Intestinal polyps are growths of the intestinal mucosa that mainly occur in the colon and rectum. Intestinal polyps are initially harmless abnormal developments that can arise from various tissues in the intestinal wall. They grow slowly, but can degenerate over the years and cause bowel cancer.
Below you will find further information on causes, symptoms and treatment as well as selected specialists for intestinal polyps.
In medicine, the transition from "benign" to "malignant" is often fluid in the case of pathological histological findings.
Doctors differentiate between hyperplastic polyps and neoplastic polyps. Hyperplastic polyps consist of tissue that has retained all the characteristics of its original tissue. They are generally harmless.
Neoplastic polyps, on the other hand, consist of tissue that has partially or completely lost the properties of its original tissue. On microscopic examination, it therefore no longer presents the normal image of the original muscle tissue.
Image of the inside of the intestine with large intestinal polyps © Alex #92534221 | AdobeStock
Neoplastic polyps are more problematic.
In chronic inflammatory bowel diseases, so-called pseudopolyps often develop after many years of disease progression. This is scar tissue that has formed as a result of repeated severe inflammation of the intestinal mucosa. Pseudopolyps are harmless. However, their increased occurrence can hinder the diagnosis of genuine intestinal polyps.
Most intestinal polyps are neoplastic adenomas. Depending on their appearance, a distinction is made between
Intestinal polyps generally grow slowly. As they grow, however, they change their character and can degenerate into malignant tumors with the ability to form metastases.
Adenomas in particular can be precursors of malignant adenocarcinomas. For this reason, most intestinal polyps found are removed as a precaution. This is an effective way of preventing the development of bowel cancer.
The tendency to develop intestinal polyps can be partly congenital. However, these hereditary polyposes only account for a few percent of all diagnosed cases of intestinal polyps.
Most intestinal polyps tend to occur in the second half of life. They are probably the result of random mutations in the tissues of the intestinal wall (sporadic occurrence).
Experts suspect that diet and lifestyle habits play a role in the development of intestinal polyps. There is also a familial accumulation.
The following are considered risk factors for the development or degeneration of intestinal polyps
However, it is difficult to prove a clear causal relationship between these factors and the occurrence of intestinal polyps, as opposed to an association between these factors alone. Connections between
have been convincingly proven. There is also a connection between the risk of intestinal polyps and other diseases. These include diabetes and chronic inflammatory bowel diseases in particular.
Small intestinal polyps almost always remain completely asymptomatic. Larger polyps can lead to blood admixtures that usually remain inconspicuous and/or to conspicuous mucus admixtures in the stool.
As the size of the polyps increases, irregular bowel movements(diarrhea or constipation) and abdominal pain may occur.
Colon polyps can be reliably diagnosed by means of acolonoscopy. A preventive colonoscopy for the early detection of bowel cancer is covered by health insurance in Germany for
every ten years and is also financed without any special indication. A stool examination for non-visible blood is recommended at annual intervals from the age of 50 and is covered by health insurance. A positive result should be followed by a colonoscopy for further clarification.
If symptoms occur or if there is a family history of increased risk, colonoscopy is a health insurance benefit at any age. Possible symptoms include
During a colonoscopy, a flexible colonoscope tube is inserted into the bowel from the anus. The tube contains a light source and a camera that continuously transmits images of the intestinal wall to a monitor.
The bowel must be as completely empty as possible for the colonoscopy. The patient prepares for this by taking a highly effective laxative, which is used to effectively flush the bowel internally.
The inspection of the entire intestinal mucosa from the rectum to the junction between the large and small intestine takes about 25 minutes. The examination is usually performed under sedation or anesthesia. This procedure is very low-risk.
If a colon polyp is discovered during the colonoscopy, it is removed immediately if possible. Different techniques are available for this, depending on the size and shape of the polyp. Basically, the required instruments are advanced through the colonoscope tube to the bowel wall. The principle is explained in the following video:
Pedunculated polyps are usually removed by placing a wire loop around the stalk and pulling it together. This method is also called snare polypectomy. An electric current through the wire cuts the polyp away from the bowel wall and simultaneously cauterizes (closes) the wound.
Sessile polyps (non-stalked, flat and broadly growing polyps) can also be removed with the wire snare. However, this often has to be done in several pieces. The risk of not completely removing the polyp or causing significant damage to the bowel wall is relatively high.
Improved methods for removing sessile intestinal polyps have been available for several years: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). In both procedures, the sessile intestinal polyp is lifted from the intestinal wall by injecting saline solution or another specially formulated injection solution.
In EMR, the altered tissue is then grasped again with a snare and removed. In ESD, the polyp is cut around with a special blade inserted through the endoscope tube and removed.
The alternative to ESD for large polyps is surgical removal. The procedure can be minimally invasive (keyhole surgery/MIC) or classic surgery from the outside.
Removal of intestinal polyps using an electric snare during a colonoscopy © phonlamaiphoto | AdobeStock
After removal of the intestinal polyp(s), a thorough microscopic examination of the tissue is carried out. If a polyp proves to be neoplastic (i.e. with the potential for malignant degeneration) with more or less pronounced changes compared to the characteristics of normal tissue, follow-up colonoscopies are scheduled at regular intervals.
This provides an excellent basis for the timely diagnosis and removal of further polyps.
The risk of recurrence of adenoma-type intestinal polyps is reduced, depending on
is estimated at 10 to 20 percent. Recurrent adenomas can also be removed without complications in over 90 percent of cases.
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