Colonoscopy in the management of colon polyps

Abstract

The technique and indications for colonoscopic polypectomy are reviewed. The results compare very favourahly with those of surgical polypectomy and represent a major advance. Three hundred polyps of up to 4.5 cm diameter were removed with the diathermy snare ,from 169 patients, and a further 107 smaller polyps were destroyed with a new 'hot-biopsy' technique. There were no serious complications, but I patient sustained a 'closed' perforation, which was managed conservatively, and in 2 others signifcant haemorrhage occurred. Comparison of colonoscopy with the Malmo double contrast enema shows that up to 95 per cent of polyps over 5 mrn in diameter can be demonstrated radiologically. High quality X-rays allow limited colonoscopy and justqy radiological rather than colonoscopic follow-up. Colonoscopic removal of all polyps saves the patient unnecessary irradiation, since barium enema examination need then be repeated only every 3-5 years.

Predictive value of a diagnosis of colonic polyp on the double-contrast barium enema

“…The presence of stool contributed to at least one-third of the errors. Its importance as a cause for both false positive and false negative error has been stressed, but needs constant reinforcement [2,4,8,13,14,[16][17][18][19][20][21][22]. Diverticula are often confused with polyps on doublecontrast barium enema and were an important cause for error in our study.…”

“…These results indicate that any segment of the colon is a potential site for false positive error. By comparison, the sigmoid colon has been shown to be the most common site for false negative error when polyps are missed radiographically [2,[13][14][15]. The usual redundancy of the sigmoid colon, with obscuration of overlapping segments, appears to play a more important role when polyps are missed than when they are overcalled.…”

“…On the other hand, assessment of the predictive reliability of the doublecontrast enema has received less attention [2][3][4][5][6][7]. We have studied the positive predictive value of the double-contrast barium enema for diagnosing polypoid disease of the colon.…”

Reliability of routine double-contrast examination (DCE) of the large bowel in polyp detection: A prospective clinical study

“…This shows that the DCE technique is sensitive for detecting colonic polyps and justifies radiographic [43,44] rather than colonoscopic follow-up after polypectomy [45,46].…”

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

“…Once the technique is mastered, however, colonoscopy often clarifies the diagnosis in colonic disease and may prevent an unnecessary laparotomy for suspected tumours (Hunt et al, 1975) or unexplained rectal bleeding (Waye, 1976;Teague et al, 1978). Colonoscopic polypectomy has transformed the management of patients with adenomatous polyps (Wolff and Shinya, 1973;Williams et al, 1974). This paper presents the results of colonoscopy performed by a general surgeon in the investigation of patients with suspected large bowel tumours.…”