Endoscopic management of familial colonic neoplasia

Cold snare polypectomy effectively reduces polyp burden in familial adenomatous polyposis

BACKGROUND AND STUDY AIMS

Familial adenomatous polyposis (FAP) is generally managed by colectomy, but in some cases surgery is delayed and polyp burdens are managed endoscopically. We aimed to describe the use of cold snare polypectomy to control the polyp burden in selected patients with FAP.

PATIENTS AND METHODS

This was a retrospective cohort study. Polyps were counted and the range of polyp size recorded at each examination. Patients with a reduction in polyp number and mean size were considered to have successful endoscopic reduction of their polyp burdens.

RESULTS

Of 79 patients with FAP, 21 had an attempt at delaying surgery by cold snaring of at least 30 adenomas, and had at least one follow-up at our institution. Ten patients had intact colons, 6 had intact rectums, and 5 had heavy polyp burdens in an ileo-anal pouch. Among the 21 patients, the mean number of polyps resected at the first examination was 85, range 30 - 342. Nineteen of 21 patients had fewer polyps at the second examination, and of those, only one had any persistence of adenomas ≥ 1 cm in size. During follow-up, two patients underwent surgical resection and the remainder had reductions in their polyp burdens at follow-up endoscopy.

CONCLUSIONS

Cold snare polypectomy effectively reduces polyp burden in selected FAP patients.

Colorectal polyps in children: a retrospective study of clinical features and the value of ultrasonography in their diagnosis

BACKGROUND

Colorectal polyps are common in children. The purpose of this report was to describe a clinical experience with colorectal polyps at the Beijing Children's Hospital and to evaluate the diagnostic value of ultrasonography in screening colorectal polyps in children.

METHOD

This was a retrospective medical record review of 487 children with colorectal polyps managed at the Beijing Children's Hospital between August 2003 and April 2010.

RESULTS

The mean age at presentation was 4.7 ± 2.5 years, with a male predominance (M/F ratio, 1.9:1). Most children (n = 458, 94%) presented with hematochezia associated with other symptoms, such as recurrent abdominal pain (n = 42, 8.6%), prolapse of the polyp from the anus (n = 43, 8.8%), and diarrhea (n = 10, 2.1%). Anemia was observed in 33 (6.8%) children, 4 of whom required a blood transfusion before the colonoscopy. Among the 487 patients, 352 (72.3%) patients underwent ultrasonography before the colonoscopy. Polyps were detected on 345 of 352 ultrasonographic examinations in which patients subsequently underwent colonoscopy and were found to have colonic polyps. The most common polyp locations were the sigmoid colon (n = 212, 46.1%) and the rectum (n = 174, 37.8%). Solitary polyps were identified in 421 patients (88.4%), and multiple polyps were identified in 55 (11.6%) patients. Colonoscopy complications were rare, with colonic perforation observed in 2 patients and postcolonoscopy hemorrhage observed in 1 patient. The available pathology records showed that the most frequent histological type was juvenile polyps (n = 435, 91.8%), followed by Peutz-Jeghers polyps (n = 17, 3.6%), juvenile polyposis (n = 14, 3.0%), hamartomas (n = 6, 1.3%), familial adenomatous polyposis (n = 1, 0.2%), and inflammatory polyps (n = 1, 0.2%).

CONCLUSION

Ultrasonic examination is a valid, accurate, and safe technique for screening colorectal polyps in children; and a full colonoscopy should be performed to remove the polyp(s) as soon as possible.