Abstract
Acording to the statistics of mortality in Japan, the number of patients with cob-rectal cancers have been increasing. It is possible that the mortality of cob-rectal cancer will exceed that of gastric cancer by the year 2000 As regards the histological development of cob-rectal cancer, adenoma-cancer sequence is postulated. Therefore, early detection and treatment of adenoma as a precancerous state is very important. Moreover, many cases of so-called focal cancer can be completely cured by mere polypectomy. On the basis of these facts, endoscopic polypectomy, which is more easier than surgery, has rapidly been used for cob-rectal neoplastic polyps in Japan. Authors experienced 60 cases (a total of 96 lesions) of cob-rectal neoplastic polyp from 1976 to 1981.
Results of the analysis of these cases were as follows: (1) As regards the location of the polyp, most cases were found in the sigmoid colon (38.5%). Fourteen of 96 lesions (14.6%). showed false negative findings on the films of Barium enema. Therefore, endo-scopy should at least be used up to the level of sigmoid colon concomitant with Barium enema. (2) Sessile polyp became more creased at its base, more atypical and more reddened as they grew larger. On the other hand, some of the larger pedunculated polyp unexpectedly showed less atypical pattern. (3) 10.4% of the polypectomied lesions were unable to retrieve. (4) Fourteen cases (15 lesions) of early cancers were endosopically polypectomied. Four of these 14 cases underwent surgical operation, too. (5) On polypectomy for polyps of larger than 1 cm in size, authors have been injecting Indian ink into the cob-rectal wall as far as possible, so that the surgeon can easily find the operation site later when it is necessary, and endoscopist can easily do follow-up endoscopy. (6) Half of the patients with early cancer had another neoplastic legion in the colon or rectum, so it is important to closely examine these patients with neoplastic polyps before polypectomy, and follow them periodically after polypectomy, since they seem a high risk gronp. (7) No complications have been observed so far.
