Recently, around the world, including in Belarus, there has been an increase in the number of patients with polyps of the gastrointestinal tract (gastrointestinal tract). This is due to the one hand with some absolute growth of this pathology in adults and children, on the other hand, with the rapid development of endoscopy, which is the main reliable method of diagnosing this disease. Polypes occupy a significant place among various diseases of the gastrointestinal tract and in a large percentage of cases undergo malignancy. The absence of reliable clinical criteria, characteristic only for polyps of the gastrointestinal tract, puts in a difficult situation of practical doctors when diagnosing and conducting differential diagnosis, as well as therapeutic tactics, choosing the method and volume of surgery, depending on the localization, prevalence and morphological structure of polyps.
What are gastrointestinal polyps?
Polyp - any formation on the mucous membrane, protruding into the lumen of the hollow organ and a leg associated with its wall or a wide base. The frequency of the localization of polyps in various departments of the gastrointestinal tract is not the same, most often they are localized in the stomach, then in the rectum and colon, less often in the esophagus, duodenum and small intestines.
Esophagus:
Detailing tumors of the esophagus are rare, somewhat more often in men and middle -aged people. In relation to the esophagus cancer, they are 6.2%. More often develop in places of natural narrowing and in the lower third of the esophagus.
What are benign tumors of the esophagus?
There are two types of benign tumors - epithelial (polyps, adenoma, epithelial cysts) and non -epithelial (leiomyoma, fibroma, neurinomas, hemangiomas, etc.), which are much more common. Polyps and adenomas can be localized at any level of the esophagus, but more often they are located at the proximal end or in its abdominal section. These tumors can have a wide base or a long leg. In the latter case, they are sometimes infringed in the cardia area or fall out of the esophagus into the throat, causing appropriate symptoms. These are usually clearly limited reddish, sometimes lobed tumors. With the surface location of the vessels, they easily bleed when touched. These formations do not need to be confused with more common papillomatic growths on the mucous membrane of the esophagus that occur in the elderly due to chronic inflammatory changes. Such papillomas do not reach large sizes.
Stomach:
In the stomach there are epithelial and non -epithelial benign tumors. Epithelial benign tumors (Polyps and polyposis). Polyps of the stomach make up 5-10% of all stomach tumors, more often in people aged 40-50 years. Men are sick 2-4 times more often than women. The question of the possibility of transition of a polyp of the stomach to cancer is confirmed by numerous observations of clinicians and pathologists. More often the malignant transformation (malignancy) of the polyp begins with the base. A wide base, cartilage consistency, the presence of ulceration in the center of Pli at the base are characteristic macroscopic signs of polyp malignization. Polyps of the stomach are localized (approximately 80%) mainly in the antrum, but can develop in other departments. In the field of cardia, polyps are extremely rare. The size and appearance of the polyps are diverse, but most often they appear in the form of a mushroom, papilloma or cauliflower. It is necessary to distinguish between the polyp on the leg and a wide base, the last form should alarm in the sense of malignation, especially if the polyp has reached a significant size. Polyps can be single and multiple. If several polyps are formed within the same segment of the organ - multiple polyps, if in two or more segments- Polyposis.
12-first gut:
Benctional tumors of the duodenum are extremely rare. Most often, polyps are observed, then leiomyoma, very rarely - neurinomas, as well as lipomas, fibroma, lymphangiomas and hemangiomas.
Colon:
Benign tumors of the colon can come from any non -epithelial and epithelial tissue that makes up the intestinal wall. Epithelial tumors come from glandular epithelium, have the form of individual or multiple polyps, sometimes occupying significant areas of the colon. Single polyps are 3 times more likely than multiple. The villous tumor, representing the multiple papillary growths of the mucous membrane, it may look like a separate tumor knot, or to lift the intestinal wall on a rather vast last length. With different frequencies (from 10 to 60% of various statistics), a vill tumor gives rise to malignant growth, in view of which is of great practical significance, knowledge of its clinical features.
The reasons for the formation of polyps
There is still no universally recognized theory of etiology of polyps and polyposis. There are several theories of polyps:
- Inflammatory theory;
- Theory of embryonic ectopia;
- Disregenerator theory;
However, there is no single opinion of scientists to the nature of this disease.
Clinical manifestations of gastrointestinal polyps
The absence of reliable clinical criteria, characteristic only for polyps of the gastrointestinal tract, puts in a difficult situation of practical doctors when diagnosing and conducting differential diagnosis, as well as therapeutic tactics, choosing the method and volume of surgery, depending on the localization, prevalence and morphological structure of polyps. However, certain symptoms, depending on the localization, size and effect on the body, are still available.
Esophagus:
Small benign tumors of the esophagus are quite common. They do not cause clinical manifestations and are often unexpectedly detected in an endoscopic examination. The disease manifests itself in the onset of dysphagia. Benign tumors rarely cause obturation of the esophagus. Dysphagia was observed only in 50% of patients. With large tumors, in addition to dysphagia, patients experience a feeling of a foreign body in the esophagus, calls to vomiting and nausea, sometimes pain when eating. It happens that large tumors do not cause any symptoms and are accidentally detected by an X-ray or endoscopic examination. Unlike esophagus cancer, dysphagia for polyps does not have a tendency towards steady and rapid growth and may remain without change for several months or even years. In the history of some patients, periods of improving food patency are noted due to a decrease in spasms. The course of polyps depends on the morphological structure and growth rates. With rapid growth of the polyp, rapid malignancy is possible, especially at a young age. The general condition of patients with polyp does not suffer. Sometimes some weight loss is noted due to power disorders and natural anxiety in such cases.
Stomach:
Perhaps the existence of polyps without clinical symptoms, in such cases, they are a random find in an X -ray or endoscopic examination. Pain symptomatics, often observed with polyps of the stomach, is largely due to the degree of severity of inflammatory phenomena, against which there is a polyp. In most cases, pains are localized in the submarine area, first they have a connection with eating, and then acquire a character that is not dependent on eating. If polyps close the exit from the stomach, then the patient has vomiting. Polyps that have a long leg can fall into the duodenum and infringe on the gatekeeper, causing attacks of sharp cramping pain in the submarine with irradiation throughout the stomach. Patients complain of a bitter taste in their mouth, nausea, belching. The appetite does not suffer. In the case of a nonsense of the severity of these symptoms, patients may not consult a doctor for years. With the ulceration of the polyp, moderate gastric bleeding (a positive reaction of the Hidden blood in the feces) are observed, and in more pronounced cases, blood in the vomit, the fat -like nature of the stool is detected. The signs usual for blood loss may occur: weakness, pallor of the skin, secondary hypochromic anemia. The malignancy of the polyp occurs gradually: loss of appetite, general weakness, weight loss, i.e. Signs characterized by stomach cancer develop. It should be noted that the beginning of the transition of the polyp to cancer cannot be caught either clinically or radiologically. Therefore, patients in whom the polyps of the stomach are detected should be under the systematic dynamic observation of the endoscopist; At the slightest suspicion of malignant transformation of the patient’s polyp should be subjected to surgical treatment.
Colon:
The clinical picture is located depending on the quantity, location and morphological structure of polyps. With single polyps for a long time, there may be no complaints. With multiple polyps and polyposis of the asymptomatic current, it is not found. Polyposis is manifested by pain along the colon, a rapid, often painful stool with an admixture of blood, mucus, pus. With polyps located in the distal parts of the colon, tenesmas are often noted, and when combined with the polyps of the rectum - discomfort, pain, itching in the area of the anus. If the presence of a single polyp is not worried about patients, then with multiple polyposes the disease is accompanied by bleeding during, and after defecation, diarrhea leading to dehydration, intoxication and anemia.
Diagnosis of gastrointestinal polyps.
The main diagnostic method is an endoscopic study that allows you to determine the localization, size, shape of the polyp, as well as perform an aiming biopsy. In addition, endoscopic examination allows us to solve the issues of further tactics of the patient.
Treatment of gastrointestinal polyps.
The main method of treating gastrointestinal polyps isEndoscopic polypectomy(minimally invasive operation performed without opening cavities).
Polypectomy methods:
- Excision;
- Electroxcia;
- Electrocoagulation;
- Photocoagulation;
- Drug polypectomy;
- A combination of several methods;
The decision on the method of polypectomy is made by an endoscopist, depending on the localization, form, size of the polyp, the results of morphological research, as well as in accordance with the available equipment and qualifications of the endoscopist.
Polyps less than 5 millimeters are subject to dynamic endoscopic observation 1 time in 6 months. Polyps in size of more than 4 centimeters if it is impossible to endoscopic removal are subject to surgical treatment.
Endoscopic polypectomy is performed in endoscopic departments of surgical hospitals in the framework of minimally invasive surgery of one day.
After endoscopic polypectomy, control endoscopic studies are needed through1, 3, 6 and 12 monthsAnd then 1 time per year for life.
Head. Endoscopic department A.E. Danovich
