experience of polypectomy in children and adults in Karachi

ABSTRACT

To see the morphological types of polyps, the acceptability of the procedure and the complications following polypectomy. Out patients department of Gastroenterology at PMRC, Research Centre, Jinnah Postgraduate Medical Centre, Karachi. All patients [children and adults] referred with history of bleeding per rectum underwent flexible sigmoidoscopy or colonoscopy without sedation or analgesia. Bowel cleansing was done using a laxative the night before the procedure and an enema on the morning of the procedure. The site, size and number of polyps were noted and polypectomy performed using Olympus PSD 10 cautry and a snare. Polyp was retrieved with a basket for histological examination. Post polypectomy patients were asked to report if there were any signs of bleed or abdominal distension. Over 3 years, 126 colonic polyps were seen [60 children and 66 adults]. The ages of the patients ranged from 2 - 82 years. The main presenting feature was rectal bleeding and the site of polyp was mostly the recto sigmoid area or the descending colon. Of 60 children, 13 were less than 5 years of age and 47 were between 5 - 15 years. The polyp was mostly single pedunculated cherry red in color. Five children had multiple polyps of whom 3 had polyposis coli. In adults majority had single polyp in the rectum or sigmoid and 11 had multiple polyps with 3 having polyposis coli. In adults most polyps had an ulcerated surface and a short pedicle. Post polypectomy 3 cases had a bleed within 24 hours, [1 child and 2 adults]. Both were admitted and transfused blood. On repeat examination the bleeding was seen from the base of the stalk which was electro coagulated with a hot biopsy forceps. None required surgery. On histology 58 polyps were hyperplasic and 51 hamartomatous including juvenile polyps. Only one adult had a tub-villous adenoma. Biopsy was not done in 9 adults and 7 children. All patients tolerated the procedure well and none required anesthesia or analgesia. Majority of the polyps in children and adults were hyperplasic or hamartomatous with only one adult having tubovillous adenoma. Only 3 [2.4%] had a post polypectomy bleed which was managed by electro coagulation of the stump