The Role Of Digestive Endoscopy In Diagnosis And Follow-up Of Gastrointestinal Disease

PartⅠThe clinical and endoscopic features of colon and rectum polypsObjective To analyze the clinical and endoscopic features of different pathologic types of colon and rectum polyps. To research the positive rate of colon and rectum polyps and its size, distribution and appearance in the examination of colonoscope, and to provide instructions for gastrointestinal physicians and endoscopists in clinical practice.Methods The subject of the research was the patients diagnosed as colon or/and rectum polyps, who also received endoscopic treatment and pathology analysis in the Union Hospital of Huazhong University of Science and Technology. We analyzed both the age, gender and symptoms of the patients and the site, size, number, appearance of the polyps according to the WHO standard pathology category criterion for intestinal polyps in 2010.Results 1. The included number of patients was 2002, with 1336 males and 666 females. We detected and finished biopsy in 3837 polyps,1790 adenomatous polyps and 2047 non-adenomatous polyps included.2. The most common site for polyps was sigmoid colon and rectum, and incidence of polyps in the descending colon and splenic flexure in male was significantly higher than female(P=0.013). The incidence of inflammatory and proliferative polyps in female was significantly higher than male, however, the incidence of harmatoma and serration adenoma in male was significantly higher than female.3. Rectum polyps was common in patients younger than 30 years (30.91%), and sigmoid colon polyps was common in patients between 31 and 60 years old (40.2%), and transverse colon(hepatic flexure) polyps was common in the old that were older than 60 years (14.49%).4. In the patients younger than 30 years, the polyps with the diameter less than 2mm occupied 30 percent, and the polyps with the diameter between 6 and 10 mm occupied 21.36%. The polyps whose diameter was between 3 and 5mm occupied 31.36%,57.51% and 62.37% in patients in young, middle and old ages, respectively. The polyps whose diameter was between 11 and 19mm occupied 6.36%,3.70% and 1.41% in patients in young, middle and old ages, respectively, which had significant difference.5. There was no significant difference between the incidence of type I polyps in different ages (P>0.1). For type II and type III polyps, the incidence was significantly higher in middle and old age group than young age group (P<0.001). Type IV polyps was more common in young age group, and the number was 136 (30.91%), which was significantly higher than the number in other age groups.6. The average diameter of the inflammatory and proliferative polyps was 3.07±1.97mm,3.77±3.63mm, and the number was less than 5mm in common. The average diameter of the tubular adenomas and serration adenoma was 5.22±4.93mm, 5.15±4.02mm, and the number was less than 10mm in common. The average diameter of the villous adenoma, tubiform-villiform and hamartoma was 17.62±8.73mm, 13.34±10.83mm, and 11.96±9.48mm, respectively, and the number was more than 10mm in common. There was significant difference between the diameter of different pathologic types of polyposis (P<0.001), suggesting the pathologic type was closely related to the size of the polyposis.7. There were 930 hemorrhagic polyps (24.24%) and 2907 non-hemorrhagic polyps (24.24%) in the total 3837 polyps. The most common symptoms in non-hemorrhagic polyps were compound symptoms (19.65%), abdominal pain (17.51) and diarrhia (14.65%). The diameter of hemorrhagic polyp was significantly larger than non-hemorrhagic polyp (P<0.001).Hemorrhagic polyp was common in the left colon (77.20%), especially in the rectum. The number of hemorrhagic villiform, tubiform-villiform, and serration adenoma was significantly higher than non-hemorrhagic ones (P<0.05), and the number was opposite in tubular adenoma. For non-tumor polyposis, the bleeding rate of hemorrhagic hamartoma was significantly higher than non-hemorragic group (P<0.001), and the situation was opposite in proliferative polyps, and there was no significant difference between hemorrhagic and non-hemorrhagic group in inflammatory polyps.Conclusion 1.Colon polyps are commonly distributed in rectum and sigmoid colon, and as the age grows, the common site for polyps are tending to be near the anus. The incidence of polyps in the descending colon and splenic flexure in male was significantly higher than female.2. The diameter of colorectal polyp was below 5mm, and the polyps with the diameter below 2mm and 6-10mm were commonly detected in patients younger than 30 years old. As the age grows, the incidence of the polyps with the diameter between 3 and 5mm were increasing, and on contrary, the incidence of the polyps with the diameter betweenl 1 and 19mm were decreasing as age grows. The diameter of the inflammatory and proliferative polyps was the smallest, the diameter of tubular and serration adenoma was moderate, and the diameter of villiform, tubiform-villiform and hamartoma was the largest.3. The most common type of colorectal polyps was type II, and type II and III polyps was common in patients older than 30 years old, and type IV polyps was common in ones younger than 30 years old.4. The most common pathologic type of colorectal polyps was proliferative polyp and tubular adenoma, and the serration adenoma inflammatory polyp was less common. The incidence of inflammatory and proliferative polyp was higher in females than males, and on contrary, the incidence of hamartoma and serration adenoma in males was higher in males than females.5. The rectal polyp was more likely to bleed. The larger the size of the polyp is, the higher the possibility for the polyp to bleed. Villiform adenoma, tubiform-villiform, serration adenoma and hamartoma were more likely to bleed. Patr II The relationship of intraepithelial neoplasia and adenomatous polypObjective To analyze the clinical and endoscopic features of tumorous Polyps and intraepithelial neoplasia. Guiding the clinical examination and treatment.Methods The subject of the research was the patients diagnosed as colon or/and return polyps, who also received endoscopic treatment and pathology analysis in the Union Hospital of Huazhong University of Science and Technology. We analyzed both the age, gender and symptoms of the patients and the site, size, number, appearance of the polyps according to the WHO standard pathology category criterion for intestinal polyps in 2010.Results 1. There were 2021 patients included in the research, and 3665 polyps were detected. The number of non-intraepithelial neoplasia and intraepithelial neoplasia was 319 and 1702, and the rate for intraepithelial neoplasia was 15.8%. The number of non-intraepithelial neoplasia, low grade and high grade intraepithelial neoplasia was 3230,305 and 130, respectively.2. The number of intraepithelial neoplasia for male and female was 318(12.7%) and 117(10.07%), and males were more likely to have intraepithelial neoplasia(P=0.025). There was significant differences between female and male in low grade intraepithelial neoplasia(P=0.027), and no significant difference was found between female and male in high grade intraepithelial neoplasia(P=0.602).3. The incidence of intraepithelial neoplasia in young, middle, and old age group was 5.15%,13.58%and 9.66%, respectively. The incidence of low grade intraepithelial neoplasia in three age groups was 2.21%,10.21%and 5.52%, and there was significant difference(P<0.05). The incidence of high grade intraepithelial neoplasia in three age groups was 2.94%,3.36%and 4.14%, and there was no significant difference(P>0.1), however, the incidence increased as the age became old.4. The average diameter for the non-intraepithelial neoplasia, low grade and high grade intraepithelial neoplasia polyp was 4.83±4.90mm 8.72±7.71mm、15.78±12.54mm, and there was significant difference(P<0.001).5. The incidence for intraepithelial neoplasia was 15.93%,12.55%,13.27%,7.48%, and 7.99% in the rectum, sigmoid colon, descending colon(splenic flexure), transverse colon(hepatic flexure), and ascending colon(ileocecal junction), respectively. The incidence of intraepithelial neoplasia was significantly higher in the left than the right colon (13.60% vs 7.79%; P<0.001).6. The possibility for villiform and tubiform-villiform adenoma to have intraepithelial neoplasia was significantly higher than other type polyps(P<0.001), and the intraepithelial neoplasia that the other types of polyps had was commonly low grade intraepithelial neoplasia.7. The incidence of intraepithelial neoplasia in I, II, III and IV type polyposis was 0.37%,8.00%,16.90% and 28.30%, respectively. There was significant difference among the four types(P<0.001). The incidence for Type IV polyps developed into low and high grade intraepithelial neoplasia was 16.80% and 11.51%, and the percentage was significantly higher than other groups(P<0.001).8. The hemorrhage rate for non-intraepithelial neoplasia and intraepithelial neoplasia polyp was 42.5% and 22.35%, and there was significant difference(P<0.001). There was no significant difference in bleeding rate between low grade and high grade noeplasia(P=0.964).Conclusion 1. It’s more likely to happen intraepithelial neoplasia in male, but there is no obvious correlation between the high level intraepithelial neoplasia and gender.2. The incidence of intraepithelial neoplasia is higher in the middle and high age group especially in the high age group. So as the low level intraepithelial neoplasia. But the incidence of high level intraepithelial neoplasia increased with age rised.3. It’s more likely to happen intraepithelial neoplasia in bigger polyps, so as the variable lever of intraepithelial neoplasia.4. Left colon polyps have the higher incidence of intraepithelial neoplasia than the right-side colon.5. Villous adenomas and villous tubular adenomas are more likely to happen intraepithelial neoplasia, especially in high-level intraepithelial neoplasia.6. The polyps with type IV have the higher incidence of intraepithelial neoplasia than other three types.7. The polyps with intraepithelial neoplasia are more likely to hemorrhage. Part III The application value of capsule endoscopy in the diagnosis of obscure gastrointestinal bleedingObjective To understand the application and diagnostic value of capsule endoscopy in the diagnosis of obscure gastrointestinal bleeding.Methods Retrospectively analyze 161 patients with obscure gastrointestinal bleeding and 33 persons of routine health examination in our hospital between March 2003 and September 2010.Result The positive rate of capsule endoscopy was 68.94 percent, and the undetermined rate was 24.84 percent. The negative rate of capsule endoscopy was 6.21 percent, and the detecting rate was 93.79 percent. After the confirmation of surgeries and small bowel enteroscopy, the diagnostic yield of capsule endoscopy was 83.78 percent, specificity was 97.4%, and the false negative rate was 11.11 percent. The most common causes for the obscure gastrointestinal bleeding were vascular malformation, tumor and Crohn’s disease. The transit time of capsule endoscopy was significantly longer in the patients with abnormal result than the persons of routine health examination. The ratio of self-cure for the obscure gastrointestinal bleeding patients with negative result was higher than the patients with positive result(P=0.025).Conclusion The detecting and diagnostic rate of capsule endoscopy was high for obscure gastrointestinal bleeding patients, and it has high diagnostic value in the diagnosis of obscure gastrointestinal bleeding.