ABSTRACT
Missed polyps are frequently observed in surveillance colonoscopy or referral resection. We evaluated the polyp missing rate and its associated risk factors in patients who were referred to a tertiary hospital for endoscopic resection of advanced colorectal neoplasia.A total of 388 patients with advanced neoplasia who underwent colonoscopy in their referring hospitals and only endoscopic resection without total colonoscopy in Pusan National University Yangsan Hospital from 2009 to 2014 and who underwent surveillance colonoscopy within 6 to 12 months were retrospectively analyzed.The per-patient missing rate for polyps, adenomas, and advanced neoplasia in referring hospital were 58.2% (226 cases), 47.2% (183 cases), and 5.7% (22 cases), respectively. The advanced neoplasia in surveillance colonoscopy comprised the following: ≥1âcm lesions (11 cases, 50%), high-grade dysplasia (4 cases, 18.2%), villous adenoma (4 cases, 18.2%), and invasive cancer (3 cases, 13.6%). Risk factors for missed adenomas in multivariate analysis were ≥60 years (Pâ=â.004), male (Pâ<.001), and no usage of the cap-assisted colonoscopy (Pâ=â.015). Missed polyps/adenomas were most frequent in the ascending colon (Pâ<.001).The missing rate for polyps/adenomas of referring hospitals was higher than expected. Especially, patients with old age or male, or no usage of cap-assisted colonoscopy on initial colonoscopy were at increased risk of missed adenoma. Careful complete colonoscopy during referral resection or early surveillance colonoscopy is mandatory in the patients with advanced colorectal neoplasia and unknown-quality index colonoscopy.
Subject(s)
Colonic Polyps/surgery , Colonoscopy , Colorectal Neoplasms/surgery , Diagnostic Errors , Referral and Consultation , Adenomatous Polyps/diagnostic imaging , Adenomatous Polyps/surgery , Age Factors , Colonic Polyps/diagnostic imaging , Colorectal Neoplasms/diagnostic imaging , Diagnostic Errors/statistics & numerical data , Female , Follow-Up Studies , Humans , Male , Middle Aged , Multivariate Analysis , Referral and Consultation/statistics & numerical data , Retrospective Studies , Risk Factors , Sex Factors , Tertiary Care CentersABSTRACT
Intramural hematoma of the esophagus is a rare condition that can be spontaneous or secondary to trauma, toxic ingestion, or intervention. If it is the spontaneous type, it usually presents initially with epigastric pain, hematemesis or dysphagia. We present a case of intramural hematoma of the esophagus mimicking acute coronary syndrome. A 63-year-old man presented with severe acute chest pain. He has four coronary stents that were inserted five years ago, from a different hospital, and is on dual antiplatelet agents. Coronary angiography was performed immediately under the suspicion of acute coronary syndrome, and we found that there was no obvious clogging of the coronary arteries. Next, chest computed tomography was performed due to suspected aortic dissection, and the result was also negative. Four days later, endoscopy was performed and intramural hematoma covered with large ulcers was diagnosed.
Subject(s)
Esophageal Diseases/diagnosis , Hematoma/diagnosis , Acute Coronary Syndrome/diagnosis , Clopidogrel , Diagnosis, Differential , Endoscopy, Gastrointestinal , Esophageal Diseases/drug therapy , Esophagus/pathology , Hematoma/drug therapy , Humans , Male , Middle Aged , Platelet Aggregation Inhibitors/therapeutic use , Ticlopidine/analogs & derivatives , Ticlopidine/therapeutic use , Tomography, X-Ray ComputedABSTRACT
Midazolam is a type of anesthetic agent frequently used for conscious sedation during a variety of medical procedures. Anaphylactic reactions to midazolam are rarely reported. However, we observed a case of midazolam hypersensitivity in which emergency measures were required to ensure patient recovery after administration of midazolam as a sedative. The occurrence of the anaphylactic reaction to midazolam was confirmed by elevated serum tryptase levels. The current case report presents a discussion of our findings.
