The polyp wasn't removed at the time of the colonoscopy because the patient was on Heparin, and there was a great risk of bleeding. He is a smoker. He is hypothyroid. His CEA and Ca 19.9 were elevated. No masses or ulcers were detected in the Upper GI endoscope. Abdominal Ultrasound was clear. Full body CT scan with and without contrast was clear. It's been 2 months since the colonoscopy was done. What should be done now regarding the polyp?
Dear Alia,
This is the question I sometimes have while performing colonoscopy.
Before removing the colon polyp, I think close examination of the polyp regarding histological type is necessary. I usually use indigo carmine or narrow band imaging for histological examination. Depending on the pit pattern, I decide whether the polyp should be removed regardless its size.
I was taught that a polyp over 10 mm should be removed because there is a greater risk of malignant transformation if a colon polyp grows over 10 mm. However, there remains a little chance of a colon polyp < 10 mm becoming cancerous. If the polyp is over 10 mm but it cannot be removed for some reasons, I will remove it within three months.
Why do you try observing the polyp with indigo carmine or narrow band imaging? Is it possible to discontinue heparin when you give colonoscopy the next time? If I were in your case, I would perform colonoscopy one year later and remove it with discontinuation of Heparin.
I wish you the best of good luck!
Nobuhiro
Dear Dr Takeuchi,
Thank you for your answer. It is very helpful. I'll definitely consider your advise.
Best wishes.
I basically do agree with Dr. Takeuchi but you are in the frontier of saying is this really a 7 mm or a larger sessil polyp ?. This is difficult to asses regarding measurement. Regarding the architecture of the polyp Kudo has a very clarifying classification. But this is a sessil polyp not a pedunculated one and the measurement in this type of polyp does not have the same clinical significance. I would rather speak with the patient about the endoscopic findings and the need to perform a new colonoscopy holding the Heparin and remove the polyp with your preferred technique as soon as possible.
Remove and after that make histopaathology examination. Biopsy of such polip may be not infornative. You may take to biopsy a part without dispalsia or cancer (if it present). More rational clinical tactic is polipectomy.
I destroy with hot snaring or HBFP any polyp under 10 mm whatever anticoagulation without any significant bleeding. Bleeding risk was a false problem. Anyway, heparin can be stopped easily or blocked in very special cases by using protamine. If anticoagulation can't be stopped and if you are very very anxious, you can put a plastic snare at the base, take a biopsy and in case of any question, control the site which could have been spotted with a tattoo!
But much ado about almost nothing!
since the polyp is less than 10mm the risk of cancer is low. you do not have to rush in to making rash decisions as there is time. the bestrode of removal of the polyp will be by transanal submucosal endoscopic resection. you will have to find a gastroenterologist who has experience in this if you have not performed it. The polyp needs to be excised en mass for you to make an informed decision based on histology. if removed piecemeal the information is of no use. but as i said before you don't have to be rushing as the size of the polyp is small. will have to be covered to unfractionated heparin.
In my opinion, after destruction of approximately 40,000 polyps, submucosal resection fails to have any indication for such a small, very probably benign polyp.
Don't complicate simple things!
In less than one mn, without risk, providing a good technique, HBFP will solve the problem.
Always take in consideration the duplicity of colonoscopy examen and duplicity of sedation, so we prefer to take off the polyp particularly after assessement with indigo carmín or NBI. For the patient even 7mm polyp has a matter and generally aske for remove polyp. I agree with Dr. Takeuchi
I agree with Dr. Bernard Maroy's opinion. Too small a polyp, antacoagulation not an issue for small mucosal lesions, other endoscopic hemostatic measures may be taken if anxious about bleeding. Just stop Heparin for a day afterwards.
did you really mean .7mm or .7cm=7mm?---if patient no longer on anticoag what is concern?
- Badges
- Science topic
- Similar topics
- Biological Science
- Histology