Retrospective analysis of polyps detected in colonoscopy and investigation of the relationship with anemia

Abstract

Aims: Patients with colonic polyps are generally asymptomatic. On the other hand, colon polyps are considered as colorectal cancer progenitors. In this study, we aimed to present the retrospective analysis of colon polyps detected in a gastroenterology unit within one year and the relationship between polyp features and anemia. Methods: Patients with colon polyps who applied to our center between January 2015- January 2016 and underwent colonoscopy were included in the study. Polyps were grouped and compared as 1,2,3 and ≥4 according to their number; as hyperplastic, tubular, tubulovillous and villous according to their histopathological type; as ≤6 mm, 7-10 mm and ≥11 mm according to their size; as proximal, distal and proximal+distal according to their location. Results: A total of 350 patients were recruited for the study, The median age of the study group was 60 years (54-65 years), of which 180 (51.4%) were male. The mean hemoglobin value was 12.82±1.90 g/dl. More than half of the patients (n=166, 52.5%) had single polyp. The most common type of polyp was tubular polyp (n=203, 55%). The majority of the polyps (63%) were smaller than 6 mm in size and the vast majority (47.2%) were located distally. When the polyp size and polyp types were compared, it was found that the incidence of tubulovillous pathology increased as the polyp size increased (p<0.001 for all comprasions). A positive, linear significant correlation was found between age and the number of polyps (r=0.209; p<0.001). There was a statistically significant difference between hemoglobin value according to polyp sizes (p<0.001). Conclusion: We demonstrated that the number of polyps increased with age, and the incidence of tubulovillous pathology and the depth of anemia increased as the size of the polyp increased.

Keywords

• Colon polyp
• polypectomy
• hemoglobin
• colonoscopy

References

1. East JE, Atkin WS, Bateman AC, et al. British Society of Gastroenterology position statement on serrated polyps in the colon and rectum. Gut. 2017;66(7):1181-1196.
2. Tanaka S, Saitoh Y, Matsuda T, et al. Evidence-based clinical practice guidelines for management of colorectal polyps. J Gastroenterol. 2021;56(4):323-335.
3. Sullivan BA, Noujaim M, Roper J. Cause, epidemiology, and histology of polyps and pathways to colorectal cancer. Gastrointest Endosc Clin N Am. 2022;32(2):177-194.
4. Hashiguchi Y, Muro K, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. 2020;25(1):1-42.
5. Shaukat A, Kahi CJ, Burke CA, Rabeneck L, Sauer BG, Rex DK. ACG Clinical Guidelines: Colorectal Cancer Screening 2021. Am J Gastroenterol. 2021;116(3):458-479.
6. Lieberman DA, Holub JL, Moravec MD, Eisen GM, Peters D, Morris CD. Prevalence of colon polyps detected by colonoscopy screening in asymptomatic black and white patients. JAMA. 2008;300(12):1417-1422.
7. Su MY, Ho YP, Hsu CM, et al. How can colorectal neoplasms be treated during colonoscopy? World J Gastroenterol. 2005;11(18):2806-2810.
8. Brenner H, Hoffmeister M, Arndt V, Stegmaier C, Altenhofen L, Haug U. Protection from right- and left-sided colorectal neoplasms after colonoscopy: population-based study. J Natl Cancer Inst. 2010;102(2):89-95.

9. Zauber AG, Winawer SJ, O’Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. New England J Med. 2012;366(8):687-696.
10. Sung JJ, Ng SC, Chan FK, et al. Asia Pacific Working Group. An updated Asia Pacific Consensus Recommendations on colorectal cancer screening. Gut. 2015;64(1):121-132.
11. Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2017;112(7):1016-1030.
12. Ladabaum U, Dominitz JA, Kahi C, Schoen RE. Strategies for colorectal cancer screening. Gastroenterology. 2020;158(2):418-432.
13. Citarda F, Tomaselli G, Capocaccia R, Barcherini S, Crespi M. Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut. 2001;48(6):812-815.
14. Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM. American College of Gastroenterology guidelines for colorectal cancer screening 2008. Am J Gastroenterol. 2009; 104(3):739-750.
15. Patel K, Hoffman NE. The anatomical distribution of colorectal polyps at colonoscopy. J Clin Gastroenterol. 2001;33(3):222-225.
16. Burgart LJ. Colorectal polyps and other precursor lesions. need for an expanded view. Gastroenterol Clin North Am. 2002; 31(4):959-970.
17. Song M, Emilsson L, Bozorg SR, et al. Risk of colorectal cancer incidence and mortality after polypectomy: a Swedish record-linkage study. Lancet Gastroenterol Hepatol. 2020;5(6):537-547.
18. Edwards BK, Ward E, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116(3):544-573.
19. Saks K, Enestvedt BK, Holub JL, Lieberman D. Colonoscopy identifies increased prevalence of large polyps or tumors in patients 40-49 years old with hematochezia vs other gastrointestinal indications. Clin Gastroenterol Hepatol. 2016;14(6):843-849.
20. Capurso G, Baccini F, Osborn J, et al. Can patient characteristics predict the outcome of endoscopic evaluation of iron deficiency anemia: a multiple logistic regression analysis. Gastrointest Endosc. 2004;59(7):766-771.
21. Marderstein EL, Church JM. Classic “outlet” rectal bleeding does not require full colonoscopy to exclude significant pathology. Dis Colon Rectum. 2008;51(2):202-206.