Multiple Osteomas of Mandible in a Patient with Gardner’s Syndrome - Report of a Case

Introduction: Osteomas are benign tumors of the bone usually seen in craniofacial bones which arise from either the cortex or medulla. They are usually asymptomatic with slow painless growth. Multiple osteomas are often associated with Gardners syndrome. Solitary osteomas are typically non syndromic. Case Presentation: The patient presented with remarkable facial asymmetry following the growth in the mandible. Multiple os- teomas were noted which invoked suspicion of a syndrome. On endoscopic evaluation the patient was found to have multiple intestinal polyps, pathgnomonic for Gardners syndrome. Management and prognosis: The lesion was surgically removed under local anaesthesia. as an excisional biopsy and the asymmetry was rectified. Histopathologic examination revealed it to be ivory osteoma with dense compact bone and less mar- row spaces. The jaw lesions would precede the development of colonic polyps and therefore may contribute to early diagnosis of Gardner’s syndrome. There is also a chance of malignant evolution associated with the polyps Conclusion: People with the condition have a higher risk of developing other family adenomatous polyp (FAP)related cancers including pancreatic cancer and liver cancer. The patient should be in close follow up

Analysis of the effect of cold snare endoscopic mucosal resection in the treatment of colorectal polyps / 中国医师进修杂志

Objective:To explore the effect of cold-strap endoscopic mucosal resection (CS-EMR) in patients with colorectal polyps.Methods:A prospective randomized clinical trial was conducted to 320 selected patients with colorectal polyps diagnosed by Shenzhen Luohu District People′s Hospital from May 2019 to June 2021. The patients were randomly divided into CS-EMR group and HS-EMR group with 160 cases each, using a random number table generated by Excel 2007. The main parameters for statistical analysis contain the process indicators of the two groups of surgical methods, the complete polypectomy rate of patients after surgery, the degree of postoperative pain and the recovery of gastrointestinal function, and the differences in surgical complications.Results:The polypectomy time of CS-EMR group was shorter than that of HS-EMR group: (4.11 ± 1.20) min vs. (4.42 ± 0.98) min, with a statistically significant difference ( P<0.05). The score of visual analogue pain scale (VAS) in CS-EMR group was lower than that in HS-EMR group at 4 and 12 hours after operation: (3.11 ± 0.78) scores vs. (3.48 ± 0.80) scores, (3.38 ± 0.80) scores vs. (3.61 ± 0.92) scores, with a statistically significant difference ( P<0.05). The first anal exhaust time and first defecation time in CS-EMR group were lower than those in HS-EMR group: (27.83 ± 5.01) h vs. (29.66 ± 4.84) h, (43.73 ± 7.80) h vs. (47.28 ± 8.14) h, with a statistically significant difference ( P<0.05). The complications in CS-EMR group were significantly lower than those in HS-EMR group: 5.63% (9/160) vs. 12.50% (20/160), with a statistically significant difference ( P<0.05). Conclusions:The effect of CS-EMR in the treatment of colorectal polyps is not different from that of HS-EMR, but the former has the advantages of short resection time, rapid recovery of gastrointestinal function after operation, light pain and less complications.

Discussion on the pathogenesis of "spleen deficiency and dampness accumulation" of colorectal polyps based on intestinal flora and glucose and lipid metabolism / 国际中医中药杂志

Intestinal flora imbalance and abnormal glucose and lipid metabolism are important risk factors and pathological mechanisms of colorectal polyps. "Spleen deficiency and dampness accumulation" is the core pathogenesis of colorectal polyps. The imbalance of intestinal flora is related to spleen deficiency, and the application of Chinese herbs for invigorating spleen is helpful to the recovery of intestinal flora balance. Abnormal glucose and lipid metabolism is related to dampness accumulation, and it is effective to treat it with bitter and spicy herbs or spleen-invigorating and dampness-eliminating herbs. The interaction between intestinal flora imbalance and abnormal glucose and lipid metabolism changes intestinal microenvironment, damages intestinal epithelial cells, causes abnormal proliferation of intestinal stem cells and leads to colorectal polyps, which is consistent with the pathogenesis of spleen deficiency and dampness accumulation in Traditional Chinese Medicine. Thus, we tried to explore the biological connotation of the pathogenesis of "spleen deficiency and dampness accumulation" of colorectal polyps from the perspective of the interaction of intestinal flora and glucose and lipid metabolism, in order to provide reference for identifying high-risk population and analyzing the therapeutic mechanism of compound prescription for invigorating spleen and removing dampness.

Calcifying fibrous tumor

ABSTRACT Calcifying fibrous tumor is a rare benign mesenchymal neoplasm. The etiology and pathogenesis of this tumor are uncertain. It has wide anatomical distribution. The tumor is most commonly found in the soft tissues of the extremities in younger individuals. However, in middle-aged patients, it tends to affect the visceral locations more commonly. In visceral location, it can mimic aggressive lesions clinically. The purpose of this report is to describe a case of calcifying fibrous tumor in a 71-year-old female with a history of breast carcinoma who was found to have an incidental small bowel mass on her follow-up. Clinically and radiologically, the mass was suspicious for either metastatic disease or gastrointestinal stromal tumor. The patient underwent open small bowel resection, and a 6.5 cm segment of the small bowel was sent to pathology. Grossly, a 2.0 cm tan-pink smooth round submucosal polyploid mass protruding into the lumen, mimicking a gastrointestinal stromal tumor, was identified. The tumor was hard and serially sectioned to reveal a white, calcified cut surface. Microscopically, the tumor appeared hypocellular and composed of scant spindle cells embedded in a dense, hyalinized and calcified collagenous stroma. Immunohistochemical stains for pan-cytokeratin, DOG1, desmin, S100, CD34, and MUC4 were negative, and a diagnosis of the calcifying fibrous tumor was rendered. This case provides a rare gross specimen image of calcifying fibrous tumor and highlights the importance of knowledge of rare entities in providing an accurate diagnosis for entities that can mimic other lesions.

Preliminary treatment experience of double-balloon enteroscopy in children with intussusception caused by Peutz-Jeghers syndrome / 中华消化内镜杂志

Peutz-Jeghers syndrome (PJS) presents in early childhood, and children have a higher risk of intussusception due to a smaller abdominal space than adults. Double-balloon enteroscopy (DBE) has been proven to be a safe and effective method for the diagnosis and treatment of small bowel lesions, but the efficacy and safety of its prophylactic polypectomy in children with PJS need to be determined. Data of 6 children (median age 10.6 years) diagnosed as having PJS from 2018 to 2020 were reviewed. DBE was performed 14 times, and 3 children were successfully relieved of intussusception after DBE treatment. The sizes of the resected intussusception polyps were 50 mm×60 mm, 40 mm×35 mm, and 50 mm×40 mm. Symptoms associated with polyps (abdominal pain, intussusception and obstruction) relieved after DBE in all children. No direct complications such as bleeding or perforation were found during the operation, and no recurrence of intussusception was found during follow-up. It can be seen that DBE polypectomy is safe and effective in the treatment of intussusception caused by PJS.

Clinical and endoscopic features and endoscopic treatment efficacy of cap polyposis / 中华消化内镜杂志

To investigate the clinical and endoscopic characteristics and endoscopic treatment efficacy of cap polyposis, data of 14 patients (56 polyps) who were histologically diagnosed as having cap polyposis after endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) in Beijing Friendship Hospital from June 2017 to February 2021 was retrospectively analyzed. Of the 14 patients, 8 were males and 6 were females. The age ranged from 14 to 74 years, including 7 cases of <60 years old and 7 cases of ≥60 years old. 7 patients (50.0%) had clinical manifestations. Four cases had multiple polyps and 10 cases (71.4%) had single polyps. There were 42 polyps (75.0%) located in the rectum, 13 (23.2%) in the sigmoid colon and 1 in the transverse colon. According to the classification of Yamada, 44 polyps (78.6%) were type Ⅰ, 3 polyps were type Ⅱ, 5 polyps were type Ⅲ and 4 polyps were type Ⅳ. Under endoscopy, there were 41 polyps (73.2%) with obvious white cap-like coverings on the surface and 23 polyps with obvious hyperemia and redness on the mucosa, 8 of which were both visible. Two cases were treated with ESD and 12 cases were treated with EMR, all of which were completely excised. No bleeding, perforation, infection or other complications occurred during and after operation. The clinical symptoms of 7 patients were relieved. During the follow-up period, 11 cases (78.6%) completed colonoscopy, and no polyp recurrence was found. In conclusion, there is no gender or age difference in patients of cap polyposis. It is usually single and located in the rectum and sigmoid colon with Yamada type Ⅰ. The surface of lesions is mostly covered with white cap. Patients may have no obvious clinical symptoms. Treatment of ESD and EMR is safe and effective for cap polyposis.

A clinical study of cold snare resection for large colorectal polyps / 中华消化内镜杂志

Objective:To investigate the efficacy and safety of cold snare polypectomy (CSP) and hot snare polypectomy (HSP) for the removal of colorectal polyps of 10-15 mm.Methods:A total of 173 polyps of 154 patients with at least one polyp of 10-15 mm were resected under colonoscopy from December 2019 to December 2020. Based on Paris classification, the polyps were divided into Ⅰsp, Ⅰs and Ⅱa. According to random number table, the polyps were randomly divided into CSP group ( n=85) and HSP group ( n=88). The polyp size, location, morphology, histological classification, complete resection rate, incidence of complications, resection time and the number of prophylactic clips were compared between the two groups. Results:There were no significant differences in age, sex, indication of colonoscopy or the success rate of intubation at the end of ileum between the two groups. The polyps of the two groups were comparable in size, position, morphology and histological classification. There were no significant differences in the complete resection rate of polyps, rates of intraoperative bleeding and postoperative bleeding or perforation between the CSP group and the HSP group. The operation time in CSP group was significantly shorter than that in HSP group (63.5 ±23.6 s VS 184.3 ±62.4 s, P<0.05). The number of prophylactic clips used in CSP group was significantly less than that in HSP group (0.8±0.5 VS 1.4±0.7, P<0.05). Conclusion:CSP shows similar complete resection rate and complication incidence, and requires shorter operation time and fewer prophylactic clips, compared with HSP, in the resection of colorectal sessile polyps of 10-15 mm.

Comparison of the efficacy of CT virtual colonoscopy with two different gases / 中国基层医药

Objective:To investigate the efficacy of CT virtual colonoscopy with carbon dioxide (CO 2) versus room air and the effects of bowel cleanliness on polyp detection rate. Methods:A total of 186 patients who underwent CT virtual colonoscopy in the Affiliated Hospital of Hangzhou Normal University (Hangzhou Second People's Hospital), China between October 2015 and November 2020 were included in this study. They were randomly divided into CO 2 and control groups ( n = 93/group). In the CO 2 and control groups, CO 2 and room air were respectively injected through the anus to fill the intestinal cavity. The Boston Bowel Preparation Scale (BBPS) score, abdominal distension score, Visual Analogue Scale (VAS) score, Bruggrmann comfort scale (BCS) score and polyp detection rate were compared between the two groups. Results:According to BBPS score, there were 62 and 60 patients with good bowel cleanliness (BBPS score ≥ 7 points), and 31 and 33 patients with poor bowel cleanliness (BBPS score < 7 points) in the CO 2 and control groups, respectively. There were no significant differences in abdominal distension score, VAS score and BCS score measured during the examination between the two groups (all P > 0.05). At 30 minutes after examination, abdominal distension score and VAS score in the CO 2 group were (2.21 ± 0.40) points and (1.43 ± 0.34) points, respectively, which were significantly lower than those in the control group [(3.50 ± 0.49) points, (3.03 ± 0.55) points, t = 2.59, 2.38, both P < 0.05)]. At 60 minutes after examination, abdominal distension score, VAS score and BCS score in the CO 2 group were (1.15 ± 0.39) points, (1.22 ± 0.28) points, (1.27 ± 0.35) points, which were significantly lower than those in the control group [(2.16 ± 0.43) points, (1.91 ± 0.32) points, (1.85 ± 0.37) points, t = 2.45, 2.27, 2.40, all P < 0.05). The detection rate of small (< 6 mm) - and large (≥ 6 mm) -sized polyps in the CO 2 group was 32.7% (34/104) and 88.1% (37/42), respectively and they were 29.0% (29/100) and 85.1% (40/47) respectively in the control group. There were no significant differences in the detection rate of small- and large-sized polyps between CO 2 and control groups (both P > 0.05). The detection rate of large-sized polyps in patients with good bowel cleanliness in the CO 2 group was 92.3% (24/26) and 89.7% (26/29), respectively, which were significantly higher than those in patients with poor bowel cleanliness in the control group [81.3% (13/16), 77.8% (14/18), χ2 = 6.03, 6.44, both P < 0.05]. The detection rate of small-sized polyps in patients with poor bowel cleanliness in the CO 2 group was 41.9% (26/62) and 42.9% (21/49), respectively, which were significantly higher than those in patients with poor bowel cleanliness in the control group [19.0% (8/42), 15.7% (8/51), χ2 = 15.32, 13.78, both P < 0.01]. Conclusion:CT virtual colonoscopy with CO 2 injection is less uncomfortable than CT virtual colonoscopy with room air and it does not affect polyp detection rate. Bowel cleanliness has a remarkable effect on polyp detection rate in virtual colonoscopy.

Relationship between the endoscopic withdrawal time at different colonic segments and the quality of colonoscopy / 中华消化内镜杂志

Objective:To explore the reasonable withdrawal time at different colonic segments.Methods:It was a prospective observational study involving 465 patients who underwent colonoscopy from November 2019 to November 2020 at our endoscopy center. Colonoscopy records in our center from July 2017 to September 2017 were retrospectively analyzed as a validation set.Results:The cut-off values of withdrawal time at ascending colon, transverse colon, descending colon, and sigmoid colon and rectum determined by receiver operating characteristic (ROC) curve were 77 s, 61 s, 56 s, and 109 s, respectively. At the ascending colon, the adenoma detection rate (ADR) was significantly higher (17.3% VS 2.8%, P<0.001) when the colonoscopy withdrawal time was ≥77 s. When the withdrawal time was ≥61 s at the transverse colon (6.9% VS 2.8%, P=0.036), that over 59 s at the descending colon (6.3% VS 1.7%, P=0.019), and that ≥109 s at the sigmoid colon and rectum (31.0% VS 7.9%, P<0.001), the ADR was significantly higher. Multivariate analysis showed that withdrawal time of ≥77 s at the ascending colon ( OR=6.427, P<0.001), those ≥56 s at the descending colon ( OR=3.564, P=0.045) and ≥109 s at the sigmoid colon and rectum ( OR=5.073, P<0.001) were independent risk factors for the increase of ADR. In the validation set, when the withdrawal times at the ascending colon, the transverse colon, the descending colon, and the sigmoid colon and rectum were ≥77 s, 61 s, 56 s, and 109 s, respectively, the total ADR (48.3% VS 17.6%, OR=2.952, P<0.001) and polyp detection rate (PDR) (63.2% VS 23.0%, OR=4.191, P<0.001) significantly increased. There were no significant differences in ADR ( P=0.563) or PDR ( P=0.770) compared with those where withdrawal time was over 6 min. Conclusion:The ADR and PDR significantly increase when the withdrawal times are ≥77 s at the ascending colon, ≥61 s at the transverse colon, ≥56 s at the descending colon, and ≥109 s at the sigmoid colon and rectum.

Acurácia diagnóstica de teste quantitativo imunoquímico fecal com uma amostra ou com duas amostras para detectar neoplasia intestinal / Diagnostic accuracy of one sample or two samples quantitative fecal immunochemical tests for intestinal neoplasia detection

ABSTRACT BACKGROUND: Rectal bleeding is the most important symptom of intestinal neoplasia; thus, tests of occult blood detection in stools are widely used for pre neoplastic lesions and colorectal cancer (CRC) screening. OBJECTIVE: Evaluate the accuracy of OC-Sensor quantitative test (Eiken Chemical, Tokyo, Japan) at cut-off 10 µg Hb/g feces (50 ng/mL) in a cohort of subjects that had to undergo diagnostic colonoscopy, and if more than one sample collected in consecutive days would improve the diagnostic accuracy of the test. METHODS: Patients (mean age 56.3±9.7 years) that underwent colonoscopy prospectively randomly received one (1-sample FIT, FIT 1) or two (2-sample FIT, FIT 2) collection tubes. They collected the stool sample before starting colonoscopy preparation. Samples were analyzed by the OC-Auto Micro 80 (Eiken Chemical, Tokyo, Japan). The performance of FIT 1 and FIT 2 were compared to the colonoscopy findings. RESULTS: Among 289 patients, CRC was diagnosed in 14 (4.8%), advanced adenoma in 37 (12.8%), early adenoma in 71 (24.6%) and no abnormalities in 141 (48.8%). For FIT 1, the sensitivity for CRC was 83.3% (95%CI 36.5-99.1%), for advanced adenoma was 24% (95%CI 10.1-45.5%), with specificity of 86.9% (95%CI 77.3-92.9%). For FIT 2, the sensitivity for CRC was 75% (95%CI 35.6-95.5%), for advanced adenoma was 50% (95%CI 22.3-77.7%), with specificity of 92.9% (95%CI 82.2-97.7%). The positive likelihood ratios were 1.8 (95%CI 0.7-4.4 for FIT 1) and 7.1 (95%CI 2.4-21.4 for FIT 2) for advanced adenoma, and 6.4 (95%CI 3.3-12.3, for FIT 1) and 10.7 (95%CI 3.8-29.8, for FIT 2) for CRC. The negative likelihood ratio were 0.9 (95%CI 0.7-1, for FIT 1) and 0.5 (95%CI 0.3-0.9, for FIT 2) for advanced adenoma, and 0.2 (0.03-1.1, for FIT 1) and 0.3 (0.08-0.9, for FIT 2) for CRC. The differences between FIT 1 and FIT 2 performances were not significant. However, the comparison of the levels of hemoglobin in feces of patients of FIT 1 and FIT 2 showed that the differences between no polyp group and advanced adenoma and CRC were significant. CONCLUSION: The accuracy of OCR Sensor with 10 µg Hb/g feces cut-off was comparable to other reports and two-sample collection improved the detection rate of advanced adenoma, a pre neoplastic condition to prevent CRC incidence.

RESUMO CONTEXTO: Sangramento retal é o sintoma mais importante de neoplasia intestinal; portanto, testes para detecção de sangue oculto nas fezes são amplamente usados para rastreamento de lesões pré-neoplásicas e de câncer colorretal (CCR). OBJETIVO: Avaliar a acurácia do teste quantitativo OC-Sensor (Eiken Chemical, Tokyo, Japan) com o valor de corte de 10 µg Hb/g fezes (50 ng/mL) numa coorte de indivíduos que se submeteram à colonoscopia diagnóstica, e se mais de uma amostra coletada em dias consecutivos melhoraria a acurácia diagnóstica do teste. MÉTODOS: Pacientes (idade média 56,3±9,7 anos) que se submeteram à colonoscopia prospectivamente, randomicamente, receberam tubos de coleta: um (1-amostra FIT, FIT 1), ou dois (2-amostra FIT, FIT 2). Eles coletaram as amostras de fezes antes de iniciar o preparo da colonoscopia. As amostras foram analisadas pelo OC-Auto Micro 80 (Eiken Chemical, Tokyo, Japan). As performances do FIT 1 e do FIT 2 foram comparadas com os achados da colonoscopia. RESULTADOS: Entre 289 pacientes, CCR foi diagnosticado em 14 (4,8%), adenoma avançado em 37 (12,8%), adenoma precoce em 71 (24,6%) e sem anormalidades em 141 (48,8%). Para FIT 1, a sensibilidade para CCR foi 83,3% (95%IC 36,5-99,1%), para adenoma avançado foi 24% (95%IC 10,1-45,5%), com especificidade de 86,9% (95%IC 77,3-92,9%). Para FIT 2, a sensibilidade para CCR foi 75% (95%IC 35,6-95,5%), para adenoma avançado foi 50% (95%IC 22,3-77,7%), com especificidade de 92,9% (95%IC 82,2-97,7%). A razão de verossimilhança positiva foi 1,8 (95%IC 0,7-4,4 para FIT 1) e 7,1 (95%IC 2,4-21,4 para FIT 2) para adenoma avançado, e 6,4 (95%IC 3,3-12,3, para FIT 1) e 10,7 (95%IC 3,8-29,8, para FIT 2) para CCR. A razão de verossimilhança negativa foi 0,9 (95%IC 0,7-1, para FIT 1) e 0,5 (95%IC 0,3-0,9, para FIT 2) para adenoma avançado, e 0,2 (0,03-1,1, para FIT 1) e 0,3 (0,08-0,9, para FIT 2) para CCR. As diferenças de performance entre FIT 1 e FIT 2 não foram significantes. Entretanto, a comparação dos níveis de hemoglobina nas fezes dos pacientes de FIT 1 e FIT 2 mostraram que as diferenças entre sem pólipo e adenoma avançado e CCR foram significantes. CONCLUSÃO: A acurácia do OCR Sensor com valor de corte de 10 µg Hb/g de fezes foi comparável a outras publicações e a coleta de duas amostras melhorou a taxa de detecção de adenoma avançado, lesão pré-neoplásica, para prevenir CCR.

Invaginación intestinal en el adulto secundaria a pólipo mesenquimatoso. Presentación de un caso / Intestinal invagination in adults secondary to mesenchymal polyp. Case presentation

RESUMEN Fundamento: La invaginación intestinal como causa de dolor abdominal es un motivo infrecuente de consulta en la edad adulta. Una lesión orgánica es la causante en el 90 % de los casos. Pueden ser lesiones malignas o benignas, y entre estas últimas se mencionan los lipomas de intestino delgado. Objetivo: Presentar el caso de una paciente con invaginación intestinal secundaria a pólipo mesenquimatoso. Presentación del caso: Paciente femenina de 47 años de edad, con antecedentes de dolor abdominal recurrente hacia fosa ilíaca derecha y cambios intermitentes en el hábito intestinal. En los estudios de imagen realizados se le diagnosticó una invaginación de intestino delgado, la cual se corroboró en el acto quirúrgico y mediante anatomía patológica que informó un pólipo mesenquimatoso (fibrolipoma) como causante. Conclusiones: La invaginación intestinal, aunque infrecuente, puede ser la forma de presentación de dolor abdominal recurrente en el adulto.

ABSTRACT Background: Intestinal invagination as a cause of abdominal pain is an infrequent reason for consultation in adulthood. An organic injury is the cause in 90 % of cases. They can be malignant or benign lesions, and among the latter, lipomas of the small intestine are mentioned. Objective: To present the case of a patient with intestinal invagination secondary to a mesenchymal polyp. Case presentation: A 47-year-old female patient with a history of recurrent abdominal pain towards the right iliac fossa and intermittent changes in bowel habit. In the imaging studies, an invagination of the small intestine was diagnosed which was corroborated in the surgical act and by pathological anatomy that reported a mesenchymal polyp (fibrolipoma) as the cause. Conclusion: Intestinal invagination, although infrequent, may be the form of presentation of recurrent abdominal pain in adults.

Ressecção da mucosa endoscópica sob imersão dágua para lesões colorretais não pediculadas. Um estudo prospectivo de braço único / Underwater endoscopic mucosal resection for non-pedunculated colorectal lesions. a prospective single-arm study

ABSTRACT BACKGROUND: Underwater endoscopic mucosal resection (UEMR) has emerged as a revolutionary method allowing resection of colorectal lesions without submucosal injection. Brazilian literature about this technique is sparse. OBJECTIVE: The aim of this study was evaluate the efficacy and safety of UEMR technique for removing non-pedunculated colorectal lesions in two Brazilian tertiary centers. METHODS: This prospective study was conducted between June 2016 and May 2017. Naïve and non-pedunculated lesions without signs of submucosal invasion were resected using UEMR technique. RESULTS: A total of 55 patients with 65 lesions were included. All lesions, except one, were successfully and completely removed by UEMR (success rate 98.5%). During UEMR, two cases of bleeding were observed (3.0%). One patient had abdominal pain on the day after resection without pneumoperitoneum. There was no perforation or delayed bleeding. CONCLUSION: This study supports the existing data indicating acceptable rates of technical success, and low incidence of adverse events with UEMR. The results of this Brazilian study were consistent with previous abroad studies.

RESUMO CONTEXTO: A ressecção endoscópica da mucosa sob imersão d'água (REMS) surgiu como um método revolucionário que permite a ressecção de lesões colorretais sem injeção submucosa. A literatura brasileira sobre essa técnica é escassa. OBJETIVO: A finalidade deste estudo foi avaliar a eficácia e segurança da técnica REMS na remoção de lesões colorretais não pediculadas em dois centros terciários brasileiros. MÉTODOS: Este estudo prospectivo foi realizado entre junho de 2016 e maio de 2017. As lesões sem tentativa de ressecção prévia, não pediculadas e sem sinais de invasão submucosa foram ressecadas pela técnica REMS. RESULTADOS: Um total de 55 pacientes com 65 lesões foram incluídos. Todas as lesões, exceto uma, foram removidas com sucesso e completamente por REMS (taxa de sucesso de 98,5%). Durante a REMS, foram observados dois casos de sangramento (3,0%). Uma paciente apresentou dor abdominal no dia seguinte à ressecção sem pneumoperitônio. Não houve perfuração ou sangramento tardio. CONCLUSÃO: Este estudo apoia os dados existentes, indicando taxas aceitáveis de sucesso técnico e baixa incidência de eventos adversos com a REMS. Os resultados deste estudo brasileiro foram consistentes com estudos internacionais prévios.

Investigação da população de Enterococcus faecalis em pacientes com pólipo e câncer colorretal em comparação a indivíduos saudáveis / Investigation of enterococcus faecalis population in patients with polyp and colorectal cancer in comparison of healthy individuals

ABSTRACT BACKGROUND: Colorectal cancer is one of the most commonly diagnosed cancers around the world. One of the factors involved in the development of colorectal cancer is the changes in the normal flora of the intestine. OBJECTIVE: In this study, the mean copy number of Enterococcus faecalis in people with polyps and people with colorectal cancer has been evaluated in comparison with healthy controls. METHODS: In this study, 25 patients with colorectal cancer and 28 patients with intestinal polyps were selected and stool specimens were taken. In addition, 24 healthy individuals were selected as control group. Extraction of bacterial DNA from the stool sample were performed. The molecular methods of PCR for confirmation of standard strain and absolute Real Time PCR (qRT-PCR) method were used to evaluate the number of Enterococcus faecalis in the studied groups. RESULTS: The results of this study indicate that the mean copy number of Enterococcus faecalis in patients with colorectal cancer was 11.2x109 per gram of stool, and in patients with polyps was 9.4x108 per gram of stool. In healthy people, this number was 9x108 per gram of stool. There was a significant difference between the implicit copy numbers in the three groups. (P<0.05). CONCLUSION: Enterococcus faecalis in faecal flora of people with colorectal cancer was significantly higher than those with polyps and healthy people. This could potentially signify the ability of this bacterium to induce colorectal cancer. More studies are needed to prove this theory.

RESUMO CONTEXTO: O câncer colorretal é um dos cânceres mais comumente diagnosticados em todo o mundo. Um dos fatores envolvidos no desenvolvimento do câncer colorretal é a mudança na flora normal do intestino. OBJETIVO: O número médio de cópias de Enterococcus faecalis em pessoas com pólipos e pessoas com câncer colorretal foram avaliados em comparação com controles saudáveis. MÉTODOS: Neste estudo, 25 pacientes com câncer colorretal e 28 pacientes com pólipos intestinais foram selecionados e amostras de fezes foram adquiridas. Além disso, 24 indivíduos saudáveis foram selecionados como grupo controle. A extração do DNA bacteriano da amostra coletada foi executada. Os métodos moleculares de PCR para confirmação da cepa padrão e o método absoluto de PCR em tempo real (qRT-PCR) foram utilizados para avaliar o número de Enterococcus faecalis nos grupos estudados. RESULTADOS: Os resultados deste estudo indicam que o número médio de cópias de Enterococcus faecalis em pacientes com câncer colorretal foi de 11,2x109 por grama de fezes, e em pacientes com pólipos foi de 9,4x108 por grama de fezes. Em pessoas saudáveis, este número foi de 9x108 por grama de fezes. Houve diferença significativa entre os números de cópia implícita nos três grupos. (P<0,05). CONCLUSÃO: Enterococcus faecalis na flora fecal de pessoas com câncer colorretal foi significativamente maior do que aqueles com pólipos e pessoas saudáveis. Isto poderia potencialmente significar a capacidade desta bactéria para induzir o câncer colorretal. Mais estudos são necessários para provar esta teoria.

Clinical analysis of rectal bleeding after anorectal operation / 中国基层医药

Objective To study the cause and outcome measures of rectal bleeding after anorectal surgery. Methods From January 2016 to December 2016,60 patients with rectal bleeding after anorectal surgery in Yuncheng Central Hospital were selected. The bleeding phenomena in these patients were analyzed. Results After anorectal surgery,the rectal hemorrhage rates of anterior sphincter rectal polypectomy,rectal abscess incision drainage,anal fistula incision operation,mixed hemorrhoid external strip were 6. 67％ (1 / 15),14. 29％ (1 / 7),7. 41％ (2 / 27), 9. 09％ (1 / 11),respectively. The rectal bleeding rate of anorectal surgery was 8. 33％ (5 / 60). Conclusion The effective preventive measures can effectively reduce the probability of postoperative rectal bleeding in patients with anorectal surgery.

Influencing factors on the detection rate of colorectal polyps in colonoscopy using repeated examination / 中华消化内镜杂志

Objective@#To study influencing factors on the detection rate of colorectal polyps by repeated examination in colonoscopy.@*Methods@#A total of 900 patients in the digestive endoscopy center of the People′s Hospital of Xinjiang Uygur Autonomous Region received colonoscopy, 300 patients were randomly selected for a second examination and they were selected for three times examination from August 2016 to March 2017. Objective factors for colonoscopy were strictly controlled during the examination, such as endoscopists′ experience, endoscopic operating method, cleansing degree of the intestine and withdrawal time. The characteristics of polyps were recorded, including number, location, shape, size and pathological types of polyps. The characteristics of polyps were compared between the same patient, and between the first-examination group, the second-examination group and the third-examination group. Logistic regression was used to analyze the independent influencing factors of missed diagnosis.@*Results@#A relatively high rate of missed diagnosis could occur in multiple polyps, ascending colon polyps, transverse colon polyps, sigmoid polyps, stepless polyps and small polyps (<5 mm) (All P<0.05), and the pathological type was irrelevant to missed diagnosis (P>0.05). Logistic regression analysis showed that the number, location, shape and size of colorectal polyps were all independent factors influencing the detection rate(all P<0.05). The detection rate of polyps in the two times colonoscopy group was higher than that of the one time colonoscopy group, but there was no statistical difference between the second observation and the third observation (P>0.05).@*Conclusion@#The number, location, shape and size of colorectal polyps are all independent factors influencing the detection rate. The detection rate of polyps may be improved by using the second colonoscopy.

Diagnostic value of i-Scan high definition endoscopy for screening polypoid lesions in right hemicolon / 中华消化内镜杂志

Objective To explore the diagnostic value of the i-Scan for detection of polypoid lesions in right hemicolon during colonoscopy. Methods A total of 200 patients who underwent colonoscopy in Beijing Shijitan Hospital from January 2015 to December 2015 were enrolled. After completion of the first colonoscopy in right hemicolon, a second withdrawal was performed, using white light mode ( white light group, n=93) and i-Scan mode ( i-scan group, n=96) to detect polypoid lesions in the proximal colon. The detection rates of polyp and adenoma were compared between the two groups. Results During the twice withdrawal, compared with white light group, more polyps and adenomas were detected in i-Scan group (1. 469 VS 1. 011, P=0. 028; 0. 979 VS 0. 624,P=0. 039). The proportion of patients with more polyps and adenomas in the i-Scan group was significantly higher than that in the white light group [ 37. 5％( 36/96) VS 22. 6％ ( 21/93) , P=0. 025;24. 0％ ( 23/96) VS 11. 8％ ( 11/93) ,P=0. 030] . i-Scan mode detected more small polyps with diameter<5 mm [ 84. 0％ ( 42/50 ) VS 58. 3％ ( 14/24 ) , P=0. 016 ] . However, there were no differences between the two groups in the size, location, and morphology of the detected adenomas ( all P>0. 05) . The polyp detection rates of the i-Scan group and white light group were 61. 5％ (59/96) and 48. 4％ (45/93), respectively (P=0. 071), and the adenoma detection rates were 47. 9％ (46/96) and 35. 5％ (33/93), respectively (P=0. 083). Conclusion I-Scan mode can increase the detection rate of polyps and adenomas in right hemicolon, and improve detection of polypoid lesions and bsmall polyps in patients with multiple polyps and adenomas.

Correlation Between Serum Uric Acid,Serum Lipids and Colorectal Polyps / 胃肠病学

Background:Colorectal polyps(CRP)has nonspecific clinical manifestation,and is closely related to the pathogenesis of colorectal cancer. Studies have shown that abnormalities of serum uric acid(UA),serum lipids are closely related to pathogenesis of CRP,but is still in controversial. Aims:To investigate the correlation between serum UA,TG, TC,LDL-C,HDL-C and incidence of CRP. Methods:A total of 142 CRP patients from Jan. 2016 to Oct. 2016 at Qingdao Municipal Hospital were enrolled,and 116 patients without CRP were served as controls. The serum levels of UA, TG,TC,LDL-C,HDL-C were determined,and correlation between UA and serum lipids was analyzed. Results:Compared with controls,serum levels of TG,UA were significantly increased in CRP patients(P<0.05),HDL-C level was significantly decreased(P<0.05),however,no significant differences in TC,LDL-C levels were found between the two groups. Serum UA level was positively correlated to TG,TC,LDL-C levels in patients with CRP(r=0.32,r=0.21, r=0.15;P<0.05),and negatively correlated to HDL-C level(r= -0.07,P<0.05). Conclusions:Increased serum TG and UA levels and decreased serum HDL-C level may be correlated to the pathogenesis of CRP. The interaction between serum UA,TG,TC,LDL-C and HDL-C may increase the risk of CRP.

Analysis of Correlation Between Nonalcoholic Fatty Liver Disease and Colorectal Polyps / 胃肠病学

Background:Nonalcoholic fatty liver disease(NAFLD)is the liver manifestation of metabolic syndrome,and may be related with the incidence of colorectal polyps. However,studies on the correlation between NAFLD and colorectal polyps are rare. Aims:To investigate the correlation between NAFLD and colorectal polyps. Methods:Clinical data of 130 asymptomatic patients accepted physical examination were retrospectively analyzed. Detection rates of NAFLD and colorectal polyps were evaluated,and the correlations with body mass index(BMI),hs-CRP,triglyceride,low density lipoprotein,total cholesterol,alanine aminotransferase(ALT),glutamyltranspeptidase(GGT)were analyzed. Results:Compared with non-NAFLD patients,the detection rate of colorectal polyps in NAFLD patients was significantly increased (66.3% vs. 40.0%,P=0.003 9),BMI,triglyceride and ALT were significantly increased(P<0.05). However,no significant differences in hs-CRP,low density lipoprotein,total cholesterol and GGT were found between NAFLD and non-NAFLD patients. Compared with non-colorectal polyps patients,the average age of patients with colorectal polyps was higher(P =0.013),and detection rate of NAFLD was significantly increased(72.6% vs. 47.4%,P =0.003 9). However,no significant differences in BMI,hs-CRP,triglyceride,low density lipoprotein,total cholesterol,ALT,GGT were found between colorectal polyps group and non-colorectal polyps group(P>0.05). Conclusions:NAFLD may be closely correlated with the incidence of colorectal polyps.

Progress in Research on Serrated Polyps / 胃肠病学

Colorectal cancer is a common malignant tumor of digestive tract,and its carcinogenesis pathway includes adenoma pathway (50％-70％),de novo pathway (3％-5％) and serrated polyps pathway (30％-50％).Although a lot of studies on serrated polyps have been published,there is still no consensus understanding on carcinogenesis,endoscopic features and therapeutic strategies of serrated polyps.This article reviewed the endoscopic features,molecular pathological features,and therapeutic strategies of serrated polyps.

A randomized controlled clinical trial of full-spectrum endoscopy versus conventional colonoscopy for the diagnosis of colonic polyps / 中华消化内镜杂志

Objective To evaluate the diagnostic efficiency of full-spectrum endoscopy(FUSE) versus conventional colonoscopy for colonic polyps and adenoma. Methods Patients who underwent colonoscopy were randomly allotted into two groups according to randomization and self-control criteria. Patients in group A underwent conventional endoscopy firstly and then to FUSE. Patients in group B were opposite performed the examinations. The polyps and adenomatous polyps were resected or biopsied for pathological examination. Miss rate of colonic polyps as well as adenomatous polyps was calculated. Results A total of 100 patients were recruited for the study,including 45 in group A and 55 in group B. FUSE was significantly superior compared to conventional endoscopy with lower miss rate of polyps(6.52% VS 34.04%,χ2=17.685,P=0.000)as well as adenomatous polyps(5.00% VS 34.38%, χ2=11.774, P=0.001). For the first endoscopic examination,the adenomatous polyps which were found out by FUSE were more than that of ordinary colonoscopy in the right colon(χ2=5.153,P=0.023). The size of adenoma found by ordinary colonoscopy and FUSE was no statistically different whether in the first(t=0.334,P=0.739)or second(t=1.297,P=0.219)endoscopic examinations. Conclusion FUSE is useful to improve the quality of endoscopic examination because of its broad view-field.