Polipectomia a frio: um procedimento seguro para remover pequenas lesões colorretais não pediculadas / Cold snare polypectomy: a safe procedure for removing small non-pedunculated colorectal lesions

ABSTRACT Background: Polypectomy is an important treatment option for preventing colorectal cancer. Incomplete polyp resection (IPR) is re­cognized as a risk factor for interval cancer. Objective: The primary objective was to evaluate the complete polyp resection (CPR) rate for cold snare polypectomy (CSP) in small non-pedunculated polyps and, secondarily, specimen retrieval and complication rates. Methods: We prospectively evaluated 479 polyps <10 mm removed by CSP in 276 patients by an inexperienced endoscopist. Results: A total of 476 polyps (99.4%) were resected en bloc. A negative margin (classified as CPR) was observed in 435 polyps (90.8%). An unclear or positive margin (classified as IPR) was observed in 43 cases (9.0%) and 1 case (0.2%), respectively, for an overall IPR rate of 9.2% (44/479). The IPR rate was 12.2% in the first half of cases and 5.9% in the second half (P=0.02). Dividing into tertiles, the IPR rate was 15.0% in the first tertile, 6.9% in the second tertile, and 5.7% in the third tertile (P=0.01). Dividing into quartiles, the IPR rate was 15.8% in the first quartile and 5.9% in the fourth quartile (P=0.03). The IPR rate was 6.3% for type 0-IIa lesions and 14.1% for type 0-Is lesions (P=0.01). For serrated and adenomatous lesions, the IPR rate was 9.2%. Specimen retrieval failed in 3.6% of cases. Immediate bleeding (>30 s) occurred in 1 case (0.2%), treated with argon plasma coagulation. No delayed bleeding or perforation occurred. Conclusion: CSP is a safe technique that provides good results for the resection of small non-pedunculated polyps, with a short learning curve.

RESUMO Contexto: A polipectomia é uma importante opção terapêutica na prevenção do câncer colorretal (CCR). A ressecção incompleta do pólipo (RIP) é reconhecida como fator de risco para o câncer de intervalo. Objetivo: O principal objetivo foi avaliar o índice de ressecção completa da polipectomia a frio (PF) em pequenos pólipos não pediculados e, secundariamente, a recuperação do espécime e índice de complicações. Métodos: Avaliamos prospectivamente 479 pólipos <10 mm removidos por PF em 276 pacientes, por um endoscopista sem experiência com este método. Resultados: Foram ressecados em bloco 476 pólipos (99,4%). Tivemos margem negativa, considerada ressecção completa do pólipo (RCP), em 435 (90,8%) casos. Margem indefinida ou positiva (classificada como RIP) foi observada em 43 (9,0%) casos e em 1 (0,2%) caso, respectivamente, com um índice global de RIP de 9,2% (44/479). O índice de RIP foi de 12,5% na primeira metade dos casos e 5,9% na última metade (P=0,02). Dividindo em tercis, o índice de RIP foi de 15,0% no primeiro terço, 6,9% no segundo terço e 5,7% no terceiro quarto, P=0,01. Dividindo em quartis, o índice de RIP foi de 15,8% no primeiro quarto, enquanto o último quarto foi de 5,9%, P=0,03. O índice de RIP foi de 6,3% para lesões tipo 0-IIa e de 14,1% para lesões tipo 0-Is, P=0,01. O índice de RIP foi de 9,2% para lesões serrilhadas e adenomatosas. Houve falha na recuperação dos espécimes em 3,6% dos casos. Sangramento imediato (>30 s) ocorreu em um caso (0,2%), controlado com plasma de argônio. Sem sangramento tardio e perfuração. Conclusão: PF é uma técnica segura que apresenta bons resultados para a ressecção de pequenas lesões não pediculadas, com uma curta curva aprendizado.

Prognostic roles and survival benefits of endoscopic resection versus surgical resection in the management of malignant colon polyps

Background: Due to few sufficient data regarding the comparison between endoscopic and surgical resection of malignant colorectal polyps regarding outcomes and survival benefits, there are no clear guidelines of management strategies of malignant colorectal polyps. The aims of the present study were to compare endoscopic resection alone and surgical resection in patients with malignant polyps in the colon (T1N0M0) readings advantages, disadvantages, recurrence risks, survival benefits, and long-term prognosis to detect how management strategy affects outcome. Patients and methods: we included 350 patients. All included patients were divided into 2 groups; the first group included 100 patients who underwent only endoscopic polypectomy and the second group included 250 patients who underwent endoscopic polypectomy followed by definitive surgical resection after histopathological diagnosis. We followed all patients for about 5 years, ranging from 18 to 55 months. The primarily evaluated parameters are surgical consequences and patients' morbidity. The secondary evaluated parameters are recurrence risks, recurrence free survival, and overall survival rates. Results: The age of patients who underwent polypectomy is usually younger than the surgical group, males have more liability to polypectomy in comparison with females. Patients with tumors in the left colon have more liability to polypectomy in comparison with the right colon (p< 0.0001). Tumor factors associated with more liability to surgical resection are presence of lymphovascular invasion, high grade, and poor tumor differentiation (p< 0.0001). The management strategy was the most significant predictor of overall and recurrence free survival rates in patients with malignant colon polyps (p< 0.001). Conclusions: We found that survival benefits and lower incidence of recurrence are detected in the surgical resection group more than in the polypectomy group. (AU)

Gastric endoscopic mucosal resection and polypectomy among patients with liver cirrhosis and esophageal varices in the setting of acute upper gastrointestinal bleeding

Background Gastric polyps are not infrequently reported among cirrhotic patients. Endoscopic resection of gastric polyps among patients with liver cirrhosis and esophageal varices carries the risk of post-polypectomy bleeding. This may explain why endoscopists are reluctant to its excision. The aim is to evaluate the incidence of immediate (intraoperative) and delayed (within 30 days) post-polypectomy bleeding among cirrhotic patients with esophageal varices and portal hypertension and determine its risk factors. Methods This study comprised 39 cirrhotic patients with portal hypertension and varices who presented with gastrointestinal bleeding, and they had gastric polyps detected during th endoscopic intervention to control the acute bleeding or during follow-up. All patients were exposed to the entire history, clinical examination, and basic laboratory workup. Esophagogastroduodenoscopy was done to combine bleeding control and polypectomy simultaneously. Results Immediate (intraoperative) post-polypectomy bleeding occurred in 38.8% of patients, and no delayed bleeding was reported. Most of the reported bleeding was mild and clinically non-significant, and it stopped spontaneously or endoscopically. Furthermore, no mortality was reported. The risk of immediate (intraoperative) bleeding significantly increased with advanced age, advanced liver disease, increased portal hypertension with large varices, and decreased platelet count; meanwhile, the sex of patients, size, location, and method of polypectomy did not significantly increase the risk of gastric post-polypectomy bleeding among cirrhotic patients with portal hypertension and esophageal varices. Conclusions. Among patients with cirrhosis and portal hypertension, gastric polypectomy simultaneously done during endoscopic intervention for esophageal varices is considered a safe maneuver.

Comparison study colonic polypectomy / Монголын Анагаах Ухаан

Introduction@#Colorectal cancer remains one of the critical healthcare challenges nowadays. There are a lot of studies done on colonic polypectomy around the world, and mostly diagnosis with dysplasia change, so we consider to chose to study this topic.@*Aim@#In this study, we aimed to compare the between cold snare polypectomy (CSP) and hot snare polypectomy (HSP) of removing colon polyps. This method helped us to investigate which of the two methods is most prevalent for polypectomy.@*Materials and Method@#The research was carried out using a targeted sampling method from the cases where colonoscopy was performed between 2022 and 2023, based on the Center for Imaging Diagnostics and Pathology of Third General Hospital of Mongolia with a colon polyps less than 5mm in size should be removed using the cold snare method according to the recommendation, and polyps between 5-10 mm should be removed using the hot snare method. After polypectomy, we assessed deep mucosal lesions using the Sydney classification.@*Result@#The average age of the 81 cases included in the study was 57.9 years, and the male-female ratio was 1:1.2.149 cases (75.6%) of slightly elevated type 0-IIa according to the Paris classification, according to the morphological structure revealed by endoscopy, while 79 cases (75.6%) were tubular adenoma according to histological analysis. (38.9%), low grade dysplasia 52 (25.6%) and high grade dysplasia 3 (1.5%) cases are noteworthy. Average polyp was 5-9 mm. Most of polyps removed was left side of colon especially in sigmoid colon. Bleeding rate was higher in hot snare method 11.5%. (1/149, 0.7%, 5/52, 9.6%; P = 0.6). There was no recurrent rate and no perforation in our study. @*Conclusions@#In our study, average size of 5-9 mm were removed and slightly elevated (0-IIa), sessile (0-Is) type of polyps were commonly found in the sigmoid colon. There is a higher risk of bleeding due to mucosal damage in hot snare polypectomy. A combination of hot and cold methods is equally effective for resection of colon pollyps up to 1 cm in size.

A comparative study of cold snare and hot snare resection of colon polyps / Монголын Анагаах Ухаан

Introduction@#Colorectal cancer remains one of the critical healthcare challenges nowadays. Most patients’ disease, especially colorectal polyps develop via the adenoma carcinoma sequence; using colonoscopy with polypectomy reduces both mortality and incidence by removing precancerous adenomas, which are called polyps. In recent years, colorectal cancer tends to increase among Asian population. There are only limited studies that have been conducted in Mongolia regarding colorectal polypectomy and its complications. Both cold polypectomy and hot polypectomy are accepted methods. In this study, we aimed to compare the complications (bleeding, perforation) between cold snare polypectomy (CSP) and hot snare polypectomy (HSP) of adenomas and hyperplastic polyps. After the procedure, repeated endoscopy was performed to compare the incomplete resection rate (IRR) and complete resection rate (CRR) of mucosal residual and presence of recurrency. This method helped us to investigate which of the two methods is most prevalent for polypectomy.@*Materials and Method@#The research was carried out using a targeted sampling method from the cases where colonoscopy was performed between 2020 and 2022, based on the Center for Imaging Diagnostics and Pathology of Third General Hospital of Mongolia with a colonoscopy with a high-performance Olympus EVIS EXERA III brand NBI from Japan. In this study, we selected only hyperplastic polyps and adenomas <10 mm in size. Polyps less than 5 mm in size should be removed using the cold snare method according to the recommendation, and polyps between 5-10 mm should be removed using the hot snare method. After polypectomy, we assessed deep mucosal lesions using the Sydney classification.@*Result @#According to the results of the study, in terms of age, the percentage of people having a polyp removed was relatively low among 15-39 year olds compared to the other age groups, while it was higher in those aged >65 years. In terms of body mass index, 75% of the total number of people who had a tumor removed were overweight, indicating that overweight or obese people are at higher risk of developing a colorectal polyps. In terms of gender, 63% of people who had a polyp removed were male, indicating a male predominance in polyp prevalence. The percentage of tumor questionnaires in the total study population was 0% or absent. Early detection of adenomas and hyperplastic polyps, which are precursors of tumor, is the main way to prevent the development of cancer. A slightly raised polyp was present in 53 or 79.1% of the polyps, while a broad-based polyp occurred in 13 or 19% of the polyps, indicating the predominance of the slightly raised polyp in the population. In terms of location, polyps occurred more often in the descending colon and the sigmoid colon, and complications (perforation, bleeding) related to the anatomical structure and location are more likely to occur in these parts of the colon. However, the likelihood of relapse is very low. The procedure time was 17.6 minutes on average, and in 14 cases, hemostatic clamps were placed to prevent the risk of bleeding, and in 5 cases, epinephrine was injected for hemostasis. Early detection of colorectal diseases (endoscopy), changes in the lifestyle of clients, and regular preventive examinations are the main factors to reduce the risk of cancer development, and early start of treatment as well as complete removal of adenoma, an antecedent to cancer, will have a significant impact on cancer prevention and mortality reduction.@*Conclusions@#</br>1. Left sided polyps were commonly diagnosed among study participants. </br>2. Correlation between the probability of recurrence and the anatomical location of the polyps was very low. </br>3. Our results suggest that HSP and CSP techniques can be effectively used for the complete removal of 4–10mm colorectal polyps. Moreover, there was no significant difference between CSP and HSP in terms of overall complications.

A comparative study of the complications between hot snare and cold snare polypectomy / Монголын Анагаах Ухаан

@#Colorectal cancer remains one of the critical healthcare challenges nowadays. Most patients’ disease, especially colorectal polyps develop via the adenoma carcinoma sequence; using colonoscopy with polypectomy reduces both mortality and incidence by removing precancerous adenomas, which are called polyps. In recent years, colorectal cancer tends to increase among Asian population. There are only limited studies that have been conducted in Mongolia regarding colorectal polypectomy and its complications. Both cold polypectomy and hot polypectomy are accepted methods. In this study, we aim to compare the complications (bleeding, perforation) between cold snare polypectomy (CSP) and hot snare polypectomy (HSP) of adenomas and hyperplastic polyps. After the procedure, repeated endoscopy will be performed to compare the incomplete resection rate (IRR) and complete resection rate (CRR) of mucosal residual and presence of recurrency. This will help us to investigate which of the two methods is most prevalent for polypectomy.

Effect of levonorgestrel intrauterine system assisted progesterone capsule on menstruation and recurrence after hysteroscopic polypectomy in patients with endometrial polyps / 中国医师进修杂志

Objective:To explore the effect of Mirena assisted progesterone capsule in the treatment of endometrial polyps after hysteroscopic polypectomy (TCRP).Methods:One hundred and two patients with endometrial polyps treated with TCRP in Shapingba District People′s Hospital of Chongqing City from September 2018 to September 2019 were randomly divided into observation group and control group, with 51 cases in each group. In the control group, levonorgestrel intrauterine system was placed in the uterine cavity after operation, and the observation group was given progesterone capsule for 3 menstrual cycles on the basis of the control group. The curative effect, endometrial thickness, menstrual condition (menstrual period and menstrual volume) before and after treatment were compared between the two groups; and the endometrial tyrosine kinase growth factor receptor (C-kit), C-kit ligand stem cell factor (SCF) and aldehyde dehydrogenase 1(ALDH1) levels before and after treatment were compared between the two groups.Results:After treatment for 3 menstrual cycles, the total effective rate in the observation group was higher than that in the control group: 96.08% (49/51) vs. 82.35% (42/51), χ2 = 4.99, P<0.05. After treatment for 3 menstrual cycles, the endometrial thickness, menstrual period and menstrual volume in the observation group were shorter than those in the control group: (0.50 ± 0.09) cm vs. (0.63 ± 0.12) cm, (5.08 ± 0.64) d vs. (6.14 ± 0.79) d, (182.27 ± 15.04) ml vs. (236.17 ± 17.18) ml, the differences were statistically significant ( P<0.05). After treatment for 3 menstrual cycles, the levels of C-kit, SCF and ALDH1 in the observation group were shorter than those in the control group: 0.11 ± 0.02 vs. 0.18 ± 0.03, 0.20 ± 0.04 vs. 0.29 ± 0.05, 0.13 ± 0.03 vs. 0.20 ± 0.04, and the differences were statistically significant( P<0.05). The recurrence rate 12 months after treatment in the observation group was lower than that in the control group: 2.08% (1/48) vs. 17.07% (7/41), χ2 = 4.38, P<0.05. Conclusions:The treatment of levonorgestrel intrauterine system combined with progesterone capsule has a positive effect on the recovery of endometrium and menstruation after TCRP for endometrial polyps. It can regulate the expression of related factors in endometrial tissue and reduce recurrence.

The risk of post-polypectomy bleeding among patients receiving antithrombotic agents: A prospective observational study

ABSTRACT BACKGROUND: In July 2012, the Japan Gastroenterological Endoscopy Society updated their guidelines for gastroenterological endoscopy in patients receiving antithrombotic therapy. Colonoscopic polypectomy procedures are associated with a high risk of bleeding. OBJECTIVES: The present study evaluated the safety of colonoscopic polypectomy procedures in terms of bleeding, among patients receiving antithrombotic therapy. DESIGN AND SETTING: Prospective observational study conducted in a tertiary-level public cardiovascular hospital in Istanbul, Turkey. METHODS: Colonoscopic polypectomies carried out in a single endoscopy unit between July 2018 and July 2019 were evaluated prospectively. The patients' data, including age, gender, comorbidities, whether antithrombotic drug use was ceased or whether patients were switched to bridging therapy, polyp size, polyp type, polyp location, histopathology, resection methods (hot snare, cold snare or forceps) and complications relating to the procedures were recorded. RESULTS: The study was completed with 94 patients who underwent a total of 167 polypectomy procedures. As per the advice of the physicians who prescribed antithrombotic medications, 108 polypectomy procedures were performed on 60 patients without discontinuing medication and 59 polypectomy procedures were performed on 34 patients after discontinuing medication. The age, gender distribution and rate of bleeding did not differ significantly between the patients whose medication was discontinued and those whose medication was continued (P > 0.05). CONCLUSION: This study found that the colonoscopic polypectomy procedure without discontinuation of antithrombotic medication did not increase the risk of bleeding. This procedure can be safely performed by experienced endoscopists in patients with an international normalized ratio (INR) below 2.5.

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.

Effect of nutritional status and comfortability of early postoperative diet of patients following sedated colonoscopic polypectomy / 中国实用护理杂志

Objective:To investigate the effect of nutritional status and comfortability of early postoperative diet of patients following sedated colonoscopic polypectomy.Methods:A total of 300 patients who undergoing sedated colonoscopic polypectomy were randomly divided into normal group and experimental group 1, group 2, with 100 cases in each group. The control group received total fasting with intravenous infusion, oral clear fluids were begun up on the first postoperative day and solid foods on the fourth day. In the experimental group 1 and group 2, clear fluids were begun up to six hours or two hours after surgery, respectively, followed by semi-liquid on the first postoperative day, and solid food three days later. The clinical outcomes such as time of first defecation, hospitalization time, abdominal pain, hypoglycemial reaction, bleeding volume and nausea/vomiting was recorded between three groups. In addition, the nutritional status and comfortability was compared by using serum albumin detection and Visual Analogue Scale (VAS), respectively.Results:The time of first defecation were (22.46±2.96) hours and (21.54±2.17) hours in the experimental group 1 and group 2, significantly shorter than that in the control group (26.37±4.87) hours; meanwhile, the time of first defecation were significantly decreased in the experimental group 2 compared to the experimental group 1, the difference was statistically significant ( F value was 51.812, P<0.05). The rate of hypoglycemial reaction were 5.10% (5/98) and 2.04% (2/98) in the experimental group 1 and group 2, significantly lower than that in the control group 13.40% (13/97), the difference was statistically significant ( χ2 value was 10.582, P<0.05). After 5th day of surgery, the level of serum albumin were (36.16±6.44) g/L and (36.55±6.57) g/L in the experimental group 1 and group 2, significantly higher than those in the control group (33.97±5.91) g/L, the difference was statistically significant ( F value was 4.732, P<0.05). However, there was no significant difference in the VAS scores among the three groups ( P>0.05). Conclusion:Two hours after sedated colonoscopic polypectomy oral feeding can obviously promote the recovery of gastrointestinal function, which does not increase the occurrence of postoperative complications, and promote the postoperative recovery of the patients.

Cold snare polypectomy for colorectal adenoma: a retrospective cohort study / 中华消化内镜杂志

Objective:To explore the curative effect and safety of cold snare polypectomy for colorectal adenoma of less than 15 mm.Methods:Data of 464 colorectal adenoma from 315 patients who were treated with cold snare polypectomy (CSP) and cold endoscopic mucosal resection (cold EMR) in the Third People′s Hospital of Jingdezhen from January 2018 to December 2019 were collected. Patients were divided into group A(3-5 mm), B (6-9 mm), and C (10-15 mm) according to the size of adenoma. Enbloc resection rate, immediate bleeding during polypectomy, delayed postpolypectomy bleeding, cold snare defect protrusions(CSDPs)and postoperative recurrence were analyzed.Results:The overall enbloc resection rate was 99.4%(461/464), and 100.0%(248/248), 98.8%(170/172), 97.7%(43/44) respectively in group A, B, and C without significant difference( P =0.126, 95% CI: 0.097-0.157). The overall incidence of immediate bleeding during polypectomy was 1.1%(5/464), and 0.4%(1/248), 1.7%(3/172), 2.3%(1/44) respectively in group A, B, and C without significant difference( P = 0.267, 95% CI: 0.227-0.308), showing an upward trend in the immediate postpolypectomy bleeding incidence with the increase of diameter of the polyps. No delayed postpolypectomy bleeding occurred. The overall incidence of CSDPs was 20.5%(95/464), 16.4%(63/384) and 40.0%(32/80) in the group of CSP and cold EMR respectively with significant difference( P<0.001, 95% CI: 0-0.006), showing an upward trend in the incidence of CSDPs with the increase of the diameter. A total of 286 adenomas in 195 patients were followed up. The median follow-up time was 9.7 months. Three patients relapsed. Conclusion:CSP is safe and effective for colorectal adenoma ≤15 mm with low incidence of immediate bleeding during polypectomy and recurrence, and no delayed postprocedural bleeding.

Pólipo del colon que genera un síndrome de ball valve. Reporte de un caso (con video) / Ball Valve syndrome caused by a colon polyp. Case report (with video)

Resumen La obstrucción intestinal es una patología potencialmente letal y cuyo tratamiento, por lo general, es quirúrgico. Presentamos el caso de un paciente con dolor abdominal y clínica de obstrucción intestinal recurrente, en quien se documenta, durante una colonoscopia, un gran pólipo pediculado que causaba obstrucciones parciales por el fenómeno de ball valve.

Abstract Intestinal obstruction is a potentially lethal pathology, and its treatment is usually surgical. The following is the case of a patient with abdominal pain and recurrent intestinal obstruction, in whom a large pediculated polyp that caused partial obstruction by Ball valve effect was observed during a colonoscopy.

Melanoma del canal anal: a propósito de un caso / Melanoma of the anal canal: a propos of a case

RESUMEN Los melanomas mucosos son tumores poco frecuentes y de mal pronóstico. Presentan un comportamiento agresivo, y pueden tener varias localizaciones en el aparato digestivo. Este tipo de tumores es más frecuente en la región anorectal. Se presentó un caso de una paciente femenina de 59 años, con un cuadro de varios meses de evolución; caracterizado por ardor, prurito anal y sensación de masa que prolapsaba a través del ano. Se constató al examen físico masa tumoral aspecto polipoideo. Se realizó polipectomía donde la biopsia arrojó como resultados el aspecto histológico de un melanoma mucoso de canal anal.

ABSTRACT Mucous melanomas are few frequent and have a bad prognosis. They present an aggressive behavior and might have several locations in the digestive system. This kind of tumors is more frequent at the anus-rectal region. The authors presented the case of a female patient, aged 59 years, with clinical conditions of several months of evolution, characterized by burning, anal pruritus and the sensation of a mass prolapsing through the anus. A tumor mass of polypoid aspect was found at physical examination. Polypectomy was carried out and the biopsy showed the histologic aspect of a mucous melanoma of the anal canal.

El signo de la hermana María José, un hallazgo semiológico que no se debe olvidar. Reporte de un caso (con video) / The Sister Mary Joseph Nodule, a Semiological Finding that Should not Be Forgotten. Case Report with Video

Resumen Se presenta el caso de una paciente con hemorragia digestiva alta, en quien durante el examen físico se documentó el signo de la hermana María José, que se confirmó ulteriormente mediante endoscopia digestiva y estudios histopatológicos la presencia de un cáncer gástrico avanzado.

Abstract We present the case of a patient with upper gastrointestinal bleeding for whom the Sister Mary Joseph nodule was documented during the physical examination. Later, advanced gastric cancer was confirmed by means of digestive endoscopy and histopathological studies.

First Characterization with Ultrasound Contrast Agent of a Fibrovascular Polyp Before Its Endoscopic Resection: A Case Report (with Videos)

We described for the first time the contrast enhancement of a giant fibrovascular esophageal polyp using ultrasound contrast agent, Sonovue® (Bracco, Milan, Italy) during echoendoscopy. Fine Doppler was unsuccessful in showing vascularization due to the mobile characteristic of the tumor. In contrast, via Sonovue®, tissue microcirculation was highlighted inside the entire head of the polyp, leading to better appreciate the risk of bleeding related to its resection. In a second part, we showed the feasibility of classic polypectomy for this giant polyp (5×5 cm) without complication and results of control endoscopy at 3 months. The present case is summarized in a video.

Risk factors of delayed colonoscopic post-polypectomy bleeding / 中华消化内镜杂志

Objective To analyze the risk factors of delayed post-polypectomy bleeding ( DPPB) of colonoscopy. Methods The data of 459 patients who underwent colonoscopic polypectomy between January 2014 and May 2017 were summarized, and the risk factors of DPPB were analyzed. Results Among the 459 patients, a total of 572 polyps were removed, and DPPB occurred in 27 patients with 42 polyps. Univariate analysis revealed that gender (male 85. 2%), number of polyps removed (≥3 polyps, 59. 3%), complicated with hyperlipidemia (29. 6%), polyps′diameter (≥10 mm, 66. 7%), morphology (pedunculated, 81. 0%), pathological type ( adenoma, 95. 2%), and excision method ( endoscopic mucosal resection, 90. 5%) were significantly correlated with DPPB ( all P＜0. 05). Logistic regression analysis showed that gender, with hyperlipidemia, number of polyps removed, polyps′ size, and morphology were independent risk factors of DPPB (P＜0. 05). Conclusion The risk factors of DPPB include male, complicated with hyperlipidemia, excision of more than 3 polyps, more than 10 mm in diameter, and pedunculated morphology.

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.

Efficacy of ultrasonograpy-guided bilateral superior laryngeal nerve block for polypectomy of vocal cord by laryngoscope / 临床麻醉学杂志

Objective To investigate the effect of ultrasonograpy (US )-guided bilateral superior laryngeal nerve (SLN)block by different concentrations of lidocaine combined with intrave-nous anesthesia for polypectomy of vocal cord by laryngoscope.Methods Sixty patients,aged 18-65 years, ASA physical status Ⅰ or Ⅱ, scheduled for elective polypectomy of vocal cord by laryngoscope were divided into 3 groups (n=20 each)using a random number table:US-guided bilat-eral SLN block by 2% lidocaine (group A),S-guided bilateral SLN block by 1% lidocaine (group B), and traditional SLN block by 2% lidocaine (group C).HR,MAP,SpO2and plasma concentration of NE were detected at the time of patients entering the operating room (T0),immediately after intuba-tion(T1),suspensing laryngoscopy (T2),5 min after suspensing laryngoscopy (T3),immediately af-ter extubation(T4),5 min after extubation(T5).Extubation time and side effects such as dysphagia and dyspnea in two hours after extubation were recorded as well.Results HR and MAP in the three groups at T1-T5were increased compared to T0(P<0.05).Compared with group C,HR and MAP in groups A and B were decreased at T1-T5(P<0.05).Plasma concentration of NE of groups A and B was more significantly decreased than group C (P<0.05),and extubation time of groups A and B was less than that of group C (P <0.05 ).Conclusion US-guided bilateral SLN block by 1% lidocaine has definite effect and better comfort level,with stable haemodynamics and less extubation time.

Safety and efficacy of endoscopy therapy for early colorectal carcinoma / 中华消化内镜杂志

Objective To evaluate safety and efficacy of endoscopy therapy for early colorectal carcinoma of different types. Methods Clinical data of 113 patients with early colorectal carcinoma who were treated with different endoscopic therapies including polypectomy,EMR and ESD(ESD with snare and standard ESD)were retrospectively analyzed. The size, en bloc resection rate, curative resection rate, procedure time,associated complications and recurrence rate were compared among groups. Results Eleven pedunculated lesions were treated with polypectomy or EMR, which were en bloc resected and curative resected with no complication or local recurrence. Nineteen semi-pedunculated lesions were treated with EMR or ESD with no complications. Lesions treated with EMR were smaller than those of ESD(P=0.026), and had a lower en bloc resection rate[77.8%(14/18)VS 1/1,P=1.000]. The difference of curative resection rate and recurrence rate between groups was not significant(P>0.05). Eighty-three sessile lesions were treated with all three procedures.Lesions treated with ESD were larger than EMR(P=0.000),with a higher curative resection rate than EMR[95.5%(42/44)VS 77.8%(28/36),P=0.041]and a longer procedure time than EMR(P=0.000). There were no significant difference in severe complications[9.1%(4/44)VS 0],en bloc resection rates and recurrence rates(P>0.05). Ten lesions treated with ESD-S had a medium size between EMR and standard ESD group, with a significant shorter procedure time than standard ESD group(36.9 ± 24.7 min VS 120.4 ± 152.3 min, P=0.004).They were en bloc resected and complete resected. Conclusion Endoscopic treatment is safe and effective for early stage colorectal carcinoma. In order to get en bloc curative resection,endoscopists should carefully choose a suitable technique based on the macroscopic morphology of lesions. ESD-S can be used as a transitional method from EMR to ESD.

Colorectal cancer screening

Colorectal cancer, which is the leading cancer in Singapore, can be prevented by increased use of screening and polypectomy. A range of screening strategies such as stool-based tests, flexible sigmoidoscopy, colonoscopy and computed tomography colonography are available, each with different strengths and limitations. Primary care physicians should discuss appropriate screening modalities with their patients, tailored to their individual needs. Physicians, patients and the government should work in partnership to improve uptake of colorectal cancer screening to reduce the morbidity and mortality from colorectal cancer.