gastrointestinal disorders
Polyps of the Colon and Rectum
Treatment of Colorectal Polyps
Complete removal during colonoscopy Sometimes follow with surgical resection Follow-up surveillance colonoscopy Polyps should be removed completely with a snare or biopsy forceps during total colonoscopy. If colonoscopic removal is unsuccessful, laparotomy should be done. Subsequent treatment depends on the histology of the polyp. If dysplastic epithelium does not invade the muscularis mucosa, the line of resection in the polyp’s stalk is clear, and the lesion is well differentiated, endoscopic excision and close endoscopic follow-up should suffice. Patients with deeper invasion, an unclear resection line, or a poorly differentiated lesion should have segmental resection of the colon. Because invasion through the muscularis mucosa provides access to lymphatics and increases the potential for lymph node metastasis, such patients should have further evaluation (as in Colorectal Cancer ). The scheduling of follow-up examinations after polypectomy is controversial and varies by the number, size, and type of polyps removed ( Treatment reference ). For example, guidelines recommend a repeat total colonoscopy (or barium enema if total colonoscopy is impossible) 3 years after removal of a tubular adenoma ≥ 10 mm or a villous adenoma of any size. 1.Gupta S, Lieberman D, Anderson JC, et al: Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer.Am J Gastroenterol115(3):415-434, 2020. doi: 10.14309/ajg.0000000000000544 