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Frequency of colonic adenomatous polyps in a tertiary hospital in Mumbai

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Abstract

Introduction

Incidence of colorectal carcinoma is increasing all over world. There is limited data on colorectal polyps from India. We evaluated the histomorphological features of colorectal polyps and determined risk stratification in adenomatous polyps.

Methods

In 4970 consecutive colonoscopies, colorectal polyps were detected in 515 cases (10.3 %). Polyps were classified using standard histological criteria. Each polyp was evaluated for presence of dysplasia. Adenomatous polyps were classified as low-risk adenomas (1–2 tubular adenomas <10 mm) and high-risk adenomas characterized by villous histology, high-grade dysplasia, size ≥10 mm, or ≥3 adenomas.

Results

Of 515 colorectal polyps, 270 (52.4 %) were adenomatous, followed by 78 (15.1 %) inflammatory, 78 (15.1 %) hyperplastic, 32 (6.2 %) hamartomatous polyps, 25 (4.8 %) benign epithelial polyps, 5 (0.9 %) cap polyps, 5 (0.9 %) lipomatous polyps, 3 (0.5 %) angiomatous polyps, 4 (0.7 %) lymphoid, and 15 (2.9 %) cases with adenocarcinoma masquerading as polyps. Mean (SD) age with colorectal polyps was 54.8 (33.0) years while for adenomatous polyps, 59.5 (14.8) years with male to female ratio of 2:1. Majority of adenomatous polyps 124 (45.9 %) were tubular adenomas present in rectosigmoid. High-grade dysplasia was found in 38 (14 %) adenomas. One hundred and fifty-five (57.4 %) were high risk of which majority were villous adenomas and nine (7.2 %) tubular adenomas.

Conclusion

The most common colorectal polyps found during routine colonoscopy were 270 adenomatous (52.4 %) cases. Of these, 155 (57.4 %) adenomatous polyps were high-risk category. Population prevalence data of colonic polyps in general population beyond the age of 50 years needs to be obtained.

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References

  1. Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2016. doi:10.1136/gutjnl-2015-310912.

  2. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127:2893–917.

    Article  CAS  PubMed  Google Scholar 

  3. Sung JJ, Ng SC, Chan FK, et al. Asia Pacific Working Group. An updated Asia Pacific Consensus Recommendations on colorectal cancer screening. Gut. 2015;64:121–32.

    Article  CAS  PubMed  Google Scholar 

  4. Cherian T, Mahadevan P, Chandramathi S, Govindan J, Mathew IL. Increasing cancer incidence in a tertiary care hospital in a developing country, India. Indian J Cancer. 2015;52:133–8.

  5. Trimbath JD, Giardiello FM. Review article: Genetic testing and counselling for hereditary colorectal cancers. Aliment Pharmacol Ther. 2002;16:1843–57.

    Article  CAS  PubMed  Google Scholar 

  6. Brenner H, Kloor M, Pox CP. Colorectal cancer. Lancet. 2014;383:1490–502.

    Article  PubMed  Google Scholar 

  7. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329:1977–81.

    Article  CAS  PubMed  Google Scholar 

  8. Risio M. The natural history of adenomas. Best Pract Res Clin Gastroenterol. 2010;24:271–80.

    Article  PubMed  Google Scholar 

  9. Strum WB. Colorectal adenomas. N Engl J Med. 2016;374:1065–75.

    Article  CAS  PubMed  Google Scholar 

  10. IJspeert JE, Medema JP, Dekker E. Colorectal neoplasia pathways: state of the art. Gastrointest Endosc Clin N Am. 2015;25:169–82.

    Article  PubMed  Google Scholar 

  11. Paik JH, Jung EJ, Ryu CG, Hwang DY. Detection of polyps after resection of colorectal cancer. Ann Coloproctol. 2015;31:182–6.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Brenner H, Hoffmeister M, Stegmaier C, Brenner G, Altenhofen L, Haug U. Risk of progression of advanced adenomas to colorectal cancer by age and sex: estimates based on 840,149 screening colonoscopies. Gut. 2007;56:1585–9.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Atkin WS, Morson BC, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med. 1992;326:658–62.

    Article  CAS  PubMed  Google Scholar 

  14. Atkin WS, Saunders BP, British Society for Gastroenterology; Association of Coloproctology for Great Britain and Ireland. Surveillance guidelines after removal of colorectal adenomatous polyps. Gut. 2002;51:V6–9.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Fairley KJ, Li J, Komar M, Steigerwalt N, Erlich P. Predicting the risk of recurrent adenoma and incident colorectal cancer based on findings of the baseline colonoscopy. Clin Transl Gastroenterol. 2014;5:e64.

  16. Leslie A, Carey FA, Pratt NR, Steele RJ. The colorectal adenoma-carcinoma sequence. Br J Surg. 2002;89:845–60.

    Article  CAS  PubMed  Google Scholar 

  17. Winawer SJ, Zauber AG, Fletcher RH, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. 2006;130:1872–85.

    Article  PubMed  Google Scholar 

  18. Almadi MA, Alharbi O, Azzam N, Wadera J, Sadaf N, Aljebreen AM. Prevalence and characteristics of colonic polyps and adenomas in 2654 colonoscopies in Saudi Arabia. Saudi J Gastroenterol. 2014;20:154–61.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Müller AD, Sonnenberg A. Prevention of colorectal cancer by flexible endoscopy and polypectomy. A case-control study of 32,702 veterans. Ann Intern Med. 1995;123:904–10.

    Article  PubMed  Google Scholar 

  20. Uraoka T, Hosoe N, Yahagi N. Colonoscopy: is it as effective as an advanced diagnostic tool for colorectal cancer screening? Expert Rev Gastroenterol Hepatol. 2015;9:129–32.

    Article  CAS  PubMed  Google Scholar 

  21. Hüneburg R, Kukuk G, Nattermann J, et al. Colonoscopy detects significantly more flat adenomas than 3-tesla magnetic resonance colonography: a pilot trial. Endosc Int Open. 2016;4:E164–9.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hornick JL, Odze RD. Polyps of the large intestine. In: Odze RD, Goldblum JR, editors. Surgical Pathology of the GI Tract, Liver, Biliary Tract and Pancreas. 3rd ed. Philadelphia: Elsevier/Saunders; 2015. p. 621–42.

    Google Scholar 

  23. Corley DA, Jensen CD, Marks AR, et al. Variation of adenoma prevalence by age, sex, race, and colon location in a large population: implications for screening and quality programs. Clin Gastroenterol Hepatol. 2013;11:172–80.

    Article  PubMed  Google Scholar 

  24. Neugut AI, Jacobson JS, Ahsan H, et al. Incidence and recurrence rates of colorectal adenomas: a prospective study. Gastroenterology. 1995;108:402–8.

    Article  CAS  PubMed  Google Scholar 

  25. Rundle AG, Lebwohl B, Vogel R, Levine S, Neugut AI. Colonoscopic screening in average-risk individuals ages 40 to 49 vs 50 to 59 years. Gastroenterology. 2008;134:1311–5.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Heitman SJ, Ronksley PE, Hilsden RJ, Manns BJ, Rostom A, Hemmelgarn BR. Prevalence of adenomas and colorectal cancer in average risk individuals: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2009;7:1272–8.

    Article  PubMed  Google Scholar 

  27. Yang MH, Rampal S, Sung J, et al. The prevalence of colorectal adenomas in asymptomatic Korean men and women. Cancer Epidemiol Biomarkers Prev. 2014;23:499–507.

    Article  PubMed  Google Scholar 

  28. Yamaji Y, Mitsushima T, Ikuma H, et al. Incidence and recurrence rates of colorectal adenomas estimated by annually repeated colonoscopies on asymptomatic Japanese. Gut. 2004;53:568–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Bhargava DK, Chopra P. Colorectal adenomas in a tropical country. Dis Colon Rectum. 1988;31:692–3.

    Article  CAS  PubMed  Google Scholar 

  30. Poddar U, Thapa BR, Vaiphei K, Singh K. Colonic polyps: experience of 236 Indian children. Am J Gastroenterol. 1998;93:619–22.

    Article  CAS  PubMed  Google Scholar 

  31. Tony J, Harish K, Ramachandran TM, Sunilkumar K, Thomas V. Profile of colonic polyps in a southern Indian population. Indian J Gastroenterol. 2007;26:127–9.

    PubMed  Google Scholar 

  32. Rathi C, Ingle M, Pandav N, Pipaliya N, Choksi D, Sawant P. Clinical, endoscopic, and pathologic characteristics of colorectal polyps in Indian children and adolescents. Indian J Gastroenterol. 2015;34:453–7.

    Article  PubMed  Google Scholar 

  33. Albasri A, Yosef H, Hussainy A, Bukhari S, Alhujaily A. Profile of colorectal polyps: a retrospective study from King Fahad Hospital, Madinah, Saudi Arabia. Asian Pac J Cancer Prev. 2014;15:2669–73.

    Article  PubMed  Google Scholar 

  34. Diamond SJ, Enestvedt BK, Jiang Z, et al. Adenoma detection rate increases with each decade of life after 50 years of age. Gastrointest Endosc. 2011;74:135–40.

    Article  PubMed  Google Scholar 

  35. Rex DK, Johnson DA, Anderson JC, et al. American College of Gastroenterology guidelines for colorectal cancer screening 2009. Am J Gastroenterol. 2009;104:739–50.

  36. Fenoglio L, Castagna E, Comino A, et al. A shift from distal to proximal neoplasia in the colon: a decade of polyps and CRC in Italy. BMC Gastroenterol. 2010;10:139.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Bonnington SN, Rutter MD. Surveillance of colonic polyps: are we getting it right? World J Gastroenterol. 2016;22:1925–34.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Lieberman DA, Weiss DG, Harford WV, et al. Five-year colon surveillance after screening colonoscopy. Gastroenterology. 2007;133:1077–85.

    Article  PubMed  Google Scholar 

  39. Noshirwani KC, van Stolk RU, Rybicki LA, Beck GJ. Adenoma size and number are predictive of adenoma recurrence: implications for surveillance colonoscopy. Gastrointest Endosc. 2000;51:433–7.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pathology, T N Medical College and B Y L Nair Charitable Hospital, Mumbai Central, Mumbai, 400 008, India

    Anjali D. Amarapurkar & Prachi Nichat

  2. Lake City Endoscopy Centre, Thane West, Thane, 400 602, India

    Nitin Narawane

  3. Bombay Hospital and Medical Research Centre, 12, Marine Lines, Mumbai, 400 020, India

    Deepak Amarapurkar

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  1. Anjali D. Amarapurkar
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Correspondence to Anjali D. Amarapurkar.

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ADA, PN, NN, and DA declare that they have no conflict of interest.

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The study has been performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Amarapurkar, A.D., Nichat, P., Narawane, N. et al. Frequency of colonic adenomatous polyps in a tertiary hospital in Mumbai. Indian J Gastroenterol 35, 299–304 (2016). https://doi.org/10.1007/s12664-016-0681-9

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  • DOI: https://doi.org/10.1007/s12664-016-0681-9

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