A step-by-step guide to approaching colon polyps

Abstract

Colorectal cancer (CRC) is considered one of the most prevalent cancers among Iranian men and women (1). Colorectal polyps, known as precursors of CRCs, are of great importance. Surveillance, locating, and removal of colorectal polyps make them the most modifiable factor apart from other genetic and environmental factors leading to CRCs. Colorectal polyps are defined as outpouchings from superficial and deep layers of mucosa of the colonic wall. They are classified as adenomas, serrated polyps, hyperplastic polyps, and hamartomas based on histological evaluation. Submucosal invasion precludes the possibility of endoscopic resection and should be ruled out via colonoscopic evaluation (2). Knowing this significance, the present study aims to present a brief review on classification, probability of endoscopic resection, complications of endoscopic polypectomy, as well as proper surveillance after polypectomy.

Keywords: Colorectal polyps; Deep mural injury.; JNET classification; Kudo pit pattern; NICE classification; Paris classification.

Figure 1

A pedunculated polyp measuring about 20mm in head and 10mm in stalk in sigmoid colon

Figure 2

A 30mm flat lesion in transverse colon

Figure 3

Paris classification (4).

Figure 4

LSL classification based on surface appearance of the lesion (7).

Figure 5

Kudo pit pattern classification for the surface appearance of polyps (9)

Figure 6

NICE classification (12)

Figure 7

JNET classification for surface pattern of polyps (15)

Figure 8

Prophylactic clip insertion before polypectomy

Figure 9

Sydney classification for deep mural injury (31)