Overview of the disease
Multiple elevated lesions on the mucosa of the colon that protrude into the intestinal lumen Most patients do not have obvious symptoms, but some have abdominal discomfort, blood in the stool, and abdominal pain The etiology of the disease has not been clarified, and the disease is associated with intestinal infections, age, genetics, and family history Most of the disease can be resected under colonoscopy
Definition
Multiple polyps of the colon are elevated lesions of the colonic mucosa that protrude into the lumen of the colon and are more than one in number [1-3].
Most polyps are asymptomatic when they are small. As polyps grow, some patients may experience abdominal pain, diarrhea, blood in stool, and mucus in stool.
Classification
According to Morson histologic classification
Tumor polyps: high risk of malignancy, histologically classified into 3 types: tubular adenoma, villous adenoma and mixed adenoma.
Dysplastic polyp: a bulging lesion of the intestinal lumen with normal tissue but structural abnormalities, commonly including Peutz-Jephers syndrome.
Inflammatory polyps: benign raised lesions that appear when the mucosa is stimulated by inflammation, commonly including inflammatory polyps and pseudopolyposis.
Hyperplastic polyps: benign elevated lesions that appear when the mucosa is stimulated by chronic inflammation, commonly including multiple hyperplastic polyps.
Colonoscopic Yamada typing
Yamada type I: broad-based bulge.
Yamada type II: hemispherical bulge.
Yamada type III: subtypical bulge.
Yamada type IV: with distinctive tip formation.
Morbidity
Multiple polyps of the colon are usually found in people aged 40 to 60 years old, with a lower incidence in younger people. The prevalence of polypoid colon polyps is in people who are obese, have unhealthy diets, and have a family history of colonic polyps [1-3].
Causes
Causes
Inflammation
Chronic inflammation of the colonic mucosa is the main cause of inflammatory polyps, commonly found in ulcerative colitis, amoebic dysentery, intestinal tuberculosis, Crohn’s disease and so on.
Genetic factors
Some colonic polyposis has a tendency of familial inheritance, for example: familial adenomatous polyp, Peutz-Jephers syndrome.
Gene mutation
The development of some neoplastic colon polyps may be associated with the loss of function of oncogenes. Oncogenes, such as APC, can inhibit tumor growth under normal conditions. If the oncogenes are absent or mutated, adenomatous polyposis as well as cancerous lesions may occur.
Dietary factors
A high-fat, low-fiber diet, smoking, and alcohol consumption can increase the risk of polyp formation.
Risk factors
Age: Middle-aged and elderly people are the most common in China.
Obesity: lack of exercise, overweight, prolonged sitting and lying down.
Symptoms
主要症状
Most of the multiple colon polyps are asymptomatic. As the polyps grow, some patients may have symptoms such as abdominal discomfort, blood in the stool, abdominal pain, and change in bowel habits.
Abdominal discomfort
Most patients with multiple colon polyps have no obvious symptoms. As the polyps grow, some patients may experience abdominal discomfort.
Blood in stool
When the surface of the polyp breaks down, there may be blood in the stool, the specific manifestation varies according to the location and the amount of bleeding, the most common manifestation is black stool, stool mixed with blood.
Abdominal pain
Abdominal pain is often sudden, mostly due to large adenomas or complications of intussusception.
Change of bowel habit
When the polyps are large or multiple, constipation or diarrhea, or alternating constipation and diarrhea, may occur. [1-3].
Complications
Intussusception or intestinal obstruction
With the development of colon polyp patients, the polyp will slowly increase in size, and when the diameter of the polyp is relatively large, it can cause narrowing of the intestinal lumen, leading to intestinal mucosal intussusception and intestinal obstruction.
Symptoms such as severe abdominal pain, abdominal distension, and cessation of bowel movement may occur.
Anemia
Some patients with multiple polyps in the colon can have anemia symptoms due to the long-term blood in stool, which can cause hemoglobin to decrease.
It is also often a reason for consultation in the clinic.
Colon cancer
Adenomatous polyps are prone to malignant changes and develop into colon cancer.
Common symptoms include blood in stool, bloating and abdominal pain.
Consultation
Department of Medicine
Gastroenterology
When the patient has symptoms such as blood in stool, abdominal pain, abdominal discomfort, or when polyps are detected by colonoscopy, it is recommended to consult the Gastroenterology Department promptly.
Preparation
Consultation: Registration, Preparation of documents, Frequently Asked Questions
Tips for medical treatment
Before the colonoscopy, take the medication prescribed by your doctor to prepare your intestines, and poop until the stool is clear and watery.
Eat a light, regular diet and get a good night’s sleep a few days before your visit.
Preparation List
Symptom checklist
Particular attention needs to be paid to the time of onset of symptoms, special manifestations, etc.
Is there an increase or decrease in the number of bowel movements? What color is the stool?
Is there any bloating or abdominal pain?
How long have these symptoms been present?
Under what circumstances do these symptoms worsen or resolve?
Medical History Checklist
Were colon polyps found during a physical examination?
Have parents, siblings, or brothers or sisters suffered from colon polyps or bowel cancer?
Any ulcerative colitis, Crohn’s disease, constipation?
Checklist
Test results in the last six months, which can be brought to the doctor’s office
Laboratory tests: fecal occult blood test, routine blood test, fecal DNA test screening.
Imaging Tests: Abdominal CT, Magnetic Resonance Imaging (MRI)
Endoscopy: colonoscopy.
Diagnosis
Diagnosis is based on
Medical history
The patient may have the following conditions:
Family history of colon polyps, bowel cancer.
History of ulcerative colitis, Crohn’s disease, constipation.
Clinical manifestations
Symptoms.
Abdominal discomfort, blood in the stool, abdominal pain, and change in bowel habit.
Laboratory tests
Fecal Occult Blood Test
The fecal occult blood test can be used to see if there is blood in the feces and to determine if the patient has gastrointestinal bleeding.
If the test result is positive, it may be the rupture and erosion of colorectal polyps, resulting in the presence of blood in the feces [5].
Blood routine examination
Routine blood tests are performed to determine whether the patient has anemia.
A test result showing decreased hemoglobin suggests that the patient is anemic.
Imaging
CT or MRI of the abdomen
Not a routine test for colon polyps, but mainly used to screen patients suspected of having colon cancer.
It can screen for some of the larger polyps, and can be used to see if the polyp is cancerous.
Colonoscopy
Colonoscopy can directly check the condition of the patient’s intestines, clarify whether there are multiple polyps in the colon, and at the same time can observe the shape, number and size of polyps.
Precautions: Three days before the examination, you need to have a non-residue diet (e.g. porridge, milk, noodles and other foods with less crude fiber content), and you need to prepare your intestines before the colonoscopy examination, and you may experience abdominal distension, abdominal pain and other uncomfortable symptoms during the examination.
Histopathological examination
Colonoscopy takes biopsies for pathologic examination, which can clarify the pathological nature of polyps and guide the next step of treatment.
鉴别诊断
Multiple polyps of the colon have similarities with colon cancer and gastrointestinal mesenchymal tumors, and should be judged by detailed examination from several aspects.
Colon cancer
Similarity: Generally there is a change in bowel habit in the early stage, without typical clinical symptoms.
Differences: according to the location, there are left half colon cancer (mostly manifesting symptoms of intestinal obstruction such as abdominal distension and stopping of defecation) and right half colon cancer (mostly manifesting symptoms of blood in stool and anemia), and patients with colon cancer will have symptoms of emaciation and fatigue, which need to be differentiated by pathological biopsy through colonoscopy.
Gastrointestinal mesenchymal tumor
Similarity: Early stage of mesenchymal tumors are characterized by changes in bowel habit and lack of typical clinical symptoms.
Differences: A small portion of mesenchymal tumors occur in the colon, and most of them show symptoms of bleeding, dyspepsia and intestinal obstruction, which are mainly identified through endoscopy, and the treatment is surgical resection.
Treatment
Treatment aim: cure the disease and eliminate the symptoms.
Treatment principle: multiple colonic adenomatous polyps should be endoscopically resected as far as possible, inflammatory polyps only need regular review, hyperplastic polyps generally do not cause symptoms and do not require special treatment.
Endoscopic treatment
After accurately localizing the location of polyps through colonoscopy, polyp removal using high-frequency electrocoagulation and electrocision, thermal biopsy forceps forceps removal, endoscopic mucosal resection is the preferred method of intestinal polyp treatment [6].
Postoperative complications such as bleeding, perforation and infection may occur [8-9].
High-frequency electrocoagulation electrosurgery
INDICATIONS: It is more widely used for all sizes of pedunculated polyps and non-pedunculated polyps with a diameter of less than 2 cm as well as fewer numbers of scattered multiple polyps.
Methods: Insert an electrically charged loopers or thermal biopsy forceps through the colonoscope, energize it, and then use the heat generated by the electrical energy to cut down the polyps.
Endoscopic mucosal resection (EMR)
Indications: For non-tipped, flat polyps.
Methods: Use a hypodermic needle to inject fluid (methylene blue, etc.) into the submucosa to lift the polyp, and then use a trap to remove the polyp in a complete circle.
Thermal biopsy forceps removal
Indications: generally applicable to small polyps of 1 to 5 mm.
Methods: Insert an electrically charged thermal biopsy forceps through the colonoscope, open the two mouths of the forceps and then clamp the polyp, energize it, and then use the heat generated by the electrical energy to cut down the polyp.
Cold trap resection
Indications: generally applicable to polyps with a diameter of ≤10mm.
Methods: Use the trap to tighten and directly remove the polyp.
Endoscopic submucosal dissection (ESD)
Indications: For patients with huge polyps or early cancerous colonic polyps.
Methods: Glycerol fructose solution containing methylene blue is injected into the submucosal layer beneath the lesion to elevate the lesion, and then the periphery and base of the lesion are gradually cut with a cutting knife, and finally the lesion is completely removed [7].
Argon ion coagulation (APC)
Indications: for patients with small or flat polyps.
Methods: Argon gas is ionized to transmit high-frequency energy to the surface layer of polyps, and argon plasma can produce coagulation effect on the target tissues without contact, which can play a therapeutic role of hemostasis and polyp removal.
Nylon rope ligation
Indications: suitable for patients with pedunculated colonic polyps.
Methods: Use nylon rope to ligate the root of the polyp, so that the blood supply of the polyp tissue is interrupted, and necrosis is detached within l to 4 d. This method is simple and easy to use. This method is simple and easy to implement, but the polyp tissue can not be recycled for pathological examination.
Laser treatment
Indications: applicable to colon polyps.
Methods: When the laser acts on the polyp, it produces thermal effect causing protein denaturation, tissue necrosis and carbonization, burning until gasification, so as to achieve the purpose of removing the polyp.
Surgery
Laparoscopic surgery
It is suitable for patients who have colon polyps that cannot be completely removed by colonoscopy but do not need open surgical treatment.
Advantages include less trauma and faster recovery after surgery.
Sigmoidectomy
Sigmoidectomy is suitable for patients with multiple polyps that cannot be completely removed by colonoscopy and for patients with cancerous intestinal polyps.
It is usually performed as a localized segmental resection or radical resection to improve the prognosis and survival rate of patients.
Prognosis
Cure
Inflammatory polyps resolve spontaneously when the inflammatory stimulus subsides.
Hyperplastic polyps with a diameter of <5mm do not require treatment and regular colonoscopy is sufficient.
Tumor polyps are prone to cancerous transformation and can develop into colon cancer if left untreated for a long time [10-12].
Daily
Daily management
Dietary management
Pay attention to dietary hygiene.
Eat more vegetables and fruits, such as carrots, celery, broccoli, bananas, etc., to consume enough dietary fiber and vitamins, which will help intestinal health and avoid constipation.
It is recommended that you can mix coarse and fine grains in your daily life, and you can eat some sweet potatoes, corn and potatoes appropriately to increase the intake of dietary fiber.
Supplement more protein-rich foods, such as lean meat, fish, eggs and milk, to enhance nutrition.
Do not eat high-fat and stimulating foods in daily life, and it is recommended to keep the diet light.
Daily life management
Ensure sufficient sleep and do not stay up late.
It is recommended to strengthen outdoor physical exercise, such as brisk walking, skipping, swimming, etc., to maintain good health and enhance the body’s resistance.
Quit smoking and drinking.
Psychological management
Patients with colon polyps may have adverse emotions such as anxiety and depression, so it is necessary to strengthen communication with patients and encourage them to maintain an optimistic state of mind.
Follow-up review
The timing of the review is usually decided based on colonoscopic pathologic findings, completeness of resection, bowel preparation, health status, family history of polyps and past medical history.
After treatment of adenomatous polyps, colonoscopy is usually reviewed once every six months to one year. If no new adenomatous polyp occurs, the timing of subsequent colonoscopy reviews can be extended to once every 2 years.
The main review program is colonoscopy.
Prevention
Aggressive treatment of diseases such as chronic colitis, ulcerative colitis, and Crohn’s disease can prevent the development of colorectal polyps.
Try not to smoke or drink alcohol.
In daily life, we should have a balanced diet, eat less spicy and stimulating, high-fat food, and eat more fruits and vegetables.
Take appropriate calcium supplement combined with vitamin D.
Maintain good bowel habits to avoid constipation.
It is recommended that healthy people over 40 years old start regular colonoscopy examination to achieve early detection and early treatment.