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PubMed2004

A novel endoscopic device for retrieval of polyps resected from the colon and rectum.

BACKGROUND: Retrieval of polyps resected from the colorectum is time consuming, despite the availability of various devices, such as grasping forceps, nets, and suction traps, for this purpose. A novel device for retrieval of polyps was developed and tested. METHODS: Patients with polyp(s) less than or equal to 6 mm in diameter were included in this study. The effectiveness of the device for polyp retrieval was evaluated. OBSERVATIONS: In total, 180 of 184 polyps were retrieved from 100 patients. Four polyp specimens (2.2%) were lost after polypectomy. None of the retrieved specimens were damaged. All retrieved polyps could be assessed histopathologically, and a definitive diagnosis was made. CONCLUSIONS: The newly developed device proved to be reliable when used in clinical practice.

Adult↗
PubMed1979

The bobbin' polyp.

Explore the source record for details and available documents.

Colonic Neoplasms↗
PubMed1997

Homeosis and intestinal tumours in Cdx2 mutant mice.

In Drosophila, disturbing the expression of the homeobox gene caudal causes a severe disruption in body segmentation and global body patterning. There are three mouse homologues of Drosophila caudal: Cdx1 (ref. 2), Cdx2 (ref. 3) and Cdx4 (ref. 4). We have generated a null mutation of murine Cdx2 by homologous recombination. Cdx2 homozygote null mutants die between 3.5 and 5.5 days post coitum (d.p.c.). Cdx2 heterozygote mutants exhibit a variable phenotype, with many showing tail abnormalities or stunted growth. Skeletal analysis demonstrates a homeotic shift of vertebrae and compatible malformations of the ribs. Within the first three months of life, 90% of Cdx2 heterozygotes develop multiple intestinal adenomatous polyps, particularly in the proximal colon. These polyps occasionally contain areas of true metaplasia. In contrast to the surrounding intestinal epithelium, the neoplastic cells do not express Cdx2 from the remaining allele. These results suggest that Cdx2 mutation is the primary event in the genesis of some intestinal tumours.

Adenomatous Polyposis Coli↗
PubMed2004

An evaluation of colorectal endoscopic mucosal resection using high-magnification chromoscopic colonoscopy: a prospective study of 1000 colonoscopies.

BACKGROUND AND STUDY AIMS: Endoscopic mucosal resection provides an alternative to surgery for resection of sessile and flat colorectal lesions. High-magnification chromoscopic colonoscopy may allow early detection and anticipate histological diagnosis by identifying colonic crypt patterns. The aim of the present study was to assess the efficacy and safety of en-bloc endoscopic mucosal resection with high-magnification chromoendoscopy in the management of sessile and flat colorectal lesions </= 20 mm. PATIENTS AND METHODS: A single endoscopist using high-magnification chromoendoscopy prospectively examined 1000 patients attending for routine colonoscopy. Patients were selected for inclusion in the study if they were considered to be at high risk for underlying colorectal neoplasia or polyps. Within the study period, 1000 patients (29 %) qualified for entry from a total of 3480 colonoscopies conducted in our institution. Endoscopic mucosal resection was carried out in appropriate flat and sessile lesions. RESULTS: Endoscopic mucosal resection was carried out in 599 lesions. Complete histological resection was confirmed in 576 (96 %). Perforation occurred in one patient (0.2 %) and bleeding in 12 (2 %). A total of 254 lesions (40 %; excluding hyperplasia/metaplasia) were flat or depressed, and 374 (60 %) were sessile. Fifty-eight flat lesions (23 %) contained high-grade dysplasia or beyond, compared to 33 sessile lesions (9.0 %; P = 0.001). After resection, 21 lesions were upgraded histologically, with 17 being defined as adenoma with high-grade dysplasia or beyond. CONCLUSIONS: This study confirms that flat adenomas and carcinomas occur in the West and demonstrates the malignant potential of such lesions, which can be managed successfully using endoscopic techniques. Endoscopic mucosal resection with high-magnification chromoscopy is a safe and effective form of treatment for sessile or flat colorectal lesions. Complete resection can improve the accuracy of histopathological diagnosis. However, colonoscopists require training in these procedures in order to improve the rate of colorectal cancer detection.

Adenoma↗
PubMed1987

[Endoscopic resection of colorectal polyps].

In 766 patients, 1413 polyps of the colon and the rectum were resected endoscopically. 79% of the polyps were located in the rectum and sigmoid colon. The histological examination revealed adenomatous polyps in 60%. 3.9% of the polyps showed a severe dysplasia in accordance with the WHO guidelines, and a further 3.1% already contained parts of an invasively growing carcinoma with involvement of the submucosa. Polyps in excess of 2 cm diameter had already undergone malignant transformation in 12%. However, the smallest malignant polyp was only 8 mm in size. Complications after endoscopic polypectomy occurred in 14 patients (1%); they could be controlled conservatively in 13 cases. Surgery was necessary in one case. No patient died.

Adult↗
PubMed2000

Patient tolerance of colonoscopy without sedation during screening examination for colorectal polyps.

BACKGROUND: The administration of sedative drugs at colonoscopy has its drawbacks such as increases in the rate of complications and cost. Our aim was to study how individuals, drawn from a population registry and invited to undergo screening colonoscopy for colorectal polyps, experienced the procedure without conscious sedation. METHODS: Four hundred fifty-one individuals underwent the screening examination (median age 67 years, range 63 to 72). The cecum was intubated in 369 (82%). Fourteen days after the examination, 429 of the attendees received a questionnaire designed to evaluate their tolerance of the procedure. RESULTS: Four hundred nine participants (95%) replied.Twenty-one (5%) of these individuals found the examination very uncomfortable, 184 (45%) found it moderately uncomfortable, and 204 (50%) did not find it uncomfortable. A larger proportion of women than men, 110 (63%) versus 79 (41%), found the procedure very or moderately uncomfortable (p<0.001). Three hundred sixty-eight (90%) individuals stated that they would undergo repeat colonoscopy in 5 years. CONCLUSION: In this screening setting, routine use of conscious sedation did not seem to be necessary, as most participants found the examination to be only moderately uncomfortable or not at all uncomfortable. Colonoscopy without conscious sedation may, however, reduce the rate of intubation of the cecum and increase the risk of missing adenomas and cancers.

Aged↗
PubMed2003

A two-step method for marking polypectomy sites in the colon and rectum.

BACKGROUND: Intraoperative localization of polypectomy sites is critical for laparoscopic and open surgery, but conventional methods of marking the colorectum are sometimes unreliable. A new two-step method for marking polypectomy sites for identification during laparoscopic and open operations is described. METHODS: Eighteen patients with postpolypectomy lesions necessitating preoperative marking were enrolled in this study. A physiologic saline solution was endoscopically injected into the submucosa to produce an artificial submucosal elevation (pseudopolyp). A small volume of India ink was then injected into the submucosal elevation (pseudopolyp) with a separate needle. RESULTS: The two-step method was easily applied for all lesions without complication. At surgery, all lesions were immediately visualized. CONCLUSION: The two-step tattooing method proved to be easy, safe, and accurate for marking polypectomy sites.

Aged↗
PubMed1991

Colorectal polyps, diet, alcohol, and family history of colorectal cancer: a case-control study.

A case-control study was conducted in Melbourne, Australia. Cases (n = 49) were patients who had one or more histologically confirmed adenomatous polyps larger than 1 cm in diameter previously removed by endoscopy. In both the cases and the community controls (n = 727), previous diet, alcohol consumption, and family history of colorectal cancer in near relatives were investigated. The family history rate of colorectal cancer was similar in the two groups. Those with adenomatous polyps were found to have a low fiber/vegetable intake (p = 0.04); in males, there was a high intake of beef (p = 0.04), milk drinks (p = 0.01), and beer (p = 0.05). This study provides further evidence for the hypothesis that dietary factors and alcohol consumption may play a role in the development of adenomatous colorectal polyps and that these factors are similar to dietary risk factors for colorectal cancer.

Aged↗
PubMed2001

Age-associated increase of 8-hydroxydeoxyguanosine in human colorectal tissue DNA.

To clarify the role of oxidative stress in aging of colorectal tissue, we analyzed the 8-hydroxydeoxyguanosine (8-OH-dG) levels in colorectal biopsy samples from normal tissue of patients with either colorectal cancer (n = 15) or benign colorectal polyps (n = 40). An age-associated increase of 8-OH-dG was observed (p =.002), although the 8-OH-dG levels were not significantly different between the patients with cancer and those with polyps. These results suggest an increased level of 8-OH-dG formation in human colorectal tissue with age.

8-Hydroxy-2'-Deoxyguanosine↗
PubMed1984

Colorectal polyps in Cowden's disease (multiple hamartoma syndrome).

Colorectal polyps are described in five patients with Cowden's disease. A brother-sister kindred and two unrelated patients had multiple colonic polyps 0.1-0.4 cm in diameter. Microscopical examination of seven polyps removed from these four patients showed distinctive lesions which were probably hamartomatous, and characterized by disorganization and proliferation of the muscularis mucosae with minimally abnormal overlying mucosa. The fifth patient had a solitary 2-cm epitheloid leiomyoma resected from the rectum. Review of all cases of Cowden's disease in the English literature suggests that gastrointestinal polyposis may be a frequent finding if it is specifically searched for. It does not appear that the previously reported association of Cowden's disease with gastrointestinal cancer is valid. The discovery of multiple colonic polyps 0.1-0.4 cm is diameter with a rectosigmoid distribution and a hamartomatous microscopical appearance is characteristic of Cowden's disease. Cowden's disease should be included in the differential diagnosis of gastrointestinal polyposis states.

Adult↗
PubMed1992

Drinking water and the prevalence of colorectal adenomas: an epidemiologic study in Telemark, Norway.

This study was based on an endoscopic screening study for detection of polyps in the rectum and sigmoid colon in a randomized, normal population sample of 400 individuals aged 50-59 years. Family disposition for cancer and indicators of lifestyle (including dietary registration) were recorded. The 310 individuals received domestic drinking water from one out of four public water supplies. The participants were categorized according to the water supply connected to their house of residence. Drinking water was analysed monthly during 2 years for chloroform, total organic carbon, colour index, calcium, magnesium and chlorine. The overall prevalence of colorectal polyps was significantly higher in residents receiving chlorinated water with a high organic content when compared with recipients of water with a low organic content. There was no association between polyp prevalence and chloroform concentration in the drinking water. Multivariate analysis revealed that age, male sex, high BMI, smoking, few stools per week, high protein intake and low intake of fibre, iron and cruciferous vegetables were far more important for the presence of polyps than the total organic content in chlorinated drinking water.

Adenoma↗
PubMed1999

Decrease in serum levels of vitamin A and zeaxanthin in patients with colorectal polyp.

OBJECTIVE: Several retrospective and prospective epidemiological investigations have demonstrated that a diet rich in carotenoids could prevent the development of pre-cancerous and neoplastic lesions of the digestive tract. The aim of this examination was to analyse the correlation between colorectal polyps with different histological classifications and serum carotenoid levels. DESIGN AND METHODS: A 10 ml blood sample was taken from all of the patients after the colonoscopic diagnosis. The serum levels of vitamin A, lutein, zeaxanthin, alpha- and beta-cryptoxanthin, alpha- and beta-carotene were measured in patients with adenomatous colorectal polyp (n = 59, 35 males, 24 females) by high-pressure liquid chromatography (HPLC) and compared with those in healthy subjects (n = 20, 10 males, 10 females). The patients were separated into four groups depending on their histological findings. RESULTS: The serum levels of vitamin A and zeaxanthin were significantly lower in all patients with polyps (vitamin A: 0.913 +/- 0.112 micromol/l, zeaxanthin: 0.071 +/- 0.012 micromol/l) than in the control healthy group (vitamin A: 2.036 +/- 0.354 micromol/l, zeaxanthin: 0.138 +/- 0.048 micromol/l). The lowest levels were found in patients with focal adenocarcinoma in the polyp. There were no significant differences in the serum levels of other carotenoids. The serum levels of cholesterol, haemoglobin, total protein and albumin were normal in these patients. CONCLUSIONS: There are close and inverse correlations between the serum level of carotenoids and colorectal polyps with different histological grades. The low mean carotenoid levels in patients with adenocarcinoma in the polyp indicate that deficiency of carotenoids may be an important factor in the development of colorectal cancer.

Adenocarcinoma↗
PubMed2001

Gender differences in colorectal polyps and tumors.

OBJECTIVES: To use a national endoscopy database (CORI) to determine 1) whether gender differences are noted in the prevalence and location of polyps and tumors; 2) whether women have a higher rate of right-sided polyps or tumors; and 3) whether age influences these results. METHODS: CORI database from April 1, 1997 to February 19, 1999, captured in a computer-generated report, was analyzed. Polyps for this study were defined as sessile or pedunculated and as >9 mm. Tumors were defined as lesions characteristic of adenocarcinoma (mass, apple-core). Pure right-sided colon (PRS) was defined as cecum, ascending, hepatic flexure; right-sided as PRS plus the transverse colon; and left-sided as the splenic flexure, descending, sigmoid and rectum. RESULTS: Men have a greater risk of polyps [odds ratio (OR), 1.5] and tumors (OR, 1.4) than women. The risk of finding polyps and tumors at colonoscopy increases with age, with the highest risk noted in those >69 yr of age relative to patients <50 yr of age (polyps, OR = 2.7; tumors, OR = 4.0). Right-side polyps and pure right-sided polyps as defined by the study design were noted to be more frequent than left-sided polyps in patients >60 yr of age. Women have a greater risk of developing pure right-sided polyps (OR, 1.2), tumors (OR, 1.6) and right-sided tumors (OR, 1.5) than men. CONCLUSIONS: Men have a higher prevalence of colon polyps and tumors than women. A progressive risk of polyp or tumor formation is noted with aging. Women had a greater number of pure right-sided polyps and tumor development. Colonoscopy is needed to correctly diagnose an increasing prevalence of right-sided pathology in the elderly.

Adenocarcinoma↗