Poliposis intestinal

MANEJO DE POLIPOSIS INTESTINAL MR2 LUIS ANGEL MARI GUTARRA CIRUGÍA DIGESTIVA ABRIL-2010 TO KMCV

MANEJO DE POLIPOSIS INTESTINAL ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Tjandra J et. al. Practice Parameters for the Management of Rectal Cancer. Dis Col Rectum 2005; 48:411-23.

MANEJO DE POLIPOSIS INTESTINAL ,[object Object],[object Object],[object Object],Jemal A, Tiwari RC, Murray T, Ghafoor A, Samuels A, Ward E, et al. American Cancer Society. Cancer statistics 2004. CA Cancer J Clin 2004; 54:8-29.

MANEJO DE POLIPOSIS INTESTINAL ,[object Object],[object Object],[object Object],[object Object],[object Object],Polyps guidelines on diagnosis, treatment and surveillance for patients with colorectal polyps.Am J Gastroenterol 2000;95(11):3053-63.

MANEJO DE POLIPOSIS INTESTINAL National Polyp Study Work Group. NEJM 2000;342:1766-72 . Poliposis inflamatoria Pseudopoliposis Poliposis linfoidea – Pólipo inflamatorio – Pseudopólipo – Pólipo linfoide INFLAMATORIOS Poliposis juvenil Pólipo del S. de Peutz-Jeghers S. Cowden S. Cronkhite-Canada Pólipo juvenil Pólipo de S. de Peutz-Jeghers HAMARTOMATOSOS Poliposis hiperplásica Hiperplásicos HIPERPLÁSICOS Poliposis adenomatosa familiar ,[object Object],[object Object],[object Object],[object Object],[object Object],NEOPLASICOS Multiples Unicos Clasificación de Pólipos Intestinales

Clasificación de Haggitt invasion tumoral en polipos pedunculados y sésiles Gastroenterology 1985;89:328–336

Clasificación de Haggitt ,[object Object],Gastroenterology 1985;89:328–336 El carcinoma invade la submucosa de la pared intestinal por debajo del tallo del pólipo, pero por encima de la capa muscular propia. Grado 4 El carcinoma invade cualquier porción del tallo. Grado 3 El carcinoma invade el plano del cuello del pólipo (entre la cabeza y el tallo) Grado 2 El carcinoma invade la submucosa a través de la túnica muscular de la mucosa, pero se limita a la cabeza del pólipo. Grado 1 El carcinoma no invade la túnica muscular de la mucosa Grado 0

MANEJO DE POLIPOSIS INTESTINAL ,[object Object],[object Object],Surgical management of early colorectal cancer. World J Surg 2000;24:1052–1055. El carcinoma invade el tercio inferior de la submucosa Sm3 El carcinoma invade el tercio medio de la submucosa. Sm2 El carcinoma invade el tercio superior de la submucosa. Sm1

Riesgo de Metástasis Ganglionares según Haggitt ,[object Object],[object Object],[object Object],[object Object],Kudo S, Kashida H, Tamura T. Early colorectal cancer: Flat or depressed type. J Gastroenterol Hepatol 2000;15:66–70

Pólipos Adenomatosos ,[object Object],[object Object],[object Object],[object Object],Dis Colon Rectum 2002;45:200–206

Pólipos Adenomatosos ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Dis Colon Rectum 2002;45:200–206

Pólipos Adenomatosos Ann Surg 2000;231:613–614 52.9% 10-3% 9.5% Velloso 45.8% 7.4% 3.9% Tubulovelloso 34.7% 10.2% 1% Tubular > 2cm 1 – 2 cm < 1cm Tamaño Tipo Histologico Pólipo Adenomatoso y Porcentaje de Carcinoma

Secuencia Adenoma-Carcinoma ,[object Object],[object Object],[object Object],[object Object],Ann Surg 2000;231:613–614

Secuencia Adenoma-Carcinoma The New England Journal of Medicine, Volume 342 Number 26

Riesgo alto de Adenoma para Carcinoma ,[object Object],[object Object],[object Object],[object Object]

Pólipos Adenomatosos ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Ann Surg 2000;231:613–614

Pólipos Adenomatosos ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Am Journal Gastroenterology – Vol. 95, No. 11, 2000

Polyp Guideline: Diagnosis, Treatment, and Surveillance for Patients With Colorectal Polyps ,[object Object],[object Object],[object Object],[object Object],Am Journal Gastroenterology – Vol. 95, No. 11, 2000

Polyp Guideline: Diagnosis, Treatment, and Surveillance for Patients With Colorectal Polyps ,[object Object],[object Object],[object Object],[object Object],[object Object],Am Journal Gastroenterology – Vol. 95, No. 11, 2000

Técnicas de Polipectomía Endoscópica O. Kronborg. Colon polyps and cancer. Endoscopy 2002;34:69-72 .

Polyp Guideline: Diagnosis, Treatment, and Surveillance for Patients With Colorectal Polyps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Polyp Guideline: Diagnosis, Treatment, and Surveillance for Patients With Colorectal Polyps Am Journal Gastroenterology – Vol. 95, No. 11, 2000 1.- Confianza visual del endoscopista de que la escisión ha sido completa. 2.- Preparación adecuada y cuidadosa del pólipo extraído 3.- Carcinoma bien o moderadamente deferenciado. 4.- Ausencia de invasión de los márgenes. 5.- Ausencia de invasión venosa y linfática. CONDICIONES PARA UNA CORRECTA ACTUACIÓN TERAPÉUTICA ENDOSCÓPICA EN UN PÓLIPO DEGENERADO.

JANO 28 DE SEPTIEMBRE-4 DE OCTUBRE 2007. N.º 1.664

Seguimiento: Study Telemark Polyp I. Scand J Gastroenterol. 1999;34:414-20.

Seguimiento: Telemark Polyp Study I. Scand J Gastroenterol. 1999;34:414-20.

Poliposis Adenomatosa Familiar ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Best Practice & Research Clinical Gastroenterology Vol. 21, No. 3, pp. 409e426, 2007

Poliposis Adenomatosa Familiar ,[object Object],[object Object],[object Object],[object Object],[object Object],Best Practice & Research Clinical Gastroenterology Vol. 21, No. 3, pp. 409e426, 2007

Poliposis Adenomatosa Familiar ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Best Practice & Research Clinical Gastroenterology Vol. 21, No. 3, pp. 409e426, 2007

Classification of severity of duodenal polyposis (Spigelman et al 1989). Best Practice & Research Clinical Gastroenterology Vol. 21, No. 3, pp. 409e426, 2007 ,[object Object],[object Object]

Poliposis Adenomatosa Familiar ,[object Object],[object Object],Best Practice & Research Clinical Gastroenterology Vol. 21, No. 3, pp. 409e426, 2007

Poliposis Adenomatosa Familiar ,[object Object],FAP patients are diagnosed in one of three ways. By symptoms: Patients may be the first in a family with FAP (a 'spontaneous' mutation). They may not know their family history (adopted, or separated from affected relatives), or they may choose to ignore it. Screening is not performed and diagnosis is made when symptoms prompt investigations. These patients tend to present late and may already have a cancer. By endoscopy: Patients are part of a recognized family and are usually diagnosed by screening endoscopy. By genetics: patients are diagnosed by genetic analysis, without undergoing endoscopy at all.

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Poliposis Adenomatosa Familiar Best Practice & Research Clinical Gastroenterology Vol. 21, No. 3, pp. 409e426, 2007

[object Object],[object Object],[object Object],Poliposis Adenomatosa Familiar

[object Object],[object Object],[object Object],[object Object],[object Object],Poliposis Adenomatosa Familiar

Eligiendo el tipo de Cirugía en PAF ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],Eligiendo el tipo de Cirugía en PAF

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Eligiendo el tipo de Cirugía en PAF

Síndromes Poliposicos Hamartomatosos. ,[object Object],[object Object],Best Practice & Research Clinical Gastroenterology Vol. 21, No. 3, pp. 409e426, 2007

Síndromes Poliposicos Hamartomatosos ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Best Practice & Research Clinical Gastroenterology Vol. 21, No. 3, pp. 409e426, 2007

Síndromes Poliposicos Hamartomatosos ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Best Practice & Research Clinical Gastroenterology Vol. 21, No. 3, pp. 409e426, 2007

Síndromes Poliposicos Hamartomatosos ,[object Object],[object Object],[object Object],[object Object],[object Object],Best Practice & Research Clinical Gastroenterology Vol. 21, No. 3, pp. 409e426, 2007

Síndromes Poliposicos Hamartomatosos ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Best Practice & Research Clinical Gastroenterology Vol. 21, No. 3, pp. 409e426, 2007

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],MANEJO DE POLIPOSIS INTESTINAL Best Practice & Research Clinical Gastroenterology Vol. 21, No. 3, pp. 409e426, 2007

[object Object],[object Object],[object Object],[object Object],[object Object],MANEJO DE POLIPOSIS INTESTINAL Best Practice & Research Clinical Gastroenterology Vol. 21, No. 3, pp. 409e426, 2007

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Recomendación del ASCRS: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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