Abstract
The authors analysed cases of colonoscopic polypectomy at our endoscopy unit in the past ten years, which has been considerably increasing in frequency. The establishment of screening method by using fecal occult blood test at outpatient clinic and mass screening is considered to be one of the reasons. A thorough investigation was performed even in patients with positive fecal occult blood test as well as overt anal bleeding. As a result, it was frequently possible to make a diagnosis of colorectal polyp available to treatment. In our series, cancer was found in 11.5% of neoplastic polyps and in 9.3% of small polyps sized 6mm to 10mm. In 3 (20%) of 15 patients with such a small polyp, cancer cells already invaded the submucosa. The treatment by colonoscopic polypectomy was completed for a lesion with cancer limited to the mucosa. Radical operation was subsequently performed in 14 patients with cancer invading the submucosa. There were no residual cancer cells and lymph node involvement in all but one with residual cancer involving the proper muscle layer . Three such cases have been followed up without surgery for some reasons. The patients having undergone colonoscopic polypectomy were on a regular surveillance program thereafter, because such patients tend to have another neoplastic polyp later. 7.1% of all the excited polyps were detected during follow-up and again excised endoscopically. From the fact that a patient who underwent radical operation for rectal cancer with submucosal involvement after polypectomy later developed metastasis to the liver, the authors would stress that a follow-up schedule should include check-up of hepatic metastasis in patients with cancer. It is concluded that a large scale screening by fecal occult blood testing would make detection of polypoid lesions easier and colonoscopic polypectomy more valuable and popular in prevention and treatment of colorectal cancer in the future.
