Polypectomy Technique and Histopathological Evaluation in Colon Polyps According to Paris Classification

Öz

Objective: Colorectal cancers are in third place in terms of incidence and second in terms of mortality. This study aims to type the polyps detected during colonoscopy according to the Paris classification, perform polypectomy with the appropriate technique, classify them as histopathological, determine the presence of dysplasia, and review the risk status of colorectal cancer. Material and Method: Our study is a retrospective study presented as a one-year review of 124 patients who were found to have colonic polyps due to colonoscopy, who underwent polypectomy with the appropriate technique, and whose histopathological determination was completed. Results: The study was conducted between 2021 and 2022 with a total of 124 cases, 37.9% female and 62.1% male. The mean age of the cases was 58.58 ± 14.40 years. The way the polyps were removed was determined according to the polyp size and the Paris classification. Polypectomy was performed with biopsy forceps for <5 mm polyps. For ≥5 mm polyps, polypectomy was performed with a hotsnare after mucosal separation with saline-methylene blue-adrenaline. A piecemeal polypectomy was performed for two very large polyps. The most important factor in determining CRC surveillance and the presence of dysplasia was polyp diameter. The dysplasia rate in polyps removed with biopsy forceps was lower than in the polypectomy group with a hot snare. Conclusion: Colorectal cancers are multifactorial, the initial architecture is polyps. The increase in the diameter of these polyps rather than the removal techniques was significant in terms of colorectal cancer risk.

Anahtar Kelimeler

• Colon polyps
• colorectal cancers surveillance
• presence of dysplasia in colon polyp
• polypectomy
• polypectomy technique

Destekleyen Kurum

None.

Etik Beyan

This retrospective study was approved by the Dicle University Faculty of Medicine Ethics Committee (Date: 09.06.2022, Number: 180).

Teşekkür

None.

Paris Sınıflamasına Göre Kolon Poliplerinde Polipektomi Tekniği Ve Histopatolojik Değerlendirme

Öz

Amaç: Kolorektal kanserler görülme sıklığı açısından üçüncü, mortalite açısından ise ikinci sırada yer almaktadır. Bu çalışmada kolonoskopi sırasında tespit edilen poliplerin Paris sınıflamasına göre tiplendirilmesi, uygun teknikle polipektomi yapılması, histopatolojik olarak sınıflandırılması, displazi varlığının belirlenmesi ve kolorektal kanser risk durumunun gözden geçirilmesi amaçlanmaktadır. Gereç ve Yöntem: Çalışmamız, kolonoskopi sonucu kolonik polip saptanan, uygun teknikle polipektomi yapılan ve histopatolojik incelemesi tamamlanan 124 hastanın bir yıllık incelemesi olarak sunulan retrospektif bir çalışmadır. Bulgular: Çalışma 2021-2022 yılları arasında %37,9’u kadın, %62,1’i erkek olmak üzere toplam 124 vaka ile gerçekleştirildi. Olguların yaş ortalaması 58,58 ± 14,40 yıldı. Poliplerin çıkarılma şekli polip boyutuna ve Paris sınıflamasına göre belirlendi. <5 mm polipler için biyopsi forsepsi ile polipektomi yapıldı. ≥5 mm’lik poliplerde salin-metilen mavisi-adrenalin ile mukoza ayrımı yapıldıktan sonra sıcak snare ile polipektomi yapıldı. İki adet çok büyük polip için parça parça polipektomi yapıldı. KRK sürveyansının ve displazi varlığının belirlenmesinde en önemli faktör polip çapıydı. Sonuç: Kolorektal kanserler multifaktöriyeldir, başlangıç mimarisi poliplerdir. Bu poliplerin alınma tekniklerinden ziyade çaplarının artması kolorektal kanser riski açısından anlamlıydı.

Anahtar Kelimeler

• Kolon polibinde displazi varlığı
• kolon polipleri
• kolorektal kanser sürveyansı
• polipektomi
• polipektomi tekniği

Destekleyen Kurum

Yok.

Etik Beyan

Bu retrospektif çalışma Dicle Üniversitesi Tıp Fakültesi Etik Kurulu tarafından onaylandı (Tarih: 09.06.2022, Sayı: 180).

Teşekkür

Yok.

Kaynakça

1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021; 71: 209–249.
2. Singh H, Turner D, Xue L, Targownik LE, Bernstein CN. Risk of developing colorectal cancer following a negative colonoscopy examination: evidence for a 10-year interval between colonoscopies. JAMA 2016; 295: 2366–2373.
3. Snover DC. Update on the serrated pathway to colorectal carcinoma. Hum Pathol 2011; 42: 1-10.
4. Zauber AG, Winawer SJ, O'Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696.
5. Nishihara R, Wu K, Lochhead P, et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 2013; 369: 1095-1105.
6. Holme Ø, Løberg M, Kalager M, et al. Effect of flexible sigmoidoscopy screening on colorectal cancer incidence and mortality: a randomized clinical trial. Jama 2014; 312: 606-615.
7. Atkin W, Wooldrage K, Parkin DM, et al. Long term effects of once-only flexible sigmoidoscopy screening after 17 years of follow-up: the UK Flexible Sigmoidoscopy Screening randomised controlled trial. Lancet 2017; 389: 1299-1311.
8. Atkin WS, Edwards R, Kralj-Hans I, et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet 2010; 375: 1624-1633.

9. He X, Hang D, Wu K, et al. Long-term Risk of Colorectal Cancer After Removal of Conventional Adenomas and Serrated Polyps. Gastroenterology 2020; 158: 852-861.e4.
10. Cairns SR, Scholefield JH, Steele RJ, et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 2010; 59: 666-689.
11. Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143: 844-857.
12. Atkin WS, Valori R, Kuipers EJ, et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition-Colonoscopic surveillance following adenoma removal. Endoscopy 2012; 44 : SE151-SE163.
13. Rex DK, Ahnen DJ, Baron JA, et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol 2012; 107: 1315-1330.
14. Hassan C, Quintero E, Dumonceau JM, et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2013; 45: 842-851.
15. 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: 1181-1196.
16. Lash RH, Genta RM, Schuler CM. Sessile serrated adenomas: prevalence of dysplasia and carcinoma in 2139 patients. J Clin Pathol 2010; 63: 681-686.
17. Lieberman DA, Weiss DG, Harford WV, et al. Five-year colon surveillance after screening colonoscopy. Gastroenterology 2007; 133: 1077-1085.
18. Martínez ME, Baron JA, Lieberman DA, et al. A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy. Gastroenterology 2009; 136: 832-841.
19. Atkin WS, Morson BC, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med 1992; 326: 658-662.
20. Longacre TA, Fenoglio-Preiser CM. Mixed hyperplastic adenomatous polyps/serrated adenomas. A distinct form of colorectal neoplasia. Am J Surg Pathol 1990; 14: 524-537.
21. Torlakovic E, Skovlund E, Snover DC, Torlakovic G, Nesland JM. Morphologic reappraisal of serrated colorectal polyps. Am J Surg Pathol 2003; 27: 65-81.
22. Torlakovic E, Snover DC. Serrated adenomatous polyposis in humans. Gastroenterology 1996; 110: 748-755.
23. Fujimori Y, Fujimori T, Imura J, et al. An assessment of the diagnostic criteria for sessile serrated adenoma/polyps: SSA/Ps using image processing software analysis for Ki67 immunohistochemistry. Diagn Pathol 2012; 7: 59.
24. Snover DC. Update on the serrated pathway to colorectal carcinoma. Hum Pathol 2011; 42: 1-10.
25. Jover R, Bretthauer M, Dekker E, et al. Rationale and design of the European Polyp Surveillance (EPoS) trials. Endoscopy 2016; 48: 571-578.
26. IJspeert JE, Vermeulen L, Meijer GA, Dekker E. Serrated neoplasia-role in colorectal carcinogenesis and clinical implications. Nat Rev Gastroenterol Hepatol 2015; 12: 401-409.
27. Schreiner MA, Weiss DG, Lieberman DA. Proximal and large hyperplastic and nondysplastic serrated polyps detected by colonoscopy are associated with neoplasia. Gastroenterology 2010; 139: 1497-1502.
28. Hiraoka S, Kato J, Fujiki S, et al. The presence of large serrated polyps increases risk for colorectal cancer. Gastroenterology 2010; 139: 1503-1510.e15103.
29. Regula J, Rupinski M, Kraszewska E, et al. Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med 2006; 355: 1863-1872.
30. Gschwantler M, Kriwanek S, Langner E, et al. High-grade dysplasia and invasive carcinoma in colorectal adenomas: a multivariate analysis of the impact of adenoma and patient characteristics. Eur J Gastroenterol Hepatol 2002; 14: 183-188.
31. Burgess NG, Pellise M, Nanda KS, et al. Clinical and endoscopic predictors of cytological dysplasia or cancer in a prospective multicentre study of large sessile serrated adenomas/polyps. Gut 2016; 65: 437-446.
32. Erichsen R, Baron JA, Hamilton-Dutoit SJ, et al. Increased Risk of Colorectal Cancer Development Among Patients With Serrated Polyps. Gastroenterology 2016; 150: 895-902.e5.
33. Phipps AI, Limburg PJ, Baron JA, et al. Association between molecular subtypes of colorectal cancer and patient survival. Gastroenterology 2015; 148: 77-87.e2.