GASTROENTEROLOGY ARTICLE OF THE WEEK

JANUARY 11, 2001

 Bond JH.  Polyp guideline:  Diagnosis, treatment and surveillance for patients with colorectal polyps.  Am J Gastroenterol 2000;95:3053-3063.

 1.  During colonoscopy in a 50 y/o male with heme positive stools, a 0.5cm polypoid lesion is resected and found to be an inflammatory polyp.  The patient should:

            a.  Be offered no additional follow up other than routine colon cancer screening

            b.  Be treated for inflammatory bowel disease

            c.  Undergo repeat colonoscopy in 3 to 5 years to assess for recurrence of

inflammatory polyps

d.  Undergo repeat colonoscopy in 6 months to assess for completeness of resection.

2.  After resecting a polyp and doing a complete colon exam in a patient, follow-up examinations should be:

            a.  yearly for the next 5 years, then every 3-5 years

            b.  in 3 years if the index lesion was a large adenoma or multiple adenomas

            c.  in 5 years if the index lesion was <1 cm and no family history of colon cancer

            d.  in 6 months if the patient has insurance

            e.  in 5 years after the first follow-up exam is negative

True or False

 3.  After resecting a malignant polyp with favorable characteristics, follow-up colonoscopy is recommended in 3 months to assess for residual abnormal tissue

 4.  A 1cm polyp found at sigmoidoscopy should be biopsied, a colonoscopy performed only if it is and adenoma.

 5.  Resection of polyps from the right side of the colon using hot forceps is associated with perforations and a relatively high rate of delayed bleeding.

 6.  Patients found to have a single tubular adenoma <1cm in size, with a negative family history for colon neoplasia may not need any additional colonoscopy exams in the future.

 7.  High grade dysplasia in a polyp is synonymous with carcinoma in-situ or intramucosal carcinoma.

 8.  The incidence of synchronous adenomas in a patient with one known adenoma is 30% to 50%.

 9.  A 69 y/o man with  severe CHF undergoes flexible sigmoidoscopy for evaluation of hematochezia.  A 3mm adenoma is found in addition to large internal hemorrhoids.  A colonoscopy must be performed given the presence of the adenoma.

 10.  A 3 mm polyp found during flexible sigmoidoscopy should be biopsied.   Colonoscopy is indicated only if the polyp is an adenoma.

 11.  A 2.5cm sessile adenoma is removed in toto.  No other lesions were found  , pathology reveals a tubulovillous adenoma without severe dysplasia.  Adequate follow up should be:

            a.  Repeat colonoscopy in 1 year

            b.  Repeat colonoscopy in 3-5 years

            c.  Repeat colonoscopy in 3-6 months to assess completeness of resection

            d.  Referral to surgery for partial colectomy

            e.  Referral to surgeryif , recurrent or residual polyp is identified on the third

follow-up colonoscopy.

 12.  Regarding malignant polyp:

            a.  is a polyp with cancer in the mucosa only

            b.  is defined as a polyp with cancer that penetrates through the muscularis

mucosa

            c.  places the patient at risk for nodal metastasis as lymphatic channels do

penetrate to the muscularis mucosae

            d.  if well differentiated, with clear resection margins, and with no lymphatic

invasion, surgery is not indicated.

            e.  If the stalk is invaded, surgical resection is always needed, regardless of

resection margin involvement.

            d.  risk for death during colon resection in elderly patients is >5%, risk of

metastasis from a malignant polyp with favorable characteristics is 0.3% to 1.5%

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