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Colorectal polyps
This document provides a comprehensive overview of colorectal polyps, detailing their definition, classification (anatomical, morphological, histological), and the associated risk of malignancy. It outlines the clinical features, diagnostic methods (like colonoscopy and CT colonography), and management strategies, including endoscopic and surgical options. Emphasis is placed on identifying neoplastic versus non-neoplastic types and their implications for treatment and cancer risk.
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Colorectal polyps
- 1. Colorectal polyps Chea ChanHooi Surgeon Department of Surgery Sibu Hospital
- 2. Content • Definition • Classification •Pathophysiology • Investigations • Management
- 3. Definition • Protuberant growthabove 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 TubulovillousVillous Frequency 75% 15% 10% Anatomical preponderance Throughout Throughout Rectum Malignant % <5 25 40
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- 7. • Risk ofmalignancy – ≥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 – Endoscopicmucosal resection (EMR) – Endoscopic submucosal dissection (ESD) • Surgical – Transanal excision – Transanal endoscopic microsurgery (TEMS) – Transanal minimally invasive surgery (TAMIS)
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