ABSTRACT
Objective: To evaluate narrow-band imaging (NBI) without magnifying in the diagnosis of colorectal lesions by NBI International Colorectal Endoscopic Criteria (NICE classification), and analyze the safety and practicability of "do-not-resect" and "resect and discard" policies in clinical practice. Methods: The patients undergoing screening or surveillance colonoscopy, who were found colorectal lesions in the examination, from May to December in 2017 were enrolled. All the patients were examined by NBI without magnifying by any of the designated two physicians. NICE classification was used to diagnose colorectal lesions, and the diagnostic confidence of each lesion was recorded. The results of endoscopy were compared with those of pathology, and the accuracy rate and the confidence rate of diagnosis were calculated. The sensitivity, specificity, positive predictive value and negative predictive value of the diagnostic method for differentiating superficial tumors from non-tumors were also calculated. Finally, the feasibility, safety and cost savings of using "do-not-resect" and "resect and discard" policies in clinic were analyzed. Results: A total of 764 lesions were detected in the 636 enrolled patients. The overall accuracy of NICE classification was 84.95% and the diagnostic confidence rate was 81.68%. The sensitivity, specificity, positive predictive value and negative predictive value for differentiating tumors from non-tumors were 91.77%, 67.68%, 88.69%, and 74.86%, respectively. The diagnostic accuracy of diminutive colorectal lesions (≤5 mm) with high confidence was 94.98%, and the negative predictive value of diminutive rectosigmoid lesions (≤5 mm) with high confidence was 96.25%. They achieved the criteria of "resect and discard" and "do-not-resect" policies. If "do-not-resect" and "resect and discard" policies had been executed in clinical practice, ¥165 490 could have been saved and the omission diagnostic rates of "do-not-resect" and "resect and discard" policies would have been 3.75% and 0, respectively, in this study. Conclusion: It is feasible to use NBI without magnifying in differentiating tumors from non-tumors. The diminutive colorectal lesions and rectosigmoid lesions with high diagnostic confidence may achieve the criteria of "resect and discard" and "do-not-resect" policies, respectively.
ABSTRACT
Objective To investigate the risk factors of electrocoagulation syndrome after endoscopic submucosal dissection (ESD) in patients with colorectal lesions.Methods Clinical data of 145 patients with colorectal mucosal lesions undergoing ESD in People's Hospital of Wuhan University between September 2010 and September 2015 were retrospectively studied.Results Among 45 patients,post endoscopic submucosal dissection electrocoagulation syndrome (PEECS) was developed in 32 cases (22％).The median age in PEECS group was higher (t =-5.783,P =0.000),the median lesion size was larger(t =-5.590,P =0.000),the median length of hospital stay was longer (t =-6.841,P =0.000) than those in non-PEECS group.Univariate regression analysis showed PEECS was associated with the age,lesion size,lesion location,length of hospital stay,malignant tumor,polyps type,resection modality.Multivariable logistic regression analysis showed that the independent risk factors for the development of electrocoagulation syndrome were age ＞65 year (OR =1.123,95％ CI:1.013-1.244,P =0.027),lesion size ＞ 3.5 cm (OR =1.173,95％ CI:1.015-1.357,P =0.031),malignant tumor (OR =3.498,95 ％ CI:1.460-8.379,P =0.005),hospital stay ＞ 10 d (OR =2.480,95％ CI:1.346-4.569,P =0.004),non-rectal lesions (OR =12.612,95％ CI:3.446-46.157,P =0.000).Conclusion Attention should be paid for colorectal lesion patients with high risk of PEECS,when endoscopic submucosal dissection is performed.
ABSTRACT
Objective To evaluate magnifying Fuji intelligent chromo endoscopy (FICE) in diagnosis of colorectal lesions,and to explore the correlation between pit pattern,expression of Angiopeietin-2 (Ang-2) and mierovessel density (MVD). Methods A total of 100 colorectal lesions with pit patterns ranging from type Ⅰ to type Ⅴ (20 cases in each type) determined by magnifying FICE were divided into group A (n = 40,type Ⅰ and Ⅲ ),group B (n = 40,type Ⅲ and Ⅳ ) and group C ( n = 20,type Ⅴ ). The resuits of FICE were compared with pathological findings. Expression of Ang-2 was examined by immunohistochemical streptavidin-perosidase method and MVD was calculated. The correlation between pit pattern,Ang2 expression and MVD was analyzed. Results The diagnostic sensitivity,specificity and consistent rates of magnifying FICE for non-neoplastic colorectal lesions were 88.0%,92. 5% and 90. 2%,respectively,and those for neoplastic lesions were 94. 8%,91.7% and 93. 2%,respectively,with an overall consistent rate for colorectal lesions at 92. 0%. The positive expression rate of Ang-2 and MVD were progressively increasing from group A,B to C. Conclusion Magnifying endoscopy with FICE is valuable to differentiate neoplastic colorectal lesions from non-neoplastic ones. The positive expression of Ang-2 and MVD are closely correlated with the pit patterns of colorectal lesions.