Risk factors for delayed bleeding after endoscopic polypectomy of colorectal polyps / 中国内镜杂志

Objective To analyze risk factors for delayed postpolypectomy bleeding (DPPB) of colorectal polyps. Methods We reviewed 1 098 patients (2 169 polyps) who accepted endoscopic polypectomy from July 2014 to July 2017. Evaluate the risk factors for DPPB. Results DPPB occurred in 18 (1.6%) cases. Univariate analysis revealed that history of hypertension (P = 0.007), polyp size ≥10 mm (P = 0.009), right hemicolon location (P = 0.015) and adenomatous polyp (P = 0.045) were risk factors for DPPB. Multivariate logistic regression analysis revealed that history of hypertension (P = 0.002, O(R) = 4.654, 95%CI: 1.755 ~ 12.343), polyp size ≥10 mm (P = 0.009, O(R) = 3.637, 95%CI: 1.390 ~ 9.517), location in the right hemicolon (P = 0.016, O(R) = 3.656, 95%CI:1.273 ~ 10.504) were independent risk factors for DPPB. Conclusion Patients with history of hypertension, polyp size ≥10 mm, polyp location in the right hemicolon are prone to DPPB. We should take effective measure to prevent DPPB.

The investigation of risk factors of post-polypectomy emergency hemorrhage / 中华急诊医学杂志

Objective To explore the risk factors in post-polypectomy hemorrhage in rectum and to discuss the appropriate interventions.Methods A total of 313 patients with 373 polypi were included in this study. The clinical data were analyzed by SPSS 16 software. Results There were 313 patients with colorectal polypus curatively resected and 373 polypi in total.There were 11 (3.5％) patients subjected to post-polypectomy hemorrhage in rectum.Regression analysis showed that the independent risk factor of postpolypectomy hemorrhage in rectum was the hypertension of patients (P ＜ 0.01 ) and this hemorrhage had no significant correlations with patientg'ender,age,size of polypus,pathological characteristics and the methods of polypectomy.Conclusions Hypertension of patients is an independent risk factor in post-polypectomy hemorrhage.

Inflammatory Myoglandular Polyps Causing Hematochezia

We report herein three cases of inflammatory myoglandular polyp (IMGP) presenting as hematochezia. The polyps had pedunculated, red, and smooth features, and were 12, 12, and 15 mm in diameter and located in the sigmoid colon, transverse colon, and rectum, respectively. Endoscopic polypectomies were performed. Histologic examination of the recovered specimens revealed inflammatory granulation in the lamina propria mucosa, proliferation of smooth muscle, and hyperplastic glands with cystic dilatation. The three colon polyps were finally diagnosed both clinically and histologically as IMGP. Endoscopists should bear in mind that a polyp featuring endoscopic findings of pedunculation or semipedunculation; a red, smooth, spherical, and hyperemic surface; and patchy mucosa exudation and erosion is likely to be an IMGP.

A Case of Hamartomatous Polyp without Peutz-Jeghers Syndrome Arising from Appendix / 대한소화기내시경학회지

Peutz-Jeghers syndrome is a familial syndrome consisting of mucocutaneous pigmentation and gastrointestinal polyposis and appears to be inherited as a single pleiotropic autosomal dominant gene with variable and incomplete penetrance. Cases of hamartomatous polyps of the Peutz-Jeghers type without Peutz-Jeghers syndrome have only rarely been reported. Moreover, only one case of a Peutz-Jeghers polyp at the appendix has been reported; it was resected by appendectomy. We report here on a case of a 45 year old man who had a hamartomatous polyp of the Peutz-Jeghers type arising from the appendix. The polyp was successfully removed by endoscopic polypectomy. To our knowledge, this is the first case of a hamartomatous polyp of the Peutz-Jeghers type that originated from the appendix and that was resected endoscopically.

The Role of Powered Instrumentation in the Removal of Antrochoanal Polyps: A 10-Year Review

Antrochoanal polyps are rare lesions. We report a series of 40 consecutive cases of antrochoanal polyps treated in our tertiary centre over a period of ten years between May 1998 and April 2008. The median age of the patients was 37 years. The most common clinical symptom was nasal obstruction (92.5%) followed by rhinorrhoea (45%), postnasal drip (35%) and snoring (22.5 %). The median period of follow-up of these patients was 30 months. Various surgical approaches were used; the commonest was powered endoscopic polypectomy and middle meatal antrostomy in 28 patients (70%), followed by endoscopic polypectomy and middle meatal antrostomy in seven patients (17.5%). Five patients (12.5%) underwent powered endoscopic polypectomy without middle meatal antrostomy. In addition, two patients had septoplasty and one had a frontal sinustomy. There were six patients (15%) who had combined sublabial antrostomy. No major complications occurred; four patients relapsed; three patients had initial operation performed elsewhere and one patient developed recurrence after the first surgery. The median hospitalization period was three days. We conclude that, the use of powered instrumentation in the removal of antrochoanal polyps is safe, effective and associated with minimal morbidity.

The Clinicopathological Features of Gastric Hyperplastic Polyps with Neoplastic Transformations: A Suggestion of Indication for Endoscopic Polypectomy

BACKGROUND/AIMS: Although gastric hyperplastic polyps are usually considered as benign lesions, a low risk of carcinomatous conversion is currently recognized. We aimed to identify the characteristics of hyperplastic polyps undergoing neoplastic transformation. METHODS: A total of 269 gastric hyperplastic polyps from 216 patients removed by endoscopic polypectomy (EP) or surgical resection were enrolled in this study, and their endoscopic pictures and pathology slides were reviewed. RESULTS: Neoplastic transformation was detected on forceps biopsy specimen in 11 cases. However, the pathology findings from the EP or surgical specimen revealed neoplastic transformation in 14 cases (5.2%; 4 with dysplasia and 10 with adenocarcinoma). No significant difference was found between hyperplastic polyps with and without neoplastic transformation in age, sex, location, number of polyps or gross appearance. However, neoplastic transformations were more frequently found in gastric hyperplastic polyps >1 cm than in polyps 1 cm. Therefore, EP should be considered for gastric hyperplastic polyps >1 cm for the accurate diagnosis and definitive treatment.

Endoscopic Polypectomy of Primary Rectal Mature Teratoma: A Case Report / 대한소화기내시경학회지

Teratoma is a type of benign germ cell tumor that often contains several different types of tissue such as hair, muscle and bone, and these tissues arise from the three germinal layers. It occurs most often in the tailbones of children, the ovaries of women and the testicles of men. Primary rectal teratoma is extremely rare. We report here on a case of a 49-year-old woman with a primary rectal teratoma, and this was incidentally found during routine health screening. The rectal teratoma was a 15 mm-sized pedunculated polyp with a short stalk at the rectum, about 15 cm from anal verge as seen on CT colonography. On sigmoidoscopy and EUS, a fat and calcium containing well-defined polypoid lesion was noted in the upper rectum, with a narrow stalk attached to the colonic wall. The tumor was successfully excised by endoscopic polypectomy in order to obtain the histologic diagnosis and administer the proper treatment.

A Case of Laterally Spreading Tumor Resected with Double Balloon Enteroscopy in a Severely Redundant Colon / 대한소화기내시경학회지

The incidence of colon cancer and cancer-related deaths has been increased in Korea. Because most colon cancers arise from colonic adenomatous polyps, it is important to detect these early and to resect such lesions, and so the incidence of endoscopic polypectomy has increased in Korea since 1970's. At present, conventional colonoscopy is the standard for evaluating the colon, and especially for the screening and treatment of colon tumor. However, the entire colon cannot be visualized during conventional colonoscopy in 5~15% of patients due to a redundant colon, an excessive loop or a history of abdominal surgery. To overcome these difficulties, many radiologic and endoscopic studies have been conducted and there are several recent reports that double balloon enteroscopy has been successfully used in cases of failed conventional colonoscopy. We report here on a case of laterally spreading tumor that was resected with double balloon enteroscopy in a severely redundant colon.

A Case of Giant Brunner's Gland Hyperplasia Combined with Adenomyomatous Hyperplasia / 대한소화기학회지

Brunner's gland hyperplasia is a rare tumor of the duodenum and might also be an unusual cause of gastrointestinal bleeding. In symptomatic patients, treatment requires either surgical resection or endoscopic polypectomy. We report a case of upper gastrointestinal bleeding from a pedunculated Brunner's gland hyperplasia in the duodenal bulb. Endoscopic resection using the detachable snare and hemoclipping was instituted to remove a large pedunculated polyp. The pathologic diagnosis was Brunner's gland hyperplasia with adenomyomatous hyperplasia.

A Case of Rectal Carcinoid Tumor in a Child / 대한소아소화기영양학회지

Carcinoid tumors are derived from the enterochromaffin cells of neural crest origin. Most are commonly found in the gastrointestinal (GI) tract. The rectum is the third most common site for GI carcinoids. Rectal carcinoid tumors make up 13.7% of all carcinoid tumors and the vast majority occurs in the sixth decade of life. Approximately 80% of rectal carcinoid tumors are less than 1 cm in size, limited to the submucosa without metastasis and can be safely treated by local excision. We report a case of rectal carcinoid tumor in a 13 year-old child that was successfully treated by endoscopic polypectomy.

A Case of Polypoid Arteriovenous Malformation Treated by Polypectomy with Detachable Snare / 대한소화기내시경학회지

Arteriovenous malformations are degenerative lesions of the gastrointestinal tract that occur with a frequency that increases with increasing age. Although the bleeding caused by arteriovenous malformations is typically chronic, slow, intermittent and recurrent, 15% of patients with arteriovenous malformations present with massive bleeding. Any part of the gastrointestinal tract can be involved and arteriovenous malformations usually appear on endoscopy as either flat or elevated discrete bright red mucosal lesions. There are a few cases of colonic arteriovenous venous malformations with a polypoid appearance with some of their endoscopic treatments resulting in profuse bleeding from the remnant stalk. We encountered a case of a polypoid arteriovenous malformation in the colon of a 69-year-old patient with active gastrointestinal bleeding. The patient was treated successfully by an endoscopic polypectomy with a detachable snare.

A Case of Granular Cell Tumor of the Colon Treated by Colonoscopy / 대한소화기내시경학회지

Granular cell tumor (GCT) is a relatively rare benign tumor that can be located anywhere throughout the body, but it is uncommon in the gastrointestinal tract, and especially in the colon and rectum. A 41-year-old man visited our hospital with a three-month history of intermittent abdominal discomfort at the left lower quadrant area. Colonoscopic examination revealed a hemispheric, submucosal lesion, about 1.5 x 1.2 cm in size, on the opposite side of the ileocecal valve in the proximal ascending colon. The tumor was removed by an endoscopic snare without any immediate complication. The pathologic findings revealed spindled or polygonal large cells that were positive for S-100, neuron-specific enolase and vimentin, and they were negative for smooth muscle actin and desmin, which was consistent with granular cell tumor. We report here on a case of granular cell tumor of the colon that was successfully treated with endoscopic polypectomy.

The Safety and Usefulness of Endoscopic Polypectomy for Treatment of Brunner's Gland Adenomas / 대한소화기학회지

BACKGROUND/AIMS: Brunner's gland adenoma is a rare benign tumor of the duodenum. Although several cases of successful endoscopic polypectomy have been reported, the studies on the safety and usefulness of endoscopic polypectomy are extremely rare. Therefore, we report the results of 10 cases of Brunner's gland adenoma treated by endoscopic polypectomy. METHODS: Between November 1998 and January 2003, 10 cases of Brunner's gland adenoma were diagnosed. The mean age of the cases (6 male, 4 female) was 60.4 years. They were located in the bulb (9) and the second portion (1) of the duodenum. All cases were diagnosed and removed by endoscopic polypectomy. RESULTS: The size of the tumor ranged from 1.0 to 3.5 cm in diameter. Pedunculated polyps were found in three cases. In other seven cases, semipedunculated polyps were observed and, three of them were presented as submucosal tumor. All cases had no malignant foci. There was no complication such as bleeding, perforation, and pancreatitis after endoscopic polypectomy. During follow-up period (range 1~39 months) after endoscopic polypectomy, there was no complication and recurrence of the lesions. CONCLUSIONS: Endoscopic polypectomy was a safe and useful method for the treatment of duodenal Brunner's gland adenoma without complication and recurrence.

A Case of Medial Rectus Muscle Injury after Functional Endoscopic Sinus Polypectomy and Ethmoidectomy

PURPOSE: To report appropriate treatment of medial rectus muscle injury after functional endoscopic sinus polypectomy and ethmoidectomy METHODS: The author experienced the right medial rectus muscle injury after functional endoscopic polypectomy and ethmoidectomy in a 42-year-old man who complained of decreased visual acuity, ocular pain, binocular diplopia, and exophthalmos in the right eye at the first postoperative day. His best corrected visual acuity of right eye was 0.3, Intraocular pressure was 26 mmHg, and pupillary light reflex was decreased. On exophthalmometry, the right eye was more exophthalmic by 3 mm than the left eye. After steroid therapy and befunolol eyedrops instillation, the visual acuity was improved to 0.8 and intraocular pressure was decreased to 18 mmHg. There was severe limitation of medial gaze and about 65 prism diopters of right exodeviation in red filter test. In computerized tomography, bony defect in the right orbital medial wall and defect in the right medial rectus muscle were confirmed. On the third postoperative day, silastic sheet was applied in dehiscent medial wall under endoscopic examination in otorhinolaryngologic outpatient department. Because exodeviation and diplopia had not improved, on the 61th postoperative day, right lateral rectus muscle recession 12 mm was carried out, and then, on the 88th postoperative day, Hummelsheim operation on right eye was done. RESULTS: Right exodeviation was decreased by about 40 prism diopters after right lateral rectus muscle recession 12 mm. and then, after Hummelsheim operation, he had right exodeviation 20 prism diopters of and less binocular diplopia. We prescribed 10 prism diopters of prism lens in each eye, but he complained of decreased visual acuity and cosmetic problem. So, we prescribed 5 prism diopters of prism lens in each eye. At the last follow-up he is satisfied with his visual acuity and cosmetic aspect.

Minimally invasive surgery for gallbladder polyps / 中国现代普通外科进展

Objective: Gallbladder polyps are frequently discovered in the past decade. Ifthe polyps are oenign,without concomitant stone and the gallbladder has a good function, it is not an absolutely indication for cholecystectomy. For this reason percutaneous endoscopio polypectomy of the gallbladden polyps were developed and applied. Methods: Among those who underwent peroutaneous endosoopic polypectomy of the gallbladder, 85 patients with gallblaeder polyps were studied. Under the epidural anesthesia, cholecystoscope was introduced into the gallbladder. The polyps were coagulated by self-made miorowave ceagulator and then resected for histopathelogical evaluation. The preserved gallbladders were followed up to evaluate the effioacy of this minimally invasive therapy. Results: All precedures were eventful with mean operation time of 1h to 1. 5h. Sixty seven patients were followed-up for a mean of 5.5 yeah (2～9 years) and showed all patients to be symptom free and in 64 cases the gallbladder function was found to be well preserved without recurrence of polyps and occurrenca of gallstones on ultraSound. Conclusion: The procedure reposed is a reliable, simple,effective and minimally invasive technique to remove gallbledder polyps and to preserve gallbladder function for the patients who have the benign gallbladder polyps.

Endoscopically Treated Gastritis Cystica Polyposa Found in an Unoperated Stomach / 대한소화기내시경학회지

Gastritis cystica polyposa (GCP) which is characterized by polypoid hyperplasia of the gastric mucosa, is known as an uncommon lesion that usually occurs at the gastroenterostomy site, although rarely it can be found in an unoperated stomach. Recently, GCP has been proposed to be a possible precancerous lesion itself. We present a rare case of GCP which presented as a large soft polypoid mass with a stalk in a previously unoperated stomach. A 44-year-old woman was admitted due to further study of large gastric mass. Previously, she had not undergone gastric surgery. Physical examination disclosed nothing abnormal. and laboratory test showed iron deficiency anemia. Endoscopy showed a large soft polypoid mass in gastric fundus and endoscopic ultrasonography showed a homogenous hypoechoic, and multilocular cystic mass with a stalk. We removed it via endoscopic polypectomy and histologic examination of this polypoid specimen showed the features consistent with the diagnosis of GCP.

Rectal Carcinoid: Effectiveness of Endoscopic Resection

PURPOSE: Small-sized carcinoids, less than 1 cm, are easily detected using flexible sigmoidoscopy or total colonoscopy and can be treated by local excision. Recently, there has been many advances in the technique of endoscopic resection. The aim of this study was to determine the endoscopic findings of a rectal carcinoid and to evaluate the effectiveness of endoscopic resection. METHODS: We experienced 22 rectal carcinoids in 21 patients who were treated by endoscopic resection from June 1996 to February 1999. Nineteen cases were followed for an average of 21 months. Follow-up studies consisted of chest P-A, hepatic ultrasonography, and total colonoscopy. RESULTS: The male-to-female ratio was 1.6 to 1. The most common age group was the 4th decade. The tumor was located at the lower rectum in 10 patients, at the upper rectum in 10 patients, and at the rectosigmoid junction in 2 patients. The tumor sizes ranged from 3 to 12 mm in diameter and were smaller than 10 mm in 20 cases (90.1%). Endoscopic finding revealed that the tumors were covered by a normally appearing mucosa in 12 cases, were yellow-discolored polyps in 17 cases, and were sessile-type tumors in 19 cases. The method of treatment was an endoscopic mucosal resection (EMR, 14 cases) or a snare polypectomy (8 cases). Microscopically positive margins were noticed in four cases, two cases of EMR (2/14, 14%) and two cases of snare polypectomy (2/8, 25%). All the patients were alive and clinically free of disease; however, the duration of the follow-up is short. CONCLUSIONS: Endoscopic resection for rectal carcinoid tumors smaller than 1 cm in diameter is a safe, functional, time-saving, and effective treatment. If the tumor suggests a carcinoid, EMR is advised rather than a polypectomy even though the tumor is small. Microscopically positive margins are not absolute indications for further surgery in the treatment of carcinoids smaller than 1 cm in diameter. It is much more important for an endoscopist to be confident that the endoscopic resection is done completely. It is necessary to identify the factors influencing the malignancy potential and to have a longer follow-up.

Polypoid Stenosing Papillitis of the Ampulla of Vater / 대한소화기내시경학회지

Stenosing papillitis is a descriptive term for an anatomic deformity of the Ampulla of Vater due to chronic inflammation and fibrosis, which is characterized by narrowing of the lower end of the bile and pancreatic duct, and by clinical symptoms resembling pancreticobiliary disease. Duodenoscopic finding of "stenosing papillitis" usually shows edema, erythema, and laceration on Ampulla of Vater, but endoscopic finding such as polypoid mass is rare. We recently experienced one case of polypoid stenosing papillitis and report with a review of relevant literatures A 54-year-old man was admitted to our hospital because of chronic right upper abdominal pain for 2 years. Duodenoscopy re-vealed a polypoid mass with erythemaous color change on Ampulla of Vater, which was endoscopically resected by using a polypectomy snare, and pathologic examination showed chronic inflammation and fibrosis.

Two Cases of Gastric Bezoar Removed by Endoscopic Polypectomy Snare and Lithotriptor / 대한소화기내시경학회지

Gastric bezoar has been known to occur occasionally in the gastrointestinal tract, as a result of foreign material accumulating in the stomach. Most case have been managed by surgical methods. Currently, the endoscopic mathod is after used for the gastrointestinal disease, and therefore we treated two cases of huge bezoars using the endoscopic polypectomy snare and lithotriptor. Subsequently, we are reporting these cases and have incorporated relevant literature which was reviewed for our report for the subject case.

Clinicopathologic Evaluation of 290 Cases Involving Endoscopic Gastric Polypectomy / 대한소화기내시경학회지

BACKGROUND/AIMS: Gastric polyps are recommended to be removed due to their premalignant potential. Endoscopic polypectomy has long been considered a safe and effective method for removal of gastric polyps. METHODS: The authors diagnosed and treated 290 gastric polyps using endoscopy on 210 patients who had been admitted to Chungnam National University Hospital from January, 1990 to August, 1996. The clinical endoscopic and pathologic findings were evaluated.