The Management of the Polyps in the Elderly

Special Article - Minimally Invasive Surgery: Current & Future Developments

Austin J Surg. 2016; 3(2): 1086.

The Management of the Polyps in the Elderly

Salih Tosun and Oktay Yener*

Goztepe Educational Hospital, Istanbul Medeniyet University, Turkey

*Corresponding author: Oktay Yener, Goztepe Educational Hospital, Istanbul Medeniyet University, Turkey

Received: June 01, 2016; Accepted: August 08, 2016; Published: August 11, 2016


Backgroud and Aim: To investigate the polyp incidence and the pathological findings in the elderly population in order to prevent them from Colorectal Carcinoma (CRC), in terms of safety polypectomy.

Methods: A retrospective analysis of colonoscopies in our hospital over 2-year period was performed. This study was performed between 2012-2014 years. The outcome measures were patients age, gender, polyp localisation, pathological findings. Those who have multiple polyposis syndrome, colonic mass, inflammatory bowel disease, active colitis and active hemoragia were excluded from the study. Patients were classified as low and high risk group by pathological findings.

Results: A total of 1432 colonoscopies were evaluated during the period, 448 patients were over 65 and 168 of them were polypectomy performed. By the pathological evaluation 57 them were non displastic, 99 have Low Grade Displasia (LGD) and 12 have High Grade Displasia (HGD). 166 patients were low and 2 patients were at high risk group. Only 1 patient went under surgery in terms of safety polypectomy.

Conclusion: Some polyps may have a high risk of CRC. Regardless of age, colonoscopy seems to be the first choice for the identification and threatment of these lesions. A common and safety classification can be usefull for the treatment and the follow up of these lesions.

Keywords: Polyp; Colon; Elderly


Nearly 10% of resected polyps have foci of carcinoma and the incidence is rising with the increasing use of colonoscopy [1]. Some of these polyps will have progression and further oncological resections should be considered for these lesions if they are not removed [2]. Surgical treatment can cause significant morbidity and mortality, especially in the elderly [3]. Screening colonoscopy surely have a possitive effect on the survival rate of colorectal cancer. Since survival rate of CRC correlates to the anatomical spread of the tumor, as well as to the surgical treatment at the right time, colonoscopy can prevent and diagnose the earliest stages of the carcinoma [4].

However there are confusions on identifying these earliest stages in the colonic polyps. Polyps showing foci of potentially malignant cells confined to the mucosa are often termed ‘carcinoma in situ’, but the lack of lymphatics in the mucosa prevents distant spread and as these lesions are neither regarded malignant, the term high grade mucosal neoplazm is now preferred [5]. When high grade dysplasia crosses the muscularis mucosa, the lesion is called malignant polyp. A malignant polyp is essentially a macroscopically benign lesion that contains malignant foci on further examination. When all parts of the polyp is comprised of malignancy the term polypoid carcinoma is often used [3]. The management of these lesions is based on the belief that the risk of spread can be stratified according to the histology of the resected polyp [6]. It is considered to divide these patients into two groups; low risk group who are safe without further treatment, high risk group for whom surgery or further treatment should be considered [7,8]. High risk group contains piecemeal or incomplete resection, vascular or lymphatic invasion, poor or undifferentiated histology, unfavorable invasion dept and involved margin [3,7-15].


We performed a retrospective review of all colonoscopies performed in our endoscopy unit by using our hospitals audit module of a computerised patient information system (SARUS internet and automotion system) over 2 years period. The data were collected retrospectively by colonoscopy records included patients’ main details, indication for colonoscopy (screening, diagnostic or surveillance), name of endoscopist, polyp location and further treatment (polypectomy, biopsy) if present. Bowel preperation was performed by oral fleet soda and fleet enema. Colonoscopies were performed by 6 endoscopist, varying backrounds and experience but all have at least 3 year endoscopic experience. Caecal intubation time was varied depends on patients situation. All polyps were removed and the pathologic evaluation was performed. Histology and degree of atypia were confirmed by our pathologists.

Exclusion critera

Age less than 65 years, colorectal mass, polyposis syndrome, inflammatory bowel disease, acute gastrointestinal bleeding and active colitis. The primary outcome was the presence of dysplasia in colonic polyps. Covariates include patient age, gender, lesion site.


During 2 years period 1432 colonoscopies were evaluated, 448 patients were over 65 and 168 of them were polypectomy performed. Of the patients polypectomy performed; 94 were male and 74 were female. By the pathological evaluation 57 them were non dysplastic, 99 have LGD and 12 have HGD. Of the 99 LGDs; 45 were located at the right colon and 54 at left colon. Of the 12 HGDs; 4 were located at the right and 8 at the left colon (Table 1). 12 of the HGD group contained 10 low risk group that are safe without further treatment but 2 of them were high risk group that had to go under further treatment (Table 2). One was incomplete polypectomy and after the second colonoscopy, polypectomy was completed with clear margins. The other was piecemal polypectomy and after the second colonoscopy this patient had gone under surgical treatment because the polyp margin is not clearly shown, unsafety polypectomy. However after the pathological evaluation of the resected material it is observed that invasion had not passed the stalk into the mucosa of the wall.