With the increasing popularity of electronic colonoscopy, it is common to find patients with intestinal polyps during colonoscopy. The first reaction of patients or their families when they hear about intestinal polyps is often “do we have to operate?
Intestinal polyps refer to bulging lesions on the mucosal surface of the rectum that protrude into the intestinal lumen, including adenomas (including villous adenomas), childhood polyps, inflammatory polyps and polyposis. Pathologically, their content varies from benign tumors to the consequences of inflammatory hyperplasia.
Let us first understand what exactly are intestinal polyps?
An intestinal polyp is a lesion that is a limited elevation of the intestinal mucosa. In general, intestinal polyps are benign lesions, which can be as small as a sesame seed or a green bean, or as large as a walnut. The number can vary from one to hundreds or thousands. In terms of shape, there are tipped polyps, subtibial polyps, and flat polyps. According to their pathological nature, intestinal polyps can be divided into five categories: neoplastic, inflammatory, malignant, and proliferative.
Do I have to undergo surgery if I find intestinal polyp?
As already mentioned, most intestinal polyps are a new organism in the intestinal mucosa, before the pathological examination, which is the “gold standard”, all diagnoses are just guesses. If it is malignant, it is not necessary to mention the danger; if it is a precancerous lesion such as adenoma, it is equivalent to a “time bomb”, as the polyp increases, the number increases, the chance of cancer increases rapidly, and nearly half of the adenomas over 2cm in diameter will become cancerous. Even inflammatory polyps, although less harmful to the body, but with the increase of polyps, may also bring a series of clinical symptoms, such as long-term blood in the stool, diarrhea, intestinal overlap and even intestinal obstruction. Therefore, intestinal polyps should be removed when they are found.
Do I have to undergo surgery to remove polyps?
With the development of medical technology, nowadays, most colon polyps can be removed without surgery. In recent decades, with the introduction of fiberoptic endoscopy, especially electronic endoscopy, endoscopic technology has developed rapidly, especially the fastest development of endoscopic treatment technology, endoscopic polypectomy is a very mature treatment method. The indications are: (1) polyps and adenomas of various sizes; (2) polyps and adenomas less than 2 cm in diameter without a tip; (3) multiple adenomas and polyps with scattered distribution and small numbers.
It can be said that endoscopic resection of intestinal polyps has become a routine method for the treatment of intestinal polyps. Except for a very small number of cases with large diameter, obvious malignant morphology or excessive number of polyps, intestinal polyps can generally be removed completely under endoscopy. Endoscopic removal of polyps has obvious advantages over open surgery.
Endoscopic polyp removal is less painful and less damaging to the body, and it is suitable for the elderly, infirm or young children.
Can colonoscopy identify the nature of polyps?
Generally speaking, polyps with tips, less than 2cm in diameter, smooth surface and good mirror pushing activity are often benign, including inflammatory and adenomatous polyps. In contrast, submucosal flattened ones with larger diameters (>2 cm), bleeding and ulcers on the surface, and poor mirror push mobility tend to have a higher chance of being malignant. A study in the United States showed that about 1% of polyps <1cm in diameter were malignant, 46% of adenomas larger than 2cm were malignant, and only 10% of adenomas between 1 and 2cm were malignant. In addition, with the help of techniques such as pigmented endoscopy and magnifying endoscopy, a preliminary determination of the type and nature of the lesion can be made based on the type of glandular duct opening on the surface of the polyp. Of course, endoscopy can only give a general and ambiguous diagnosis based on the shape of the polyp, and with the help of pigmented and magnified endoscopy, the type and nature of the lesion can be initially determined based on the type of glandular opening on the surface of the polyp. Of course, endoscopy can only make a general and ambiguous diagnosis based on the shape of the polyp. The correct treatment is to remove the polyp completely and send it to pathology for final determination of the nature of the polyp. Pathological results are the “gold standard” for polyp diagnosis.