyps were removed at the 6-month examination. Examiners were not blinded to drug therapy or previous polyp measurements. Seven patients completed 6 months of therapy (five sulindac and two piroxicam). Two additional patients treated with piroxicam were withdrawn secondary to adverse events (bleeding gastric ulcer and rash). In one patient treated with sulindac, a 6-mm polyp disappeared, and two other polyps seemed to regress partially. One polyp regressed partially in a piroxicam-treated patient. All other polyps remained unchanged. CONCLUSIONS: We did not observe dramatic regression of sporadic colon adenomatous polyps to either sulindac or piroxicam after 6 months of therapy in this small uncontrolled pilot study.

Adenomatous Polyps↗
PubMedDate not supplied

Histologic types and surveillance of gastric polyps: a seven year clinico-pathological study.

BACKGROUND/AIMS: This is a seven-year prospective study based on all gastroscopic examinations of our patient population in order to study gastric polyps. METHODOLOGY: One hundred and twenty-one polyps, removed from 96 patients were analysed. All polyps, after endoscopic polypectomy, were classified according to their histotype. The follow-up was carried out in 49 patients for a mean time of 40 months. RESULTS: Polypoid lesions were more frequent in females (57.3%) and they were preferentially located in antrum (60.3%). Hyperplastic and inflammatory polyps were 55.4% and 28.9%, respectively, while adenomatous lesions were 9.9%. Four fundic gland polyps, 1 carcinoid, 1 type I early gastric cancer and 1 pancreatic heterotopia were also found. During the follow-up no malignant lesion was encountered. On the other hand 25 benign polyps were found in 19 patients. CONCLUSIONS: Our experience confirms that there is a close relationship between the size of the polyps and the neoplastic change. In fact, in our series all polyps were smaller than 2 cm and only one malignancy was found (an early gastric cancer). None of adenomatous polyps was associated with gastric adenocarcinoma. Our data also indicates that when a polypectomy is carried out for small polyps (smaller than 2 cm.) a strict follow-up is necessary for the neoplastic polyps only.

Adenomatous Polyps↗
PubMed1999

Colorectal adenomatous and hyperplastic polyps: smoking and N-acetyltransferase 2 polymorphisms.

Arylamine N-acetyltransferase 2 (NAT2) is involved in both the detoxification and bioactivation of carcinogenic arylamines and other mutagens. This enzyme is polymorphic, and the fast and slow phenotypes are thought to be risk factors for colon and bladder cancer, respectively. Here, we report on a case-control study of adenomatous and hyperplastic polyps, with particular attention to tobacco smoking, a known risk factor for adenomas, and polymorphisms of NAT2. All participants underwent complete colonoscopy and were subsequently divided into case and control groups on the basis of pathology. Cases were diagnosed with confirmed adenomas (n = 527) or hyperplastic polyps (n = 200); controls (n = 633) had no history of colonic neoplasia and no polyps at colonoscopy. NAT2 genotype was determined using an oligonucleotide ligation assay and fast, intermediate, or slow phenotype imputed. Multivariate-adjusted odds ratios (ORs) and 95% confidence intervals were computed using logistic regression adjusting for age, sex, nonsteroidal anti-inflammatory drug use, and hormone replacement therapy use. Smoking was associated with an increased risk of adenomas [current versus never smoking OR = 2.0 (95% confidence interval, 1.4-2.9)] and hyperplastic polyps [current versus never smoking OR = 4.1 (2.6-6.5)]. NAT2 status among adenomatous polyp patients and hyperplastic polyp patients, respectively, showed ORs of 1.1 (0.8-1.4) and 1.2 (0.8-1.6; intermediate versus slow) and 1.1 (0.6-1.9) and 0.9 (0.4-1.9; fast versus slow). There were no differences in risk when adenoma patients were stratified on multiplicity, size, or histopathological subtype of polyps. Never-smokers showed no variation in risk across acetylator status for either species of polyp, whereas current smokers showed ORs of 2.0 (1.2-3.2) and 2.3 (1.4-3.9) for adenomas and 3.9 (2.1-7.1) and 4.9 (2.6-9.4) for hyperplastic polyps for slow and intermediate/fast NAT2, respectively, compared with slow-NAT2 never-smokers. Risks of both multiple [OR = 4.3 (2.1-8.8)] and large [OR = 3.8 (1.9-7.5)] adenomas were somewhat elevated in current smokers with an intermediate/fast phenotype compared with smokers with a slow NAT2 phenotype, but the interaction was not statistically significant. Risk of hyperplastic polyps and adenomatous polyps is strongly related to smoking. There is little suggestion of interaction between NAT2 status and smoking and no relationship with NAT2 genotype alone.

Adenomatous Polyps↗
PubMed1987

The value of colonoscopic surveillance after curative resection for colorectal cancer or synchronous adenomatous polyps.

Between 1975 and 1984, 270 patients underwent a potentially curative resection for colorectal carcinoma. One hundred eighty-eight patients (70%) underwent preoperative colonoscopy, of which 129 patients (69%) were followed up with at least two postoperative colonoscopies. In 91 patients (70%), preoperative colonoscopy revealed no synchronous adenomatous polyps or cancer. Synchronous adenomatous polyps were found in 35 patients (27%), and three patients (2.3%) had a synchronous invasive cancer. Nineteen (54%) of the 35 patients with synchronous adenomatous polyps developed metachronous adenomatous polyps during the follow-up period compared with 24 (26%) of 91 patients without synchronous adenomatous polyps. The median interval to the development of metachronous adenomatous polyps was 19 months, and all of these polyps were 1 cm or less in size. Patients with synchronous adenomatous polyps less than 30 cm from the primary lesion (68%) developed metachronous polyps more often than did patients whose synchronous adenomatous polyps were more than 30 cm from the primary lesion (37%). Preoperative colonoscopy is important for determining synchronous pathology and identifying patients at risk for metachronous polyps.

Adult↗
PubMed1987

Management of endoscopically removed malignant colon polyps.

The medical records of 87 patients with 89 malignant colorectal polyps removed endoscopically between 1971 and 1983 were reviewed retrospectively. Fifty-five polyps contained carcinoma-in-situ. Four polyps had "pseudo-invasion" by displaced mucosal glands. Thirty polyps contained invasive carcinoma. No patients with carcinoma-in-situ or "pseudo-invasion" had either local residual disease or metastatic disease at the time of colectomy or which was detected during subsequent follow-up. Four patients (14%) with invasive cancer would have been inadequately treated by polypectomy alone, since one had residual disease at the polypectomy site, one had nodal metastases, one had liver metastases at the time of colectomy, and one subsequently developed liver metastases. Three histologic criteria correctly predicted all four cases where residual or recurrent disease was present: involvement of the polypectomy resection margin, lymphatic invasion within the polyp, and poorly differentiated histology. Polyp size, histology (villous adenoma, adenomatous polyp, or villo-adenomatous polyp), or anatomic location did not identify those patients who warranted further therapy. We conclude that polypectomy alone is adequate treatment for polyps containing carcinoma-in-situ. Polypectomy alone is also adequate treatment for most polyps containing invasive carcinoma. However, patients with lymphatic involvement within the polyp, poorly differentiated cancer, or resection margin involvement should probably undergo colectomy.

Adult↗
PubMed2001

Adenomatous polyps develop commonly in the ileal pouch of patients with familial adenomatous polyposis.

PURPOSE: The aim of this study was to establish the prevalence of adenomatous polyps in the ileal pouch of patients with familial adenomatous polyposis. METHOD: Forty-three patients who had an ileal pouch for familial adenomatous polyposis were invited to have a careful endoscopic examination of their pouch, including dye spraying. The number of polyps was recorded, and up to ten were biopsied. In addition, four random biopsy specimens were taken from the proximal and four from the distal pouch. RESULTS: Thirty-three patients with a median age of 36 (range, 14-63) years who had a pouch (5 Kock and 28 pelvic) for a median of 7 (range, 1-19) years accepted the invitation. Twenty-one patients (64 percent) had endoscopically identified polyps, the number of polyps ranging from 1 to 100 (median, 10) and varying in size from 1 to 3 mm. Fourteen patients (42 percent) had adenomatous polyps and 4 of these also had microadenomas on random biopsies. Nine of the 14 patients with adenomas also had lymphoid polyps. Seven patients had lymphoid polyps only and two of these patients had a microadenoma on random biopsy. Four of 12 patients with no visible polyps had microadenomas in their random biopsies. The presence of adenomatous polyps (Pearson's correlation; P < 0.01) increased with the age of the pouch. In total, 20 of 33 (60 percent) patients had adenomas and or microadenomas. CONCLUSION: Adenomatous polyps occur frequently in ileal pouches. These findings are of concern, and therefore, regular surveillance seems warranted until the natural history of these adenomatous polyps is determined.

Adenomatous Polyposis Coli↗
PubMedDate not supplied

Polyps in a low-risk colonic cancer population in Colombia, South America.

Colonic polyps were systematically searched for in 508 specimens collected from unselected autopsies in individuals more than 10 years of age from Medellín, Colombia, a low-incidence geographic region for colorectal cancer. Adenomatous polyps have a low prevalence rate in both sexes, comparable to that found in Cali, Colombia and other populations with low risk for cancer. They were found more frequently in the right side of the colon and are rare in the sigmoid colon. They begin to appear in the third decade of life in both sexes. Prevalence rates for single and multiple polyps increase with age in both sexes, males showing higher rates than females at every age group. Adenomatous polyps in this population are usually less than 3 mm in diameter and do not show villous changes or epithelial atypia. Hyperplastic polyps were more frequently observed than adenomatous polyps and rates show a progressive increase with age in both sexes. Multiplicity also increases with age. Most polyps are located in the low rectum and sigmoid followed by the cecum and ascending colon. Usually hyperplastic polyps are smaller than 3 mm in diameter and do not show epithelial atypia. Juvenile polyps were infrequently found in this series because children less than 10 years old were excluded. Diverticular disease was also rare and, when found, was not associated with adenomatous polyps. The association between adenomatous polyps and colonic cancer is discussed based on findings in this report.

Adolescent↗
PubMed2000

Extraintestinal polyps in Peutz-Jeghers syndrome: presentation of four cases and review of the literature. Deutsche Peutz-Jeghers-Studiengruppe.

Peutz-Jeghers syndrome (PJS) is a rare hereditary disorder characterized by hamartomatous polyps in the gastrointestinal tract and typical pigment lesions. Extraintestinal polyps have rarely been reported. Possible sites include the respiratory tract, urogenital tract, and gallbladder. We here describe four cases of extraintestinal polyps in PJS patients and review the literature on the need for operative therapy of extraintestinal polyps in PJS. Three nonrelated patients were examined who had PJS and polyps in the gallbladder; the fourth patient had PJS and recurrent choanal polyps. Surgery has so far been performed only for symptomatic polyps: one laparoscopic cholecystectomy and removal of the choanal polyps for recurrent infections of the respiratory tract. The remaining two patients reported no symptoms from the extraintestinal polyps. No malignant transformation was found in these patients, nor has such been reported in the literature on PJS. The frequent observation of this manifestation in our patients raises the question of clinical management: Is prophylactic surgery indicated? Since malignant transformation of PJS polyps in the intestine is extremely rare we see no reason for operative therapy as long as the polyps are small and asymptomatic. Regular sonographic controls are recommended since the risk of malignant transformation cannot be ruled out at present.

Adult↗
PubMed2006

Outcome of laparoscopic colectomy for polyps not suitable for endoscopic resection.

BACKGROUND: Large colonic polyps or polyps that lie in anatomical locations that are difficult to access at endoscopy may not be suitable for endoscopic resection and therefore may require partial colectomy. This approach eradicates the polyp and allows an oncologic resection should the polyp prove to be malignant. The purpose of this study was to assess outcomes of a laparoscopic approach for the management of these polyps. METHODS: Patients referred for laparoscopic colectomy for colonic polyps were identified from the prospective colorectal laparoscopic surgery database. Demographics, operative details, and final pathology were reviewed. RESULTS: Fifty-one consecutive patients (27 male) with a mean age of 68 +/- 11.4 years, ASA classification (1/2/3/4) of 0/21/27/3, and body mass index (BMI) of 26.5 +/- 4.9 were identified. Right (RHC) and left (LHC) colectomy was performed for 39 right and 12 left colonic polyps. Mean operating time (OT) was 87 +/- 30 min (81 for RHC, 105 for LHC) and mean hospital stay was 3.1 +/- 1.9 days. There were six complications (17.7%), including anastomotic leak (n = 1), small bowel obstruction (n = 2), abscess (n = 1), and exacerbation of preexisting medical conditions (n = 2). Four patients were readmitted (7.8%); one required CT scan-guided abscess drainage (1.9%) and two required reoperation (3.9%). Five patients (9.8%) were converted because of adhesions (n = 3), obesity (n = 1), and inability to identify the area that was tattooed at colonoscopy (n = 1). Mean polyp size was 3.1 cm, and pathology revealed tubular (n = 14), tubulovillous (n = 33) and villous adenoma (n = 2), pseudopolyp (n = 1), and prolapse of the appendix into the cecum mimicking an adenoma (n = 1). High-grade dysplasia was seen in four tubular (33%) and five tubulovillous adenomas (15.5%). Adenocarcinoma not identified at colonoscopy was found in 11 polyps (20%), 9 tubulovillous (27.8%) and both villous adenomas (100%). CONCLUSIONS: Large colonic polyps unresectable at colonoscopy are associated with a high rate of unsuspected cancer. This requires a formal colectomy rather than transcolonic polypectomy. Laparoscopic colectomy offers safe and effective management of these polyps with the benefits of accelerated postoperative recovery.

Abscess↗
PubMed2003

Avoiding surgery in patients with colorectal polyps.

PURPOSE: Colonic polyps are sometimes difficult to remove endoscopically and are referred for surgical resection. This study was performed to determine how many polyps referred for surgery could actually be managed endoscopically. METHODS: An endoscopic database with data entered prospectively and consecutively was used to identify patients referred for surgery for a colonic polyp. Rectal polyps were excluded. All patients underwent colonoscopy before surgery to see if the polyp could be managed endoscopically. Cases were reviewed to see the method and outcome of treatment. RESULTS: The study population consists of 58 patients referred for surgical resection of a colorectal polyp. Endoscopic polypectomy was initially successful in 48. Five of the 48 needed surgery later for a final success rate of 43/58 avoiding surgery. There were no deaths, four complications of endoscopic polypectomy (three bleeds, one post-polypectomy syndrome) and two patients had complications of surgery (one splenic injury, one ventral hernia). Polyps ranged in size from 1.5 cm to 8.0 cm. Seven polyps contained invasive cancer (three needing surgical resection), eight contained intramucosal cancer (one operated) and 11 had severe dysplasia (three operated). Rate of persistent polyp was 16/37 at first follow up, 7/23 at second, 1/14 at third and 0/8 at fourth. CONCLUSION: Most polyps referred for surgical resection were successfully managed endoscopically. Patients with colonic polyps that are difficult or potentially dangerous to remove endoscopically should be sent for a second opinion before surgery is performed.

Aged↗