Desenvolvimento de neoplasias/adenomas avançados colorretais no seguimento a longo prazo de pacientes submetidos a colonoscopia com polipectomia

Rostirolla, Renata Andreoli; Pereira-Lima, Júlio Carlos; Teixeira, Cláudio Rolim; Schuch, Aline Weyne; Perazzoli, Camila; Saul, Carlos

doi:10.1590/s0004-28032009000300005

Cited by 9 publications

(6 citation statements)

References 20 publications

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“…Follow-up is essential due to the risk of recurrence (39) . Current guidelines recommend performing control colonoscopies between 3 and 6 months for large polyps undergoing piecemeal resection (53) .…”

Section: Discussionmentioning

confidence: 99%

Endoscopic mucosal resection in colorectal lesion: a safe and effective procedure even in lesions larger than 2 cm and in carcinomas

Santos¹,

Malaman²,

Pereira-Lima

2011

Arq. Gastroenterol.

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-Context -Endoscopic mucosal resection is a minimally invasive technique used in the treatment of colorectal neoplasms, including early carcinomas of different size and morphology. Objectives -To evaluate procedure safety, efficacy, outcomes, and recurrence rate in endoscopic mucosal resection of colorectal lesions. Methods -A total of 172 lesions in 156 patients were analyzed between May 2003 and May 2009. All lesions showed pit pattern suggestive of neoplasia (Kudo types III-V) at high-magnification chromocolonoscopy with indigo carmine. The lesions were evaluated for macroscopic classification, size, location, and histopathology. Lesions 20 mm or smaller were resected en bloc and lesions larger than 20 mm were removed using the piecemeal technique.Complications and recurrence were analyzed. Patients were followed up for 18 months. Results -There were 83 (48.2%) superficial lesions, 57 (33.1%) depressed lesions, 44 (25.6%) laterally spreading tumors, and 45 (26.2%) protruding lesions. Mean lesion size was 11.5 mm ± 9.6 mm (2 mm-60 mm). Patients' mean age was 61.6 ± 12.5 years (34-93 years). Regarding lesion site, 24 (14.0%) lesions were located in the rectum, 68 (39.5%) in the left colon, and 80 (46.5%) in the right colon (transverse, ascending, and cecum). There were 167 (97.1%) neoplasms: 142 (82.5%) adenomatous lesions, 24 (14.0%) intramucosal carcinomas, and 1 (0.6%) invasive carcinoma. En bloc resection was performed in 158 (91.9%) cases and piecemeal resection in 14 (8.1%). Bleeding occurred in 5 (2.9%) cases. Recurrence was observed in 4.1% (5/122) of cases and was associated with lesions larger than 20 mm (P<0.01), piecemeal resection (P<0.01), advanced neoplasm (P = 0.01), and carcinoma compared to adenoma (P = 0.04). Conclusions -Endoscopic mucosal resection of colorectal lesions is a safe and effective procedure, with low complication and local recurrence rates. Recurrence is associated with lesions larger than 20 mm and carcinomas.

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Section: Discussionmentioning

confidence: 99%

Endoscopic mucosal resection in colorectal lesion: a safe and effective procedure even in lesions larger than 2 cm and in carcinomas

Santos¹,

Malaman²,

Pereira-Lima

2011

Arq. Gastroenterol.

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“…Colonoscopy is considered the method of choice for this purpose 20 . Randomized clinical trials and several cohort studies have shown that colonoscopic polypectomy reduces its incidence by 76-90%, as compared with a general population registry 22 , 29 .…”

Section: Introductionmentioning

confidence: 99%

Influence of patient age and colorectal polyp size on histopathology findings

Silva

Rosa

Santos

et al. 2014

ABCD, arq. bras. cir. dig.

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BackgroundColorectal cancer is a major cause of morbidity and mortality and can arise through the adenoma-carcinoma sequence. Colonoscopy is considered the method of choice for population-wide cancer screening.AimTo assess the characteristics of endoscopically resected polyps in a consecutive series of patients who underwent colonoscopy at a university hospital and compare histopathology findings according to patient age and polyp size.MethodsRetrospective, cross-sectional of 1950 colonoscopy reports from consecutively examined patients. The sample was restricted to reports that mentioned colorectal polyps. A chart review was carried out for collection of demographic data and histopathology results. Data were compared for polyps sized ≤0.5 cm and ≥0.6 cm and then for polyps sized ≤1.0 cm and ≥1.1 cm. Finally, all polyps resected from patients aged 49 years or younger were compared with those resected from patients aged 50 years or older.ResultsA total of 272 colorectal polyps were resected in 224 of the 1950 colonoscopies included in the sample (11.5%). Polyps >1 cm tended to be pedunculated (p=0.000) and were more likely to exhibit an adenomatous component (p=0.001), a villous component (p=0.000), and dysplasia (p=0.003). These findings held true when the size cutoff was set at 0.5 cm. Patients aged 50 years or older were more likely to have sessile polyps (p=0.023) and polyps located in the proximal colon (p=0.009). There were no significant differences between groups in histopathology or presence of dysplasia.ConclusionPolyp size is associated with presence of adenomas, a villous component, and dysplasia, whereas patient age is more frequently associated with sessile polyps in the proximal colon.

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“…The adenoma-carcinoma sequence was fi rst analyzed by Morson and is considered as the main path for colorectal carcinogenesis [16][17][18] .…”

Section: Discussionmentioning

confidence: 99%

“…Recent updates of the National Polyp Study and the U.S. Multi-Society Task Force recommend that patients be identified as low risk (one or two tubular adenomas smaller than 1.0 cm or low grade dysplasia) or high risk (three or more adenomas, one of them being larger than 1.0 cm, villous or tubulovillous histology or high grade dysplasia) 10 . Low risk patients should undergo another colonoscopy in five years or more, while high risk patients should be submitted to a new colonoscopy in three years, as long as all polyps are properly removed 4,10,18 . According to guidelines of the American Gastroenterology Association and the American College of Gastroenterology, low risk patients should be re-evaluated in five years 10 .…”

Section: Vol 31 Nºmentioning

confidence: 99%

Correlation between location, size and histologic type of colorectal polyps at the presence of dysplasia and adenocarcinoma

Valarini¹,

Bortoli²,

Wassano³

et al. 2011

J. Coloproctol. (Rio J.)

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Adenocarcinoma represents 96-98% of colorectal neoplasms, and neoplastic polyps (adenomas) are their precursors. The aim of this study is to correlate size, location and histologic type of colorectal polyps at the presence of dysplasia and adenocarcinoma. Methods: Colonoscopies from January/2007 to December/2008 were retrospectively studied, in order to evaluate the characteristics of the polyps. Results and Discussion: Out of the 2,401 analyzed colonoscopies, 583 (24.3%) presented polyps. Due to the lack of histopathologic data, 139 exams were excluded. Mean age of the patients was 58±12 years, and 60% were females. Polyps were prevalent in the left colon (38.5%) and rectum (32.5%). Out of the 850 polyps which were histologically examined, 55.17% were tubular adenomas; 21.88%, hyperplastic; 17.05%, serrated; 5.4%, tubulovillous; and 0.47%, villous. As to polyps £1.0 cm, dysplasia was observed in 16.0% and adenocarcinoma in 1.9%. Those >1.0 cm, 72.0% (p<0.001) presented dysplasia, and 25.3% (p<0.001) presented adenocarcinoma. Polyps in the right and transverse colon were strongly associated with dysplasia (17.8% and 16.7%). Adenocarcinomas were prevalent in the left colon (2.5%) and rectum (2.1%). Conclusion: Polyps were more frequent in the left colon and rectum. The right and transverse colons were strongly correlated with dysplasia. Those of the left colon and rectum were associated with adenocarcinoma. Lesions >1.0 cm were positively related to dysplasia and neoplasm.
O adenocarcinoma representa 96-98% do câncer colorretal, sendo os pólipos neoplásicos (adenomas) seus precursores. O objetivo desse estudo é correlacionar tamanho, localização e tipo histológico de pólipos colorretais com a presença de displasia e adenocarcinoma. Métodos: Estudou-se retrospectivamente colonoscopias realizadas entre janeiro/2007 e dezembro/2008, avaliando-se as características dos pólipos. Resultados e Discussão: Das 2401 colonoscopias analisadas, 583 (24,3%) apresentaram pólipos. Por falta de dados histopatológicos, excluiu-se 139 exames. A média de idade foi 58±12 anos, sendo 60% mulheres. Houve predomínio no cólon esquerdo (38,5%) e reto (32,5%). Quanto ao tamanho, 86,58% eram £1 cm. Dos 850 pólipos analisados histologicamente, 55,17% eram adenomas tubulares, 21,88% hiperplásicos, 17,05% serrilhados, 5,4% tubulovilosos e 0,47% vilosos. Dos pólipos £1,0 cm, 16,0% apresentaram displasia e 1,9% adenocarcinoma; dos >1,0 cm houve displasia em 72,0% (p<0,001) e adenocarcinoma em 25,3% (p<0,001). Pólipos do cólon direito e transverso associaram-se mais à displasia (17,8% e 16,7%, respectivamente). Adenocarcinoma predominou no cólon esquerdo (2,5%) e reto (2,1%). Conclusão: Os pólipos predominaram em cólon esquerdo e reto. Os do cólon direito e transverso correlacionam-se fortemente à displasia, e os do reto e cólon esquerdo ao adenocarcinoma. Lesões maiores que 1,0 cm associaram-se positivamente com a presença de displasia e neoplasia

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Desenvolvimento de neoplasias/adenomas avançados colorretais no seguimento a longo prazo de pacientes submetidos a colonoscopia com polipectomia

Cited by 9 publications

References 20 publications

Endoscopic mucosal resection in colorectal lesion: a safe and effective procedure even in lesions larger than 2 cm and in carcinomas

Endoscopic mucosal resection in colorectal lesion: a safe and effective procedure even in lesions larger than 2 cm and in carcinomas

Influence of patient age and colorectal polyp size on histopathology findings

Correlation between location, size and histologic type of colorectal polyps at the presence of dysplasia and adenocarcinoma

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