Colonic polyp is a general term for all redundant organisms protruding into the intestinal lumen, including adenomatous, hyperplastic, inflammatory and malignant polyp. Adenomatous polyp is closely related to the occurrence of intestinal cancer, however, recent studies have confirmed the relationship between other three types of polyp and intestinal cancer. Therefore, polyps found endoscopically should be given elective resection. Since these two types of polyps are not easily distinguished by the naked eye alone, they are often diagnosed as “polyps” as the initial diagnosis, and the pathological examination after removal will further clarify the classification and diagnosis.
Only some larger polyps can cause intestinal symptoms, such as change in stool habit, increase in frequency, mucus or mucus blood in stool, intermittent abdominal pain, etc. Very few have masses coming out of the anus during stool, some patients may have anemia due to long-term blood in stool, and patients with family history often have a suggestive effect on the diagnosis of polyps.
As colorectal polyps are often clinically asymptomatic, even if there are some gastrointestinal symptoms such as bloating, diarrhea, constipation, etc. are relatively mild and atypical and are often easily overlooked. Therefore, in order to make a diagnosis of colorectal polyps, first of all, we should raise the awareness of the physician of this disease, where the cause of blood in the stool or gastrointestinal symptoms is unknown, especially patients over 40 years old, with a family history of intestinal cancer should pay attention to colonoscopy, so that the detection rate and diagnosis rate of colorectal polyps is expected to greatly improve. The early detection of colorectal cancer is also possible since then.
The principle of treatment of colon polyps is to remove the polyps found, and the current method of polyp removal is mainly endoscopic removal methods, according to the shape, size, number and the presence or absence of polyps, length and thickness are used: (1) high-frequency electrocoagulation trap resection method: mainly for polyps with tips; (2) EMR (endoscopic mucous resection), mainly (2) EMR (endoscopic mucous resection), mainly for non-tipped broad-based polyps, hemispherical or spherical; (3) EPMR, fractionated EMR, mainly for non-tipped broad-based polyps larger than 4 cm in diameter, hemispherical or spherical; (4) ESD (endoscopic submucousa dissection), mainly for non-tipped broad-based polyps, flat.
(5) Argon knife (APC), laser, microwave, and electrocoagulation: for those who do not need to keep histological specimens and have small and flat polyps; (6) Surgery: mainly for patients with polyposis and polyps that are difficult to be removed endoscopically.
All wounds treated by all methods are closed with metal clips as appropriate.
Since colorectal polyps, especially adenomatous polyps, have been recognized by scholars as pre-cancerous lesions, regular follow-up of patients with colorectal polyps has been highly recognized as prevention and treatment of early colorectal cancer. 252 patients were followed up in Southern Hospital in 10 years, including 184 cases of adenomatous polyps and 68 cases of inflammatory polyps, the first follow-up positive rate of both was 51.0% and 34.2% respectively, and the negative patients of both were followed up again. The positive rate was 9.8% for adenomatous and 8.2% for inflammatory polyps; and the positive rate was significantly higher than that of negative patients, 47.3%35.6%, respectively. In the same period, there was a female patient with adenomatous polyps, because the patient did not agree to remove, and two years later the symptoms were obvious, re-examination of the colonoscopy, the original adenoma was found to have evolved into progressive cancer and finally forced to surgery, so colon polyps, especially adenomatous polyps, regular follow-up is an important part of the prevention of polyp malignancy.
The re-detection rate of polyps is high, ranging from 13% to 86% as reported abroad. In addition to some newly detected polyps, which are recurrent polyps with residual polyps growing again, some are new polyps and missed polyps in the colon. In order to maintain a polyp-free state in the intestine and prevent the occurrence of colorectal cancer, it is necessary to develop a cost-effective follow-up time. They pointed out that patients with adenoma have different risks of new adenoma and local adenoma recurrence after adenoma resection, so they should be treated differently: adenomas that are single, tipped (or broad-based but <2 cm tubular adenoma), with mild or moderate atypical hyperplasia are in the low risk group, while those with one of the following conditions are in the high risk group The follow-up plan for the high-risk group is to remove the adenoma, perform an endoscopy every 3-6 months, and then re-examine the adenoma every 6-9 months if it is negative, or every 1 year if it is negative again, and then every 3 years if it is still negative. If the adenoma is negative, it can be examined every 3 years, and then every 5 years, but during the follow-up period, fecal occult blood must be examined every year.