Severe XXXX in the colon - how aggressive should we be?

@entity1 @entity1127 @entity5 @entity75 @entity1049 @entity3 @entity1141
INTRODUCTION: Biopsies of @entity1049 are often reported as showing @entity1141 , though in reality some lesions may harbour invasive @entity5 . AIM: To assess the risk of underlying invasive @entity5 in sessile @entity1127 where biopsies had shown severe @entity1141 and also to attempt to define a management strategy in such @entity1 . METHODS: Between 1997 and 2001, 30 @entity1 were diagnosed as having severe @entity1141 using Morson's criteria in @entity1049 not amenable for endoscopic polypectomy. Severely @entity75 were completely excised by appropriate surgical measures. RESULTS: Out of 30 @entity1 , 15 had @entity3 . Surgical intervention involved anterior resections, endoanal excisions, sigmoid colectomies, or abdomino-perineal excisions as deemed appropriate. The lesions ranged in size from 0.5 cm to 13 cm (mean 3.4 cm). There were nine T1 lesions (one of which was T1N1) and two each of T2, T3, T4 lesions (10 Dukes' A, 3 Dukes' B, 2 Dukes' C). Complete resection was confirmed histologically in all cases. One @entity1 had a leak following endoanal excision, which required intervention. There was no mortality. DISCUSSION: This study demonstrates that endoscopic sampling can be misleading and severely @entity75 should be managed along the same principles as followed for @entity3 , rather than adopting a 'wait and watch' policy with repeated endoscopies, biopsies or piece-meal polypectomies.
