Diagnosis and management

The diagnosis and management of colonic polyps consist of: (1, 2)

• history and examination

Possible investigations:

• sigmoidoscopy: about half of colonic polyps are within reach of the rigid 25cm instrument. Using a fibreoptic sigmoidoscope allows the colon to be examined as far as the splenic flexure and any polyps can be removed at the same time with a diathermy snare.
  
  
• colonoscopy allows polyp identification and removal
  
  
• computed tomographic colonography (CTC) is an alternative, less invasive test; if a polyp is identified then will require subsequent colonoscopy to remove and identify histology
  
  
• histology; vital because:
  • reveals whether the whole polyp was removed
  • reveals whether the polyp was malignant
    
    
• barium enemas
  • will show polyps of significant size
  • may not be possible to see the whole colon well - this is particularly true of the transverse colon

References

1. Lin JS, Perdue LA, Henrikson NB, et al. Screening for colorectal cancer: an evidence update for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); May 2021 [internet publication].
2. Ma C, Teriaky A, Sheh S, et al. Morbidity and mortality after surgery for non-malignant colorectal polyps: a 10-year nationwide analysis. Am J Gastroenterol. 2019 Nov;114(11):1802-10.