Lecture on colorectal polyps for medical students. Encompasses basic sciences including pathophysiology, classification and principles of management.

1. Colorectal polyps
Chea Chan Hooi
Surgeon
Department of Surgery
Sibu Hospital

2. Content
• Definition
• Classification
• Pathophysiology
• Investigations
• Management

3. Definition
• Protuberant growth above surrounding
mucosa of hollow viscus

4. Classification
• Anatomical
– Respiratory, GI tracts
• Morphology
– Sessile
– Pedunculated
• Histological
– Neoplastic
• Adenomatous
• Serrated
• Others
– Non-neoplastic
• Inflammatory
• Hamartomatous
• Hyperplastic
• Nature of neoplasm
– Benign
– Malignant

5. Adenomatous polyps
Tubular Tubulovillous Villous
Frequency 75% 15% 10%
Anatomical
preponderance
Throughout Throughout Rectum
Malignant % <5 25 40

6. Pathophysiology

7. • Risk of malignancy
– ≥3 polyps
– ≥1cm
– Villous
– High grade dysplasia (35%)

8. Non-neoplastic polyps
• Inflammatory
– IBD, diverticulitis, infective
– Usually small <5mm
• Hamartomatous
– Large (up to 3cm), smooth,pedunculated
– Juvenile polyp
• Infant & children, if adult (retention polyp)
– Peutz-Jegher
• Mucocutaneous melanin pigmentation
• GI polyps (malignant potential) & extra-intestinal tumours
• Hyperplastic
– Usual-type: plaque-like, small <5mm, no malignant potential
– Serrated type: >5mm, pre-malignant, MSI, commonly right-sided
(recently designated as neoplastic by WHO)

9. Clinical features
• Aymptomatic
• Bleeding
– Iron-deficiency anaemia
– Frank per rectal bleeding
• Tenesmus
• Prolapse → mistaken as haemorrhoid
• Intussusception
• Diarrhoea ± mucus discharge (esp. villous)
– Dehydration & electrolyte imbalance (esp. K +)

10. Diagnosis
• Colonoscopy
– Location
– Number
– Size
– Malignant transformation
– Biopsy/polypectomy/EMR/ESD
– Arrest active bleeding

11. • CT colonography
– Double contrast
– Special software for
reconstruction
– As good as
colonoscopy in
diagnosing but unable
to intervene or biopsy
– Almost non-existent
risk of perforation

12. • Barium enema
– X-ray
– Single or double contrast
– Newer contrast agent  water
soluble
– Unable to biopsy or intervene

13. Management
• Endoscopic
– Endoscopic mucosal resection (EMR)
– Endoscopic submucosal dissection (ESD)
• Surgical
– Transanal excision
– Transanal endoscopic microsurgery (TEMS)
– Transanal minimally invasive surgery (TAMIS)

14. EMR

15. ESD

17. TEMS

18. TAMIS

19. TQ!
Q&A?