[Analysis of the Cochrane Review: Chromoscopy Versus Conventional Endoscopy for the Detection of Polyps in the Colon and Rectum. Cochrane Database Syst Rev. 2016;4:CD006439]. / Análise da Revisão Cochrane: Cromoscopia Versus Colonoscopia Convencional na Deteção de Pólipos ColoRetais. Cochrane Database Syst Rev. 2016;4:CD006439.

Although colonoscopy is considered the most accurate test for the investigation of colorectal polyps, lesions ≤ 10 mm may be missed in approximately 10%. Chromoscopy may increase the detection of colorectal polyps. A systematic review and meta-analysis was performed to investigate the benefit of cromoscopy in colorectal polyps detection. Seven randomized controlled trials were included (incuding 2,727 participants) comparing polyp detection (both neoplastic and non- neoplastic polyps) in patients submitted to conventional colonoscopy or colonoscopy with chromoscopy. Chromoscopy was associated with a significant improvement in all detection endpoints (number of polyps, number of neoplastic polyps, number of diminutive polyps, number of neoplastic diminutive polyps, proportion of patients with at least one polyp and proportion of patients with at least one neoplastic polyp). However, when highdefinition colonoscopes were used in the control group, chromoscopy benefit does not seem to be significant. Besides, routine use of chromoscopy may have implications in the accessibility of colonoscopy and in the effectiveness of screening programs. Moreover, the benefit of chromoscopy in the era of high-definition colonoscopy is questionable.

Apesar de a colonoscopia convencional ser considerada o exame com maior acuidade para o diagnóstico de pólipos colo-retais, lesões com ≤ 10 mm podem ser falhadas em aproximadamente 10% dos casos. A cromoscopia pode melhorar a deteção de pólipos colo-retais. Foi realizada uma revisão sistemática e meta-análise para avaliar o benefício da cromoscopia na deteção de pólipos colo-retais. Foram incluídos sete ensaios clínicos aleatorizados (incluindo 2 727 participantes) que compararam a deteção de pólipos (neoplásicos e não-neoplásicos) em doentes submetidos a colonoscopia convencional ou a colonoscopia com cromoscopia. A cromoscopia associou-se a uma melhoria significativa nos vários endpoints de deteção (número de pólipos, número de pólipos neoplásicos, número de pólipos diminutos, número de pólipos neoplásicos diminutos, proporção de doentes com pelo menos um pólipo e proporção de doentes com pelo menos um pólipo neoplásico). Contudo, quando a colonoscopia no grupo de controlo foi efetuada com colonoscópios de alta definição, o benefício da cromoscopia parece não ser significativo. Além disso, o uso rotineiro da cromoscopia pode ter implicações na acessibilidade da colonoscopia e na efetividade dos programas de rastreio, questionando-se ainda o benefício da cromoscopia na era da colonoscopia de alta definição.

Histological classification of schistosomal egg induced polyps of colon and their clinical significance. An analysis of 272 cases.

272 cases of schistosomal egg induced polyps collected from mass-screening for colorectal carcinoma in Jiashan County were divided into 3 types: fibrous type (FT), mixed type (MT) and epithelial proliferative type (ET). The ET was characterized by crypt elongation, hypertrophy, variation in size, disorderly arrangement, as well as the high percentage of atypical hyperplasia (64.9%). The coexistence and transition between inflammatory reactive hyperplastic and neoplastic crypts were noticed. By HID/AB staining, sialomucins were increased in ET, CEA and PNA receptors detected by the ABC method were present in 18/20 and 6/18 of ET respectively. The mucin expression of ET was similar to that of adenomas. It is likely that a spectrum of ET, atypical hyperplasia and adenoma may exist. We suggest that the patients with ET, especially those with atypical hyperplasia, should be regarded as "risk group", and close follow-up is needed.

Schistosomiasis manifesting as a colon polyp: a case report.

INTRODUCTION: Schistosomiasis is a rare disease with a common intestinal involvement. However, colon polyps associated with Schistosoma in the absence of inflammation have rarely been reported, especially in young people; this is the first case with the following presentation. CASE PRESENTATION: We describe the case of a 20-year-old Ethiopian woman living in Lebanon who presented with nonspecific abdominal symptoms. Her biochemical profile was normal in addition to the results of her stool and urine tests. A colonoscopy showed normal colonic mucosa but surprisingly a large pedunculated polyp was found in her ascending colon. Pathology revealed a hamartomatous polyp but it was full of partially calcified parasitic eggs of Schistosoma mansoni compatible with chronic schistosomiasis. CONCLUSIONS: She was treated with two doses of praziquantel and showed immediate marked clinical improvement. This unusual case will give us the opportunity to discuss schistosomiasis, its occurrence in colon polyps, clinical significance and the various means of management.

Colonic polyposis due to Schistosoma intercalatum.

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.

Strongyloidiasis. An unusual cause of colonic pseudopolyposis and gastrointestinal bleeding.

This report describes a recent case in which colonoscopy of a patient with the presenting complaint of rectal bleeding revealed the right colon to be carpeted with 50-100 pseudopolyps, each 3-4 mm in diameter. Biopsy specimens taken during colonoscopy revealed the presence of Strongyloides stercoralis in the bowel wall. This diagnosis should be considered in any patient with gastrointestinal complaints and a history of travel to an endemic area.

Schistosomal colonic polyposis: clinical, radiological and parasitological study.

One hundred and eight male Egyptian farmers with schistosomal colonic polyposis were reviewed. All patients gave a history of bloody diarrhoea. Sixty-one patients presented with finger clubbing, and four of these patients had painful, tender and swollen wrist, knee and ankle joints. X-ray revealed new bone formation in the bones around these joints. The clinical condition improved with antischistosomal treatment, but the bony changes persisted. Twenty patients showed signs of dependent oedema or ascites. Thirty-one patients had a liver of 8 cm or more below costal margin and 19 patients had a spleen of 8 cm or more below costal margin, a situation not unlike patients with schistosomiasis without polyposis. Fifteen patients had tender abdominal masses in the left iliac fossa which were shown by barium enemas to be clusters of polyps. Anti-schistosomal therapy relieved the obstruction but narrowing persisted in 70% of patients followed up. Severity of schistosomal colonic polyposis correlated with the anatomical distribution of the polyps, with their number and with the egg excretion rates.

[Granulomatous colitis with pseudopolyp in schistosomiasis]. / Granulomatöse Kolitis mit Pseudopolyp bei Schistosomiasis.

A 26-year-old Arab had epigastric pain and bloody mucous stools. At coloscopy distal proctitis and a polyp at the rectosigmoid junction were discovered. The polyp had granulomatous inflammatory changes and eggs of Schistosoma mansoni with a characteristic egg shell, central miracidium and lateral spine. Bilharziasis should be considered in the differential diagnosis of chronic inflammatory disease of the intestines.

Cryptic infection by whipworm mimicking a sessile polyp of the colon.

A case of trichocephaliasis in a 70-year-old male is described. The original diagnosis, based on radiological and endoscopic findings, was of a sessile polyp of the colon. Only when a fragment of the supposed polyp was removed at biopsy and examined histologically was it revealed as a single male specimen of whipworm.