ABSTRACT
BACKGROUND: The most common complication of endoscopic polypectomy is hemorrhage. Several factors have been reported to increase the risk of hemorrhage after polypectomy, but controversies still exist. Additionally, the pathomechanism of this complication is not well understood. OBJECTIVE: To investigate the risk factors of colonoscopic postpolypectomy bleeding in patients without bleeding disorders and the blood supply of resected polyps. PATIENTS: Two hundred forty-five patients (147 men, 98 women; median age, 62.8 +/- 9.5 years [SD]) with 283 colorectal polyps, measuring > or =1 cm in diameter, were included in this prospective study. INTERVENTIONS: The polypectomies were performed using the conventional endoscopic method. Data on the patients' age and sex, as well as polyp location, size, shape, and pathology findings were recorded. The patients were observed for bleeding complications. Microscopic examination of the vascular supply of the removed polyps was performed. RESULTS: Twenty-nine postpolypectomy hemorrhages (10.2%) occurred. The bleeding rate correlated with the size, shape, and pathology results of resected polyps. The microscopic analysis revealed that sessile and thick-stalked pedunculated polyps are supplied with more vessels than other polyps. CONCLUSIONS: Patients with polyps larger than 17 mm, pedunculated polyps with a stalk diameter >5 mm, sessile polyps, and malignant lesions of the colorectal region are at high risk of hemorrhage after endoscopic excision. Moreover, on the basis of microscopic study, broad-based polyps are supplied with a considerable number of blood vessels.
Subject(s)
Colonic Polyps/surgery , Colonoscopy/adverse effects , Gastrointestinal Hemorrhage/epidemiology , Intestinal Mucosa/blood supply , Adult , Aged , Aged, 80 and over , Colon/blood supply , Colonic Polyps/pathology , Female , Humans , Male , Middle Aged , Prospective Studies , Risk FactorsABSTRACT
Incidence of postoperative anastomotic stenosis range from 5 to 30 percent though most of them are not clinically relevant. Strictures of gastrointestinal tract (GI) within reach of the endoscope may be treated successfully with dilatation. The aim of the study was to evaluate the technique of endoscopic balloon dilatation in the treatment of GI anastomotic strictures. The procedure of endoscopic dilatation was performed in 17 patients with obstruction due to the postoperative stricture of anastomosis. In 11 patients stenoses were localized in the lower and in 6 patients in the upper digestive tract. In all cases the stricture was caused by scar tissue and had benign character (confirmed by computed tomography and biopsy). Endoscopic hydraulic balloon dilatation was performed using a pressure of 2 atm. All dilatations of the upper digestive tract strictures were successful with immediate relieve of symptoms. In 4 patients with high grade stenoses after low anterior resection of the rectum anastomotic strictures did not dilate after endoscopic treatment. No complications of endoscopic dilatations were observed. Endoscopic balloon dilatation is useful in the treatment of symptomatic gastrointestinal anastomotic stenosis, but good results are expected only in low grade strictures.
