Endoscopy 2021; 53(06): 652-657
DOI: 10.1055/a-1248-2175
Innovations and brief communications

Large prolapse-related lesions of the sigmoid colon

W. Arnout van Hattem
1  Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
,
Neal Shahidi
1  Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
2  Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
3  Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
,
Sergei Vosko
1  Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
,
Iddo Bar-Yishay
1  Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
,
Scott Schoeman
1  Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
,
Mayenaaz Sidhu
1  Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
2  Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
,
Duncan McLeod
4  Department of Pathology, Westmead Hospital, Sydney, New South Wales, Australia
,
Michael J. Bourke
1  Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
2  Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
› Author Affiliations

Abstract

Background Large prolapse-related lesions (LPRL) of the sigmoid colon have been documented histologically but may not be readily recognized endoscopically.

Methods Colonic lesions referred for endoscopic mucosal resection (EMR) were enrolled prospectively. Endoscopic features were carefully documented prior to resection. Final diagnosis was made based on established histologic criteria, including vascular congestion, hemosiderin deposition, fibromuscular hyperplasia, and crypt distortion.

Results Of 134 large ( ≥ 20 mm) sigmoid lesions, 12 (9.0 %) had histologic features consistent with mucosal prolapse. Distinct endoscopic features were: broad-based morphology; vascular pattern obscured by dusky hyperemia; blurred crypts of varying size and shape; and irregular spacing of sparse crypts. Focal histologic dysplasia was identified in 6 of 12 lesions (50.0 %).

Conclusions LPRL of the sigmoid colon exhibit a distinct endoscopic profile. Although generally non-neoplastic, dysplasia may be present, warranting consideration of EMR.



Publication History

Received: 27 February 2020

Accepted: 13 July 2020

Publication Date:
22 September 2020 (online)

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