eMedicine Specialties > Radiology > Gastrointestinal

Colon, Polyps: Follow-up

Author: Justin D Pearlman, MD, PhD, ME, MA, Director of Dartmouth Advanced Imaging Center, Professor of Medicine, Professor of Radiology, Adjunct Professor, Thayer Bioengineering and Computer Science, Dartmouth-Hitchcock Medical Center
Coauthor(s): Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia; Michael J Tsapakos, MD, PhD, Assistant Professor of Radiology, Dartmouth Medical School; Consulting Staff, Director of Body MRI, Department of Radiology, Dartmouth-Hitchcock Medical Center
Contributor Information and Disclosures

Updated: Feb 27, 2008

Intervention

Optical colonoscopy

The primary interventional procedure for the evaluation and removal of colonic polyps is optical colonoscopy, and gastroenterologists typically perform this procedure. Optical colonoscopy involves preparation to evacuate and clean the colon, followed by the passage of the long, fiberoptic colonoscopic tubing from the anus to the ileocecal valve. During this passage, all surfaces should be viewed en route or when the tubing is pulled back, through the video-enabled, distal tip of the flexible tube.

Air and saline are injected, the scope is rotated, and the tip is flexed or extended by using cables. The patient is rolled into different positions as needed. Conscious sedation is used to reduce spasm of the colon and to control pain. Polyps are removed by using a snare threaded to the distal end of the device.

Treatment

Daily aspirin (325 mg) appears to reduce the risk of cancers of the gastrointestinal tract. Similarly, celecoxib (Celebrex; 400 mg/d), which inhibits cyclo-oxygenase-2 (an enzyme involved in inflammation), may reduce the relative incidence of polyps 6-fold in as little as 6 months. Benefit has been observed after 6 months of treatment with exisulind (Aptosyn), which inhibits cyclic guanosine monophosphate and selectively induces apoptosis (programmed cell death) in abnormally growing, precancerous and cancerous cells (but not in normal cells).

Dietary supplements of calcium 1500 mg also may lower the risk of colon cancer. Turmeric, the spice that gives curry its yellow color, also may be protective.

Medicolegal Pitfalls

  • Failure to obtain informed consent for biopsy or lesion removal before patients are medicated.
  • Most facilities do not allow the patient to leave without a designated driver.
  • Procedural risks include pain, bowel perforation, bleeding, and infection.
  • Failure to diagnose cancer is a leading cause of malpractice litigation against gastroenterologists.22,23
 


More on Colon, Polyps

Overview: Colon, Polyps
Imaging: Colon, Polyps
Follow-up: Colon, Polyps
Multimedia: Colon, Polyps
References
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References

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Further Reading

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Keywords

virtual colonoscopy, virtual colonography, virtual coloscopy, computed colonoscopy, computed colonography, computed coloscopy, fiberoptic colonoscopy, fiberoptic colonography, fiberoptic coloscopy, optical colonoscopy, hyperplastic polyp, pedunculated adenoma, sessile adenoma, polyposis syndrome, familial adenomatous polyposis, FAP, Lynch syndrome, Lynch's syndrome, CT colonography, CTC

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Contributor Information and Disclosures

Author

Justin D Pearlman, MD, PhD, ME, MA, Director of Dartmouth Advanced Imaging Center, Professor of Medicine, Professor of Radiology, Adjunct Professor, Thayer Bioengineering and Computer Science, Dartmouth-Hitchcock Medical Center
Justin D Pearlman, MD, PhD, ME, MA is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Federation for Medical Research, International Society for Magnetic Resonance in Medicine, and Radiological Society of North America
Disclosure: Nothing to disclose.

Coauthor(s)

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP is a member of the following medical societies: American Institute of Ultrasound in Medicine, Radiological Society of North America, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Michael J Tsapakos, MD, PhD, Assistant Professor of Radiology, Dartmouth Medical School; Consulting Staff, Director of Body MRI, Department of Radiology, Dartmouth-Hitchcock Medical Center
Michael J Tsapakos, MD, PhD is a member of the following medical societies: American College of Radiology and New England Roentgen Ray Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Abraham H Dachman, MD, FACR, Professor, Department of Radiology, The University of Chicago School of Medicine; Director of CT, Department of Radiology, The University of Chicago Hospitals
Abraham H Dachman, MD, FACR is a member of the following medical societies: Radiological Society of North America
Disclosure: iCAD, Inc. Consulting fee Consulting; iCAD, Inc. Grant/research funds Other; GE Healtcare, Inc. Honoraria Speaking and teaching

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Clinical Assistant Professor of Radiology, University of Washington Medical School
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
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