Colonic Polyps, El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Pedicled Polyp of the Descending Colon. This is the case of a 54 year-old male with rectal bleeding.

 Video Endoscopic Sequence 1 of 7.

Pedicled Polyp of the Descending Colon.

 This is the case of a 54 year-old male with rectal bleeding.
 

 For more endoscopic features download the video clip by
 clicking on the endoscopic image if you would like to
 appreciate in full screen, wait to be downloaded the video
 complete then press Alt and Enter.
 All endoscopic images shown in this Atlas contains video
 clips.
Tubular Adenoma on a Long Stalk

Video Endoscopic Sequence 2 of 7.

Tubular Adenoma on a Long Stalk.

 
Adenomatous polyps are precursors of most colorectal cancers, and their prevalence increases with age. The chance of detecting adenomatous polyps at colonoscopy is generally independent of the indication for the procedure

Video Endoscopic Sequence 3 of 7.

 Adenomatous polyps are precursors of most colorectal
 cancers, and their prevalence increases with age.
 The chance of detecting adenomatous polyps at
 colonoscopy is generally independent of the indication for
 the procedure.

 
Most pedunculated polyps are removed by transection of the stalk with a polypectomy snare. The major risk with this approach is post polypectomy bleeding. As a result, many endoscopists use one or more methods to reduce the risk of bleeding, particularly in polyps with wide stalks (pedicles larger than 1 to 1.5 cm in diameter).

Video Endoscopic Sequence 4 of 7.

 Endoscopic snare excision of large pediculated polyp.

 Most pedunculated polyps are removed by transection of
 the stalk with a polypectomy snare. The major risk with this
 approach is postpolypectomy bleeding. As a result, many
 endoscopists use one or more methods to reduce the risk of
 bleeding, particularly in polyps with wide stalks (pedicles
 larger than 1 to 1.5 cm in diameter).
The practice of removing polyps at colonoscopy is based on the assumption that their removal prevents progression to cancer. This concept, often called the adenoma-carcinoma sequence, has never been directly proved

Video Endoscopic Sequence 5 of 7.

 The practice of removing polyps at colonoscopy is based on
 the assumption that their removal prevents progression to
 cancer. This concept, often called the adenoma-carcinoma
 sequence.

 
Large pedunculated polyps (> 2-3 cm) are often easily removed with standard snare cautery techniques. The difficulty most commonly encountered is when a large polyp has a particularly long stalk, and the head of the polyp prolapses in both directions when snaring is attempted.

Video Endoscopic Sequence 6 of 7.

 Large pedunculated polyps (> 2-3 cm) are often easily
 removed with standard snare cautery techniques. The
 difficulty most commonly encountered is when a large
 polyp has a particularly long stalk, and the head of the
 polyp prolapses in both directions when snaring is
 attempted.

 
Final Status of the Polypectomy

Video Endoscopic Sequence 7 of 7.

Final Status of the Polypectomy.
A 59 year-old female that underwent a colonoscopy due to medical control of routine, the image displays a sessile Tubulovillous adenoma that emerging from the ileocecal valve.

          Video Endoscopic Sequence 1 of 13.

 A 59 year-old female that underwent a colonoscopy due to
 medical control of routine, the image displays a sessile
 Tubulovillous adenoma that emerging from the ileocecal
 valve.

 

 

 

                                          Medline.
An adenoma was located at the level of the digestive mucosa. It is a benign tumor, always dysplastic and considered as a pre-cancerous lesion.

Video Endoscopic Sequence 2 of 13.

 An adenoma was located at the level of the digestive
 mucosa. It is a benign tumor, always dysplastic and
 considered as a pre-cancerous lesion.






                                          

The image and the video display the catheter spraying the methylene blue.

Video Endoscopic Sequence 3 of 13.

 The image and the video display the catheter spraying the
 methylene blue.

Chromoendoscopy. For more endoscopic features download the video clip by clicking on the image.

Video Endoscopic Sequence 4 of 13.

 Chromoendoscopy.

 For more endoscopic features download the video clip by
 clicking on the image.





                                           Medline.
Using high-magnification chromoscopic colonoscopy. Tubulovillous adenoma, Video-endoscopy with chromoscopy. Magnifying endoscopy with methylene blue demonstrates sulciform pattern.

Video Endoscopic Sequence 5 of 13.

 Using high-magnification chromoscopic colonoscopy.

 Tubulovillous adenoma, Video-endoscopy with
 chromoscopy.
 Magnifying endoscopy with methylene blue demonstrates
 sulciform pattern.


                                          Medline.      

Chromoendoscopy and magnifying endoscopy are useful for detection and recognition of small non polypoid lesions, for differential diagnosis between hyperplastic and adenomatous lesions and for determining not only the lateral extent but also the depth of a lesion. Pit analysis would especially be useful in the differential diagnosis between depressed-type early cancers (type IIIS) and flat adenomas with pseudodepression (type IIIL).

Video Endoscopic Sequence 6 of 13.

 Chromoendoscopy and magnifying endoscopy are useful for
 detection and recognition of small non polypoid lesions, for
 differential diagnosis between hyperplastic and
 adenomatous lesions and for determining not only the
 lateral extent but also the depth of a lesion. Pit analysis
 would especially be useful in the differential diagnosis
 between depressed-type early cancers (type IIIS) and flat
 adenomas with pseudodepression (type IIIL).
Another view using magnifying chromo-endoscopy.

Video Endoscopic Sequence7 of 13.

 Another view using magnifying chromo-endoscopy.

 
In order to establish the magnitude of the size of the polyp and to plan its extraction, we used forceps of biopsy, moving forwarding and pushing the adenoma. The adenoma was excised using a snare wire and electrocautery.

Video Endoscopic Sequence 8 of 13.

 In order to establish the magnitude of the size of the polyp
 and to plan its extraction, we used forceps of biopsy,
 moving forwarding and pushing the adenoma.
 The adenoma was excised using a snare wire and
 electrocautery.

 See the video clip.
A polypectomy is being performed, the polypectomy snare is appreciated.

Video Endoscopic Sequence 9 of 13.

 A polypectomy is being performed, the polypectomy snare
 is appreciated.

 
Note the traction which the lesion is being removed

Video Endoscopic Sequence 10 of 13.

 Note the traction which the lesion is being removed.
The fragment of the polyps have been falled out. Shown here after removal of the polyp.

Video Endoscopic Sequence 11 of 13.

 The fragment of the polyps have been falled out.
 Shown here after removal of the polyp.
 
Benign tubulo villous neoplasia of the ileocecal valve with Mild dysplasia. Mild dysplasia is characterized by uniform loss of mucin and hyperchromatic and elongated cells. Glands appear branched and budding.

Video Endoscopic Sequence 12 of 13.

 Benign tubulo villous neoplasia of the ileocecal valve with
 Mild dysplasia.
 Mild dysplasia is characterized by uniform loss of mucin
 and hyperchromatic and elongated cells. Glands appear
 branched and budding.
Another Histopatologic view.

Video Endoscopic Sequence 13 of 13.

 Another Histopatologic view.
 
The image and the video display several small polyps. Familiar polyposis of the colon (FPC).

Stalked polyp of the sigmoid.

 The image and the video display several small polyps.
 Familiar polyposis of the colon (FPC).


 More images and video clips about this case press here.

 
Tubulo-Villous Adenoma. Adenomatous polyps are, by definition, neoplastic. Although benign, they are the direct precursors of adenocarcinomas and follow a predictable cancerous temporal course unless interrupted by treatment. They can be either pedunculated or sessile. Adenomas are divided into 3 subtypes based on histologic criteria, (1) tubular, (2) tubulovillous, and (3) villous. According to World Health Organization (WHO) criteria, villous adenomas are composed of greater than 80% villous architecture. Tubular adenomas are encountered most frequently (80-86%). Tubulovillous adenomas are encountered less frequently (8-16%), and villous adenomas are encountered least frequently (5%).

Tubulo-Villous Adenoma.

 Adenomatous polyps are, by definition, neoplastic.
 Although benign, they are the direct precursors of
 adenocarcinomas and follow a predictable cancerous
 temporal course unless interrupted by treatment. They can
 be either pedunculated or sessile. Adenomas are divided
 into 3 subtypes based on histologic criteria, (1) tubular, (2)
 tubulovillous, and (3) villous. According to World Health
 Organization (WHO) criteria, villous adenomas are
 composed of greater than 80% villous architecture. Tubular
 adenomas are encountered most frequently (80-86%).
 Tubulovillous adenomas are encountered less frequently
 (8-16%), and villous adenomas are encountered least
 frequently (5%).

Enormous Sessile Villous Adenoma. An 80 year-old female have a sessile mass between the first and second rectal valves. Morphologically, villous adenomas of the colon are generally sessile and papilliferous. Lesions that tend to secrete mucus. The epithelial element of these adenomas is more dysplastic than that seen in tubular adenomas and consequently these have, in general, greater potential for malignant change.

Video Endoscopic Sequence 1 of 3.

Enormous Sessile Villous Adenoma.

 An 80 year-old female have a sessile mass between the
 first and second rectal valves.
 
 Morphologically, villous adenomas of the colon are
 generally sessile and papilliferous.
 Lesions that tend to secrete mucus.
 The epithelial element of these adenomas is more
 dysplastic than that seen in tubular adenomas and
 consequently these have, in general, greater potential for
 malignant change.
Enormous Sessile Villous Adenoma. The immediate risks of adenomas include hemorrhage, obstruction with intussusception, and, possibly, torsion. However, the main concern is malignant progression of the villous adenoma. Studies have defined the risk of progression of adenomas to adenocarcinoma.

Video Endoscopic Sequence 2 of 3.

 The immediate risks of adenomas include hemorrhage,
 obstruction with intussusception, and, possibly, torsion.
 However, the main concern is malignant progression of the
 villous adenoma. Studies have defined the risk of
 progression of adenomas to adenocarcinoma.

 
Enormous Sessile Villous Adenoma. Villous Adenoma, after spraying methilene blue. Adenomas are believed to have an abnormal process of cell proliferation and apoptosis. The proliferative component is not confined to the crypt base and accumulates onto the surface and infolds downward. In villous adenomas, mesenchymal proliferation results in longer projections and larger polyps. Epidemiological studies provide evidence of adenoma-to-carcinoma progression. The mean age of adenoma diagnosis is 10 years earlier than with carcinoma, and progression to carcinoma takes a minimum of 4 years.

Video Endoscopic Sequence 3 of 3.

 Villous Adenoma, after spraying methilene blue.

 Adenomas are believed to have an abnormal process of cell
 proliferation and apoptosis. The proliferative component is
 not confined to the crypt base and accumulates onto the
 surface and infolds downward. In villous adenomas,
 mesenchymal proliferation results in longer projections and
 larger polyps.
 Epidemiological studies provide evidence of
 adenoma-to-carcinoma progression. The mean age of
 adenoma diagnosis is 10 years earlier than with carcinoma,
 and progression to carcinoma takes a minimum of 4 years.
The polyp cap that resemble a adenocarcinoma of the rectum. This 22 year-old lady, that has been presented with rectal bleeding and mucus discharge. Digital rectal examinations revealed polypoidal masses in the rectum.

Video Endoscopic Sequence 1 of 7.

Cap polyposis that resemble a adenocarcinoma of the rectum.

 This 22 year-old lady, has been presented with rectal
 bleeding and mucus discharge, also has been suffering of
 Bulimia Nervosa.

Digital rectal examinations revealed polypoidal masses in the rectum.

.
Cap polyposis is characterized by the presence of inflammatory polyps with a "cap" of granulation tissue. It may represent one end of a spectrum of conditions caused by chronic straining.

Video Endoscopic Sequence 2 of 7.

 Cap polyposis is characterized by the presence of
 inflammatory polyps with a "cap" of granulation tissue. It
 may represent one end of a spectrum of conditions caused
 by chronic straining.

 Polyps have an erythematous and inflamed appearance
 and are capped with a purulent fibrin exudate.

 The pathogenesis is not well known although many
 affected individuals have long standing colonic dysmotility
 manifested by chronic constipation. It is hypothesized that
 recurrent mucosal trauma due to chronic straining can
 result in the clinical spectrum of mucosal prolapse
 syndrome which includes solitary rectal ulcer syndrome
 and the more dramatic finding of cap polyposis.
 
The findings here are of cap polyposis, a rare condition thought to be related to chronic constipation and straining causing prolapse of mucosa in the rectum and sigmoid. Often mistaken for pseudopolyps, the polyps seen can range from sessile to pedunculated in morphology and can be found anywhere from the rectum to the cecum although the vast majority are found in the rectosigmoid region as in this example.

Video Endoscopic Sequence 3 of 7.

 The findings here are of cap polyposis, a rare condition
 thought to be related to chronic constipation and straining
 causing prolapse of mucosa in the rectum and sigmoid.
 Often mistaken for pseudopolyps, the polyps seen can
 range from sessile to pedunculated in morphology and can
 be found anywhere from the rectum to the cecum although
 the vast majority are found in the rectosigmoid region as in
 this example.
Chromoendoscopy with indigo carmin. Cap polyposis is characterized by rectosigmoid polyps that have tortuous elongated crypts and are covered by a cap of fibropurulent exudate. The pathogenesis is unknown, but the histology suggests that mucosal prolapse may play a role. The current therapy often used for inflammatory bowel diseases has frequently been ineffective. Overall, infliximab lead to symptomatic improvement and histologic resolution of the polyps

Video Endoscopic Sequence 4 of 7.

Chromoendoscopy with indigo carmin.

 Cap polyposis is characterized by rectosigmoid polyps that
 have tortuous elongated crypts and are covered by a cap
 of fibropurulent exudate. The pathogenesis is unknown,
 but the histology suggests that mucosal prolapse may play
 a role. The current therapy often used for inflammatory
 bowel diseases has frequently been ineffective. Overall,
 infliximab lead to symptomatic improvement and histologic
 resolution of the polyps.

 
Argon Plasma Coagulation was used as ablative therapy.

Video Endoscopic Sequence 5 of 7.

Argon Plasma Coagulation was used as ablative therapy.
Recently, there was a case report published, on a patient with cap polyposis who was treated with a single infusion of infliximab 5 mg/kg and who demonstrated dramatic symptomatic improvement

Video Endoscopic Sequence 6 of 7.

 Recently, there was a case report published, on a patient
 with cap polyposis who was treated with a single infusion of
 infliximab 5 mg/kg and who demonstrated dramatic
 symptomatic improvement.

 

 

 

                                          Medline.
Status after the polyps were considered successfully ablated with argon plasma coagulation. Three different session of argon plasma coagulator were used.

Video Endoscopic Sequence 7 of 7.

Status after the polyps were considered successfully
 ablated with argon plasma coagulation.

Three different session of argon plasma coagulator were used.

Cap Polyposis.Another Case. This 47 year-old female, who has been suffering of rectal discharge with mucoid secretion.

Cap Polyposis.

Another Case.

This 47 year-old female, who has been suffering of rectal discharge with mucoid secretion.

Flat Adenoma of the third rectal valve, with irregular surface is appreciated.

Video Endoscopic Sequence 1 of 3.

 Flat Adenoma of the third rectal valve, with irregular
 surface is appreciated.

 
High magnification with Cresyl violet. Dye spray technique may result in a higher detection rate of flat colonic lesions. Clinical usefulness of high-resolution chromoendoscopy, i.e. colonoscopy with topically applied agents, in an attempt to discriminate neoplastic from non-neoplastic colorectal polyps. Using both specially designed videocolonoscopes that produce high-resolution images at great magnification and dye spray, a contrast stain which accentuates epithelial topography, thus allowing recognition of otherwise unnoticeable epithelial changes, it seems possible to distinguish adenomatous from nonadenomatous colorectal polyps measuring <10 mm3. The clinical utility of standard videocolonoscopy and staining with a dye especially in the diagnosis of very small colorectal polyps.

Video Endoscopic Sequence 2 of 3.

High magnification with Cresyl violet.

 Dye spray technique may result in a higher detection rate
 of flat colonic lesions.
 Clinical usefulness of high-resolution chromoendoscopy, i.e.
 colonoscopy with topically applied agents, in an attempt to
 discriminate neoplastic from non-neoplastic colorectal
 polyps. Using both specially designed videocolonoscopes
 that produce high-resolution images at great magnification
 and dye spray, a contrast stain which accentuates epithelial
 topography, thus allowing recognition of otherwise
 unnoticeable epithelial changes, it seems possible
 to distinguish adenomatous from nonadenomatous
 colorectal polyps measuring <10 mm3. The clinical utility of
 standard videocolonoscopy and staining with a dye
 especially in the diagnosis of very small colorectal polyps.

High-resolution video endoscopy and chromoscopy.

Video Endoscopic Sequence 3 of 3.

 High-resolution video colonoscopy and chromoscopy.

 
Of the third rectal valve some diverticulae are observed nearby.Most colonic polyps are asymptomatics. Adenomoatous Polyps result of epithelial and dysplasia. Tree types: tubular, villous and mixed. Risk of malignancy related to size, histologic type and severity of dysplasia. Since they are considered premalignant all should be removed.

 Tubular Adenoma.

 Of the third rectal valve some diverticulae are observed
 nearby.
 

 Most colonic polyps are asymptomatics.
 Adenomoatous Polyps result of epithelial and dysplasia.
 Tree types: tubular, villous and mixed.
 Risk of malignancy related to size, histologic type and
 severity of dysplasia.
 Since they are considered premalignant all should be
 removed.

Large and long stalk villous adenoma inserting in the rectal dentate line, appearing as a multi lobular mass.

Video Endoscopic Sequence 1 of 2.

 Large and long stalk villous adenoma inserting in the
 rectal dentate line, appearing as a multi lobular mass.
 

 Polyps are classified based on the type of tissue they contain:

 Tubular adenomas are the most common type. About 80%
 to 86% of adenomatous polyps are this type. Tubular adenomas
 are the polyps that are least likely to develop into colon cancer.

 
 Villous adenomas are the least common type. About 3% to
 16% of adenomatous polyps are this type. Villous adenomas are
 most likely to become cancerous.

 Tubulovillous adenomas are a combination of the other
 two tissue types. About 8% to 16% of adenomatous polyps are
 this type and are more likely than tubular but less likely than
 villous adenomas to develop into cancer.

Prolapsing tumor through the anus.

Video Endoscopic Sequence 2 of 2.


 Prolapsing tumor through the anus.
  

Pediculated tubular adenoma. Colonoscopic picture of a pediculated tubular adenoma. Note the stalk and raspberry-like appearance of the polyp. Most adenomas are encountered incidentally during colorectal cancer surveillance.

Pediculated tubular adenoma.

 Colonoscopic picture of a pediculated tubular adenoma.
 Note the stalk and raspberry-like appearance of the
 polyp. Most adenomas are encountered incidentally
 during colorectal cancer surveillance.
Large villous adenoma of the sigmoid. The cancer risk of a tubular adenoma is controversial, but strong evidence suggests that it can become malignant. Risk of malignancy is related to size; a 1.5-cm tubular adenoma has a 2% risk. As its size increases, its glands become villous. When > 50% of its glands are villous, it is called a villoglandular polyp; its malignancy potential is still that of a tubular adenoma. When > 80% of the glands are villous, the polyp is called a villous adenoma, which becomes malignant in about 35% of cases. A villous adenoma has a greater risk of malignancy than a tubular adenoma of the same size.

Large Villous Adenoma of the Sigmoid.

 The cancer risk of a tubular adenoma is controversial, but
 strong evidence suggests that it can become malignant. Risk of
 malignancy is related to size; a 1.5-cm tubular adenoma has a 2%
 risk. As its size increases, its glands become villous. When > 50%
 of its glands are villous, it is called a villoglandular polyp; its
 malignancy potential is still that of a tubular adenoma. When > 80
 % of the glands are villous, the polyp is called a villous adenoma
 , which becomes malignant in about 35% of cases. A villous
 adenoma has a greater risk of malignancy than a tubular adenoma
 of the same size.
Cecum stalk polyp inside of the appendiceal orifice.

Video Endoscopic Sequence 1 of 2.

 Cecum stalk polyp inside of the appendiceal orifice.
The appendiceal orifice is appreciated after the biopsies of the polyp. The diameter of the orifice is enlarged and almost permitted introduction of the tip of the colonoscope.

Video Endoscopic Sequence 2 of 2.

 The appendiceal orifice is appreciated after the biopsies of
 the polyp.
 The diameter of the orifice is enlarged and almost
 permitted introduction of the tip of the colonoscope.
 
 
Flat ulcerated tubular adenoma.Flat ulcerated tubular adenoma in the ascending colon that caused severe hemorrhage and hypovolemic shock.

Flat ulcerated tubular adenoma.

 Flat ulcerated tubular adenoma in the ascending colon
 that caused severe hemorrhage and hypovolemic shock. 
    

Serrated large mass. A 32 year-old physician, who had rectal bleeding. A large mass between the second and third rectal valve is appreciated. The histopathologic study reveled tubular adenoma. The hyperplastic polyp is considered a benign lesion with no malignant potential, whereas serrated adenoma is a precursor of adenocarcinoma. The morphologic complexity of the serrated adenoma varies from being clearly adenomatous to being difficult to distinguish from hyperplastic polyp, which creates a need for more detailed morphologic analysis of all serrated polyps.

Serrated large Mass.

 A 32 year-old physician, who had rectal bleeding.
 A large mass between the second and third rectal
 valve is appreciated.
 The histopathologic study reveled tubular adenoma.

 The "hyperplastic polyp" is considered a benign lesion with
 no malignant potential, whereas "serrated adenoma" is a
 precursor of adenocarcinoma. The morphologic complexity
 of the serrated adenoma varies from being clearly
 adenomatous to being difficult to distinguish from
 hyperplastic polyp, which creates a need for more detailed
 morphologic analysis of all serrated polyps.
Large ulcerated polyp at the splecnic flexure. A 71 year-old male that had severe rectal bleeding and shock due to this tumor.

 Large ulcerated polyp at the splecnic flexure.

 A 71 year-old male that had severe rectal bleeding and
 shock due to this tumor.

Bilobulated, pediculated villotubular adenoma.

Video Endoscopic Sequence 1 of 2.

Bilobulated, Pediculated Villotubular Adenoma.
 
A large stalk is seen, as the same case described above.

Video Endoscopic Sequence 2 of 2.

 A large stalk is seen.

Lymphoid hyperplasia. Seen at hepatic angle, multiple tiny 1 to 2 mm in size usually incidental.

Lymphoid hyperplasia.

 Seen at hepatic angle, multiple tiny 1 to 2 mm in size
 usually incidental.
            

Enormous tubulovillous tumour of the sigmoid with wide pediculated stalk.

Video Endoscopic Sequence 1 of 2.

 Enormous tubulovillous tumor of the sigmoid with wide
 pediculated stalk.
Another view of the wide stalk with the mass.

Video Endoscopic Sequence 2 of 2.

 Another view of the wide stalk with the mass.

Juvenile polyps in a 15 year-old girl. She presented rectal hemorrhage for a week. The image displays a bleeding juvenile polyp. The video displays two rectal polyps.

Video Endoscopic Sequence 1 of 2.

 Juvenile polyps in a 15 year-old girl. She presented rectal
 hemorrhage for a week.
 The image displays a bleeding juvenile polyp.
 The video displays two rectal polyps.
   

Endoscopic Polypectomy of a rectal juvenile polyp.

Video Endoscopic Sequence 2 of 2.

 Endoscopic Polypectomy of a rectal juvenile polyp.

 More cases of Polypectomy see Polypectomy and
 Juvenile Polyposis.
 More polyps should see Familiar polyposis.