Gastroenterological Medicine: Colon Polyp

• Collective term of elevated lesion developed in colon
• Classification of colon polyp
• Mostly no symptom but be careful about blood feces
• Treatment method is decided through surface structure or tissue examination.
• Cut cancer suspicious off using endoscope

Collective term of elevated lesion developed in colon

Colon Polyp is a collective name of elevated lesion ejected to inner cavity from mucosal. Pathologically, they include several things, but mostly they are adenoma of neoplastic, or hyperplastic polyp of non-neoplastic. Multiple occurrence may happen simultaneously (within certain period) or intertemporally (after certain period).

Classification of Colon Polyp

	Classification		Provability of cancer
Neoplasm	adenoma	Highest frequency, if being too large, it may lead to cancer. Occur simultaneously or intertemporally.	Yes
	cancer	Cut of as polyp for part of early stage cancer, and after cut-off it is diagnosed as cancer pathologically	Yes
Non-neoplastic	Hyperplastic polyp	Developed by hyperplastic of upper skin. Mostly seen at sigmoid colon	Rare
	Inflammatory polyp	Can be seen in inflammatory bowel disease, like ulcerative colitis, clone disease, or bowel inflammation	Rare
	Hamartomatous polyp	Excess proliferation of the part of organ. There is inherited disease.	Rare

Other than the above, there are the polyp taking the status of submucosal tumor, like Carcinoid, lymphatic malignancy or lipoma as neoplastic. In non-neoplastic , there is Lymphoid follicular polyp. SSA/P similar to hyperplastic polyp at right-side colon has a possibility of being cancer.

Mostly no symptom but be careful about blood feces

Occurrence mechanism of sporadic polyp is unknown. It is considered that the inherited factor, alcoholic drink, smoking, obesity, lack of exercise, life style or inflammation are complicatedly mixed up then polyp is developed. Mostly no symptom but there is a case where fecal occult blood is positive, or in case its too large, it lead to bleeding.

Treatment method is decided through surface structure or tissue examination.

Endoscopic exam is very useful. Treatment method is determined through Pigment strewing (dyeing), NBI, surface structure and vessel evaluation by enlarged observation, tissue exam by forceps. There is CT Colonography, Capsule Endoscopic test as new test method.

Cut cancer suspicious off using endoscope

Endoscope Treatment (Hot Biopsy, polypectomy, EMR, ESD) is applied for adenoma more than 5mm, part of cancer suspicious, case having bleeding symptom. There is a possibility for bleeding for about one week after the cut by endoscopic surgery. Need to take care of meals (refrain from taking spicy meals), and also refrain from alcoholic drink, physical exercise, physical work and bathing. It is requested to adjust and consult for drugs (antiplatelet agent, anticlotting drug). In case when endoscopic ablation is difficult, laparotomy or surgical ablation under celioscope can be performed.