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OBJECTIVES The lack of risk profile data on changes in multiple polyps identified by a colonoscopy constrains the creation of evidence-based guidelines. Our study aimed to investigate the relationship between size, location and histology of multiple polyps and patients' characteristics in a large teaching hospital-based Chinese population. METHODS We conducted a large, case-control, retrospective analysis on polyps obtained from 8308 patients who presented at the Digestive Endoscopy Center, Changhai Hospital (Shanghai, China) from January 2013 to August 2015. In total 10572 polyps were analyzed, with risk factors extrapolated through chart reviews of patients' electronic medical records. RESULTS Single polyps were identified in 6843 (82.4%) patients while multiple polyps were found in 1465 (17.6%). A multivariate analysis indicated that men were more likely than women to have multiple polyps (P < 0.001). Compared with the single polyps group, the numbers of patients with multiple polyps increased significantly with age (P < 0.001). Multiple small (6-9 mm) non-advanced adenomas were more likely to be found than were diminutive (

PURPOSE OF REVIEW The goal of this review is to help providers recognize, diagnose and manage gastrointestinal (GI) polyposis syndromes. RECENT FINDINGS Intestinal polyps include a number of histological sub-types such as adenomas, serrated, hamartomas among others. Over a quarter of individuals undergoing screening colonoscopy are expected to have colonic adenomas. Although it is not uncommon for adults to have a few GI polyps in their lifetime, some individuals are found to have multiple polyps of varying histology throughout the GI tract. In these individuals, depending on polyp histology, number, location and size as well as extra-intestinal features and/or family history, a polyposis syndrome should be considered with appropriate testing and management. SUMMARY Diagnosis and management of polyposis syndromes has evolved with advent of multigene panel testing and new data on optimal surveillance strategies. Evidence-based recommendations and current practice guidelines for polyposis syndromes are reviewed here. Areas of uncertainty and future research are also highlighted.

A 45-year-old man visited our institution due to the onset of hematochezia. He had a previous episode nine years earlier and colonoscopy at that time revealed multiple polyps, which were consistent with inflammatory cloacogenic polyps (ICPs) on the dentate line. Colonoscopy was performed again and two of the ICPs had grown. Both lesions were pathologically diagnosed as adenocarcinomas based on biopsies. Endoscopic submucosal dissection (ESD) was performed and the two lesions were diagnosed as double well-differentiated adenocarcinomas arising from ICPs. To our knowledge, this is the first reported case of double early rectal cancer in ICPs, which were followed endoscopically and successfully resected with ESD.

Introduction. Results from single medical centers having large numbers of patients with multiple colonic polyps that have undergone colonoscopy management are rare. Material and method. The present study is based on 2,000 cases enrolled during 2009 and 2017, including patients that underwent colonoscopy for various reasons in the Department for Upper and Lower Endoscopy of Witting Clinical Hospital, Bucharest, Romania. Results. Of the 2,000 patients examined during 2009 - 2017, 594 tumor formations were detected; 148 (24.9%) patients had colorectal malignancies, and 446 (75%) polypoid formations in 313 patients who had one or more colon polyps were found. Discussions. After performing statistical analyses on several general parameters (such as age, sex, overall clinical outcome of the patient) and polyp-related characteristics (such as: dimensions, location, histological type), we developed a stepwise algorithm for clinical management (with endoscopic polypectomy) of patients with multiple polyposis, with the goal of reducing unnecessary colorectal surgeries. Conclusions. We believe that this type of stepwise algorithm-based approach in the clinical management of patients with multiple polyposis can lead to a substantial decrease in unnecessary colectomies (no matter the approach, via laparotomy or laparoscopic procedures), with the accompanying benefit of avoiding the complications and negative long-life impact that they impose.

Diagnostic systems designed to detect possibly multiple lesions per patient (e.g. multiple polyps during CT colonoscopy) are often evaluated in “free-response” studies that allow for diagnostic responses unconstrained in their number and locations. Analysis of free-response studies requires extensions of the traditional receiver operating characteristic (ROC) analysis, which are termed free-response ROC (FROC) methodology. Despite substantial developments in this area, FROC tools and approaches are much more cumbersome than traditional ROC methods. Alternative approaches that use well-known ROC tools (e.g. ROI-ROC) require defining and physically delineating regions of interest (ROI) and combine FROC data within ROIs. We propose an approach that allows analyzing FROC data using conventional ROC tools without delineating the actual ROIs or reducing data. The design parameters of FROC study are used to make FROC data analyzable using ROC tools and to calibrate the corresponding FROC and ROC curves on both conceptual and numerical levels. Differences in the performance indices of the nonparametric FROC and the new approach are shown to be asymptotically negligible and typically rather small in practice. Data from a large multi-reader study of colon cancer detection are used to illustrate the new approach.

// Clara Esteban-Jurado 1 , David Gimenez-Zaragoza 2 , Jenifer Munoz 1 , Sebastia Franch-Exposito 1 , Miriam Alvarez-Barona 3 , Teresa Ocana 1 , Miriam Cuatrecasas 4 , Sabela Carballal 1 , Maria Lopez-Ceron 1 , Maria Marti-Solano 5 , Marcos Diaz-Gay 1 , Tom van Wezel 6 , Antoni Castells 1 , Luis Bujanda 7 , Judith Balmana 8 , Victoria Gonzalo 9 , Gemma Llort 10 , Clara Ruiz-Ponte 3 , Joaquin Cubiella 11 , Francesc Balaguer 1 , Rosa Aligue 2 , Sergi Castellvi-Bel 1 1 Gastroenterology Department, Hospital Clinic, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Catalonia, Spain 2 Biomedical Sciences Department, School of Medicine, University de Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain 3 Galician Public Foundation of Genomic Medicine (FPGMX), Centro de Investigacion Biomedica en Red de Enfermedades Raras (CIBERER), Genomics Medicine Group, Hospital Clinico, Santiago de Compostela, University of Santiago de Compostela, Galicia, Spain 4 Department of Pathology, Hospital Clinic, Biobanc Clinic-IDIBAPS, Barcelona, Catalonia, Spain 5 Department of Pharmaceutical Chemistry, Philipps-University Marburg, Marburg, Germany 6 Leiden University Medical Center (LUMC), Leiden, Netherlands 7 Gastroenterology Department, Hospital Donostia–Instituto Biodonostia, Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Basque Country University (UPV/EHU), San Sebastian, Spain 8 High Risk and Cancer Prevention Unit, Medical Oncology Department, University Hospital Vall d’Hebron and Vall d’Hebron Institute of Oncology, Barcelona, Spain 9 Gastroenterology Department, Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain 10 Clinical Oncology Department, Corporacio Parc Tauli, Sabadell, Barcelona, Spain 11 Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Instituto de Investigacion Biomedica Ourense, Pontevedra y Vigo, Ourense, Spain Correspondence to: Sergi Castellvi-Bel, email: sbel@clinic.cat Keywords: colorectal neoplasm, colorectal adenoma, genetic predisposition to disease, POLE, POLD1 Received: January 04, 2017 Accepted: February 18, 2017 Published: March 01, 2017 ABSTRACT Germline mutations in POLE and POLD1 have been shown to cause predisposition to colorectal multiple polyposis and a wide range of neoplasms, early-onset colorectal cancer being the most prevalent. In order to find additional mutations affecting the proofreading activity of these polymerases, we sequenced its exonuclease domain in 155 patients with multiple polyps or an early-onset colorectal cancer phenotype without alterations in the known hereditary colorectal cancer genes. Interestingly, none of the previously reported mutations in POLE and POLD1 were found. On the other hand, among the genetic variants detected, only two of them stood out as putative pathogenic in the POLE gene, c.1359 + 46del71 and c.1420G > A (p.Val474Ile). The first variant, detected in two families, was not proven to alter correct RNA splicing. Contrarily, c.1420G > A (p.Val474Ile) was detected in one early-onset colorectal cancer patient and located right next to the exonuclease domain. The pathogenicity of this change was suggested by its rarity and bioinformatics predictions, and it was further indicated by functional assays in Schizosaccharomyces pombe . This is the first study to functionally analyze a POLE genetic variant outside the exonuclease domain and widens the spectrum of genetic changes in this DNA polymerase that could lead to colorectal cancer predisposition.

Introduction: There are gaps in the literature regarding outcome of multiple polyps and dilemmas in the management issues in polyposis syndromes in children. Objective: We aimed to study the clinical behaviour of gastrointestinal (GI) polyps with emphasis on therapeutic outcomes of polyposis syndrome. Methods: Proven cases of GI polyp(s) on endoscopy were classified as single polyp, multiple polyps, and polyposis syndrome. Complex presentation was defined as 1 or more of the following: severe anaemia, anasarca, intussusception, rectal mucosal prolapse, and diarrhoea. A clinico-endoscopic criterion was applied in polyposis syndrome patients for the decision of surgery versus endoscopic therapy with surveillance. Results: Of total 240 patients, there were no significant differences between single (52.5%, n = 126) versus multiple polyps (27.5%, n = 66) with respect to age, symptoms, histology, and recurrence. Polyposis syndrome (20%, n = 48) presented with complex symptoms (50%), higher family history, significantly lower haemoglobin, total protein, and albumin as compared to single and multiple polyps (p < 0.01). Nineteen polyposis patients with favourable clinico-endoscopic criteria were endoscopically eradicated for polyps in 3 (1–4) sessions with sustenance of laboratory parameters at 1 year and 30% symptomatic recurrence at follow-up of 23.5 (7–40) months. There were no major endoscopic complications. Nineteen patients required proctocolectomy with improvement in laboratory parameters 6 months post-surgery. Conclusions: Multiple polyps behave similar to single polyps in children. A clinico-endoscopic criterion may guide for optimal management of polyposis syndrome. Colectomy may be effectively deferred in a large proportion of polyposis syndrome patients if maintained on an endoscopic protocol.

Familial adenomatous polyposis (FAP) is an inherited disorder that typically presents with multiple polyps in the colon. These polyps become cancerous if not monitored in the early stages or if left untreated. For those with a family history of FAP, colonoscopy screenings begin in adolescence and continue throughout adulthood because polyps can arise at an early age. Colon cancer in untreated individuals develops before age 40 years. This topic warrants discussion to aid in the prompt recognition of symptom presentation. This article will address the development of FAP, its presentation, and potential treatment strategies that may be used by nurse practitioners.

This clinical case demonstrates the diagnostic value of capsule endoscopy for the detection of polyposis of gastro-intestinal tract (Peutz–Jeghers syndrome). We report the case of a 5-year-old male presenting with a chronic iron refractory iron deficiency anemia. Multiple polyps of the stomach and small intestine with an erosive and hemorrhagic component were identified by the method of capsule endoscopy.

Purpose To understand the prognosis of polypoidal choroidal vasculopathy (PCV) by evaluating the responsiveness to intravitreal ranibizumab (IVR) monotherapy according to the presence of a single or multiple polyps. Design Retrospective case series. Methods We included 48 treatment-naive eyes of 48 patients who received IVR monotherapy at the Medical Retina Division Clinic, Keio University Hospital between March 2009 and January 2013 and attended the clinic for at least 12 months. All patients received 3 monthly IVR injections followed by pro re nata injections and were divided into single polyp and multiple polyps groups according to indocyanine green angiography and optical coherence tomography (OCT) findings. The outcome measures included changes in best-corrected visual acuity (BCVA) and OCT findings over 2 years after initial IVR. Results At baseline, the multiple polyps group exhibited a poorer BCVA, larger greatest linear dimension, and higher prevalence of fibrovascular pigment epithelial detachment compared with the single polyp group. Over 2 years, the multiple polyps group showed no improvement in BCVA, although the central retinal thickness (CRT) decreased in both groups. The multiple polyps group exhibited a significantly greater CRT at 1 year and required more injections in the first year compared with the single polyp group; furthermore, it included a higher number of nonresponders judged either by BCVA or fundus findings at 1 year and fundus findings at 2 years. Conclusions We propose that the stratification of PCV lesions according to the presence of single or multiple polyps may be valuable to understand the prognosis.

Peutz-Jeghers syndrome (PJS) is characterized by scattered black pigmentations on fingers and lips and multiple polyps in the gastrointestinal tract. Patients with PJS often have severe complications secondary to multiple large polyps. Herein, we presented a young woman complicated with a large polyp in her colon without any clinical symptoms. We also emphasized the necessity of early diagnosis and treatment of multiple polyps in such patients.

Corals and humans represent two extremely disparate metazoan lineages and are therefore useful for comparative evolutionary studies. Two lipid-based molecules that are central to human immunity, platelet-activating factor (PAF) and Lyso-PAF were recently identified in scleractinian corals. To identify processes in corals that involve these molecules, PAF and Lyso-PAF biosynthesis was quantified in conditions known to stimulate PAF production in mammals (tissue growth and exposure to elevated levels of ultraviolet light) and in conditions unique to corals (competing with neighbouring colonies over benthic space). Similar to observations in mammals, PAF production was higher in regions of active tissue growth and increased when corals were exposed to elevated levels of ultraviolet light. PAF production also increased when corals were attacked by the stinging cells of a neighbouring colony, though only the attacked coral exhibited an increase in PAF. This reaction was observed in adjacent areas of the colony, indicating that this response is coordinated across multiple polyps including those not directly subject to the stress. PAF and Lyso-PAF are involved in coral stress responses that are both shared with mammals and unique to the ecology of cnidarians.

Gardner's syndrome (GS) is an autosomal dominant, well-documented disease with characteristic systemic and maxillofacial manifestations. The diagnosis of GS is established by the presence of simultaneous findings of intestinal or colorectal polyposis and jaw pathologies. Multiple polyps of GS are likely to become carcinomas at older ages. Cooperation between medical disciplines is important in the diagnosis of GS. Patient with multiple adenoid polyposis should be referred to dental examination in order to discard GS. Dental radiographic examination may be crucial in the primary diagnosis of the disease. In this case report, a case of GS is presented with prominent histologic features and the importance of the dental examination in the diagnosis of GS is discussed.

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Only 49 % of diminutive colorectal polyps are neoplastic, but a tiny percentage contains advanced histology. We aimed to determine the rate of advanced diminutive polyps and to evaluate the influence of age, gender, number, and localization. Patients undergoing a videocolonoscopy in October 2010 and April 2012 were collected prospectively. Subjects with polyps ≤5 mm in diameter were recruited into the study. The presence of a villous component of >25 % and a high degree of dysplasia were categorized as polyps with advanced histology. Two hundred eight diminutive polyps were identified in 102 patients. Twenty (9.6 %) diminutive polyps in 13 (12.74 %) patients showed advanced histology. The probability of having an advanced diminutive polyp was higher in patients who have more than one polyp or have polyps localized all along the colon or only to the distal part (p

Multiple intestinal lipomas (lipomatous polyposis) are quite rare, and they can be quite challenging to diagnose because this condition may be clinically confused with familial adenomatous polyposis with a suggestive family history. Herein, we present a case of lipomatous polyposis that was presented with abdominal pain and, in colonoscopy, had more than 100 polyps. The patient was admitted for surgery with diagnosis of familial polyposis. Resected colon specimen had multiple polyps ranging from 0.1 to 1.5 cm. Microscopically, the polyps were composed of mature adipose tissue with normal overlying mucosa. There were also increased fat cells in the submucosa of the colon adjacent to the polyps. Lipomatous polyposis rarely occurs and can be confused with familial polyposis. Polypectomy is a simple and cost-effective procedure to help in diagnosis and prevent a major surgery.

The serrated pathway has recently been proposed as a route for the development of colorectal cancer with microsatellite instability. Hyperplastic polyposis syndrome is a rare syndrome defined by the presence of numerous serrated polyps, with a high risk of developing into colorectal cancer. We present here a case of hyperplastic polyposis syndrome developing into colorectal cancer with microsatellite instability from a serrated polyp. BRAF mutation and the loss of MLH1 protein were observed in the colorectal cancer, but not in the other serrated polyps around the colorectal cancer, suggesting that colorectal cancer with microsatellite instability develops rapidly from a specific serrated polyp with distinct molecular properties.

BACKGROUND: The impact of video capsule endoscopy (VCE) on the decision-making of clinical care for children with different gastrointestinal (GI) disorders is currently under-investigated. AIMS: The aim of this study was to examine how VCE impacts the management of children with different GI disorders in real world clinical practice METHODS: A retrospective chart review was performed for all consecutive children who under-went VCE at the Children’s Hospital, Winnipeg, Manitoba from April 2012 to July 2016. Variables collected included any changes in diagnosis or treatment that took place based on VCE findings. RESULTS: A total of 41 VCE studies for 37 children (median age 13 years, IQR = 10.5 – 15.5 years) with different GI disorders were included. There were changes in the diagnoses of 6 (15%) participants based on their VCE findings. Diagnostic categories included three children with inflammatory bowel disease (IBD), two participants with small bowel polyposis, and one with protein losing enteropathy secondary to primary intestinal lymphangiectasia. IBD was ruled out in 8 studies (20%) based on normal VCE. There were 12 studies (29%) where VCE resulted in meaningful changes in management including major changes in participants’ treatment. VCE findings were discordant with findings from other small bowel imaging techniques in 15 (37%) studies. CONCLUSIONS: VCE is a useful tool with major impacts on clinical management of children with different GI disorders. FUNDING AGENCIES: None

Intestinal polyposis syndromes are characterized by the development of multiple polyps throughout the colorectum and the GI tract. They can be differentiated based on clinical characteristics, including age at onset, type, number, and histology of polyps, extraintestinal manifestations, and pattern of familial recurrence. However, there is phenotypic overlap among the different forms, and clinical examination may not be sufficient to obtain a diagnosis.

Summary Gastrointestinal polyps are common lesions that usually present singly or in small numbers. Although the term ‘multiple colorectal polyposis' was originally applied to patients carrying at least 100 large intestinal adenomas, it has subsequently become broadened to include patients carrying multiple polyps regardless of their nature. Most of the non-adenomatous polyposis syndromes are hereditary. They can be classified according to the dominant type of polyp, their distribution in the gastrointestinal tract and their potential for the development of gastrointestinal cancers. This review summarises their main clinical, genetic and histopathological features.

Collection of multiple resected proximal colon polyps >10 mm in size through a scope channel via aspiration following an endoscopic mucosal resection (EMR) is difficult; thus, polyps are currently all grasped at once using net forceps. However, the simultaneous collection by net forceps makes it difficult to identify the accurate locations of all resected polyps.1 Therefore, we aimed to investigate a novel technique to identify the accurate location of resected polyps using colored ring-threads.

Schistosomiasis polyps induced by Schistosoma mansoni and S. japonicum have been reported from pathological observations but this is not the case for colonic schistosomiasis infection by S. intercalatum which has always been associated with mild clinical presentations. We report the case of a 17-year-old man, native from Equatorial Guinea, with colonic polyposis associated with infection by S. intercalatum.

Cap polyposis (CP) is a rare disease that was first described by Williams et al.1 in 1985. It is characterized by multiple polyps with a mucoid and fibrinopurulent cap. Although the pathogenesis is unknown, the characteristic histological appearance is similar to that of mucosal prolapse syndrome (MPS). Endoscopically, it is difficult to distinguish the polyps of CP from inflammatory polyps and neoplasms. True neoplasms can be differentiated from non-neoplastic lesions by magnifying colonoscopy, but the changes in the mucosal surface of CP have not been investigated in detail. A case of CP that was treated successfully with conservative therapy, is described, as well as the findings obtained by magnifying colonoscopy.

Polyps of the intestines represent a considerable proportion of the practising pathologist's workload. There are many types of intestinal polyp and accurate histological assessment is imporant to ensure the accurate diagnosis and appropriate management of patients. Most polyps have a corresponding polyposis syndrome, the presence of multiple polyps. Some of these are well established and clearly defined in clinical, molecular and pathological terms, whilst other polyposis syndromes are less precisely characterized. The most important recent advances in our understanding of polyposis syndromes have come from molecular biological studies: these have considerable potential in the diagnosis and management of these syndromes. They also provide insights into the pathobiology of sporadic polyps and the pathogenesis of intestinal cancer.

J. Balmana1, F. Balaguer2, A. Cervantes3 & D. Arnold4, on behalf of the ESMO Guidelines Working Group* Department of Medical Oncology, Hospital Vall d’Hebron, Vall d’Hebron Institute of Oncology (VHIO), Universitat Autonoma de Barcelona, Barcelona; Department of Gastroenterology, Hospital Clinic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona; Department of Hematology and Medical Oncology, INCLIVA, University of Valencia, Valencia, Spain; Department of Medical Oncology, Tumor Biology Clinic, Albert Ludwigs University, Freiburg, Germany

Cronkhite–Canada syndrome (CCS) is a sporadic, idiopathic syndrome characterized by multiple polyps in the gastrointestinal (GI) tract. First documented in 1955 by Drs. Cronkhite and Canada, only about 400 cases have been reported worldwide, 75 % of which in Japan. Patients of European or Asian descent are most frequently affected, with an incidence of 1 per 1,000,000. Mean age of onset is the fifth to sixth decade with slight 3:2 predominance in men. An autoimmune process is suspected. Men are generally affected in a 2:1 ratio, with two thirds of all patients being of Japanese origin.

The classical pigmentation of Peutz-Jeghers syndrome distinguishes it immediately from the other polyposis syndromes. Less widely appreciated than this most obvious manifestation are the pitfalls in management presented by the risk of cancer and by the performance of multiple laparotomies that also characterize this condition. An outline of these risks and an approach that minimizes them is presented.

Multiple lymphomatous polyposis is a rare form of gastrointestinal lymphoma characterized by the presence of multiple polyps throughout the length of the digestive tract. We present a typical case diagnosed by using an intestinal barium follow-through and CT scan which revealed gastric, ileac and colonic involvement as well as retroperitoneal adenopathy. We discuss the radiological differential diagnosis.

Objectives Serrated polyposis (hyperplastic polyposis) is characterized by multiple polyps with serrated architecture in the colorectum. While patients with serrated polyposis are known to be at increased risk of colorectal cancer (CRC) and possibly extracolonic cancers, cancer risks for their relatives have not been widely explored. The aim of this study was to estimate the risks of CRC and extracolonic cancers for relatives of patients with serrated polyposis.

A case of multiple polyps originating in a skin tube for esophageal reconstruction was reported in this paper. A 62-year-old man received a subtotal esophagectomy for esophageal cancer in June 1978. A stomach tube was used for the reconstruction of his esophagus. Because of the paralysis of the bilateral recurrent nerve, laryngectomy and a resection of the remnant esophagus were carried out 3 months after the esophagectomy, and the skin tube with a D-P flap was used for reconstruction. 8 years after this operation, multiple polyps developed in the skin tube, and the number of polyps has gradually increased. Since a malignancy was suspected in some of these polyps from an endoscopic examination, tissue specimens taken in frequent biopsies have been examined histologically. However, no malignancy has been found. The histological finding showed an inflammatory squamous polyp without malignancy. Another report of polyps originating in a skin tube has not been seen so far. Because the long survival of patients with esophageal cancer after reconstruction with a skin tube is unlikely, a suficient observation of the skin tube may not be possible.

Medical records of dogs with colorectal polyps were retrospectively reviewed, and clinical presentation of inflammatory colorectal polyps in miniature dachshunds was evaluated. Of 33 dogs found to have colorectal polyps, miniature dachshunds were markedly over-represented with 16 dogs (48%), of which 12 (75%) were found to have inflammatory polyps. Multiple polyps localized between the rectum and the descending colon was the most common finding in miniature dachshunds with inflammatory polyps. Twenty dogs (80%) out of 25 miniature dachshunds with inflammatory colorectal polyps responded to immunosuppressive therapy using prednisolone and cyclosporine. The results of this study indicate that miniature dachshunds are predisposed to develop inflammatory colorectal multiple polyps, for which immunosuppressive therapy may be a treatment option.

The gastrointestinal polyposis syndromes (PS) are characterized by the development of multiple polyps, characteristically colorectal, but occasionally involving the small intestine and (less commonly) the stomach. PS may be characterized by the histologic type of polyps found, being either adenomatous, hamartomatous, or hyperplastic. Additionally, they may be characterized by the mode of inheritance, being either autosomal dominant or autosomal recessive. Changes in both these types of characterization have recently occurred. Until recently, it was thought that all polyposis syndromes were inherited in an autosomal-dominant fashion. However, the discovery of Mut Y homologue-associated polyposis (MAP), which is inherited in an autosomal-recessive fashion, changed this [1]. Additionally, the (relatively) recent addition of hyperplastic polyposis (HPP) was unique as this was the first type of PS involving hyperplastic polyps. The last several years have been a very active time, both with the addition of these new PS and further additions to our knowledge base about the known ones. This chapter will deal with the different PS and the management of each.

The polyposis syndromes are characterized by the presence of multiple polyps affecting the intestinal lining. The adenomatous polyposes are associated with an elevated risk of gastrointestinal malignancy. The familial hamartomatous polyposes carry a risk of polyp-related complications and may also be associated with an increased risk of gastrointestinal cancers. The role of endoscopic screening and surveillance is described in detail for familial adenomatous polyposis, Peutz-Jeghers syndrome, and juvenile polyposis.

A novel endoscopic approach for the removal of nasal polyps from a cat with upper respiratory obstruction is described. The cat's small oral cavity prevented polyp removal via traditional nasopharyngoscopy and the owner declined rhinotomy because of concerns about postoperative morbidity. Access to the nasopharynx was achieved by introducing an endoscope via gastrotomy and passing the instrument orad through the esophagus into the nasopharynx. Compared with traditional endoscopic approaches, this approach provided superior exposure of the nasopharynx and facilitated use of a larger scope and instruments than would have been possible using retroflexed nasopharyngoscopy. Multiple polyps were readily removed using this approach. The procedure was well tolerated, with minimal surgical morbidity.

Intussusception of the appendix is a rare condition. We present the case of a 72-year-old woman with multiple polyps in the colon with an appendix completely intussuscepted into a polyp within the caecum. The clinical features, preoperative diagnosis, classification and treatment of this condition are discussed with reference to literature.