TY - JOUR
T1 - Colonoscopic polypectomy in chronic colitis
T2 - Conservative management after endoscopic resection of dysplastic polyps
AU - Rubin, P. H.
AU - Friedman, S.
AU - Harpaz, N.
AU - Goldstein, E.
AU - Weiser, J.
AU - Schiller, J.
AU - Waye, J. D.
AU - Present, D. H.
PY - 1999
Y1 - 1999
N2 - Background and Aims: Adenomatous polyps are by definition dysplastic and pathologically indistinguishable from the dysplasia-associated lesion or mass (DALM) described in 1981. Yet, adenomatous polyps in noncolitic colons are usually removed definitively endoscopically, whereas DALMs are regarded as harbingers of colon cancer, mandating colectomy. Methods: Since 1988, all of our patients with chronic ulcerative or Crohn's colitis and dysplastic polyps and no coexistent dysplasia in flat mucosa underwent colonoscopic polypectomy. Biopsy specimens were obtained also adjacent to polypectomy sites, from strictures, and throughout the colon at 10-cm intervals. Follow- up colonoscopies and biopsies were performed within 6 months after polypectomy and yearly thereafter. Results: Colonoscopy in 48 patients with chronic colitis (mean duration, 25.4 years) resected 70 polyps (60 in colitic and 10 in noncolitic mucosa). Polyps were detected on screening colonoscopies (29%) and on surveillance (71%). Pathology was tubular adenoma in all polyps from noncolitic mucosa and low-grade dysplasia (57), high-grade dysplasia (2), or carcinoma (1) in polyps from colitic mucosa. Subsequent colonoscopies (mean follow-up, 4.1 years) revealed additional polyps in 48% but no carcinomas. Surgical resection (6 patients) for recurrent polyps confirmed colonoscopic findings. No dysplasia or cancers in fiat mucosa were found at surgery or on follow-up colonoscopies. Conclusions: In patients with chronic colitis who have no dysplasia in fiat mucosa, colonoscopic resection of dysplastic polyps can be performed effectively, just as in noncolitic colons.
AB - Background and Aims: Adenomatous polyps are by definition dysplastic and pathologically indistinguishable from the dysplasia-associated lesion or mass (DALM) described in 1981. Yet, adenomatous polyps in noncolitic colons are usually removed definitively endoscopically, whereas DALMs are regarded as harbingers of colon cancer, mandating colectomy. Methods: Since 1988, all of our patients with chronic ulcerative or Crohn's colitis and dysplastic polyps and no coexistent dysplasia in flat mucosa underwent colonoscopic polypectomy. Biopsy specimens were obtained also adjacent to polypectomy sites, from strictures, and throughout the colon at 10-cm intervals. Follow- up colonoscopies and biopsies were performed within 6 months after polypectomy and yearly thereafter. Results: Colonoscopy in 48 patients with chronic colitis (mean duration, 25.4 years) resected 70 polyps (60 in colitic and 10 in noncolitic mucosa). Polyps were detected on screening colonoscopies (29%) and on surveillance (71%). Pathology was tubular adenoma in all polyps from noncolitic mucosa and low-grade dysplasia (57), high-grade dysplasia (2), or carcinoma (1) in polyps from colitic mucosa. Subsequent colonoscopies (mean follow-up, 4.1 years) revealed additional polyps in 48% but no carcinomas. Surgical resection (6 patients) for recurrent polyps confirmed colonoscopic findings. No dysplasia or cancers in fiat mucosa were found at surgery or on follow-up colonoscopies. Conclusions: In patients with chronic colitis who have no dysplasia in fiat mucosa, colonoscopic resection of dysplastic polyps can be performed effectively, just as in noncolitic colons.
UR - http://www.scopus.com/inward/record.url?scp=0032739687&partnerID=8YFLogxK
U2 - 10.1016/S0016-5085(99)70279-9
DO - 10.1016/S0016-5085(99)70279-9
M3 - Article
C2 - 10579970
AN - SCOPUS:0032739687
SN - 0016-5085
VL - 117
SP - 1295
EP - 1300
JO - Gastroenterology
JF - Gastroenterology
IS - 6
ER -