The possibilities of endoscopy in the diagnosis and treatment of colon polyps
Science Articles / / May 01, 2016
Turutin AD, Shorin NA
In recent years greatly increased interest in the study of the pathogenesis, diagnosis and treatment of diseases of the colon due to their significant growth.The development of endoscopy and endoscopic creating perfect technology led to the development of minimally invasive methods of investigation and treatment of colon polyps
significant role in the early diagnosis of colon polyps assigned fibrocolonoscopy (FCC).With it you can quickly and with great certainty to establish the presence or absence of pathological changes in the investigated organ.At the same time it is possible to obtain material for morphological studies to evaluate the dynamics of the process.The indication for the FCC is conducting clinical signs indicating the presence of diseases of the rectum and colon, or the need for differential diagnosis with a view to removing them.Endoscopy was performed to monitor the effectiveness of therapy.It is indicated for patients of the so-called risk groups.Our report
FCC indicated for all patients who seek advice from a specialized agency, who were diagnosed with polyps in the rectum, in cases where there is suspicion of ulcerative colitis, diverticulosis or cancer.
We distinguish the following groups of patients who had a colonoscopy is a first:
- patients with colon polyps detected during sigmoidoscopy;
- patients with clinical and radiological suspicion of benign or malignant neoplasm of the colon;
- patients with unclear origin sources of bleeding from the rectum;
- Patients diagnosed with X-rays and malignancies or the FCC is required to determine the nature and extent of the process, as well as to identify other tumors (polyps, villous tumor, cancer) which can not be detected by barium enema;
- patients with diffuse polyposis of the colon in order to establish the possible malignancy of polyps;
- patients with ulcerative colitis and Crohn's disease of the colon;
- Patients with any process in the colon, which is needed for further diagnosis histological examination of the lesion;
- patients with benign tumors of the colon, which due to severe comorbidities surgery is contraindicated.Such patients need to be dynamic observation, periodic endoscopic regular biopsy.
During the period from 1993 to 2003.in the endoscopic department conducted 16,721 endoscopic examinations of the colon, and ambulatory 1638 (9.8%) patients.Of these, colon cancer was diagnosed in 1622 (9.7%), polyps, colorectal cancer - in 3851 (23%) patients.Diverticula and diverticulosis - 749 (4.5%), ulcerative colitis - from 520 (3.1%), Crohn's disease of the colon - in 196 (1.2%) patients.Thus, an obvious pathology of the colon, requiring active treatment policy, was diagnosed in 8576 (51.8%) patients endoscopically.
colon polyps detected during the FCC average, 27.8% of surveyed.With increasing age of the patients increased incidence of polyps.Most polyps are often found in the age groups from 40 to 70 years, and in men more often than women - 54.1 and 45.9%, respectively.
single polyp was detected in 1433 (37.2%) patients in 1411 (36.6%) - Group polyps (polyps under the group we mean a group of polyps from 2 to 5-7; in 1007 (26.1%) in 2746 patients (71.3%) polyps were located in the left half of the colon, of whom 2307 (59.9%) polyps were located in the sigmoid colon and rectum. in 709 subjects (18.4%) iolipy diagnosed in the right parts of the colon. single, group and multiple polyps of the colon sectionsand rectum were found in 397 patients (10.7%).
biopsy through the FCC allows us with sufficient accuracy to judge the morphological nature of the polyp. However plucked biopsy has its negative sides, so it is impossible to take a tumor tissue in sufficient quantities due to its featuresgrowth. Pre-biopsy does not provide information about the severity of proliferative changes in a polyp. to assess the possible malignancy of the polyp is necessary to examine it in its entirety or a large part.In this regard, we consider that a preliminary pinch biopsy of the tumor with no endoscopic evidence of malignancy was inappropriate and even dangerous because of the possibility of bleeding.Such polyps for histological examination is best removed in its entirety.
Polypectomy by the FCC is the first of its total biopsy.This intervention is a delicate and complicated intervention, which requires possession of endoscopy equipment, high medical qualification.
Most researchers acknowledge that adenomatous polyps of the colon for several years by successive transformation can turn into cancer and, according to their pre-cancerous diseases.Our clinical experience also testifies to this process.We have seen that the rate of polyp malignancy increases with villous adenoma structures.
Failures of endoscopic electrosurgical colon polyps we observed at all stages of the operation.Among them we include:
- inability to hold the endoscope to the area adenoma;
- due to difficulties in the spraying loop intestinal wall;
- the inability to remove all polyps severed.
Thus, for the diagnosis of colon polyps FCC has a guide value.This method, of course, subject to possession of technique of its implementation, knowledge of anatomical features of each department and bowel, in the first place, the ability to differentiate polypous defeat other similar diseases, provides a great opportunity to make a correct diagnosis.When choosing the endoscopic treatment of colon polyps and rational selection of coagulation and cutting modes, the optimal result is achieved with the removal of minimum damage of the intestinal wall, while maintaining its functions.The use of preventive measures in the performance of endoscopic polypectomy can significantly reduce the number of postoperative complications.