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At least 1,567 records · Page 87Linked to original sources
PubMed2004

Capsule endoscopy, technical impact, benefits and limitations.

BACKGROUND: The small bowel is the most difficult part of the bowel to examine owing to the distance from the mouth to anus. Conventional endoscopic techniques for examining the small bowel are limited by its length and its multiple, complex, looped configurations. However, for a wide variety of specific lesions, the diagnostic value of other tests for imaging the small bowel is low. For the first time wireless capsule endoscopy has made non-invasive imaging of the entire small bowel possible. A number of peer-reviewed studies has been published that compare the method with push-enteroscopy in patients with obscure gastrointestinal bleeding and have shown superior diagnostic results. CONCLUSION: Capsule endoscopy has opened up new horizons for the diagnosis of small-bowel disease. All published studies show a higher diagnostic yield of capsule endoscopy compared with push-enteroscopy and standard radiographic investigations.

Abdominal Pain↗
PubMed1994

Rectal proliferation and polyp occurrence in patients with familial adenomatous polyposis after sulindac treatment.

BACKGROUND/AIMS: Sulindac, a nonsteroidal anti-inflammatory drug (NSAID), decreases the occurrence of polyps in patients with familial adenomatous polyposis (FAP). The effects of colectomy with ileorectal anastomosis (IRA) and sulindac treatment on rectal mucosa proliferation and polyp occurrence were examined in patients with FAP. METHODS: The number and size of rectal polyps were measured with colonoscopy. The labeling index, the percentage of labeled cells per crypt compartment, was assessed in rectal biopsy specimens with [3H]thymidine incorporation and autoradiography in 6 non-IRA and 14 IRA patients before and after treatment with 200 mg of sulindac/day for 60 days. RESULTS: The IRA patients had a lower labeling index and a decrease in the percentage of labeled cells in the upper compartment of the crypt (P < 0.01) relative to non-IRA subjects. Sulindac did not influence the labeling index and the distribution of labeled cells along the crypt. On the contrary, a dramatic decrease in the size and number of polyps was observed after sulindac treatment (P < 0.001). CONCLUSIONS: The persistence of a abnormal mucosal proliferation after sulindac therapy, in spite of the reduction of polyp number, suggests caution in assuming a lower risk of rectal cancer in patients with FAP.

Adenomatous Polyposis Coli↗
PubMed1995

First observation of microadenomas in the ileal mucosa of patients with familial adenomatous polyposis and colectomies.

BACKGROUND & AIMS: Little data are available on the type and prevalence of mucosal changes involved in the development of ileal adenomas in patients with familial adenomatous polyposis who have undergone colectomy. However, colonic metaplasia of the ileal epithelium is thought to be an important step in the development of such adenomas. METHODS: Retrograde endoscopy and biopsy of the distal ileum were performed in 17 affected patients who underwent total colectomy or proctocolectomy 3-184.1 months (mean, 80.3 +/- 13.9 months) before the study. RESULTS: Macroscopic ileal polyps were identified in 14 (82.4%) patients. All polyps were sessile and 1-5 mm in size. Histological analysis showed adenomas in 9 (52.9%) patients and lymphoid hyperplasia or inflammation in the others. In 1 patient, an area of colonic-type metaplasia of the ileal mucosa was found close to an adenoma. However, in 5 (29.4%) patients, random biopsy specimens of the normal-appearing mucosa showed foci of abnormal crypts in the absence of metaplasia, with histological appearance similar to the findings described in dysplastic aberrant crypt foci of the colon. Such lesions, previously observed only in colorectal mucosa and referred to as microadenomas or oligocryptal adenomas, are considered putative preneoplastic abnormalities. CONCLUSIONS: Although the hypothesized sequence normal ileal mucosa leading to colonic-type metaplasia leading to adenoma cannot be excluded, our findings support the sequence normal ileal mucosa leading to microadenoma leading to gross adenoma and possibly cancer as the main histogenetic pathway, as already suggested for the large bowel.

Adenoma↗
PubMed1992

Gastroduodenal polyps in familial adenomatous polyposis.

A retrospective review of the medical records of 30 patients with familial adenomatous polyposis who underwent oesophagogastroduodenoscopy was performed to evaluate the spectrum of gastroduodenal polyps. Twenty-five patients (83%) had gastroduodenal polyps. Eighteen patients (60%) had gastric polyps and 21 patients (70%) had duodenal polyps. Five patients (17%) had gastric and 20 patients (67%) had duodenal adenomatous polyps. Three patients (10%) died from an upper gastrointestinal tract adenocarcinoma. Three of nine patients with periampullary adenomas had a normal-appearing papilla of Vater. Since gastroduodenal polyps are common in familial adenomatous polyposis, oesophagogastroduodenoscopy should be performed at the time of diagnosis. Biopsy of polyps as well as biopsy of a normal-appearing papilla of Vater should be performed. Due to their malignant potential, if identified, gastroduodenal adenomatous polyps should be destroyed.

Adenomatous Polyposis Coli↗
PubMed2003

Adenomas at resection margins do not influence the long-term development of pouch polyps after restorative proctocolectomy for familial adenomatous polyposis.

BACKGROUND: The aim of this study was to consider whether adenomas in the resection margins could represent a risk factor for pouch polyps in familial adenomatous polyposis (FAP) patients. METHODS: We reviewed 46 patients treated by restorative proctocolectomy (RPC) for FAP: 9 hand-sewn and 37 stapled ileal pouch-anal anastomosis (IPAA). We analyzed the presence of polyps in the doughnuts from stapled anastomosis and in the resection margins from hand-sewn anastomosis. The presence of polyps in the IPAA was then assessed in 30 patients (6 hand-sewn and 24 stapled IPAA): 4 from the histology of the excised pouch and 26 by endoscopy (range 4 months to 12 years after operation, mean 6 years). RESULTS: Surprisingly, pouch adenomas were found in only 2 of 30 (7%) of patients, 1 of 6 hand-sewn and 1 of 24 stapled anastomosis (P > 0.1), 9 and 11 years, respectively, after operation. However, there were 6 patients with inflammatory (3), fibroepithelial (2), or lymphoid (1) polyps. The risk of pouch adenomas after 8 years was 20% (P < 0.05). Pouch adenomas were found in 1 of 11 patients having adenomas in the margins or in the doughnuts (9%) and in 1 of 19 with no adenomas at the margins (5%; P > 0.1). CONCLUSIONS: Incidence of pouch adenomas was low. There was no correlation between adenomas in the resection margins and the development of pouch adenomas.

Adenoma↗
PubMed1997

Juvenile polyposis (coli)--high incidence of dysplastic epithelium.

BACKGROUND: A juvenile polyp is a commonly seen condition in the pediatric age group as an etiological factor for rectal bleeding. The histological appearance was considered to be nonneoplastic and was distinguished from other neoplastic polyps. But this concept has been changing over the years as higher incidence of colonic and rectal adenocarcinomas are seen in patients with both familial and nonfamilial polyposis. The malignant potential was first recognized in 1980. METHODS: With this background knowledge, the authors carried out a retrospective study of juvenile polyposis patients, who underwent full-length colonoscopy and upper gastrointestinal endoscopy to assess the presence of dysplastic epithelium. There were eleven cases of nonfamilial juvenile polyposis (one case with foregut polyps). RESULTS: Ten cases showed presence of dysplastic epithelium in focal areas in the juvenile polyps, mild in degree in three cases and moderate in degree in 10 cases, with focal severe degree in two. CONCLUSION: All polyps of juvenile polyposis after polypectomy must be subjected to histopathologic examination to determine the presence of dysplastic/adenomatous epithelium.

Adenomatous Polyposis Coli↗
PubMed2002

Familial and inherited colorectal cancer: endoscopic screening and surveillance.

Familial risk of colorectal cancer is very common. The high-risk inherited syndromes are well described and much is known about the genetics and the effectiveness of registration, endoscopic surveillance, and appropriate intervention in these patients. The inherited syndromes, however, are extremely rare. There is a large group of patients in our population who can benefit from risk stratification based on the number of their relatives with colon cancer or adenomas and the age at which those relatives developed neoplasm. The GI endoscopist has a vital role in recommending and providing colonoscopic screening for this large group of patients.

Adenomatous Polyposis Coli↗
PubMed1994

Multiple lymphomatous polyposis of the gut. A case with unusually widespread distribution.

Multiple lymphomatous polyposis (MLP) is a term used to describe malignant lymphomas of the gastrointestinal tract that manifest as polyposis. The cell population of MLP is identical to that in "mantle cell lymphoma." In most instances, relatively small segments of small and large intestine are affected. We report a case of MLP in which involvement was unusually widespread. A 56-year-old man, with abdominal pain and weight loss, proved to have a large mass at the ileocecal valve as well as multiple polyps of the stomach and small and large intestine. MLP is distinctive both grossly and microscopically. Clinically, it may be confused with epithelial polyps, and histologically it must be distinguished from benign lymphoid proliferations as well as other types of lymphoma. The latter distinction is important because of the relatively poor prognosis (median survival of < 3 years).

Colon↗
PubMed1987

Gastric and duodenal polyps in familial adenomatous polyposis: a prospective study of the nature and prevalence of upper gastrointestinal polyps.

One hundred patients with familial adenomatous polyposis have prospectively undergone gastroduodenoscopy to identify and characterise polyps found. Forty six patients had polyps in the stomach or duodenum. Thirty five patients had adenomas (33 in duodenum, two in stomach) and 26 patients had fundic gland polyps. Some of these patients had polyps in the stomach and the duodenum. Adenomas in the duodenum were present in 33% of patients studied with Gardner's syndrome variant (p = 0.04). Adenomas were also more common in older patients. As adenomas may be a precursor of adenocarcinoma, routine surveillance of the stomach and duodenum with gastroduodenoscopy is recommended in patients affected with familial adenomatous polyposis.

Adenomatous Polyposis Coli↗
PubMed1993

Cap polyposis--an unusual cause of diarrhoea.

'Cap polyposis' is a poorly recognised condition with distinct clinical, sigmoidoscopic, and pathological features that may be confused with other inflammatory conditions of the large intestine including pseudomembranous colitis and idiopathic chronic inflammatory bowel disease. The pathogenesis is unknown but on the basis of the characteristic histological appearances, which are similar to those seen in situations where mucosal prolapse is the underlying mechanism, it has been suggested that the latter may be an important aetiological factor. Two cases are described. Histological features in the first (presence of intramucosal elastin) and clinical features in the second (rectal prolapse) support the above hypothesis.

Aged↗