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  • Endoscopy Polypectomy of Polyp of Descending Colon

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    Endoscopy Polypectomy of Polyp of Descending Colon
    This is a 21 year old lady that presented with Gi bleeding a colonoscopy was performed finding this ulcerated polyp that was removed with polypectomy

    TYPES OF COLON POLYPS

    The most common types of polyps are hyperplastic and adenomatous polyps. Other types of polyps can also be found in the colon, although these are far less common and are not discussed here.

    Hyperplastic polyps — Hyperplastic polyps are usually small, located in the end-portion of the colon (the rectum and sigmoid colon), have no potential to become malignant, and are not worrisome. It is not always possible to distinguish a hyperplastic polyp from an adenomatous polyp based upon appearance during colonoscopy, which means that hyperplastic polyps are often removed or biopsied to allow microscopic examination.

    Adenomatous polyps — Two-thirds of colon polyps are adenomas. Most of these polyps do not develop into cancer, although they have the potential to become cancerous. Adenomas are classified by their size, general appearance, and their specific features as seen under the microscope.

    As a general rule, the larger the adenoma, the more likely it is to eventually become a cancer. As a result, large polyps are usually removed completely to prevent cancer and for microscopic examination to guide follow-up testing.

    Malignant polyps — Polyps that contain pre-cancerous or cancerous cells are known as malignant polyps. The optimal treatment for malignant polyps depends upon the extent of the cancer (when examined with a microscope) and other individual factors.

    COLON POLYP DIAGNOSIS

    Polyps usually do not cause symptoms but may be detected during a colon cancer screening examination (such as flexible sigmoidoscopy or colonoscopy) (picture 1) or after a positive fecal occult blood test. Polyps can also be detected on a barium enema x-ray, although small polyps are more difficult to see with x-ray.

    Colonoscopy is the best way to evaluate the colon because it allows the physician to see the entire lining of the colon and remove any polyps that are found. During colonoscopy, a physician inserts a very thin flexible tube with a light source and small camera into the anus. The tube is advanced through the entire length of the large intestine (colon).
    The inside of the colon is a tube-like structure with a flat surface with curved folds. A polyp appears as a lump that protrudes into the inside of the colon (picture 1). The tissue covering a polyp may look the same as normal colon tissue, or, there may be tissue changes ranging from subtle color changes to ulceration and bleeding. Some polyps are flat (“sessile”) and others extend out on a stalk (“pedunculated”).

    Colonoscopy is also the best test for the follow-up examination of polyps. Virtual colonoscopy using CT technology is another test used to detect polyps in specific circumstances.

    COLON POLYP REMOVAL

    Colorectal cancer is the second leading cause of cancer deaths in the United States, accounting for 14 percent of cancer deaths. Colorectal cancer is preventable if precancerous polyps (ie, adenomas) are detected and removed before they become malignant (cancerous). Over time, small polyps can change their structure and become cancerous. Polyps are usually removed when they are found on colonoscopy, which eliminates the chance for that polyp to become cancerous.

    Procedure — The medical term for removing polyps is polypectomy. Most polypectomies can be performed through a colonoscope. Small polyps can be removed with an instrument that is inserted through the colonoscope and snips off small pieces of tissue. Larger polyps are usually removed by placing a noose, or snare, around the polyp base and burning through it with electric cautery. The cautery also helps to stop bleeding after the polyp is removed.

    Polyp removal is not painful because the lining of the colon does not have the ability to feel pain. In addition, a sedative medication is given before the colonoscopy to prevent pain caused by stretching of the colon. Rarely, a polyp will be too large to remove during colonoscopy, which means that a surgical procedure will be needed at a later time.

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