Application of preoperative colonoscopic autologous blood labeling to localization for laparoscopic colorectal surgery / 中华消化内镜杂志

To evaluate the effect of preoperative colonoscopic autologous blood labeling to localization for laparoscopic colorectal surgery, data of 30 patients with colorectal neoplasms who underwent colonoscopic autologous blood localization followed by laparoscopic surgery in Shanghai East Hospital, Tongji University from January 2019 to January 2021 were retrospectively analyzed. The location of lesions was determined by local red marks on the serosal surface of the colon during laparoscopic surgery. The clarity of staining and whether there was leakage of injected autologous blood were observed. All patients successfully completed the localization of autologous blood under colonoscopy, without bleeding, perforation, fever or other complications. Laparoscopic exploration showed clear sites of autologous blood staining, without staining dispersion or leakage polluting the operation field. Postoperative pathology confirmed that the margin of the specimen was negative. The injection of autologous blood under colonoscopy is a safe and effective preoperative localization method for laparoscopic colorectal neoplasms surgery, which is worthy of clinical recommendation.

Efficacy of Fecal Microbiota Transplant in Patients with Moderate or Severe Irritable Bowel Syndrome in India

Background and Aim: To study effect of FMT in patients with moderate or severe IBS. Methods: Patients with IBS for more than one year were offered three sessions of colonoscopicFMT in addition to standard of care. Severity of disease, psychological distress and QOL were assessed by IBS-SSS, HAM-D, HAM-A and WHO-QOL scores. Results: Ten patients with IBS (IBS-D 5, IBS-C 4 and IBS-M 1) were studied. Median IBS-SSS reduced from 313.5 (SD ± 66.8) at baseline to 163 (SD ± 84.5) at 1 week (p = 0.0005), 216 (SD ± 79.3) at 2 weeks (p = 0.003), 201(SD ± 86.6) at 4 weeks (p = 0.005) and 262 (SD ± 69.4) at 8 weeks. Median IBS-SSS at 12 weeks and 24 weeks was not significantly different from baseline. Reduction of IBS-SSS severity was seen in 8 (80%) patients at one week, 6(60%) at 2 and 4 weeks, 3(30%) at 8 weeks and 1(10%) at 12 and 24 weeks. weeks. Of four patients with depression, there was improvement in two patients at 2 and 4 weeks and one at 8 weeks. Quality of life improved in four patients at 2, 4 and 8 weeks, two patients at 12 weeks and one at 24 weeks. Three patients reported marked improvement of symptoms at 12 months along with change in stool odor to donor type. Conclusion: FMT results in short-term improvement in global symptoms of IBS, psychological distress and QOL. Repeat sessions of FMT did not accrue additional benefit.

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.

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.

Quality Assessment of Colonoscopy in CWM Hospital From 2012 to 2016

Introduction@#Colonoscopy is the cornerstone in diagnosis and management of colorectal disease allowing direct optical diagnosis, tissue sampling for histological analysis and therapy of colonic lesions. It is a multi-step process and therefore assessment of all aspects of the procedure must be addressed. The main aim of the study is to assess the quality of colonoscopy services in the Colonial War Memorial Hospital from 1st January, 2012 to December 2016.@*Methodology@#A 5-year single-centre, retrospective study.@*Results@#A total of 341 colonoscopies were included in the study. Six Quality indicators of colonoscopy which are applicable to our setting were chosen for the study. The study showed a Cecal Intubation rate of 67% is well below the recommended rate of 90%. The bowel preparation quality is adequate in 53% of the cases compared to a recommended rate of 85%. The withdrawal time has not yet been introduced however, an average withdrawal time of above 6 minutes is recommended for a quality colonoscopy. Acquisition of biopsies in diarrhoea patients was 79% (100% tissue acquisition rate was recommended for quality of colonoscopy). @*Conclusion@#The quality of colonoscopy services carried out at the Colonial War Memorial Hospital has room for improvement in the parameters determining the quality of colonoscopies.

Preoperative Tattooing Using Indocyanine Green in Laparoscopic Colorectal Surgery

PURPOSE: The aim of the present study was to evaluate the usefulness of indocyanine green (ICG) as a preoperative marking dye for laparoscopic colorectal surgery. METHODS: Between March 2013 and March 2015, 174 patients underwent preoperative colonoscopic tattooing using 1.0 to 1.5 mL of ICG and saline solution before laparoscopic colorectal surgery. Patients’ medical records and operation videos were retrospectively assessed to evaluate the visibility, duration, and adverse effects of tattooing. RESULTS: The mean age of the patients was 65 years (range, 34–82 years), and 63.2% of the patients were male. The median interval between tattooing and operation was 1.0 day (range, 0–14 days). Tattoos placed within 2 days of surgery were visualized intraoperatively more frequently than those placed at an earlier date (95% vs. 40%, respectively, P < 0.001). For tattoos placed within 2 days before surgery, the visualization rates by tattoo site were 98.6% (134 of 136) from the ascending colon to the sigmoid colon. The visualization rates at the rectosigmoid colon and rectum were 84% (21 of 25) and 81.3% (13 of 16), respectively (P < 0.001). No complications related to preoperative ICG tattooing occurred. CONCLUSION: Endoscopic ICG tattooing is more useful for the preoperative localization of colonic lesions than it is for rectal lesions and should be performed within 2 days before laparoscopic surgery.

Clinical analysis of 76 patients with colorectal high grade intraepithelial neoplasia diagnosed by colonoscopic biopsy / 中华消化杂志

Objective To analyze colonoscopic appearances,computed tomography (CT) imaging features and their correlation with postoperative pathology in patients with colorectal high grade intraepithelial neoplasia (HGIN) diagnosed by colonoscopic biopsy.Methods From October 2009 to October 2015,patients diagnosed as colorectal HGIN by colonoscopic biopsy who received endoscopic resection or operation,and had complete postoperative pathological data were enrolled.The results of CT imaging before operation,postoperative pathological type,the maximum diameter of lesions,sessile lesions or pedunculated lesions and enlarged lymph nodes were analyzed.Chi-square test were performed for statistical analysis.Sensitivity and specificity of CT imaging before operation in the detection of invasive colorectal cancer were calculated.Results Among the 76 patients,21.1％ (16/76) patients were HGIN,and 78.9％ (60/76) were invasive cancer confirmed by postoperative pathology.The incidence rate of invasive carcinoma in patients aged ≤50 years (3/14) was significantly lower than that of patients aged ＞50 years (91.9％,57/62),and the difference was statistically significant (x2 =30.05,P＜0.01).The incidence rate of invasive carcinoma in protruding lesions with maximum diameter ≥ 3.0 cm was 98.3％ (57/58),which was higher than that of lesions with maximum diameter ＜3.0 cm(2/16),and the difference was statistically significant (x2 =51.91,P＜0.01).The incidence rate of invasive carcinoma in pedicle polyps group (2/13) was lower than that of sessile lesions (93.4％,57/61),and the difference was statistically significant (x2 =35.72,P＜0.01).The sensitivity and specificity of CT in the diagnosis of invasive colorectal cancer was 95.0％ and 84.6％,respectively.The incidence rate of invasive carcinoma in patients with enlarged lymph nodes detected by CT (93.3 ％,42/45) was significantly higher than that of patients without enlarged lymph nodes (64.3％,18/28),and the difference was statistically significant (x2=9.95,P =0.002).Conclusions CT examination can compensate for the diagnostic deficiency of colonoscopic biopsy which inadequately diagnosed some invasive carcinoma as HGIN.The incidence of invasive cancer is high in patients with age over 50 years,large lesions,sessile lesions,CT indicating colorectal neoplasms and with enlarged lymph nodes.

Endoscopic Instruments and Electrosurgical Unit for Colonoscopic Polypectomy

Colorectal polypectomy is an effective method for prevention of colorectal cancer. Many endoscopic instruments have been used for colorectal polypectomy, such as snares, forceps, endoscopic clips, a Coagrasper, retrieval net, injector, and electrosurgery generator unit (ESU). Understanding the characteristics of endoscopic instruments and their proper use according to morphology and size of the colorectal polyp will enable endoscopists to perform effective polypectomy. I reviewed the characteristics of endoscopic instruments for colorectal polypectomy and their appropriate use, as well as the basic principles and settings of the ESU.

Optimal Methods for the Management of Iatrogenic Colonoscopic Perforation

BACKGROUND/AIMS: Colonoscopic perforations have been managed with exploratory laparotomy, and have resulted in some morbidity and mortality. Recently, laparoscopic surgery is commonly performed for this purpose. The aim of this study was to compare the outcomes of several management strategies for iatrogenic colonoscopic perforations. METHODS: We retrospectively reviewed the medical records of patients who had been treated for colonoscopic perforation between January 2004 and April 2013 at CHA Bundang Medical Center in Korea. RESULTS: A total of 41 patients with colonoscopic perforation were enrolled. Twenty patients underwent conservative management with a success rate of 90%. Surgical management was performed in 23 patients including two patients who were converted to surgical management after the failure of the initial conservative management. Among 14 patients who underwent surgery at 8 hours after the perforation, there was no considerable difference in adverse outcomes between the laparotomy group and the laparoscopic surgery group. The medical costs and claim rate were 1.45 and 1.87 times greater in the exploratory laparotomy group, respectively. CONCLUSIONS: Conservative management of colonoscopic perforation could be an option for patients without overt symptoms of peritonitis or with a small defect size. If surgical management is required, laparoscopic surgery may be considered as the initial procedure even with a delayed diagnosis.

Effectiveness of Intraluminal Air Decompression on Postcolonoscopic Pain According to Reinsertion Site / 가정의학회지

BACKGROUND: Colonoscopy is a very effective and essential examination to diagnose colorectal cancer; however, many patients experience discomfort due to post-examination abdominal pain, which reduces colonoscopy compliance. This study was conducted to determine methods for reducing post-colonoscopic abdominal pain. METHODS: We conducted a randomized controlled study of 405 male and female adults who visited Hana General Hospital in Cheongju. We surveyed general characteristics, history of colonoscopy, and other related factors, then categorized examinees into 5 groups (0-5) according to the site of scope reinsertion. Pain was measured using a numeric rating scale (NRS). RESULTS: The mean age of examinees in this study was 47.8 years, and 210 participants had prior experience of colonoscopy. No significant difference was observed between variables, with the exception of reinsertion duration (P=0.005). Pain scores were different between performing physicians (P=0.006), and were higher when the subjective level of procedure difficulty was low (P=0.026) in univariate analysis. Pain scores decreased as the reinsertion site became closer to the proximal colon (P<0.001), but there was no significant difference between groups 3 and 4. The results of multiple logistic regression analysis, including univariate analysis, showed that group 1 had 0.48 times, group 2 had 0.38 times, group 3 had 0.09 times, and group 4 had 0.03 times odds ratio (moderate-to-severe pain, NRS ≥4) than control group 0. CONCLUSION: Air decompression by scope reinsertion is an effective way to reduce abdominal pain after colonoscopy. Removing air when the reinserted scope approaches the hepatic flexure seems to be the most effective method to reduce post-colonoscopic pain.

Risk Factors for Incomplete Polyp Resection during Colonoscopic Polypectomy

BACKGROUND/AIMS: Colonoscopic polypectomy is highly efficient in preventing colorectal cancer, but polyps may not always be completely removed. Improved knowledge of the risk factors for incomplete polyp resection after polypectomy may decrease the cancer risk and additional costs. The aim of this study was to investigate the conditions that can cause incomplete polyp resection (IPR) after colonoscopic polypectomy. METHODS: A total of 12,970 polyps that were removed by colonoscopic polypectomy were investigated. Among them, we identified 228 cases with a positive resection margin and 228 controls with a clear resection margin that were matched for age, gender, and polyp size. We investigated the location, morphology, and histological type of the polyps and evaluated the skills of the endoscopist and assisting nurse. RESULTS: Multivariate analysis revealed that the polyps, which were located in the proximal part of the colon and rectum, were at significant risk of IPR. Histologically, an advanced polyp and an inexperienced assistant were also independent risk factors for IPR. CONCLUSIONS: Polypectomy should be performed more carefully for polyps suspected to be cancerous and polyps located in the proximal part of the colon or rectum. A systematic training program for inexperienced assistants may be needed to decrease the risk of IPR.

Postpolypectomy Fever, a Rare Adverse Event of Polypectomy: Nested Case-Control Study

BACKGROUND/AIMS: Although postpolypectomy fever (PPF) without colon perforation or hemorrhage is rare, its incidence and risk factors have not been investigated. The objective of this study was to analyze the incidence and risk factors for PPF among inpatients. METHODS: Seven patients with PPF were matched with 70 patients without PPF from a total of 3,444 patients who underwent colonoscopic polypectomy. The PPF incidence during index hospitalization after colonoscopy was calculated, and univariate and multivariate analyses were performed to calculate the adjusted odds ratios (ORs) for risk factors. RESULTS: PPF without bleeding or perforation in the colon occurred in seven patients (0.2%). The median age was 58 years for cases and 61 years for controls. The median interval from polypectomy to occurrence of fever was 7 hours, and the median duration of fever was 9 hours. Polyp size >2 cm (adjusted OR, 1.08; 95% confidence interval [CI], 1.01 to 1.15; p=0.02) and hypertension (adjusted OR, 14.40; 95% CI, 1.23 to 180.87; p=0.03) were associated with a significantly increased risk of PPF. PPF increased the length of hospitalization. CONCLUSIONS: Although the crude incidence of PPF is low, PPF may prolong hospitalization. Risk factors for PPF include hypertension and large polyps.

Repetitive Colonoscopic Decompression as a Bridge Therapy before Surgery in a Pregnant Patient with Chronic Intestinal Pseudo-Obstruction

Chronic intestinal pseudo-obstruction is a rare clinical syndrome which is characterized by intestinal obstruction without occluding lesions in the intestinal lumen and pregnancy is one of the important aggravating factors. Here, we report a case of a woman with intractable intestinal pseudo-obstruction that was precipitated by pregnancy. She could not make any stool passage for more than 4 weeks until a fetal gestational age of 17 weeks was reached. However, the patient could be maintained by repetitive colonoscopic decompressions and finally total colectomy could be performed successfully at a fetal gestational age of 21 weeks.

Transanal Endoscopic Microsurgery for the Treatment of Well-Differentiated Rectal Neuroendocrine Tumors

PURPOSE: Recently, an increase in well-differentiated rectal neuroendocrine tumors (WRNETs) has been noted. We aimed to evaluate transanal endoscopic microsurgery (TEM) for the treatment of WRNETs. METHODS: Between December 1995 and August 2009, 109 patients with WRNETs underwent TEM. TEM was performed for patients with tumors sizes of up to 20 mm and without a lymphadenopathy. These patients had been referred from other clinics after having been diagnosed with WRNETs by using a colonoscopic biopsy; they had undergone a failed endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) and exhibited an involved resection margin and remaining tumor after ESD or EMR, regardless of the distance from the anal verge. This study included 38 patients that had more than three years of follow-up. RESULTS: The mean age of the patients was 51.3 +/- 11.9 years, the mean tumor size was 8.0 +/- 3.9 mm, and no morbidity occurred. Thirty-five patients were asymptomatic. TEM was performed after a colonoscopic resection in 13 cases because of a positive resection margin, a residual tumor or a non-lifting lesion. Complete resections were performed in 37 patients; one patient with a positive margin was considered surgically complete. In one patient, liver metastasis and a recurrent mesorectal node occurred after five and 10 years, respectively. CONCLUSION: TEM might provide an accessible and effective treatment either as an initial or as an adjunct after a colonoscopic resection for a WRNET.

Advances in colitis-associated colorectal cancer and dysplasia / 国际外科学杂志

Patients with long-standing history of ulcerative colitis have an increased risk of developing colitis-associated colorectal cancer.The risk factors include longer duration of colitis,greater anatomic extent of colitis,degree of inflammation of the bowel,family history of colorectal callcer,the presence of primary sclerosing cholangitis.etc.The two kinds of molecular pathogenesis that contribute to colon carcinogenesis are chromosomal instability and microsatellite instability.In order to reduce cancer morbidity,colonescopic surveillance and chemoprevention should be carried out in patients with ulcerative colitis especially in those high risk patients.New endoscopic techniques increase the sensitivity and shed a new light on tumor surveillance.

Autoamputation of a Giant Colonic Lipoma

Most colonic lipomas are asymptomatic and need no treatment, whereas lesions larger than 2 cm can cause acute abdominal pain, changes in bowel habits, gastrointestinal bleeding, intussusception or bowel obstruction. Autoamputation of polypoid lesions in the gastrointestinal tract is indeed a rare phenomenon, and its precise mechanism remains unknown. It presumably occurs due to ischemic necrosis of the polyp by peristalsis-induced torsion or tension. Here, we report a case of autoamputation of a giant colonic lipoma in a 48-year-old man. In our case, colonoscopic examination showed a huge autoamputated mass in the rectum and a remnant long stalk in the transverse colon. The autoamputated mass in the rectum was completely removed after fragmentation using an electrosurgical snare, and the remnant long stalk located in the transverse colon was also resected safely by endoscopic snare polypectomy. To our knowledge, these endoscopic treatments for removal of an autoamputated mass and a remnant long stalk of colonic lipoma have not been reported previously.

A Case of Delayed Massive Hemorrhage after Endoscopic Resecting a Rectal Carcinoid Tumor / 대한소화기내시경학회지

Endoscopic resection is currently accepted as a standard therapy for colon polyp because of its safety and efficiency. The indications for endoscopic resection have been expanded to treat mucosal colon cancer and submucosal tumor. The major complications of endoscopic resection are hemorrhage, perforation and post- polypectomy coagulation syndrome. Hemorrhage is the most common complication, and this can occur immediately following colonoscopic polypectomy or it can be delayed after completion of the procedure. Delayed hemorrhage usually occurs within 7 days and this can stop by itself or the hemorrhage can be controlled endoscopically in the majority of patients, with only the unusual and serious cases requiring transfusion, angiography and surgery. We experienced a case of delayed massive hemorrhage with hypotension that required transfusion 12 days after performing endoscopic resection for rectal carcinoid tumor. We report here on this case to provide a good example and to place emphasis on delayed massive hemorrhage after endoscopic resection.

Colonoscopic Perforations: 4 Years' Experience / 대한소화기내시경학회지

BACKGROUND/AIMS: Many physicians agree that colonoscopy is the best modality for either the diagnostic evaluation or use in therapy for colorectal disease. Although the incidence of perforations that occur after colonoscopy is low, the increasing number of performed colonoscopies may pose a relevant health problem with including the often lethal consequences. This study aimed to determine the frequency of perforation and the management of colonoscopic perforation. Modern Korean society has adopted westernized dietary habits, and this has led to an increased incidence of colorectal disease such as colorectal cancer, polyps and diverticulosis. METHODS: We conducted a retrospective review of the medical records of all the patients who underwent colonoscopy complicated by colon perforation between January 2004 and December 2007. The patients' demographics, the purpose of colonoscopy, the location of the perforation, the management and the outcome were compared. RESULTS: A total of 5254 patients underwent either a diagnostic or therapeutic colonoscopy procedure during four consecutive years at a single institution. Iatrogenic colonoscopic perforations (0.2%) were diagnosed in 11 patients (seven males and four females). Perforations occurred in six patients during a diagnostic colonoscopy and these occurred in five patients during a therapeutic colonoscopy. Free air in the peritoneum or retroperitoneum was seen in all the patients, as depicted on plain X-rays. Seven patients were treated with surgical intervention and four patients were treated with conservative management. One of the 11 patients with a perforation expired on postoperative day 47 due to infective endocarditis. CONCLUSIONS: The rate of iatrogenic colonoscopic perforation is still very low. Although perforation is a very serious complication and it can be a lethal malady, early recognition and treatment are very critical factors to optimize the patient outcome. Although a gold standard therapeutic modality has not been established, the patients who present with the signs and symptoms of generalized peritonitis are recommended to undergo early surgical intervention.

Laparoscopic Colectomy: Technical Considerations / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic colectomy is technically demanding. Here we share of experience with laparoscopic procedures with focusing on (1) preoperative localization by a colonoscopic tattoo and (2) comparing the laparoscopic total mesorectal excision (lapaTME) with the conventional TME (openTME) according to microscopic examination. METHODS: We retrospectively collected 112 cases of laparoscopic colectomy that was performed for treating colorectal cancer during the past 6 years. Preoperative colonoscopic tattoo was done by using india ink. The tattoo cases were compared with the non-tattoo cases. Comparison between 13 cases of lapaTME and 15 cases of openTME was assessed by both gross and microscopic examination in the 28 cases for 9 months. The lapaTME and openTME were applied to mid-rectal cancer and mid&low rectal cancer, respectively. RESULTS: Tattoo was carried out for the Tis (100%), T1 (92%), T2 (72%), T3 (36%) cases. Of the significant cases, T3 lesion was not identified at laparoscopic colectomy. LapaTME grossly showed a greater incidence of defect than that of openTME, but there was no difference microscopically between lapaTME and openTME. CONCLUSION: A tattoo was useful for early lesion and it should be considered for advanced lesion. LapaTME for mid-rectal cancer can be done without compromising the principles of TME.

Histological Quality of Small Polyps Resected Uoosing Different Electric Currents in a Colonoscopic Polypectomy / 대한소화기내시경학회지

BACKGROUND/AIMS: Most polyps encountered during a colonoscopic polypectomy are small. Thus, accurate evaluation of small polyp histology is important in the decision-making process. The aim of this study was to assess and compare the histological quality of polyps obtained by the use of snare polypectomy with two different electric currents. METHODS: Consecutive polyps less than 1 cm were identified and removed by use of either the blend mode (Blended mode, Circon, BC-200) or automatic cutting and coagulation mode (Endocut Q mode, effect 3, 40 watts, ERBE, VAIO-300). An experienced gastrointestinal pathologist evaluated the specimens for cautery damage, margin, architecture, presence of muscularis mucosa and general histological quality. RESULTS: Sixty-six patients (77.2% men; mean age, 60.2+/-9.2 years) underwent 109 polypectomies (53 using the blended mode and 56 using the Endocut Q mode; mean polyp diameter, 0.87+/-0.17 mm). Age, gender, location, diameter and the histology of the polyp was not different with the use of both methods. The cautery amount (> or =2) with use of the blended mode was not significantly different than with the use of the Endocut mode (50.9% vs. 39.2%, p=0.22). The cautery degree, margin, architecture, presence of muscular mucosa and overall histological quality was not different with the use of both methods. CONCLUSIONS: The histological quality of polyps less than 1 cm obtained by use of either the blended mode or Endocut Q mode was not different.