ISSN: 2008-2258
Vol 16, No 2 (2023): Spring
A step-by-step guide to approaching colon polyps
Gastroenterology and Hepatology from Bed to Bench,
,
https://doi.org/10.22037/ghfbb.v16i2.2512
Abstract
Colorectal cancer (CRC) is introduced to be one of the most prevalent cancers among Iranian men and women.(1) Colorectal polyps as known precursors of CRCs are of great importance. Surveillance, locating and removal of colorectal polyps make them the most modifiable factor outside of other genetic and environmental factors leading to CRCs. Colorectal polyps are defined as outpouchings from superficial and deep layers of mucosa of the colonic wall. They are classified as adenomas, serrated polyps, hyperplastic polyps and hamartomas based on histological evaluation. Submucosal invasion precludes the possibility of endoscopic resection and should be ruled out via colonoscopic evaluation.(2) In keeping with this significance, the present study is intended to have a brief review on classification, probability of endoscopic resection, complications of endoscopic polypectomy as well as proper surveillance after polypectomy.
Keywords:
- Colon polyps
- Polypectomy
- Colorectal cancer
How to Cite
Sadeghi, A., Salarieh, N., & Ketabi Moghadam, P. (2023). A step-by-step guide to approaching colon polyps. Gastroenterology and Hepatology from Bed to Bench, 16(2). https://doi.org/10.22037/ghfbb.v16i2.2512
References
References
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2. Meseeha M, Attia M. Colon polyps. StatPearls Publishing. 2021.
3. The Paris endoscopic classification of superficial neoplastic lesions: Esophagus, stomach and colon. Gastroint Endosc 2003; 58: S3-43.
4. Gupta S. Trouble in Paris classification: polyp morphology is in the eye of the beholder. Am J Gastroenterol. 2015; 110(1): 188-91.
5. Oka S, Tanaka S, Kanao H, Oba S, Chayama K. Therapeutic strategy for colorectal laterally spreading tumor. Dig Endosc Off J Jpn Gastroenterol Endosc Soc. 2009; 21: S43-S46.
6. Yamada M, Saito Y, Sakamoto T, Nakajima T, Kushima R, Parra-Blanco A et al. Endoscopic predictors of deep submucosal invasion in colorectal laterally spreading tumors. Endoscopy. 2016; 48(5): 456-64.
7. Meier B, Caca K, Fischer A, Schmidt A. Endoscopic management of colorectal adenomas. Ann Gastroenterol. 2017; 30(6): 592-7.
8. Hayashi N, Tanaka S, Hewett DG, Kaltenbach TR, Sano Y, Ponchon T et al. Endoscopic prediction of deep submucosal invasive carcinoma: validation of the narrow-band imaging international colorectal endoscopic (NICE) classification. Gastrointest Endosc. 2013;78(4): 625-32.
9. Tanaka S, Kaltenbach T, Chayama K, Soetikno R. High magnification colonoscopy. GIE. 2006; 64(4): 604-13.
10. Li M, Ali SM, Gilani SUO, Liu J, Li YQ and Zuo XL. Kudo’s pit pattern classification for colorectal neoplasms: A meta-analysis. World J Gastroenterol. 2014; 20(35): 12649-56.
11. Tung SY, Wu Cs, Su MY. Magnifying colonoscopy in differentiating neoplastic from nonneoplastic colorectal lesions. Am J Gastroenterol. 2001; 96: 2628-32.
12. Hayashi N, Tanaka S, Hewett DG, Saunders BP, Rex DK, Soetikno RM. Endoscopoc prediction of deep submucosal invasive carcinoma: validation of the NICE classification. GIE. 2013; 78(4): 625-32.
13. Patrun J,Okresa L, Ivekovic H and Rustemovic N. Diagnostic accuracy of NICE classification system for optical recognition of predictive morphology of colorectal polyps. Gastroenterol Res Pract. 2018; 2018: 7531368.
14. Hewett DG, Kaltenbach T, Sano Y, Tanaka S, Saunders BP, Ponchon T et al. Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology. 2012; 143(3):599-607.
15. Okamoto Y, Oka S, Tanaka S, Kamigaichi Y, Tamari H, Shimohara H et al. Effect of educational lecture on the diagnostic accuracy of Japan NBI Expert Team classification for colorectal lesions. BMC Gastroenterology. 2021; 21: 110.
16. Kobayashi S, Yamada M, Takamaru H, Sakamoto T, Matsuda T, Sekine S et al. United Eur Gastroent J. 2019; 7(7):914-23.
17. Li DH, Liu XY, Huang C, Deng CN, Zhang JL, Xu XW et al. Pathological analysis and endoscopic characteristics of colorectal laterally spreading tumors. Cancer Manag Res. 2021; 13: 1137-44.
18. Ferlitsch M, Moss A, Hassan C, Bhandari P, Dumonceau JM, Papatis G et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 2017; 49.
19. Ramirez M, Schierling S, Papaconstantinou HT and Thomas JS. Management of the malignant polyp. Clin Colon Rectal Surg. 2008; 21(4): 286-290.
20. Neilson LJ, Rutter MD, Saunders BP, Plumb A and Rees CJ. Frontline Gastroenterol. 2015; 6(2): 117-126.
21. Friedland S, Shelton A, Kothari S, Kochar R, Chen A and Benerjee S. Endoscopic Management of nonlifting colon polyps. Diagn Ther Endosc. 2013.
22. Russo P, Barbeiro S, Awadie H, Libanio D, Dinis-Ribeiro M and Bourke M. Management of colorectal laterally spreading tumors: a systematic review and meta-analysis. Endosc Int Open. 2019; 7(2): E239-59.
23. Choo WK and Subhani J. Complication rates of colonic polypectomy in relation to polyp characteristics and techniques: a district hospital experience. J Interv Gastroenterol. 2012; 2(1): 8-11.
24. Amato A, Radaelli F, Correale L, Giulio ED, Buda A, Cennamo V et al. Intra-procedural and delayed bleeding after resection of large colorectal lesions: The SCALP study. United European Gastroenterol J. 2019; 7(10):1361-72.
25. Fahrtash-Bahin F, Holt BA, Jayasekeran V, Sonson R, Lee EY, Williams SJ et al. Tu1499 snare tip soft coagulation technique for hemostasis of intraprocedural bleeding during wide field endoscopic mucosal resection of large colonic lesions. GIE. 2013; 77(5): AB562-3.
26. Mack A, Mangira D and Moss A. Prevention of delayed post-polypectomy bleeding: should we amend the 2017 ESGE guideline? Endosc Int Open. 2020; 8(9): E1111-14.
27. Luning TH, Keemers-Gels ME, Barendregt WB, Tan AC and Rosman C. Colonoscopic perforations: a review of 30366 patients. Surg Endosc. 2007; 21: 994-997.
28. Avgerinos DV, Llaguna OH, Lo AY, Leitman IM. Evolving management of colonoscopic perforations. J Gastrointest Surg. 2008; 12: 1783-9.
29. Hormati A, Ghadir MR, Alavinejad P, Sarkeshikian SS, Pezeshki Modares M. Repair of polypectomy colonic perforation by endoclip: a case report. Jcol. 2013; 35(4): 227-9.
30. Castro R, Libanio D, Pita I, Dinis Ribeiro M. Solutions for submucosal injection: What to choose and how to do it. World J Gastroenterol. 2019; 25: 777-8.
31. Burgess NG, Bassan MS, McLeod D, Williams SJ, Byth K, Bourke MJ. Deep mural injury and perforation after colonic endoscopic mucosal resection: a new classification and analysis of risk factors. Gut. 2017; 66(10): 1779-89.
32. Kim HW. What is different between postpolypectomy fever and postpolypectomy coagulation syndrome? Clin Endosc. 2014; 47(3): 205-6.
33. Benson BC, Myers JJ, Laczek JT. Postpolypectomy electrocoagulation syndrome: A mimicker of colonic perforation. Case reports in emergency medicine. 2013; 3 pages.
34. Jehangir A, Bennett KM, Rettew AC, Fadahunsi O, Shaikh B and Donato A. Post-polypectomy electrocoagulation syndrome: a rare cause of acute abdominal pain. J Community Hosp Intern Med Perspect. 2015; 5(5): 29147.
35. Belderbos TD, Leenders M, Moons LM, Siersema PD. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy. 2014; 46: 388-402.
36. Tanaka S, Kashida H, Saito Y, Yahagi N, Yamano H, Saito S et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc. 2015; 27: 417-34.
37. Shichijo S, Takeuchi Y, Uedo N and Ishihara R. Management of local recurrence after endoscopic resection of neoplastic colonic polyps. World J Gastrointest Endosc. 2018; 10(12): 378-82.
38. Seo GJ, Sohn DK, Han KS, Hong CW, Kim BC, Park JW et al. Recurrence after endoscopic piecemeal mucosal resection for large sessile colorectal polyps. World J Gastroenterol. 2010; 16(22): 2806-11.
1. Rafiemanesh H, Pakzad R, Abedi M, Kor Y, Moludi J, Towhidi F et al. Colorectal cancer in Iran: Epidemiology and morphology trends. EXCLI Journal 2016; 15: 738-44.
2. Meseeha M, Attia M. Colon polyps. StatPearls Publishing. 2021.
3. The Paris endoscopic classification of superficial neoplastic lesions: Esophagus, stomach and colon. Gastroint Endosc 2003; 58: S3-43.
4. Gupta S. Trouble in Paris classification: polyp morphology is in the eye of the beholder. Am J Gastroenterol. 2015; 110(1): 188-91.
5. Oka S, Tanaka S, Kanao H, Oba S, Chayama K. Therapeutic strategy for colorectal laterally spreading tumor. Dig Endosc Off J Jpn Gastroenterol Endosc Soc. 2009; 21: S43-S46.
6. Yamada M, Saito Y, Sakamoto T, Nakajima T, Kushima R, Parra-Blanco A et al. Endoscopic predictors of deep submucosal invasion in colorectal laterally spreading tumors. Endoscopy. 2016; 48(5): 456-64.
7. Meier B, Caca K, Fischer A, Schmidt A. Endoscopic management of colorectal adenomas. Ann Gastroenterol. 2017; 30(6): 592-7.
8. Hayashi N, Tanaka S, Hewett DG, Kaltenbach TR, Sano Y, Ponchon T et al. Endoscopic prediction of deep submucosal invasive carcinoma: validation of the narrow-band imaging international colorectal endoscopic (NICE) classification. Gastrointest Endosc. 2013;78(4): 625-32.
9. Tanaka S, Kaltenbach T, Chayama K, Soetikno R. High magnification colonoscopy. GIE. 2006; 64(4): 604-13.
10. Li M, Ali SM, Gilani SUO, Liu J, Li YQ and Zuo XL. Kudo’s pit pattern classification for colorectal neoplasms: A meta-analysis. World J Gastroenterol. 2014; 20(35): 12649-56.
11. Tung SY, Wu Cs, Su MY. Magnifying colonoscopy in differentiating neoplastic from nonneoplastic colorectal lesions. Am J Gastroenterol. 2001; 96: 2628-32.
12. Hayashi N, Tanaka S, Hewett DG, Saunders BP, Rex DK, Soetikno RM. Endoscopoc prediction of deep submucosal invasive carcinoma: validation of the NICE classification. GIE. 2013; 78(4): 625-32.
13. Patrun J,Okresa L, Ivekovic H and Rustemovic N. Diagnostic accuracy of NICE classification system for optical recognition of predictive morphology of colorectal polyps. Gastroenterol Res Pract. 2018; 2018: 7531368.
14. Hewett DG, Kaltenbach T, Sano Y, Tanaka S, Saunders BP, Ponchon T et al. Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology. 2012; 143(3):599-607.
15. Okamoto Y, Oka S, Tanaka S, Kamigaichi Y, Tamari H, Shimohara H et al. Effect of educational lecture on the diagnostic accuracy of Japan NBI Expert Team classification for colorectal lesions. BMC Gastroenterology. 2021; 21: 110.
16. Kobayashi S, Yamada M, Takamaru H, Sakamoto T, Matsuda T, Sekine S et al. United Eur Gastroent J. 2019; 7(7):914-23.
17. Li DH, Liu XY, Huang C, Deng CN, Zhang JL, Xu XW et al. Pathological analysis and endoscopic characteristics of colorectal laterally spreading tumors. Cancer Manag Res. 2021; 13: 1137-44.
18. Ferlitsch M, Moss A, Hassan C, Bhandari P, Dumonceau JM, Papatis G et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 2017; 49.
19. Ramirez M, Schierling S, Papaconstantinou HT and Thomas JS. Management of the malignant polyp. Clin Colon Rectal Surg. 2008; 21(4): 286-290.
20. Neilson LJ, Rutter MD, Saunders BP, Plumb A and Rees CJ. Frontline Gastroenterol. 2015; 6(2): 117-126.
21. Friedland S, Shelton A, Kothari S, Kochar R, Chen A and Benerjee S. Endoscopic Management of nonlifting colon polyps. Diagn Ther Endosc. 2013.
22. Russo P, Barbeiro S, Awadie H, Libanio D, Dinis-Ribeiro M and Bourke M. Management of colorectal laterally spreading tumors: a systematic review and meta-analysis. Endosc Int Open. 2019; 7(2): E239-59.
23. Choo WK and Subhani J. Complication rates of colonic polypectomy in relation to polyp characteristics and techniques: a district hospital experience. J Interv Gastroenterol. 2012; 2(1): 8-11.
24. Amato A, Radaelli F, Correale L, Giulio ED, Buda A, Cennamo V et al. Intra-procedural and delayed bleeding after resection of large colorectal lesions: The SCALP study. United European Gastroenterol J. 2019; 7(10):1361-72.
25. Fahrtash-Bahin F, Holt BA, Jayasekeran V, Sonson R, Lee EY, Williams SJ et al. Tu1499 snare tip soft coagulation technique for hemostasis of intraprocedural bleeding during wide field endoscopic mucosal resection of large colonic lesions. GIE. 2013; 77(5): AB562-3.
26. Mack A, Mangira D and Moss A. Prevention of delayed post-polypectomy bleeding: should we amend the 2017 ESGE guideline? Endosc Int Open. 2020; 8(9): E1111-14.
27. Luning TH, Keemers-Gels ME, Barendregt WB, Tan AC and Rosman C. Colonoscopic perforations: a review of 30366 patients. Surg Endosc. 2007; 21: 994-997.
28. Avgerinos DV, Llaguna OH, Lo AY, Leitman IM. Evolving management of colonoscopic perforations. J Gastrointest Surg. 2008; 12: 1783-9.
29. Hormati A, Ghadir MR, Alavinejad P, Sarkeshikian SS, Pezeshki Modares M. Repair of polypectomy colonic perforation by endoclip: a case report. Jcol. 2013; 35(4): 227-9.
30. Castro R, Libanio D, Pita I, Dinis Ribeiro M. Solutions for submucosal injection: What to choose and how to do it. World J Gastroenterol. 2019; 25: 777-8.
31. Burgess NG, Bassan MS, McLeod D, Williams SJ, Byth K, Bourke MJ. Deep mural injury and perforation after colonic endoscopic mucosal resection: a new classification and analysis of risk factors. Gut. 2017; 66(10): 1779-89.
32. Kim HW. What is different between postpolypectomy fever and postpolypectomy coagulation syndrome? Clin Endosc. 2014; 47(3): 205-6.
33. Benson BC, Myers JJ, Laczek JT. Postpolypectomy electrocoagulation syndrome: A mimicker of colonic perforation. Case reports in emergency medicine. 2013; 3 pages.
34. Jehangir A, Bennett KM, Rettew AC, Fadahunsi O, Shaikh B and Donato A. Post-polypectomy electrocoagulation syndrome: a rare cause of acute abdominal pain. J Community Hosp Intern Med Perspect. 2015; 5(5): 29147.
35. Belderbos TD, Leenders M, Moons LM, Siersema PD. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy. 2014; 46: 388-402.
36. Tanaka S, Kashida H, Saito Y, Yahagi N, Yamano H, Saito S et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc. 2015; 27: 417-34.
37. Shichijo S, Takeuchi Y, Uedo N and Ishihara R. Management of local recurrence after endoscopic resection of neoplastic colonic polyps. World J Gastrointest Endosc. 2018; 10(12): 378-82.
38. Seo GJ, Sohn DK, Han KS, Hong CW, Kim BC, Park JW et al. Recurrence after endoscopic piecemeal mucosal resection for large sessile colorectal polyps. World J Gastroenterol. 2010; 16(22): 2806-11.
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