scholarly journals “Obscure” Appendiceal Orifice Polyps Can Be Challenging to Identify by Colonoscopy

2020 ◽  
Vol 14 (1) ◽  
pp. 15-26
Author(s):  
Afshin Amini ◽  
Elliot Koury ◽  
Zahra Vaezi ◽  
Amirsina Talebian ◽  
Elie Chahla
Keyword(s):  
Surgical Resection ◽  
Colonic Polyps ◽  
Screening Colonoscopy ◽  
Subsequent Removal ◽  
Appendiceal Neoplasm

The primary purpose of screening colonoscopy is the detection and subsequent removal of precancerous polyps. However, effective recognition of appendiceal lesions with a standard endoscope is often challenging and is limited to the base of the cecum and appendiceal orifice. The majority of appendiceal polyps are found incidentally following an appendectomy, though rarely they may be discovered during a colonoscopy. Despite being visualized by colonoscopy, most of these polyps are generally referred for surgical resection. The risk of developing carcinoma in patients with appendiceal polyps is likely similar to that of other colonic polyps, so it is essential for the endoscopist to examine and visualize the appendiceal orifice thoroughly. Various techniques are available to the endoscopist that can increase the accuracy of colonoscopic evaluation. These include luminal inflation and deflation, looking behind and pressing haustral folds, and repetitive passage of the scope over poorly visualized areas. To our knowledge, only 3 cases have been reported in the literature describing the discovery of obscure appendiceal polyps using colonoscopic techniques. Here we describe three cases of appendiceal orifice polyps missed on initial visualization but subsequently protruded into the cecum following prolonged examination and gentle deflation in the cecum. The endoscopist should consider the possibility of an appendiceal neoplasm, especially if other colonic polyps have been found. Endoscopists should spend adequate time examining the cecum during a screening colonoscopy to expose and thoroughly examine the appendiceal region.

Fr562 DETECTION OF PKS+ ESCHERICHIA COLI ASSOCIATES WITH THE PRESENCE OF TUBULAR ADENOMAS AND LEFT-SIDE COLONIC POLYPS IN HEALTHY PATIENTS UNDERGOING SCREENING COLONOSCOPY.

2021 ◽  
Vol 160 (6) ◽  
pp. S-364
Author(s):  
Victoria L. Campodónico ◽  
Myron Jackson ◽  
Madison Mcmann ◽  
Emma Spence ◽  
Celina Santiago ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Colonic Polyps ◽  
Screening Colonoscopy

scholarly journals A167 MANAGEMENT OF LARGE COLORECTAL POLYPS IN NOVA SCOTIA

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 32-33
Author(s):  
H Petropolis ◽  
D Farina ◽  
A R Kohansal
Keyword(s):  
Nova Scotia ◽  
Surgical Resection ◽  
Colonic Polyps ◽  
Colorectal Polyps ◽  
Current Data ◽  
Screening Programs ◽  
European Guidelines ◽  
Health Zone ◽  
Average Size ◽  
Surgical Group

Abstract Background Colorectal cancer (CRC) has the third highest cancer incidence for males and females in Canada1. CRC rates are decreasing, likely due to implementation of CRC screening programs and removal of precancerous polyps. In Nova Scotia, management of large (> 2 cm) polyps is varied. Some patients are referred for endoscopic mucosal resection (EMR), while others referred for surgical resection. EMR is effective2 and associated with less morbidity and mortality compared to surgery3. Furthermore, EMR is less expensive than surgery and requires less resources when performed as a day procedure. Management of these polyps are unknown in Canada and are potentially changing with gathering evidence on the safety and effectiveness of EMR. North American and European guidelines recommend EMR for non-invasive colonic polyps as first line management. Aims This projects aim is to determine how large polyps are being treated in a group of FIT positive patients from Nova Scotia. Methods This is a retrospective observational study. The Nova Scotia Colon Cancer screening database was searched for FIT positive patients in 2017. Patients found to have > 2 cm colonic polyps were included. Malignant polyps were excluded. Electronic charts were reviewed to determine method of polyp removal. Endoscopic and histologic polyp information was obtained. Results 196 patients had at least one polyp > 2 cm. Within the central health zone where pathology results were available 78 patients had > 2cm polyps. 13 were excluded for malignancy, one lost to follow up and one patient was miscoded. In total 63 patients were included, 8 of which underwent a surgical resection. Of these surgically resected polyps the average size was 4 cm and 3 cm for the EMR group. The average time to removal was 3 months in the surgical group and one month in the EMR group. The average age was 68 years in the surgical group and 67 years in the EMR group. The endoscopists referring for surgery were 75% surgeon and 25% GI and the endoscopists performing EMR were 45% surgeon and 55% GI. 1 of 8 (12.5%) patients experienced complications (anastomotic leak) in the surgical group and 2 of 56 (3.6%) patients experienced post polypectomy bleeding in the EMR group. Conclusions In this study 12.5% of large nonmalignant polyps found in a group of FIT positive patients from Nova Scotia were removed surgically via resection. Polyps were on average larger by 1 cm in the surgical group and patients experienced a higher rate of complication. This study highlights the need for a structured system of referral and assessment for endoscopic removal of advanced polyps by expert endoscopists, to reduce the number of surgical resections. Additional investigation of additional years, and health zones outside the tertiary central health zone is ongoing. This will help provide more validity to our current data, and allow comparison of academic vs community management of large polyps. Funding Agencies None

Outcomes of surgical resections for benign colon polyps: a systematic review

Endoscopy ◽  
2019 ◽  
Vol 51 (10) ◽  
pp. 961-972 ◽  
Author(s):  
Michael P.M. de Neree tot Babberich ◽  
Maxime E.S. Bronzwaer ◽  
Jurr O. Andriessen ◽  
Barbara A. J. Bastiaansen ◽  
Nahid Mostafavi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Resection ◽  
Endoscopic Treatment ◽  
Clinical Decision Making ◽  
Colonic Polyps ◽  
Morbidity And Mortality ◽  
Cochrane Library ◽  
Colon Polyps ◽  
Polyp Size ◽  
Year 2000

Abstract Background Not all benign colonic polyps are suitable for endoscopic resection, although criteria for endoscopic non-resectability vary worldwide. Clinical decision-making largely depends on endoscopic treatment options, as well as postoperative risks after surgical resection. This systematic review aimed to determine postoperative outcomes and the characteristics of surgically resected benign colonic polyps. Methods MEDLINE, EMBASE, and the Cochrane Library were searched for studies investigating the outcomes of surgical resection for benign colonic polyps since 1980. Studies were considered eligible when at least one postoperative outcome (morbidity and/or mortality) was reported. Meta-analyses were conducted for the primary outcome measures (morbidity and mortality) for studies that included patients only after the year 2000. Results Of the 4210 studies retrieved, 26 studies describing 139 897 patients were included. The most common indications for surgical resection were polyp location in the right-sided colon, non-pedunculated morphology, and large polyp size. The pooled 1-month complication and mortality rates of studies that included patients after the year 2000 were 24 % (95 % confidence interval [CI] 15 % – 36 %) and 0.7 % (95 %CI 0.6 % – 0.8 %), respectively. Conclusion The postoperative morbidity and mortality after colonic resection for benign polyps are substantial. Referral to an advanced interventional endoscopist should be considered before referral for surgery to evaluate the possibilities for endoscopic treatment of large, non-pedunculated, and/or colonic polyps in difficult locations without suspicion of submucosal malignant invasion.

scholarly journals Colonoscopic Preoperative Localization Using Submucosal Injection of Radiolabelled Colloid

2008 ◽  
Vol 22 (7) ◽  
pp. 637-639
Author(s):  
Carolyn Cho ◽  
Sanjiv Jain ◽  
Mark Pilbeam ◽  
Noel Tait ◽  
Andrew Thomson
Keyword(s):  
Surgical Resection ◽  
Gamma Probe ◽  
Colonic Polyps ◽  
Preoperative Localization ◽  
New Technique ◽  
Submucosal Injection ◽  
Technetium 99M ◽  
A New Technique ◽  
Intraoperative Localization

Malignant colonic polyps can be removed endoscopically but surgical resection is sometimes required. However, the polypectomy site can be difficult to locate. Current methods use various tattooing agents, with varying degrees of success. A new technique using pre-operative injection of technetium-99m-labelled antimony colloid, with intraoperative localization using a handheld gamma probe, is described. Although unsuccessful in terms of localizing a previously partially resected polyp, the technique itself proved safe and simple, and has some advantages over other endoscopic approaches.

scholarly journals Diagnostic value of distal colonic polyps for prediction of advanced proximal neoplasia in an average-risk population undergoing screening colonoscopy

2004 ◽  
Vol 59 (6) ◽  
pp. 634-641 ◽  
Author(s):  
Maite Betés Ibáñez ◽  
Miguel A Muñoz-Navas ◽  
José M Duque ◽  
Ramón Angós ◽  
Elena Macı́as ◽  
...  
Keyword(s):  
Colonic Polyps ◽  
Diagnostic Value ◽  
Screening Colonoscopy ◽  
Average Risk ◽  
Risk Population

scholarly journals Case Report: Schwannoma of the sigmoid colon: a case report of a rare colonic neoplasm and review of literature

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 652
Author(s):  
Gangmi Kim ◽  
Sun Il Kim ◽  
Kang Young Lee
Keyword(s):  
Case Report ◽  
Sigmoid Colon ◽  
Tumor Cells ◽  
Surgical Resection ◽  
Submucosal Tumor ◽  
Regional Lymph Node ◽  
Screening Colonoscopy ◽  
Resection Margins ◽  
Resected Specimen ◽  
S 100

Background: Schwannomas are tumors originating in Schwann cells of the peripheral nerve system and uncommonly develop in the gastrointestinal tract. Sigmoid colon schwannomas are very rare and only 28 cases have been reported. This study aims to report a case of a sigmoid colon schwannoma and present a literature review. Case report: We report a case of a 66-year-old female with asymptomatic sigmoid colon schwannoma. The patient underwent a screening colonoscopy and about 4cm sized submucosal tumor was identified at the sigmoid colon. A colonoscopic biopsy was performed and the microscopic exam revealed an ulcerated lesion with a proliferation of fibroblast-like spindle cells beneath ulcer, which was insufficient for diagnosis. Abdominopelvic computerized tomography (CT) scan showed a well-defined, well-enhancing, round shaped and slightly heterogenous mass at the sigmoid colon. No distant metastasis was identified in abdominopelvic CT and chest CT scans. Carcinoembryonic antigen level was within a normal range (1.33ng/mL). The patient underwent laparoscopic anterior resection. Immunohistochemical staining of the resected specimen showed positivity for S-100 protein in tumor cells and schwannoma was diagnosed post-surgically. Surgical resection margins were free from tumor and no regional lymph node metastasis was reported. Conclusion: Colon schwannomas are rare diseases. Most cases of colon schwannomas are accidentally identified during screening colonoscopy. The tumors usually present as submucosal masses and colonoscopic biopsies are mostly non-diagnostic. Surgical resection is required, and definitive diagnosis is made by confirming S-100 positive tumor cells in immunohistochemical analysis. Most cases are benign; a few cases have been reported to be malignant. Surgical resection with free negative margins is the treatment of choice

scholarly journals Appendiceal mucocele secondary to torsion in an asymptomatic patient

2019 ◽  
Vol 2019 (8) ◽  
Author(s):  
Nikhil Aggarwal ◽  
Aman Bhargava
Keyword(s):  
Surgical Resection ◽  
Pseudomyxoma Peritonei ◽  
Poor Prognosis ◽  
Asymptomatic Patient ◽  
Histopathological Diagnosis ◽  
Appendiceal Neoplasm ◽  
Diagnosis And Management ◽  
Appendiceal Mucocele ◽  
First Case

Abstract Torsion of the appendix associated with an appendiceal mucocele is extremely rare with just a few published cases. To our knowledge, we report the first case of appendiceal mucocele secondary to torsion in an asymptomatic patient. In this case, numerous adhesions were found attaching the tip of the appendix mucocele to the peritoneum contributing to torsion as well as a lack of evidence for appendiceal neoplasm. Complications of appendiceal mucocele include obstruction, intussusception and pseudomyxoma peritonei, which has a particularly poor prognosis. Clinicians should, therefore, consider prompt surgical resection for definitive histopathological diagnosis and management.

scholarly journals Case of colonic mucosal Schwann cell hamartoma and review of literature on unusual colonic polyps

2018 ◽  
pp. bcr-2018-224931 ◽  
Author(s):  
JayaKrishna Chintanaboina ◽  
Kofi Clarke
Keyword(s):  
Schwann Cell ◽  
Ganglion Cells ◽  
Colonic Polyps ◽  
Low Risk ◽  
Screening Colonoscopy ◽  
Tubular Adenoma ◽  
Ascending Colon ◽  
Review Of Literature ◽  
History Of ◽  
Mesenchymal Tumours

Mucosal Schwann cell hamartomas (MSCH) are benign mesenchymal tumours rarely seen in the gastrointestinal tract. They occasionally present as incidental sessile polyps during colonoscopy. A 55-year-old asymptomatic female patient with a medical history of multiple sclerosis presented for a screening colonoscopy. A 5 mm low-risk tubular adenoma was noted in the caecum, and a second 5 mm polyp was found in the ascending colon. Histopathology of the ascending colon polyp showed proliferation of spindle cells without ganglion cells in the lamina propria. Immunohistochemical findings are compatible with an MSCH. Surveillance colonoscopy was scheduled in 5 years based on the presence of a single low-risk tubular adenoma.

scholarly journals Minimally Invasive Approaches for the Management of “Difficult” Colonic Polyps

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
R. Alejandro Cruz ◽  
Madhu Ragupathi ◽  
Rodrigo Pedraza ◽  
T. Bartley Pickron ◽  
Anne T. Le ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Endoscopic Mucosal Resection ◽  
Surgical Resection ◽  
Malignant Disease ◽  
Colonic Polyps ◽  
Colon Resection ◽  
Endoscopic Polypectomy ◽  
Endoscopic Removal ◽  
Number Of Patients ◽  
Laparoscopic Assisted

Traditionally, patients with colonic polyps not amenable to endoscopic removal require open colectomy for management. We evaluated our experience with minimally invasive approaches including endoscopic mucosal resection (EMR), laparoscopic-assisted endoscopic polypectomy (LAEP), and laparoscopic-assisted colectomy (LAC). Patients referred for surgery for colonic polyps were selected for one of three minimally invasive modalities. A total of 123 patients were referred for resection of “difficult” polyps. Thirty underwent EMR, 25 underwent LAEP, and 68 underwent LAC. Of those selected to undergo EMR or LAEP, 76.4% were successfully managed without colon resection. The remaining 23.6% underwent LAC. Nine complications were encountered, including two requiring reoperative intervention. Of the 123 patients, three were found to have malignant disease on final pathology. Surgical resection can be avoided in a significant number of patients with “difficult” polyps referred for surgery by performing EMR and LAEP. In those who require surgery, minimally invasive resection can be achieved.

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