Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지

Clinical Observation of Colorectal Polyps

대장 용종의 임상적 고찰

Ko, Youn-Uk;Kim, Jong-In;Nam, Ju-Yeon;Jung, Jung-IM;An, Jin-Kwang;Kim, Kwang-Jin;Kim, Hyung-Wook;Park, Won-Il;Yang, Ung-Suk
고원욱;김종인;남주연;정정임;안진광;김광진;김형욱;박원일;양웅석

  • Published : 2008.08.30
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Abstract

Background/Aims: The detection and removal of colorectal polyps are important for secondary prevention of colorectal cancer. We investigated the characteristics and histopathologic finding of polyps to better plan their management. Methods: We analyzed 334 patients who underwent polypectomies for 770 colorectal polyps between October, 2005 and April, 2007 at Bong Seng Memorial Hospital. Results: Colorectal polyps were frequent in the sixth decade in both sexes. The ratio of male to female patients was 1.72:1. Abdominal pain/discomfort was the most common symptom (34.4%), and the most common site of polyp localization was the rectosigmoid colon. Histopathologic examination showed tubular adenomas (54.6%), hyperplastic polyps (36.4%), and inflammatory polyps (5.6%). Adenomatous polyps were more common in patients with multiple polyps than in patients with a single polyp. Adenomatous polyps with villous histology were more common in patients with large polyps than in patients with small polyps. Non-neoplastic polyps were common before the fifth decade. Neoplastic polyps were common past the fifth decade. Conclusions: In this study, tubular adenomas were frequently found on histopathologic examination, sessile type were frequently found on gross examination, and colorectal polyps were found principally in the rectosigmoid colon. Neoplastic polyps were more frequent in patients beyond the fifth decade. There fore colonoscopy examination is recommended for secondary prevention of colon cancer. (Korean J Gastrointest Endosc 2008;37:105-111)

목적: 대장 용종의 발견 및 제거는 대장암의 예방 차원에서 중요하다. 이에 본원에서 용종 절제술을 시행받은 환자들을 대상으로 용종의 특성과 조직병리학적 소견을 조사하여 실제 환자 진료에 활용하고자 하였다. 대상 및 방법: 2005년 10월부터 2007년 4월까지 본원에서 대장 용종으로 진단되어 용종 절제술을 시행받은 334명의 환자와 절제된 770개의 용종을 후향적으로 분석하였다. 결과: 1) 대상환자 334명 중 남자는 211명, 여자는 123명으로 남녀의 비는 1.72:1이었고, 평균 연령은 58.2세, 남녀 모두 50대에 33.5%로 가장 많았다. 2) 대장 내시경 검사를 하게된 계기는 복부 통증/불편감이 34.7%로 가장 많았고, 다음은 정기검진(26.3%)이었다. 3) 대장 용종의 평균 크기는 5.4 mm였고 5 mm 미만이 411예로 53.4%를 차지하였으며, 직-에스상 결장(50.5%)에 가장 많이 분포하였다. 4) 내시경 소견에서 무경성 용종이 전체의 60.6%를 차지하였으며, Is 형이 55%로 가장 많았다. 5) 용종의 조직학적 소견으로 관상 선종이 54.6%로 가장 많았고, 과형성 용종 36.4%, 염증성 용종 5.6% 순이었다. 6) 선종성 용종은 단발성 용종 환자에서 48.9%, 다발성 용종 환자에서 70.4%로 증가하였고, 1 cm 이하보다 1 cm 이상의 선종성 용종에서 융모형 조직을 지닌 선종이 1.1%에서 24.7%로 증가하였다. 7) 40대 이전의 연령층에서 과형성 용종 등 비종양성 용종이 64.5%로 많았고, 40대 이후에서 관상 선종 등 종양성 용종이 58.3%로 많았다. 결론: 대장 용종은 조직병리학적 검사상 관상 선종이, 육안적 소견상 무경성 용종이 가장 많았으며, 해부학적 위치로는 직-에스상 결장에서 가장 많이 분포하고 있었다. 40대 이후의 연령층에서 종양성 용종의 빈도가 증가하므로, 40대 이상의 연령층에서는 대장 내시경 검사를 적극적으로 권장할 필요가 있다.

Keywords

References

  1. Vogelstein B, Fearon ER, Hamilton SR, et al. Genetic alteration during colorectal tumor development. N Engl J Med 1988;319:525-532 https://doi.org/10.1056/NEJM198809013190901
  2. Konishi F, Morson BC. Pathology of colorectal adenomas: a colonoscopic survey. J Clin Pathol 1982;35:830-841 https://doi.org/10.1136/jcp.35.8.830
  3. Yoon SJ, Kim NY, Kim YT, et al. Colorectal polyp in Korea. Korean J Gastroenterol 1991;23:450-458
  4. Ministry of Health and Welfare: Central Cancer Rigistry Center in Korea. Annual report of the central cancer registry in korea (1996.1-1996.12). 1998
  5. Matsui T, Yao I, Iwashita A. Natural history of early colorectal cancer. World J Surg 2000;24:1022-1028 https://doi.org/10.1007/s002680010153
  6. Goldman H, Ming S, Hickok DF. Nature and significance of hyperplastic polyps of the human colon. Arch Pathol 1970;89:349-354
  7. Horn RC Jr. Malignant potential of polypoid lesions of the colon and rectum. Cancer 1971;28:146-152 https://doi.org/10.1002/1097-0142(197107)28:1<146::AID-CNCR2820280130>3.0.CO;2-G
  8. Patel K, Hoffman NE. The anatomical distribution of colorectal polyps at colonoscopy. J Clin Gastroenterol 2001;33:222-225 https://doi.org/10.1097/00004836-200109000-00011
  9. Bond JH. Polyp guideline; diagnosis, treatment and surveillancefor patients with nonfamilial colorectal polyps: the practice parameters committee of the American College of Gastroenterology. Ann Intern Med 1993;119:836-843 https://doi.org/10.7326/0003-4819-119-8-199310150-00010
  10. Ackroyd FW, Hedberg SE. Colonic polyps. Ann Rev Med 1985;36:619-625 https://doi.org/10.1146/annurev.me.36.020185.003155
  11. Neugut AI, Jacobson JS, Rella VA. Prevalence and incidence of colorectal adenomas and cancer in asymptomatic persons. Gastrointest Endosc Clin N Am 1997;7:387-399
  12. Clark JC, Collan Y, Eide TJ, et al. Prevalence of polyps in an autopsy series from areas with varying incidence of large bowel cancer. Int J Cancer 1985;36:179-186 https://doi.org/10.1002/ijc.2910360209
  13. Provenzale D, Garrett JW, Condon SE, Sandler RS. Risk for colon adenomas in patients with rectosigmoid hyperplastic polyps. Ann Intern Med 1990;113:760-763 https://doi.org/10.7326/0003-4819-113-10-760
  14. Ansher AF, Lewis JH, Fleischer DE, et al. Hyperplastic colonic polyps as a marker for adenomatous colonic polyps. Am J Gastroenterol 1989;84:113-117
  15. Coode PE, Chan KW, Chan YT. Polyps and diverticula of the large intestine: a necropsy survey in Hong Kong. Gut 1985;26:1045-1048 https://doi.org/10.1136/gut.26.10.1045
  16. Sleisenger MH, Fordtan JS. Gastrointestinal disease: polyps and benign neoplasms of the colon. Saunder company 5th edition, 1993:1402-1430
  17. Johnson DA, Gurney MS, Volpe RJ, et al. A prospective study of the prevalence of colonic neoplasms in asymptomatic patients with an age-related risk. Am J Gastroenterol 1990;85:969-974
  18. Welch CE, Hedberg SE. Polypoid lesion of the gastrointestinal tract. Second edition Major Probl Clin surg 1975;2:1-215
  19. Wolff WI, Shinya H. Definitive treatment of "malignant polyps" of the colon. Ann Surg 1975;182:516-525 https://doi.org/10.1097/00000658-197510000-00018
  20. Williams CB, Hunt RH, Loose H, Riddel RH, Sakai Y, Swarbrick ET. Colonoscopy in the management of colon polyps. Br J Surg 1974;61:673-682 https://doi.org/10.1002/bjs.1800610902
  21. Behringer GE. Polypoid lesions of the colon. Which should be removed? Surg Clin North Am 1974;54:699-712 https://doi.org/10.1016/S0039-6109(16)40343-9
  22. Turell R, Wilkinson RS. Adenomas of the colon and rectum. Surgery 1950;28:651-661
  23. Welch CE. Polyps and cancer of the colon. Am J Surg 1979;138:625-626 https://doi.org/10.1016/0002-9610(79)90331-3
  24. Mutto T, Bussey HJ, Morson BC. The evolution of cancer of the colon and rectum. Cancer 1975;36:2251-2270 https://doi.org/10.1002/cncr.2820360944
  25. Lee SC, Hong SC, Kim JP. Malignant potential of the colo-rectal adenoma. Korean J Gastroenterol 1988;20:321-329
  26. Wegener M, Borsch G, Schmidt G. Colorectal adenomas. Distribution, incidence of malignant transformation and rate of recurrence. Dis Colon Rectum 1986;29:383-387 https://doi.org/10.1007/BF02555053
  27. Fleischer DE, Goldberg SB, Browning TH, et al. Detection and surveillance of colorectal cancer. JAMA 1989;261:580-585 https://doi.org/10.1001/jama.261.4.580
  28. Morson BC, Bussey HJ. Magnitude of risk for cancer in patients with colorectal adenomas. Br J Surg 1985;72(suppl):23S-25S https://doi.org/10.1002/bjs.1800720111
  29. Atkin WS, Morson Bc, Cuzick J. Long term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med 1992;326:658-662 https://doi.org/10.1056/NEJM199203053261002
  30. Nusko G, Mansmann U, Partzsch U, et al. Invasive carcinoma in colorectal adenomas; multivariate analysis of patient and adenoma characteristics. Endoscopy 1997;29:626-631 https://doi.org/10.1055/s-2007-1004268
  31. Stryker SJ, Wofff BG, Culp CD, Libbe SD, Ilstrup DM, MacCarty RL. Natural history of untreated colonic polyps. Gastroenterology 1987;93:1009-1013 https://doi.org/10.1016/0016-5085(87)90563-4
  32. Agrawal J, Syngal S. Colon cancer screening strategies. Curr Opin Gastroenterol 2005;21:59-63
  33. Rex DK, Weddle RA, Lehman GA, et al. Flexible sigmoidoscopy plus air contrast barium enema versus colonoscopy for suspected lower gastrointestinal bleeding. Gastroenterology 1990;98:855-861 https://doi.org/10.1016/0016-5085(90)90007-N
  34. Van Dam J. Prevention of colorectal cancer by endoscopic polypectomy. Ann Intern Med 1995;123:949-950 https://doi.org/10.7326/0003-4819-123-12-199512150-00009
  35. Jung SY. The guideline for early screening of colorectal cancer. J Korean Soc Coloproctol 2003;19(suppl):85S-88S
  36. Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF. Results of screening colonoscopy among persons 40 to 49 years of age. N Engl J Med 2002;346:1781-1785 https://doi.org/10.1056/NEJM200206063462304