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Colonic Polyps Treatment & Management

  • Author: Gregory H Enders, MD, PhD; Chief Editor: BS Anand, MD  more...
 
Updated: Sep 28, 2015
 

Medical Care

Some studies have demonstrated that medical treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) decreases the number and the size of colonic polyps. However, NSAIDs, such as sulindac, do not prevent cancer development. These drugs do not yet constitute established therapies or chemopreventives for colonic polyps.

One study suggests that aspirin may be beneficial in reducing the incidence of recurrent colonic polyps, particularly advanced colonic polyps in select patients with a high risk of colon cancer (and coronary artery disease) and an acceptably low risk of gastrointestinal bleeding or hemorrhagic stroke.[2]

Consultations

Obtain a Surgical consultation; this is critical in patients with multiple polyps, including patients with familial adenomatous polyposis (FAP). Explain and discuss the type and timing of surgery with the patient.

Diet and activity

A regular diet may be continued. The patient can consider calcium and folate supplements to decrease the risk of colonic polyp recurrence.

Activities may be maintained as tolerated.

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Surgical Care

Polypectomy

In the case of a solitary pedunculated polyp, colonoscopic removal can be performed concurrently with the search for other lesions.

Removal of a solitary colonic polyp is usually curative for that lesion. However, a complete colonoscopic examination should be performed because the finding of a single adenomatous polyp confers an increased risk for the development of others. The rate of colonic polyp recurrence (discovered at follow-up colonoscopy) at 1-year postpolypectomy is small, and recurrence may in fact represent missed synchronous lesions. Repeat colonoscopy at 3-12 months is sometimes advocated if there is substantial doubt whether a colonic polyp has been completely resected and/or contains high-grade dysplasia.[15]

Higher risk (eg, large, aggressive appearing) polyps are often marked at the time of resection by injection of ink (“tattooing”). This method helps to locate the site again, either during colonoscopy or surgery, for follow-up examination, biopsy, or resection.[16] Resection of a large, flat or sessile lesion, particularly when it is removed in pieces, or a polyp with a focus of high-grade dysplasia or cancer is often followed by repeat endoscopy in 3 months to confirm complete excision.

Colonic resection

In the case of multiple intestinal polyps associated with FAP, resection remains the only feasible option.

Colonic resection is also advocated for patients with long-standing ulcerative colitis who have developed high-grade dysplasia or a dysplasia-associated lesion or mass (DALM).[2]

Surgical resection may be advocated for large, sessile polyps that are difficult to remove or for advanced colonic polyps that recur despite adequate initial endoscopic treatment.

Several surgical options should be discussed with the patient, including total colectomy, subtotal colectomy with rectal sparing, or segmental resection.

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Prevention

Currently, no firm guidelines exist regarding the prevention of the development of colonic polyps. However, note the following:

  • Calcium may be modestly protective.
  • Fiber may also have some activity; the best evidence is for cereal fiber.
  • Aspirin may be considered in select patients.
  • Studies have demonstrated that a diet high in antioxidants has no impact on colonic polyp recurrence.
  • In one study, supplementary folate was also found to have no benefit, although this conclusion bears the caveat that the tested population had substantial basal folate intake. Thus, some folate intake may be protective.
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Long-Term Monitoring

Most gastroenterologists now advocate repeat colonoscopy 5 years following complete removal of a low-risk adenomatous polyp (as defined histologically). Colonoscopy is repeated in 3 years if the polyp has higher-risk features. Repeat colonoscopy may be advised in 3-12 months if the adequacy of polyp removal is a matter of substantial doubt. If no colonic polyps are found at the initial examination, follow-up colonoscopy at approximately 10-year intervals is recommended.

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Contributor Information and Disclosures
Author

Gregory H Enders, MD, PhD Associate Professor, Fox Chase Cancer Center

Gregory H Enders, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American Association for Cancer Research, American Gastroenterological Association, American Medical Association, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Wafik S El-Deiry, MD, PhD Rose Dunlap Professor of Medicine, Chief, Division of Hematology and Oncology, Penn State Hershey Medical Center

Wafik S El-Deiry, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Society for Clinical Investigation, American Society of Gene and Cell Therapy

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Manoop S Bhutani, MD Professor, Co-Director, Center for Endoscopic Research, Training and Innovation (CERTAIN), Director, Center for Endoscopic Ultrasound, Department of Medicine, Division of Gastroenterology, University of Texas Medical Branch; Director, Endoscopic Research and Development, The University of Texas MD Anderson Cancer Center

Manoop S Bhutani, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Institute of Ultrasound in Medicine, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

Research on colon neoplasia in the author's laboratory has been supported by NIH grant #R01DK64758.

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