Transanal endoscopic microsurgery in small, large, and giant rectal adenomas.

OBJECTIVE To assess the outcomes of transanal endoscopic microsurgery in small (<3 cm), large (3-5 cm), and giant (>5 cm) lesions and compare these with reports of alternative techniques. DESIGN Data from January 1998 to February 2010 were prospectively collected. Lesions were divided into 3 groups according to the maximum diameter (group A, <3 cm; group B, 3-5 cm; and group C, >5 cm) and outcomes were analyzed separately. SETTING Colorectal unit in a single-district general hospital. PATIENTS Patients diagnosed as having benign rectal adenomas. INTERVENTION Transanal endoscopic microsurgery excision. MAIN OUTCOME MEASURES Completion of excision (R0), en bloc and full-thickness excisions, complication and local recurrence rates, and disease-free survival. RESULTS A total of 320 lesions were analyzed. Overall en bloc and full-thickness excision rates were 99% and 80.7%, respectively. In the 279 benign lesions, the R0 rate was 90.3%. Outcomes for groups A, B, and C were, respectively: 9.3%, 12.8%, and 14.4% incidence of unexpected malignancy (P = .64); 95.9%, 92.2%, and 85.1% R0 resection for benign lesions (P = .19); and 7.4%, 14.9%, and 24.6% complication rates (P < .05). Overall operative mortality was 1 of 320 (0.3%). In group C, there was a higher estimated recurrence rate, therefore a lower disease-free survival than groups A and B; this difference was significant 40 months after surgery. Recurrences were associated with closeness to dentate line and advanced age (univariate analysis) and R1 resection (Cox regression). CONCLUSIONS Outcomes of transanal endoscopic microsurgery on large rectal lesions compared favorably with literature reports of alternative techniques. Postoperative complications and recurrences increased significantly with lesions larger than 5 cm.

Appendiceal intussusception mistaken for a polyp at colonoscopy: case report and review of literature.

We report a case of appendiceal intussusception which was erroneously labelled as a 10-mm polypoid caecal lesion on colonoscopy and, therefore, followed up over an 11-year period before the correct diagnosis was made. We present the radiological and endoscopic appearance of appendiceal intussusception and a review of the literature.

Reduction in late diagnosis of colorectal cancer following introduction of a specialist colorectal surgery service.

INTRODUCTION: An audit of patients presenting with colorectal cancer to our district general hospital during a 2-year period from November 1994 found that 12.1% of cases were diagnosed later than 6 months after initial presentation to a physician. This audit was repeated for a 2-year period from December 2001, to determine whether the introduction of a specialist coloproctology surgery service had led to a reduction in late diagnosis of colorectal cancer. PATIENTS AND METHODS: Case notes were reviewed of all patients presenting with colorectal cancer between December 2001 and November 2003. Late diagnosis was defined as diagnosis of colorectal cancer more than 6 months after their first attendance to either their general practitioner or district general hospital. The results were compared with those of the previous study. RESULTS: Of a total of 218 patients presenting with colorectal cancer during the study period, 14 (6.4%; 10 men and 4 women) satisfied the criteria for late diagnosis, with the longest delay being 12.5 months. Reasons for late diagnosis were false-negative reporting of barium studies (n = 3), inaccurate tumour biopsy (n = 2), concurrent pathology causing anaemia (n = 4), inappropriate delay in definitive investigation (n = 3), and refusal of investigation by patients (n = 2). CONCLUSIONS: There has been a reduction of nearly 50% (12.1% to 6.4%) in the proportion of patients with a late diagnosis of colorectal cancer compared with our previous audit. It is suggested that an important factor in this improvement in diagnosis has been the introduction of a specialist coloproctology surgery service.

Percutaneous endoscopic colostomy in patients with chronic intestinal pseudo-obstruction.

BACKGROUND: Percutaneous endoscopic colostomy was used successfully to treat 3 patients with chronic intestinal pseudo-obstruction whose symptoms were not controlled by conservative measures. METHODS: Percutaneous endoscopic colostomy tubes were placed to allow intermittent decompression of the colon in response to the occurrence of symptoms. The technique and the equipment are the same as for PEG and are described herein. OBSERVATIONS: Symptom improvement was observed in 3 patients, and, to date, surgery has been avoided for all. CONCLUSIONS: Percutaneous endoscopic colostomy is a safe and effective management option for selected patients with chronic intestinal pseudo-obstruction.