Sessile Polyp

What is Sessile Polyp?

Benign poly development at the large intestine region and can be represented as pre-cancerous growth. A sessile polyp is one of the neoplasms that can cause the cancerous growth of the colorectal region. The detail description of the Sessile polyp can be demonstrated as a cytological featureless lesion of the large intestine is collected form of serrated glands with structural disorders of the profound crypts. It has been found that Sessile polyps become carcinogenic with the association with genetic involvement.

A sessile polyp is not similar as other conventional adenomas. The Sessile polyp under the microscope appears as jagged appearance and for that, they are termed as a Sessile polyp. Alternatively, Sessile polyps have several other names, including Serrated adenoma, Serrated adenoma type I or Serrated polyp with abnormal proliferation^1,2.

History

Previous days, all types of serrated colorectal lesions were grouped as hyperplastic polyps. But the advancement of the field diagnostic provides molecular and genetic advent tools. These sophisticated diagnosis processes able to differentiate the Sessile polyp with another type of hyperplastic polyps. During diagnosis, it has been also understood that Sessile polyp does not possess malignancy, but has a neoplastic profile. The detailed nature of the Sessile polyps is serrated adenomas polyps^1,2

Symptoms & Signs

The characteristic features of the Sessile Polyps include the poly grow with slightly flattened surface and the nature of the polyps is broad-based. Sessile Polyps are asymptomatic in nature. Rectal bleeding is a common complaint, but rarely it becomes a massive problem. In the case of the largely sized lesion, the abdominal pain, cramp in the lower abdomen and obstruction in the large intestine may develop at Sessile Polyps. The digital examination can assist to detect rectal polyps. In a rare instance, polyps may protrude through the anus. In some cases, an extension of polyps can cause watery diarrhea and resultant of this leads to hypokalemia^2,3.

Diagnosis

Sessile Polyps can be diagnosed through colonoscopy. The usual diagnosis is incidental as Sessile Polyp is asymptomatic. Apart from colonoscopy, a Barium enema can also apply to Sessile Polyps. The particular application of Barium enema method is a double-contrast examination. But doctors usually prefer to conduct colonoscopy, as during procedure the scope of polyps removal is more. The extension of the lesion to the caecum due to multiple rectal polyps, which may be found during flexible sigmoidoscopy require completing colonoscopy³.

Treatment

There are three steps are followed in Sessile Polyp treatment process:

• Entire removal of the Sessile Polyps during colonoscopy
• Followed by surgical intervention in case of incomplete Sessile Polyps removal through colonoscopy
• Periodic follow-up and followed with colonoscopy are important

In a complete colonoscopy, the polyps can be removed through electrosurgical biopsy forceps method or snare procedure. In the case of large sized villous adenomas, a complete excision of the lesion is very important to lessen the risk of cancer.

Depending on the diagnostic reports and physical examination, if the doctor thought that there is no requirement of colonoscopic removal, then laparotomy is a better option for a secondary therapeutic approach to manage Sessile Polyp. Tattooing with India ink is the method applied to the distal margin of the polyps.

Subsequent treatment depends upon the histology of the polyps. If the muscularis mucosa does not invade by dysplastic epithelium, the resection line of the stalk of the polyp is clear. Therefore, well-differentiated lesions line can be easily removed through endoscopy. In addition, the close endoscopic follow-up is additional benefits for this process.

Segmental resection of the colon is required for the lesion with deeper invasion, an unclear resection line or an undifferentiated lesion. The muscularis mucosa invasion can cause involvement of the lymphatics, which increases the potential risk for metastasis of the lymph node. This type of findings requires further detail screening test for colon cancer.

The follow-up schedule of post-polypectomy is variable. The schedule of post- polypectomy is depending upon the size of the polyps, number of the polyps and types of the polyps. According to the American College of Gastroenterology, greater than 10 mm of a tubular adenoma or any sized villous adenoma require repetition of total colonoscopy after three years of the removal of the lesion^1,2,3,4.

Prognosis

There is a higher risk of developing colon cancer from sessile polyps. Therefore, the prognosis of the sessile polyp is completely depended upon the regular follow up, as advanced stage colon cancer increases the risk of less survival rate. Regular follow up and repetitive colonoscopy of the therapeutic measure of the sessile polyps can decrease the risk of colon cancer and provide good prognosis^2,3.

References

1. Sessile serrated polyps: Cancer risk and appropriate surveillance. Cleveland Clinic Journal of Medicine. 2012 December;79(12):865-871. http://www.mdedge.com/ccjm/article/95697/gastroenterology/sessile-serrated-polyps-cancer-risk-and-appropriate-surveillance
2. Sessile Serrated Polyp / Adenoma. Stanford Medicine. http://surgpathcriteria.stanford.edu/gitumors/sessile-serrated-polyp-adenoma/
3. Elliot M. Livstone, Polyps of the Colon and Rectum. http://www.merckmanuals.com/professional/gastrointestinal-disorders/tumors-of-the-gi-tract/polyps-of-the-colon-and-rectum
4. Colon Polyps – Treatment Overview. http://www.webmd.com/colorectal-cancer/tc/colon-polyps-treatment-overview

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