List of Abbreviations
AC – anal canal
AP – anal polyp
ACP – anal canal polyp
GI – gastrointestinal tract
GRS – grade of recommendation strength
LCE – level of confidence of evidence
Terms and Definitions
Anal canal is the terminal part of the digestive tract between the lower ampullary rectum and the external opening — the anus, the border of which is the transition site of unpigmented anoderm into pigmented (true) skin.
Anal polyps or anal canal polyps (anal polyp, anal papilla, anal tags) is a descriptive clinical term referring to any benign intraluminal formation within the boundaries of the anal canal.
1. Brief information on the disease or condition
1.1 Definition of the disease or condition
The term "anal canal", proposed by J. Symington [1] in 1888, was widespread only among clinicians until it was officially recognized and recommended for use by the International Paris Anatomical Nomenclature in 1955. However, to date, there is no single consensus on the boundaries of the anal canal, which has led to the emergence of terms such as the surgical anal canal, anatomical, histological, etc. [2,3,4].
The Association of Coloproctologists of Russia adheres to the following definition: "The anal canal is the terminal part of the digestive tract, beginning at the anorectal junction at the upper border of the pelvic floor and ending at the external opening – the anus, the boundary of which is the transition point from non-pigmented anoderm to pigmented (true) skin" [4].
Anal canal polyps (anal polyp, anal papilla) is a descriptive clinical term referring to any intraluminal formation within the boundaries of the anal canal.
Synonyms: hypertrophic anal papilla, fibroepithelial polyp, anal canal polyp, fibrous polyp, cloacogenic polyp, anal polyp.
1.2 Etiology and pathogenesis of the disease or condition (group of diseases or conditions)
Fibroepithelial formations are considered anal canal polyps. The latter are benign in nature and characterized by the presence of mononuclear and multinucleated, sometimes atypical, CD34+ stromal cells, indicating fibroblastic and myofibroblastic differentiation [1]. Atypical cells are found only in large anal polyps. The morphological similarity between these structures and the normal mucosa of the anal canal supports the hypothesis that fibroepithelial polyps may represent a reactive hyperplasia of the subepithelial connective tissue of the anal canal mucosa. Therefore, mast cells, through their fibrogenic, fibrolytic, and angiogenic effects, may play an important role in the pathogenesis of these structures [1].
1.3 Epidemiology of the Disease or Condition
Currently, the true prevalence of anal canal polyps is unknown. This is primarily due to the lack of classification, as well as the fact that the term "anal polyp" is often used to describe any intraluminal formation of the anal canal. However, the overwhelming majority of studies are case-control in nature and account only for the clinical manifestations of this pathology. It is also known that anal polyps occur in 30% of patients diagnosed with chronic anal fissure and in 10% of patients with rectal mucosal prolapse.
1.4 Features of Coding the Disease or Condition
ICD-10 Codes
Diseases of the digestive system (K00-K93):
K62 - Other diseases of anus and rectum
K62.0 - Anal polyp
1.5 Classification of the disease or condition
There are different classifications of polyps based on their various characteristics:
1.5.1 Growth pattern of polyps:
benign;
malignant.
1.5.2 Features of attachment to the anal canal mucosa:
pedunculated polyp;
sessile polyp.
1.5.3 Morphological data:
adenoma;
hyperplastic polyp.
1.5.4 Histological structure:
tubular;
villous.
1.5.5 Z. Maržak classification [1996]
- "true":
- epithelial (carcinoid);
- non-epithelial (leiomyoma, lipoma, hemangioma, etc.)
- of non-neoplastic origin
- hyperplastic, hamartomatous, inflammatory polyps, and anal
papillary hyperplasia.
Comment: histomorphological data are of primary importance in determining the patient's treatment strategy and subsequent follow-up.
Given that the absolute majority of benign neoplasms of the anal canal are incidental findings, the absence of randomized studies is entirely understandable; consequently, when analyzing the literature, it is difficult to determine levels of evidence according to the generally accepted Oxford Centre for Evidence-Based Medicine classification.
Explanations of the anal polyp classification
Hyperplastic polyps
Hyperplastic polyps are the most common, resulting from chronic inflammatory processes in the anal canal, and do not represent true neoplasms. Most frequently, they are pedunculated and can therefore prolapse from the anal canal during defecation and bleed, which is usually the reason patients consult a coloproctologist. Unlike true adenomas, they typically have a smooth surface and are detected when they reach sizes of up to several centimeters.
Hypertrophied anal papilla
The lower part of the ampullary rectum contains anal columns (Morgagni's columns) and anal crypts bordered by semilunar valves. Elevations—anal papillae—can frequently be observed on these valves along the border of the dentate line. Sometimes they can hypertrophy and often reach 3–4 cm in diameter. Many causes of anal papillae hypertrophy are described, but the majority of authors point to the presence of a chronic inflammatory process in the anal canal. Hypertrophied anal papillae are often mistaken for anal polyps.
Cloacogenic polyps
Recently, the terms "cloacogenic polyp" and "cloacogenic carcinoma" have been appearing more and more frequently in the literature. By these terms, authors denote neoplasms located in the transitional zone, the site of transition from glandular to squamous epithelium. The most frequent complaint of such patients is the presence of rectal bleeding. An association of these neoplasms with a solitary rectal ulcer has also been noted [4, 6, 7, 8, 9, 10, 11].
Adenomas of the anal canal
An adenoma is a benign tumor originating from the glandular epithelium, exhibiting varying degrees of cellular dysplasia. For a long time, clinicians held the view that true adenomas could not be located in the anal canal, given the squamous structure of its mucosa. However, it was subsequently revealed that 10–15% of malignant tumors of the anal canal are adenocarcinomas. Thus, the capacity for true adenomas to grow in the anal canal was proven [4].
They may be mushroom-shaped (pedunculated) or sessile (broad-based). Adenomatous polyps can be either solitary or multiple and range in size from a few millimeters to several centimeters. The surface may be either smooth or nodular. This type of polyp is often asymptomatic and is detected incidentally during digital rectal examination or when a pedunculated polyp prolapses outward during defecation. Sometimes patients also complain of mucus discharge (in the presence of a villous adenoma).
Fibrous polyp (synonym: fibroepithelial polyp)
One of the most frequent lesions of the transitional zone. Macroscopically, the nodule has a spherical or elongated shape and a diameter ranging from a few millimeters to 4 cm. Its surface is white or gray, often ulcerated. Histological examination reveals a collagenized stroma lined with stratified squamous epithelium. Fibroblasts with two or more nuclei are visible within it, as well as a large number of mast cells and occasionally granulomas [12].
Miscellaneous
Isolated cases have been described in the literature where Schistosoma eggs were detected within neoplasms of the anal canal and rectum [13, 14, 15].
Raso P. et al. (2013) described a clinical case of an anal canal polyp where examination revealed Schistosoma mansoni eggs, as a result of which the patient underwent a course of treatment with praziquantel with a clinical effect.
1.6 Clinical presentation of the disease or condition
The main clinical symptoms of an anal polyp include their prolapse from the anus during defecation, blood admixtures in the stool, discomfort, itching, burning sensation, and even pain in the anal region. Rarer symptoms include perianal moisture and rectal mucus discharge. Pain associated with an anal canal polyp is generally mild, infrequent, and related to trauma during prolapse.
2. Diagnostics, medical indications and contraindications for diagnostic methods
Criteria for establishing the diagnosis/condition - based on pathognomonic data:
1) complaints
2) anamestic data
3) physical examination
4) instrumental examination.
2.1 Complaints and Anamnesis
Complaints characteristic of an anal polyp are listed in subsection 1.6 Clinical Presentation.
It is recommended that patients with an anal polyp undergo identification of the etiological factors of the disease to clarify the diagnosis and determine management tactics: gastrointestinal disorders, dietary errors, alcohol abuse, intestinal infections, inflammatory diseases of the distal colon, and a history of relatives who suffered from benign and malignant gastrointestinal neoplasms [1, 4, 5].
GCP CLEL 5Grade of Recommendation – C (Level of Evidence – 5)
2.2 Physical Examination
In all patients with suspected anal polyp, it is recommended to routinely perform a physical examination to clarify the diagnosis and determine management tactics [1, 16, 17]:
- inspection of the perianal region;
- digital transrectal examination of the rectum.
GCP CLEL 5Grade of Recommendation – C (Level of Evidence – 5)
Comment. During external examination of the perineal and anal regions, attention is paid to the shape of the anus, its patulousness, the presence of cicatricial changes and deformation, and the condition of the skin integument.
2.3 Laboratory Diagnostics
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2.4 Instrumental Diagnostics
For all patients with an anal canal polyp at the diagnosis stage, anoscopy is recommended to assess the size, location of the polyp, and condition of the mucosa [1].
GCP CLEL 5Grade of Recommendation – C (Level of Evidence – 5)
Comments. It is necessary to inspect the anal canal and the distal rectum, evaluate the location, size and appearance of anal polyps, the condition of the mucosa and the dentate line with anal crypts, as well as the mucosa of the lower ampullary rectum. This is a mandatory examination, performed to accurately determine the localization, visualization and assessment of the diameter of the anal polyp, the presence or absence of scarring of the walls of the anal canal and rectum, and to assess the presence of concomitant diseases of the anal canal.
For all patients with an anal canal polyp at the diagnosis stage, it is recommended to undergo an endoscopic examination of the rectum and the distal sigmoid colon (sigmoidoscopy) to diagnose concomitant inflammatory diseases of the rectum and sigmoid colon (proctitis, proctosigmoiditis, internal prolapse, Crohn's disease, ulcerative colitis) [1].
GOR CLOE 5Grade of Recommendation — C (Level of Evidence — 5)
For all patients with an anal canal polyp at the diagnosis establishment stage, it is recommended to perform a colonoscopy to detect concomitant diseases of the colon and rule out inflammatory changes characteristic of ulcerative colitis and Crohn's disease [18, 19].
GCP CLEL 5Grade of Recommendation – C (Level of Evidence – 5)
2.5 Other Procedures
It is recommended to perform a biopsy of the anus and perianal region if a malignant process is suspected in order to verify the diagnosis [1, 4].
GCP CLEL 5Grade of Recommendation – C (Level of Evidence – 5)
Additional instrumental and laboratory tests are performed primarily for the purpose of differential diagnosis with a number of diseases.
Differential diagnosis is performed with:
Rectal mucosal prolapse;
Rectal prolapse;
Prolapse of internal hemorrhoids;
Anal fissure;
Malignant tumor of the rectum and anal canal;
Ulcerative colitis, Crohn's disease;
Hemangioma;
Endometriosis;
Rectal trauma;
Solitary rectal ulcer syndrome;
Tumor of the rectum and anal canal;
Complicated caudal teratomas;
Idiopathic coccygodynia;
Proctalgia;
Condylomata acuminata;
Irritable bowel syndrome.
3. Treatment, including drug and non-drug therapies, diet therapy, and pain management
3.1 Surgical Treatment
Indications and contraindications for surgical treatment:
Indications: the only radical method of treatment for anal polyps is their surgical removal [17, 21, 22].
Contraindications: severe decompensated diseases of various organs and systems. If improvement is achieved after treatment, surgery becomes possible.
Comment:
- Polyp removal should not be performed without examining the colon;
- removal of large anal canal polyps (greater than 3 cm) should not be performed without a preliminary biopsy to determine their morphological structure;
- removal of broad-based anal canal polyps should not be performed without a preliminary transrectal ultrasound;
- hypertrophied anal papillae smaller than 5 mm in the absence of clinical manifestations should not be removed.
Patients with an anal canal polyp are recommended to undergo surgical removal of the anal polyp under anesthesia to improve treatment outcomes and reduce the risk of complications [1].
GCP CLEL 5Grade of Recommendation – C (Level of Evidence – 5)
3.1.1 Hyperplastic polyps
If a patient has pedunculated anal polyps or polyps larger than 5 mm, their removal is recommended with mandatory pathomorphological examination of the biopsy (surgical) material of the rectum to rule out a true adenoma [4, 5].
GCP CLEL 5Grade of Recommendation – C (Level of Evidence – 5)
Comments. The polyp must be excised within healthy tissues. For hemostasis, a sterile absorbable gelatin sponge can be placed into the anal canal. The removed specimen is sent for histological examination.
3.1.2 Hypertrophied anal papilla
Patients with hypertrophied anal papillae are recommended to undergo their removal with excision of the inflamed crypt and semilunar valve to eliminate the pathological formation and improve the patients' quality of life [17].
Comments: The surgical technique is similar to the removal of hyperplastic polyps.
GCP CLEL 5Grade of Recommendation – C (Level of Evidence – 5)
3.1.3 Cloacogenic polyps
If cloacogenic polyps are detected in a patient, their removal within healthy tissues with mandatory pathomorphological examination of the biopsy (surgical) material of the rectum is recommended [8-12].
GIB CLOE 4Grade of Recommendation – C (Level of Evidence – 4)
Comments: The surgical technique is similar to the removal of hyperplastic polyps.
3.1.4 Anal canal adenomas
When an anal canal adenoma is detected in a patient, its mandatory removal via a sterile disposable medical anoscope or transanal excision of perianal and anal canal neoplasms followed by pathomorphological examination of the rectal biopsy (surgical) material is recommended to eliminate the pathological formation and improve patients' quality of life [1].
GCP CLEL 5Grade of Recommendation – C (Level of Evidence – 5)
Comments: The surgical technique is similar to the removal of hyperplastic polyps.
3.1.5 Fibrous polyp
It is recommended for all patients with an anal canal polyp, after its removal, to undergo a mandatory pathomorphological examination of the rectal biopsy (surgical) material, as it is necessary to differentiate fibrous polyps from cloacogenic ones, given their location in the transitional zone [1-3].
GCP CLEL 5Grade of Recommendation – C (Level of Evidence – 5)
Comments: The surgical technique is similar to the removal of hyperplastic polyps.
3.2. Diet therapy
Patients with an anal canal polyp in the postoperative period are recommended to follow a diet rich in dietary fiber, as well as to exclude irritating foods (alcohol intake, spicy food) to accelerate healing and prevent postoperative complications [1]
GCP CLEL 5Grade of Recommendation – C (Level of Evidence – 5)
3.3 Pain management
Pain management principles for acute or chronic pain in a patient, including, as indicated, the use of nonsteroidal anti-inflammatory and antirheumatic drugs, comply with the principles outlined in the clinical guidelines of the Russian Federation of Anesthesiologists and Intensivists "Postoperative Pain Management" for pain relief in the postoperative period.
4. Medical Rehabilitation and Sanatorium-Resort Treatment
Special rehabilitation is not provided.
5. Prevention and Dispensary Observation
Prevention and treatment of inflammatory bowel diseases (proctosigmoiditis) and anal canal diseases (cryptitis) are recommended for patients with anal canal neoplasms, namely: hyperplastic, cloacogenic, fibrous polyps, and hypertrophied anal papillae [1, 18, 19].
GCP CLEL 5Grade of Recommendation – C (Level of Evidence – 5)
For all patients with true anal canal adenomas who have reached the age of 40, an endoscopic examination of the colon (sigmoidoscopy, colonoscopy) is recommended at least once every 3 years for secondary prevention of malignant neoplasms [1, 2, 18, 19].
GCP CLEL 5Grade of Recommendation – C (Level of Evidence – 5)
For all patients with true anal canal adenomas who have a burdened family history (presence of polyps in close relatives, gastrointestinal tumors), anoscopy, sigmoidoscopy, and colonoscopy are recommended for secondary prevention of malignant neoplasms [1, 18, 19].
GCP CLEL 5Grade of Recommendation – C (Level of Evidence – 5)
For all patients with true anal canal adenomas, in the absence of pathological formations in the colon for 5 years after polyp removal, dispensary follow-up with colonoscopy once every 3 years is recommended [18, 19, 22-24].
GCP CLEL 5Grade of Recommendation – C (Level of Evidence – 5)
During the wound healing period after anal canal polyp removal, it is recommended to follow a diet rich in dietary fiber to restore spontaneous bowel movements in the postoperative period, as well as to exclude irritating foods (alcohol and spicy food intake) to accelerate healing and prevent postoperative complications [17].
GCP CLOE 5Grade of Recommendation – C (Level of Evidence – 5)
After patient discharge following treatment for an anal canal polyp, follow-up examinations are recommended until complete healing of the anal canal wound to improve treatment outcomes and reduce the risk of complications [17].
GCP CLOE 5Grade of Recommendation – C (Level of Evidence – 5)
6. Organization of Medical Care
treatment of patients with an anal canal polyp is carried out on an outpatient basis, as well as in day and 24-hour coloproctology departments depending on the clinical situation;
care for patients is provided by coloproctologists;
hospitalization of patients is carried out on a scheduled basis.
Indications for planned hospitalization:
in case of the need for treatment adjustment or the impossibility of therapeutic measures in outpatient settings;
inability to perform diagnostic or therapeutic procedures in an outpatient setting;
inefficacy of outpatient treatment in frequently and chronically ill patients.
Indications for patient discharge:
in the absence of indications for further inpatient treatment;
if there is a need to transfer the patient to another medical institution;
at the request of the patient or their legal representative;
in cases of non-compliance by the patient with prescriptions or the internal regulations of the hospital, provided this does not threaten the patient's life or the health of others.
7. Additional Information
Negative factors affecting treatment outcomes include:
1. Development of infectious complications.
2. Bowel habit disorders (diarrhea or constipation).
3. Non-compliance by the patient with restrictions on physical activity and exertion.
Criteria for Evaluating the Quality of Medical Care
Criteria for evaluating the quality of primary health care for adults with an anal canal polyp (ICD-10 codes: K62.0)
No. | Quality assessment criteria | Evaluation of compliance |
|---|---|---|
1. | Coloproctologist consultation (examination, assessment) performed | Yes/No |
2. | Digital rectal examination performed (upon establishment of diagnosis) | Yes/No |
3. | Anoscopy performed (at diagnosis) | Yes/No |
4. | Sigmoidoscopy performed (at diagnosis) | Yes/No |
Criteria for evaluating the quality of specialized medical care for adults with an anal canal polyp (ICD-10 codes: K62.0)
No. | Quality assessment criteria | Evaluation of compliance |
|---|---|---|
1. | Coloproctologist consultation (examination, assessment) performed | Yes/No |
2. | Digital rectal examination performed (upon establishment of diagnosis) | Yes/No |
3. | Anoscopy performed (at diagnosis) | Yes/No |
4. | Sigmoidoscopy performed (at diagnosis) | Yes/No |
5. | Anal canal polyp removal performed | Yes/No |
6. | Pathomorphological examination of rectal biopsy (surgical) material performed | Yes/No |
References
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Appendix A1. Working Group Composition
№ | Full Name | Academic Degree | Academic Title | Professional Association |
|---|---|---|---|---|
1. | Fuad Sh. Aliev | D.Sc. in Medicine | Professor | Association of Coloproctologists of Russia |
2. | Sergey I. Achkasov | Doctor of Medical Sciences | Corresponding Member of the RAS, Professor | Association of Coloproctologists of Russia |
3. | Blagodarny Leonid Alekseevich | Doctor of Medical Sciences | Professor | Association of Coloproctologists of Russia |
4. | Grigoriev Evgeny Grigorievich | Doctor of Medical Sciences | Corresponding Member of the RAS, Professor | Association of Coloproctologists of Russia |
5. | Zakharchenko Aleksandr Alexandrovich | Doctor of Medical Sciences | Professor | Association of Coloproctologists of Russia |
6. | Ivanov Vladimir Vasilyevich | Candidate of Medical Sciences | Association of Coloproctologists of Russia | |
7. | Kashnikov Vladimir Nikolaevich | Doctor of Medical Sciences | Association of Coloproctologists of Russia | |
8. | Korolik Vyacheslav Yuryevich | Candidate of Medical Sciences | Association of Coloproctologists of Russia | |
9. | Korotkikh Nikolay Nikolaevich | Doctor of Medical Sciences | Associate Professor | Association of Coloproctologists of Russia |
10. | Kostarev Ivan Vasilyevich | Doctor of Medical Sciences | Association of Coloproctologists of Russia | |
11. | Kostenko Nikolay Vladimirovich | Doctor of Medical Sciences | Professor | Association of Coloproctologists of Russia |
12. | Kuzminov Aleksandr Mikhailovich | Doctor of Medical Sciences | Professor | Association of Coloproctologists of Russia |
13. | Moskalev Aleksey I. | Candidate of Medical Sciences | Association of Coloproctologists of Russia | |
14. | Aleksandr V. Muravyev | Doctor of Medical Sciences | Professor | Association of Coloproctologists of Russia |
15. | Popov Dmitry Evgenievich | Candidate of Medical Sciences | Association of Coloproctologists of Russia | |
16. | Totikov Valery Z. | Doctor of Medical Sciences | Professor | Association of Coloproctologists of Russia |
17. | Timerbulatov Vil M. | Doctor of Medical Sciences | Corresponding Member of the RAS, Professor | Association of Coloproctologists of Russia |
18. | Titov Aleksandr Yu. | Doctor of Medical Sciences | Association of Coloproctologists of Russia | |
19. | Frolov Sergey A. | Doctor of Medical Sciences | Associate Professor | Association of Coloproctologists of Russia |
20. | Shelygin Yury A. | Doctor of Medical Sciences | Academician of the RAS, Professor, | Association of Coloproctologists of Russia |
All members of the working group are members of the All-Russian Public Organization "Association of Coloproctologists of Russia". There is no conflict of interest.
Appendix A2. Methodology for Developing Clinical Guidelines
Target audience of the clinical guidelines:
1. Coloproctologists
2. Surgeons
3. Gastroenterologists
4. Internists
5. General practitioners / Family physicians
6. Endoscopists
7. Nursing personnel with secondary medical education
8. Healthcare organizers
9. Expert physicians of medical insurance organizations (including when conducting medical and economic expertise)
10. Medical university students, residents, postgraduate students.
In these clinical guidelines, all data are ranked by level of reliability (evidence) depending on the quantity and quality of studies on the issue.
Table 1. Scale for grading levels of evidence (LE) for diagnostic methods (diagnostic interventions)
LoE | Definition |
|---|---|
1 | Systematic reviews of studies with reference standard control or systematic reviews of randomized controlled trials with meta-analysis |
2 | Individual studies with reference method control or individual randomized clinical trials and systematic reviews of studies of any design, except for randomized clinical trials with meta-analysis |
3 | Studies without consecutive reference standard control or studies with a reference standard not independent of the test method, or non-randomized comparative studies, including cohort studies |
4 | Non-comparative studies, case report |
5 | There is only a rationale for the mechanism of action or expert opinion |
Table 2. Rating scale for levels of evidence (LE) for prevention, treatment and rehabilitation methods (preventive, therapeutic, rehabilitation interventions)
LoE | Definition |
|---|---|
1 | Systematic review of randomized controlled trials with meta-analysis |
2 | Individual randomized controlled trials and systematic reviews of studies of any design, except randomized controlled trials, with meta-analysis |
3 | Non-randomized comparative studies, including cohort studies |
4 | Non-comparative studies, case reports or case series, case-control studies |
5 | There is only a rationale for the mechanism of action of the intervention (preclinical studies) or expert opinion |
Table 3. Rating scale for grades of recommendation (GR) for prevention, treatment and rehabilitation methods (preventive, diagnostic, therapeutic, rehabilitation interventions)
GoR | Definition |
|---|---|
A | Strong recommendation (all considered efficacy criteria (outcomes) are important, all studies are of high satisfactory methodological quality, and their conclusions regarding the outcomes of interest are consistent) |
C | Conditional recommendation (not all considered efficacy criteria (outcomes) are important, not all studies are of high satisfactory methodological quality and/or their conclusions regarding the outcomes of interest are inconsistent) |
C | Weak recommendation (lack of adequate quality evidence (all considered efficacy criteria (outcomes) are unimportant, all studies are of low methodological quality, and their conclusions on the outcomes of interest are inconsistent) |
Procedure for updating clinical guidelines
The mechanism for updating clinical guidelines provides for systematic revision at least once every three years, as well as upon the emergence of new evidence-based medicine data regarding the diagnosis, treatment, prevention, and rehabilitation of specific diseases, or in the presence of justified additions/comments to previously approved clinical guidelines, but no more frequently than once every 6 months.
Appendix A3. Reference Materials
These clinical guidelines were developed taking into account the following regulatory legal documents:
Paragraph 3 of Article 37 of Federal Law of the Russian Federation No. 323-FZ dated November 21, 2011 "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation" (as amended, effective from January 11, 2023);
Order of the Ministry of Health of the Russian Federation No. 203n dated May 10, 2017 "On Approval of Criteria for Assessing the Quality of Medical Care";
Order of the Ministry of Health of the Russian Federation No. 206n dated April 2, 2010 (as amended on February 21, 2020) "On Approval of the Rules for the Provision of Medical Care to the Population with Colonic, Anal Canal, and Perineal Diseases of Coloproctological Profile";
Order of the Russian Ministry of Health No. 657n dated June 22, 2021 "On the approval of standards of medical care for adults with anal canal polyp"
Appendix B. Physician Action Algorithms
Appendix C. Patient Information
An anal canal polyp is a disease of predominantly benign origin and in the vast majority of cases may act as an outcome of concomitant pathology of the distal digestive tract (chronic anal fissure, thrombosed internal hemorrhoid, rectal mucosal prolapse, etc.). Currently, the true prevalence of this pathology is unknown. This circumstance, in turn, significantly complicates risk assessment and the development of prevention methods. However, it is known that the clinical manifestations of this pathology can vary: prolapse of the anal polyp from the anal canal, ulceration, bleeding, pain. In this case, a screening examination of the patient is necessary in the scope of anoscopy with biopsy, colonoscopy, and if necessary, ultrasound examination using a rectal probe. According to Z. Maržatka's classification, all anal canal polyps are divided into "true" polyps and polyps of non-neoplastic nature. "True" polyps include epithelial (adenoma, carcinoid) and non-epithelial ones (leiomyoma, lipoma, hemangioma, etc.). Non-neoplastic polyps include hyperplastic polyps, anal canal hamartoma, inflammatory polyps, and anal papillae hyperplasia. In this case, the morphological structure of the formation is of particular importance in determining the treatment tactics and subsequent follow-up of the patient.
The complex of diagnostic and therapeutic measures is determined individually based on the clinical manifestations and features of the disease course.
Appendix G. Assessment Scales, Questionnaires, and Other Evaluation Tools
Assessment tools are not provided.