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DOI: 10.1055/a-1924-7382
Clinical characteristics and histopathological findings in colorectal polyps among colonoscopy patients at a sub-Saharan hospital
Introduction
Colonic polyps, especially adenomatous polyps, are clinically significant because they are precursors to colorectal cancer (CRC) [1]. The incidence of colorectal polyps is rapidly increasing worldwide [2]. A report from sub-Saharan African countries showed that colonic polyps are rare in the African colon [3] Recent evidence, however, from most sub-Saharan African countries has shown a sharp rise in the incidence of CRC [4].
We conducted a study aimed at identifying the clinical, endoscopic characteristics and histopathological features of colorectal polyps among patients who underwent colonoscopy at Nsambya Hospital from 2015 to 2021. A hospital-based cross-sectional study that used endoscopy records and the pathology laboratory database system of St. Francis Hospital Nsambya was conducted. Age, sex, colonoscopy report and histopathology report were analyzed. A total of 1630 patients had colonoscopies performed at the endoscopy unit of St. Francis hospital Nsambya during the study period and 142 patients with polyps who had polypectomy were included in the study.
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Results
The median age of patients with colorectal polyps was 60 years (interquartile range: 47–70; ratio of males to females 1.6:1). Rectal bleeding was the most common indication. The most common sites were the sigmoid in 61 (43 %) and the rectum in 60 patients (42.3 %). The majority of colorectal polyps (91; 64.1%) were pedunculated whereas the remainder (52; 35.9 %) were sessile. Of the patients, 60 (42.3 %) had neoplastic colorectal polyps and 82 (57.8 %) had benign colorectal polyps ([Fig. 1], [Supplementary Fig. 1]).




Dysplasia in adenomatous colorectal polyp was detected at a rate in 29 of 60 polyp (48.3 %), of which nine polyps (31%) had low-grade dysplasia and 20 (69 %) had high-grade dysplasia ([Table 1], [Table 2]).
Our study showed that 4.2 % of the patients studied had already presented with malignant change in a colorectal polyp ([Table 3]).
[Table 3] shows the Sociodemographic characteristics of the patients in the study. The median age was 60 years (IQR: 47–70) with the majority being aged between 61–80 years, 55 (38.7 %), while 8(5.6 %) were aged 20 years and below, 21(14.8 %) were 20 to 40 years, 44(31 %) were 40 to 60 years.
There were more males, 88 (62 %) than females 54 (38 %) in the study with a ratio of 1.6:1.
The majority of the patients were from Central Uganda, 92 (64.8 %) followed by Western Uganda 30 (21.1 %) and 11 (7.7 %) from eastern Uganda, 6 (4.2 %) from northern Uganda, 2 (1.4 %) from southern Uganda and only 1 (0.7 %) from DRC ([Table 4]).
PR, prevalence ratio; CI, confidence interval.
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Conclusion
In this study in sub-Saharan Africa, the anatomical distribution of colorectal polyps in patients was mainly in the descending colon, sigmoid colon, and rectum. Of the colorectal polyps studied, 4.2 % had malignant change at the time of presentation.
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Recommendation
This study represents a starting point for assessing the clinical and pathological spectrum of colorectal polyps in our setting. Given the high presence of distal polyp neoplasia, sigmoidoscopy could be used to detect the majority of polyps in our setting.
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Competing interests
The authors declare that they have no conflict of interest.
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References
- 1 Eshghi MJ, Fatemi R, Hashemy A. et al. A retrospective study of patients with colorectal polyps. Gastroenterol Hepatol Bed Bench 2011; 4: 17-22
- 2 Torre LA, Bray F, Siegel RL. et al. Global cancer statistics, 2012. CA Cancer J Clin 2012; 65: 87-108
- 3 Segal I. Rarity of colorectal adenomas in the African black population. Europ J Cancer Prev 1998; 7: 387-391
- 4 Oluyemi A, Awolola N, Oyedeji O. Clinicopathologic review of polyps biopsied at colonoscopy in Lagos, Nigeria. Pan African Med 2015; 24 DOI: 10.11604/pamj.2016.24.333.9434.
Corresponding author
Publication History
Article published online:
08 March 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Eshghi MJ, Fatemi R, Hashemy A. et al. A retrospective study of patients with colorectal polyps. Gastroenterol Hepatol Bed Bench 2011; 4: 17-22
- 2 Torre LA, Bray F, Siegel RL. et al. Global cancer statistics, 2012. CA Cancer J Clin 2012; 65: 87-108
- 3 Segal I. Rarity of colorectal adenomas in the African black population. Europ J Cancer Prev 1998; 7: 387-391
- 4 Oluyemi A, Awolola N, Oyedeji O. Clinicopathologic review of polyps biopsied at colonoscopy in Lagos, Nigeria. Pan African Med 2015; 24 DOI: 10.11604/pamj.2016.24.333.9434.



