ENDOSCOPIC EXAMINATION OF THE RECTUM AND COLON:5th Report : POLYP

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A minute mucosal excrescence can be documented by the progressed fiberscopy, even though barium enema radiography fails to reveal the shadow of the polyp. Of 250 cases examined using colonofiberscope model CF-SB or CF-LB (Olympus Optical Company, Tokyo) 30 cases were diagnosed as having polyps of the rectum or colon including 2 cases of Peutz-Jeghers syndrome. Twenty eight cases with 45 polyps including 3 mucosal excrescences were classified into 4 groups according to the shape and into 3 groups according to the size endoscopically, and into 6 groups according to the degree of histopathological atypia ranging from normal to cancerous mucosa. In 18 cases with the single polyp, glandular hyperplasia or slightly atypical changes of the glandular epithelial cell and its structure are seen. In 5 cases with 19 multiple polyps, mean histopathological changes were also similar. In the group accompanied by cancer of the rectum or colon, one revealed an adenocarcinoma tubulare which is presumed to be canceration of a benign polyp, but the remaining 4 showed only glandular hyperplasia or atypical changes. Prevalence increased with the age of the subjects examined especially in females. However, age distribution is equal in males over 30 years but the great majority are encountered in 5 th decade group. More than 50 per cent of polyps are found in the rectum endoscopically and almost all we found are present below the junction between the descending colon and sigmoid. As we routinely used the colonofiberscope model CF-SB with 85cm. in working length for examining the rectum and sigmoid, it was impossible to evaluate the exact distribution through the data obtained using this scope. Polyps in the proximal segment of the large bowel are found usually by accident in using colon-fiberscope model CF-LB with 200cm. in working length. In the near future, one will be able to visualize the locational incidence through the cases observed up to the cecum. In comparison with the endoscopical shape and size of the polyp, the pedunclated polyp is larger and sessile one is smaller as indicated previously. In the sessile group, mucosal excrescences are 0.5cm. or under, hemispherical polyp is 0.5 to 1 cm., and spherical one is mainly 1cm. (0.5 to 2cm.) in diameter. These suggest noticiable correlation between shape and size of the polyp. Relationship between histopathological change and size of the polyp with or without stalk are scrutinized simultaneously. Glandular hyperplasia or slight atypical changes are seen mainly in polyps of 0.5cm. or under in diameter, while highly atypical changes are seen in polyps of 1 cm. or greater in diameter. Although it has been bescribed previously that the relationship to cancer correlates to the size and multiplicity of the polyp, overall agreement can be scarcely obtained in our series. Unsatisfactorily, shape, size, multiplicity, and endoscopical nature of the surface of the polyp are not effective way for early diagnosis of inclination to the malignancy, especially in small sized one. Endoscopical follow-up study along with zeal and motive of the examiner is necessary in order to control the polyp for long time and not one but a few biopsies under direct vision will be helpful to find the cellular irregularity in the early stages.
社団法人日本消化器内視鏡学会の論文

ENDOSCOPIC EXAMINATION OF THE RECTUM AND COLON:5th Report : POLYP

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