Bardají Bofill Manel

Most colonic polyps are asymptomatic, but may present with fecal occult blood, iron deficiency anemia, or mucus removal. Others can be detected by digital rectal examination. Most are discovered during routine health studies.

The field of the study of fecal occult blood has been the subject of research over the past three decades. In patients who have had a positive fecal occult blood test, colonoscopy has detected the presence of polyps in 1/3 of them and cancer in 10% of cases. The number of adenomas and cancer increased with age in patients with positive occult blood tests. Fecal occult blood tests performed during digital rectal examination are not specific for adenomas when sampled after defecation.

Adenoma or carcinoma are found at the time of diagnosis by colonoscopy in 22% and 11% of patients, respectively, in whom they present without rectal bleeding (blood mixed with fecal matter). On the other hand, the incidence of adenoma or carcinoma of the colon detected is only 14% and 8% respectively in patients presenting with lower gastrointestinal bleeding. Colonoscopies performed in patients with a family history of colon cancer demonstrate the presence of adenomas in 22% in first-degree relatives. In asymptomatic male patients with an average age of 60 years, approximately 25% of them find adenomas during colonoscopy. In general, the risk of occult colon adenoma is higher in adult men.

Patients who are going to undergo colonoscopic treatment of polyps should have mechanical preparation of the colon. Most polyps can be resected via colonoscopy using electrocautery. Surgical removal should be performed only when an experienced endocopist cannot perform the removal of the polyp, or when the polyp has an invasion due to its malignancy. Total removal of the polyp is desirable but small polyps (0.5 cm or less) can be treated with biopsy and fulguration. The incidence of malignancy in small polyps is less than 0.1%. Pedunculated polyps are possible to resection through the use of electrocautery.

Sessile polyps larger than 2 cm usually contain hairy features, have a high degree of malignancy, and are prone to recurrence after polypectomy. If the resection cannot be performed completely endoscopically due to technical problems, a biopsy should be performed and the patient referred for surgery. In cases where the lesion can be removed by colonoscopic route, colonoscopic follow-up should be performed every 3-6 months to confirm complete resection of the polyp. If the presence of a polyp is detected, it should be resected and a new control must be done after 3 months. If abnormal tissue is observed after the second or third colonoscopy control, surgical removal should be indicated.

The removed polyp should be analyzed by a pathologist. Histologically, adenomatous polyps may show a benign adenoma (tubular, tubulovillous, villous), carcinoma in situ or invasive carcinoma. Colonoscopic removal is the definitive treatment for patients with benign adenomatous polyps or polyps with carcinoma in situ. In case of pedunculated polyps with invasive carcinoma, colonocopic removal is considered an appropriate treatment when there are indicators of good prognosis such as complete excision, without lymphovascular invasion, clean margins and well-differentiated histology. Follow-up should be performed every three months to rule out the presence of residual tissue. All patients who have lesions without these criteria should undergo elective resection of the colon segment involved. If the risks of surgery are elevated due to the patient's morbidity, follow-up monitoring with colonoscopies is indicated periodically.

Polypectomy colonoscopic has a complication rate of 1 - 2%. The most common is bleeding. Other complications include perforation of the colon, microperforations, colonic wall burn with electrocautery, intestinal cystic pneumatosis, splenic and mesenteric vessel lesions. Many of these complications can be treated expectantly, but peritonitis and hemorrhages require emergency laparotomies.