RESUMEN
Objective To analyze the incidence and risk factors of colorectal adenomatous polyps (CAP) in recipients after liver transplantation. Methods Seventy-seven liver transplant recipients and 231 individuals undergoing colonoscopy during physical examination were recruited in this study. The incidence of CAP and pathological examination results were analyzed. Clinical data of liver transplant recipients were collected. According to the incidence of CAP, liver transplant recipients were divided into the CAP group (n=28) and non-CAP group (n=49). The risk factors of CAP after liver transplantation were identified. Results The 5-year cumulative incidence rates of colorectal polyps in liver transplant recipients and physical examination individuals were 43% and 34%, and 29% and 23% for the 5-year cumulative incidence rates of CAP, with no significant differences (both P > 0.05). Among all liver transplant recipients, 65 polyps were detected. The quantity of polyps in 1 case was excessively high and not counted. Multiple polyps were identified in certain recipients. Five polyps were not prepared for pathological examination due to small size. Pathological examination of 60 polyps demonstrated 25 inflammatory polyps, 33 CAP (8 complicated with low-grade intraepithelial neoplasia and 3 complicated with high-grade intraepithelial neoplasia), and 2 well-differentiated adenocarcinoma. Cox model analysis prompted that use of ciclosporine after liver transplantation was an independent risk factor for CAP in the recipients. Conclusions The risk of CAP is slightly elevated after liver transplantation. Postoperative use of ciclosporine is an independent risk factor for CAP in recipients after liver transplantation. Colonoscopy should be emphasized in the recipients after liver transplantation.
RESUMEN
En pacientes con enfermedad inflamatoria intestinal (EII) de larga duración, pueden aparecer pólipos postinflamatorios o seudopólipos, los cuales se presentan en los sitios en donde previamente hubo inflamación severa. Se describe el caso de un paciente con colitis ulcerativa de 5 años de evolución, en quien se encontró una poliposis postinflamatoria generalizada durante la colonoscopia de control. Se hace una revisión del significado de esta alteración, su clasificación y de su tratamiento.
Post-inflammatory polyps or pseudopolyps may occur in patients who have long-term inflammatory bowel disease (IBD). They occur at sites where severe inflammation had previously occurred. We describe the case of a patient who had suffered from ulcerative colitis for five years when generalized post-inflammatory polyposis was discovered during a follow-upl colonoscopy. We review the meaning of this condition as well as its classification and treatment
Asunto(s)
Colitis Ulcerosa , Pólipos , RevisiónRESUMEN
BACKGROUND: Inflammatory polyps are common sequelae in patients with inflammatory bowel diseases (IBD). Those polyps can usually be removed with snare polypectomy. There were limited data evaluating the management of hot snare-resistant inflammatory polyps. METHODS: We reported on two cases with hot snare-resistant inflammatory polyps, one was a Crohn's disease (CD) patient with the polyp at the ileo-colonic anastomosis (ICA) and the other one was an ulcerative colitis (UC) patient with polyp at the pouch inlet. RESULTS: Sedated endoscopy was performed, which showed a large 2.5 cm pedunculated polyp at the ICA in the first patient and a large 5 cm pedunculated polyp at the pouch inlet in the second patient. Hot snare polypectomy was initially attempted, but failed in both patients. Then endoscopic needle knife polypectomy was performed, which helped complete polypectomy. Both procedures took approximately 25 minutes each. The patients tolerated the procedure well and continued to do well after the procedure. The final pathological diagnoses for both patients were inflammatory polyps with extensive fibrosis. CONCLUSIONS: Endoscopic needle knife-assisted polypectomy appeared to be an effective technique for the management of hot snare-resistant inflammatory polyps. (AU)
EXPERIÊNCIA: Pólipos inflamatórios são sequelas comuns em pacientes com doença intestinal inflamatória (DII). Geralmente esses pólipos podem ser removidos pela polipectomia por cauterização com laço. São limitados os dados que avaliam o tratamento de pólipos inflamatórios resistentes à cauterização por laço. MÉTODOS: Descrevemos dois casos com pólipos inflamatórios resistentes à cauterização por laço; um deles se tratava de paciente com doença de Crohn (DC) com o pólipo na anastomose íleo-colônica (AIC), e o outro era paciente de colite ulcerativa (CU) com pólipo na entrada da bolsa. RESULTADOS: Foi efetuada uma endoscopia com o paciente sedado, demonstrando um grande pólipo pedunculado (2,5 cm) na AIC do primeiro paciente e um grande pólipo pedunculado (5 cm) na abertura da bolsa no segundo paciente. Inicialmente, foi tentada polipectomia por cauterização com laço, que falhou nos dois pacientes. Foi então executada a polipectomia assistida por bisturi-agulha, que ajudou na polipectomia completa. Os dois procedimentos levaram 25 minutos cada. Os pacientes toleraram satisfatoriamente o procedimento e, depois da polipectomia, ficaram bem. Os diagnósticos patológicos finais para os dois pacientes foram pólipos inflamatórios com fibrose extensa. CONCLUSÕES: Ao que parece, a polipectomia endoscópica por bisturi-agulha é técnica efetiva para o tratamento de pólipos inflamatórios resistentes à cauterização por laço. (AU)