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Bowel Polyps are formed by the abnormal overgrowth of the normal “epithelial” cells which line the large bowel. The overgrowth may be appear like a small pearly, raised area, a grape on a stalk attached to the normal bowel lining or look like an area of carpet pile spreading in a thin layer. All usually appear distinctly different up against the otherwise smooth, shiny looking normal bowel that surrounds them.
Although polyps may give symptoms, most do not and are found incidentally. It is usually the potential risk that a polyp has developed or may develop into a bowel cancer that most concerns surgeons and patients. The larger a polyp becomes the greater the chance it has of harbouring a bowel cancer.
A variety of types of bowel polyps exist. Their precise type may only be determined under the microscope for certain and it is for this reason that they are all best removed and examined closely. It is thought that colorectal cancers begin as benign polyps in the bowel that undergo malignant change with time and it is this fact that underpins the rationale for screening programmes for prevention and early detection of colorectal cancer.
- Almost always none
- Change in bowel habit – Mucus may be passed with the stools
- Rectal bleeding – Often mixed into the stools
- Abdominal pain – From bowel obstruction
- Usually at Flexible Sigmoidoscopy or Colonoscopy
- On Barium enema or CT colography
The mainstay of treatment for bowel polyps is with colonoscopy. Most polyps are small enough to be safely removed with a tiny grasping device which rips or burns them off (biopsy) or with a wire snare which cuts through the base of the polyp. The involved tissue is then removed through the anus.
Endoscopic Mucosal Resection (EMR) and Trans-anal Endoscopic Microsurgery (TEM) are newer techniques that work in a similar way biopsy or snare but offer the advantage that they can remove larger and more inaccessible polyps that would ordinarily require abdominal surgery. In the few cases where surgery is necessary, a laparoscopic approach is favoured.
According to the type, size and number of polyps removed surveillance of the bowel is recommended to detect any further polyps at an early stage when removal is straightforward. Usually The British Society of Gastroenterology guidelines are followed to determine the appropriate screening interval (commonly three and five years). If a polyp is found to contain an area of cancer then according to its size, type and proximity to a rim of normal tissue taken during the procedure, definitive formal cancer surgery may be advised.