Diathermy-Biopsy – A Technique for the Endoscopic Management of Small Polyps

Williams, Calvin B.

doi:10.1055/s-0028-1098245

Cited by 61 publications

(14 citation statements)

References 4 publications

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“…This policy of eradication applies not only to larger polyps, but also to the smaller lesions (representing almost 50% of all adenomas in our series), which before colonoscopy were often not detected in life. The procedure of 'hot-biopsy' fulguration (Williams, 1973) is particularly effective in the management of lesions less than 0-7 cm in size, and the safety and technique of conventional snare loop polypectomy for larger polyps is established (Williams et al, 1974;Shinya and Wolff, 1975). It should be stressed that colonoscopy is primarily a therapeutic procedure and that a high quality barium enema should remain the major means of detecting the presence of larger (more than 1 0 cm in diameter) polyps.…”

Section: Discussionmentioning

confidence: 99%

“…Seven hundred and nine adenomas were removed by snare polypectomy, while 34 were biopsied either by conventional biopsy technique or snare loop biopsy (Martin et al, 1976), as they were unsuitable for total endoscopic removal. In another 323 adenomas less than 0 7 cm in diameter, tissue was obtained using the 'hot-biopsy' fulguration method (Williams, 1973). In the patients examined, a total of 83 polyps (65 lost and 18 left in situ) were not obtained for histological examination.…”

Section: Patientsmentioning

confidence: 99%

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Colonic adenomas--a colonoscopy survey.

Gillespie¹,

Chambers²,

Chan³

et al. 1979

Gut

153

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SUMMARY A colonoscopy survey of 620 patients with 1049 colon adenomas showed a predominantly left-sided distribution (77 %). Of these lesions 97 % were amenable to endoscopic removal or ablation. Sixty per cent of patients presented with rectal bleeding as their major symptom. There was agreement between radiology and colonoscopy in only 62 % of patients, as many of the studies were single contrast barium enemas, performed before referral. Forty-eight per cent of adenomas in our series were less than I 0 cm in diameter. Of the larger adenomas ( > 2-0 cm in diameter) 66 % were situated in the sigmoid colon, and of those containing invasive carcinoma (4-8 % of the total) an even higher percentage (94 %) were in the sigmoid and low descending colon. With increasing polyp size, there was a greater predominance of villous elements and this was associated with a higher risk of malignant change than the more frequent and generally smaller tubular adenoma. Local colonoscopic excision alone is sufficient treatment for adenomas with malignant change unless they are poorly differentiated histologically and providing adequate resection is demonstrated. Twenty-eight patients treated in this way are alive without recurrence at periods from six to 62 months. Although 65 % of patients had only one adenoma, and 90% three or less, there is a risk of developing other benign and malignant colon neoplasms and careful follow-up is required.It is now widely accepted that adenomas of the colorectum are premalignant (Grinnell and Lane, 1958;Kalus, 1972;Morson, 1974;Muto et al., 1975;Enterline, 1976), although only a small minority will develop into invasive carcinoma, and the risk for an individual adenoma is difficult to assess. Acceptance of the concept of the 'adenoma-cancer' sequence (Morson, 1974) means that removal of all colonic adenomas is desirable. Since the advent of fibreoptic colonoscopy polypectomy is now possible without the need to resort to abdominal surgery in the majority of patients except those with familial polyposis coli. Removal and histological examination allow for a clear separation between adenomas and other types of polyp, and enable the histopathologist to exclude the presence of malignancy and to assess the cancer risk factors for a particular adenoma and perhaps for the particular patient. The risk factors used are size (especially in excess of 1I0 cm in diameter), histological type (particularly where there is a villous pattern), and the presence of cellular atypia (Muto et al., 1975).Previous reports of adenoma distribution, size, and histopathology have largely been based on resected colon specimens obtained at necropsy or at Received for publication 2 October 1978 surgery (Grinnell and Lane, 1958;Blatt, 1961;Chapman, 1963;Arminski and McLean, 1964;Hughes, 1968). The purpose of this study is to present the clinical and pathological features of 1049 adenomas observed at colonoscopy in a symptomatic population of 620 patients over a five year period, and to outline the role of colonoscopy in their manage...

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Section: Discussionmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

Colonic adenomas--a colonoscopy survey.

Gillespie¹,

Chambers²,

Chan³

et al. 1979

Gut

153

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show abstract

“…In one patient tenderness in the left iliac fossa was present for 72 h after fulguration of a small polyp with an insulated probe. The risk of full-thickness cautery can be avoided by the use of the hot biopsy technique (Williams, 1973) and all small sessile polyps can now be safely destroyed. Examination of at least the left colon, and perferably of the whole colon, should be carried out in conjunction with polypectomy as it is usual to find more polyps than were demonstrated by the barium enema examination.…”

Section: Discussionmentioning

confidence: 99%

“…Coagulation of the bowel wall is prevented by not snaring too close to the base of the stalk and also by moving the position of the polyp between each short burst of current so that the opposite wall of the bowel is not damaged by current passing through the apex of the polyp. The coagulation of small sessile polyps is safe if a pseudopedicle is first created by pulling on the polyp using insulated biopsy forceps (Williams, 1973).…”

Section: Discussionmentioning

confidence: 99%

The management of suspected tumours of the colon: The role of colonoscopy in general surgery

McKelvey

1979

Journal of British Surgery

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The role of colonoscopy in the management of 100 cases of suspected large bowel tumour is described. Forty out of 47 patients with an equivocal barium enema examination were satisfactorily examined and the possibility of a tumour being present was either confirmed or refuted. Examination of 30 patients with otherwise unexplained blood loss from the bowel revealed the cause in 50 per cent of them. Twenty-nine patients had pedunculated polyps which were snared and removed, thus avoiding laparotomy and colotomy. The problem of distinguishing tumours from other lesions or retained faeces by radiology arises most often in the sigmoid colon. This segment is easily examined using a short flexible endoscope. General surgeons taking up colonoscopy will find a 1-m single-channel instrument convenient to use and capable of reaching approximately 90 per cent of colonic tumours that require further investigation or endoscopic resection. Facilities for the examination of the whole colon should be available in established endoscopy units.

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“…1). For HBF, the technique was based on the procedure first described in 1973, as follows: Slight pulling force was applied to the polyp, and then, the electrocautery current was applied until the white coagulum was seen at the polyp base [13]. Coagulating current was used at a setting of 30 W for each patient.…”

Section: Endoscopic Techniquesmentioning

confidence: 99%