Special Issue Colorectal Polyps : Endoscopic Diagnosis and Polypectomy Seung Taek Oh, M.D. Department of General Surgery The Catholic University of Ko

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1 Colorectal Polyps : Endoscopic Diagnosis and Polypectomy Seung Taek Oh, M.D. Department of General Surgery The Catholic University of Korea, College of Medicine Kangnam St. Mary's Hospital E mail : stoh@catholic.ac.kr Abstract Acolonic polyp is a circumscribed mass of tissue that projects above the surface of the intestinal mucosa, which may be classified as either pedunculated or sessile, depending on whether or not it contains a discrete stalk, and according to the size and type. It has been believed that colorectal cancer evolves from a precursor lesion, the adenomatous polyp. The introduction of colonoscopy in the early 1970s, followed by the demonstration of the feasibility of colonoscopic polypectomy, provided the technology for the application of this concept to clinical practice. Colorectal cancer can be prevented through examination of the entire colon and identification of a polyp to be resected. According to the National Polyp Study in the USA, the incidence of colorectal cancer is reduced by 76~90% following colonoscopic polypectomy. Colonoscopy and polypectomy, when performed by adequately trained physicians, is a safe and effective procedure that can decrease deaths resulting from colorectal cancer. Keywords : Colonic polyp; Colon cancer; Colonoscopic polypectomy 594

2 sporadic polyps Non neoplastic NeoHyperplastic* (metaplastic) NeoInflammatory NeoJuvenile NeoLymphoid Neoplastic NeoAdenoma* NeoDALM* Hereditary polyps and polyposis Non neoplastic polyposis `Hyperplastic polyposis NeoJuvenile polyposis NeoPeutz Jeghers syndrome Neoplastic polyps NeoHNPCC* Neoplastic polyposis NeoFAP* NeoFlat adenoma syndrome DALM, dysplasia associated lesion or mass ; HNPCC, hereditary nonpolyposis colorectal cancer ; FAP, famillial adenomatous polyposis (includes Gardner's syndrome). * These polyps may display protruding and nonprotruding (flat) profiles. Despite the benign histological profile, patients are at risk for gastrointestinal and/or extraintestinal cancers. Carcinoma changes in neoplastic polyps and lesions : carcinoma in situ, intramucosal carcinoma, questionable invaslve carcinoma, submucosal carcinoma, de novo carcinoma. 595

3 Ip pedunculated Protruded Isp subpedunculated type Is sessile IIa flat elevated Superficial elevated IIa+dep flat elevated with depression type IIb flat Flat type IIa+IIc IIc slightly depressed Depressed type IIc+IIa LST 596

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