Doble revisión de colon derecho vs revisión simple durante lacolonoscopia para la detección de pólipos y adenomas de colon: revisión sistemática de la literatura

El tamizaje por colonoscopia es un método efectivo para prevenir cáncer de colon a traves de la detección de pólipos sobre los cuales se desarrolla en un mayor porcentaje el cáncer de colon; sin embargo la detección de estas lesiones varía en los diferentes segmentos del colon y de ellos en colon derecho su tasa detección suele ser menor. Objetivo: El objetivo de este estudio es evaluar si la doble revisión endoscópica de colon derecho durante la colonoscopia es un mecanismo para mejorar su rendimiento en cuanto a la tasa de detección de pólipos (TDP) y la tasa de detección de adenomas (TDA). Materiales y métodos: Revisión sistemática y metaanálisis de la literatura de estudios clínicos aleatorizados que realizaron una doble revisión del colon derecho por colonoscopia comparado con una revisión simple para mejorar la detección de pólipos y adenomas. El protocolo de esta revisión se publicó en PROSPERO bajo el código CRD42022356509. Resultados: Se incluyeron 5 estudios que incluyeron 2729 participantes. Se informó la detección de pólipos en 585/1197 pacientes (48,87%) después de la segunda revisión, en comparación con 537/1206 (44,52%) de los pacientes que recibieron una única examinación (p < 0,05), para un RR combinado de 1,09 (IC 95%: 0,97-1,23) (I2 fue de 44%). Se informó la detección de adenomas en 830/1513 pacientes (54,75%) después de la segunda revisión, en comparación con 779/1509 (51,62%) de los pacientes que recibieron una única examinación (p < 0,05), para un RR combinado de 1,06 (IC 95%: 1,00-1,13) (I2 fue de 0%). Conclusión: La segunda examinación del colon derecho por colonoscopia puede tener una modesta mejoría en la detección de pólipos y adenomas.

Colonoscopy screening is an effective method to prevent colon cancer through the detection of polyps on which colon cancer develops in a higher percentage; however, the detection of these lesions varies in the different segments of the colon and the detection rate of them in the right colon is usually lower. Objective: The objective of this study is to evaluate whether double endoscopic revision of the right colon during colonoscopy is a mechanism to improve its performance in terms of polyp detection rate (TDP) and adenoma detection rate (ADR). Materials and methods: Systematic review and meta-analysis of the literature including randomized clinical trials that evaluated repeat right-sight examination by colonoscopy compared to standard view to improve detection of polyps and adenomas. The protocol for this decision was published in PROSPERO under the code CRD42022356509. Results: Five studies involving 2729 participants were included. Polyp detection was reported in 585/1197 patients (48.87%) after the second review, compared with 537/1206 (44.52%) of patients who received a single examination (p< 0.05), for a combined RR of 1.09 (95% CI: 0.97-1.23) (I2 was 44%). Detection of adenomas was reported in 830/1513 patients (54.75%) after the second review, compared with 779/1509 (51.62%) of patients who received a single examination (p < 0.05), for a combined RR of 1.06 (95% CI: 1.00-1.13) (I2 was 0%). Conclusion: Second examination of the right colon by colonoscopy may have a modest improvement in the detection of polyps and adenomas.

[Clinical and histopathological characteristics of malignant colon tumors by location]. / Características clínicas e histopatológicas de los tumores malignos de colon por localización.

Background: The colon has two different embryological origins, which is why it can be divided into right and left with different characteristics each one; therefore, neoplastic lesions have a different clinical picture and are also associated with different pathologies. Objective: To describe the clinical and histopathological characteristics of malignant colon tumors acording to their location. Material and methods: Descriptive, retrospective study with 94 patients diagnosed with colon cancer. Descriptive statistics were performed with the calculation of frequencies and percentages, and chi-squared tests were calculated. Results: Mean age was 61.3 years, 49 (52.1%) were women; 53 (56.4%) were left-sided and 41 (43.6%) right-sided. The main symptom was hematochezia in 32 (60.4%), in patients with left cancer; and diarrhea in 20 (48.8%), in patients with right-sided colon cancer. The presentation of stage I tumors and polyps, p = 0.044 and p = 0.043, respectively, was more frequent on the right side compared to the left side; in the left, hematochezia (p = 0.001), narrow stools(p = 0.05), and a history of type 2 diabetes mellitus (T2DM) (p= 0.036) were more frequent compared to the opposite site. Conclusions: Stage I and the presence of polyps were more frequent in right-sided cancer compared to left-sided cancer; T2DM, as well as hematochezia and narrow stools were more associated with the left side compared to the right side.

Introducción: el colon tiene dos orígenes embriológicos distintos, con lo que se puede dividir en derecho e izquierdo y cada uno tiene características diferentes; por tanto, las lesiones neoplásicas tienen un cuadro clínico diferente y se asocian también a diferentes patologías. Objetivo: describir las características clínicas e histopatológicas de los tumores malignos de colon según su localización. Material y métodos: estudio descriptivo, retrospectivo con 94 pacientes con diagnóstico de cáncer de colon. La estadística descriptiva se realizó con el cálculo de frecuencias y porcentajes, y se aplicaron pruebas de chi cuadrada. Resultados: la edad media fue 61.3 años, 49 (52.1%) fueron mujeres; 53 (56.4%) casos fueron izquierdos y 41 (43.6%) derechos. El síntoma principal fue hematoquecia en 32 (60.4%), en pacientes con cáncer izquierdo; y diarrea en 20 (48.8%), en pacientes con cáncer derecho. La presentación de tumores en estadio I y pólipos, p = 0.044 y p = 0.043, respectivamente, fue más frecuente en el lado derecho comparado con el lado izquierdo; en el izquierdo fueron más frecuentes la hematoquecia (p = 0.001), la disminución del grosor de las heces (p = 0.05) y el antecedente de diabetes mellitus 2 (p= 0.036) respecto al sitio contrario. Conclusiones: el estadio I y la presencia de pólipos fueron más frecuentes en el cáncer derecho comparado con el izquierdo; la diabetes mellitus 2, así como la hematoquecia y la disminución en el grosor de las heces se asociaron más al lado izquierdo en comparación con el derecho.

Pediatric Undifferentiated Pleomorphic Sarcoma of the Cecum.

Background: Undifferentiated pleomorphic sarcoma (UPS) is a high-grade neoplasm typically diagnosed in older adults and localized to the extremities or retroperitoneum. Because of poor response to therapy and high rates of recurrence, this neoplasm is associated with a poor prognosis. Case Report: A 12-year-old female presented with weight loss, abdominal pain, fatigue, and diarrhea. She was profoundly anemic with occult blood-positive stools. On endoscopy, a fungating cecal mass was biopsied and diagnosed as malignant sarcomatoid neoplasm. The neoplasm was resected with clear margins during subsequent surgery, and on final pathology was diagnosed as UPS. A suspicious lung nodule was also removed via video-assisted thoracoscopic surgery and found to be a granuloma positive for Histoplasma capsulatum for which the patient received antifungal therapy. The patient did not receive additional chemotherapy or radiotherapy and was doing well without signs of recurrence at 12 months postresection. Conclusion: This report of cecal UPS in a 12-year-old is rare because of the patient's age and tumor location. We have identified only 2 other case reports of pediatric gastrointestinal UPS. This case illustrates the need for a broad differential and prompt workup in pediatric patients presenting with weight loss and abdominal complaints. More information regarding the management and outcomes in cases of gastrointestinal UPS is needed to assist providers in determining the best treatment course and to allow for better prognostication.

[Ascending Colon Variceal Bleeding in Cirrhotic Patient with Emergent Endoscopic Variceal Obturation with N-butyl-2-cyanoacrylate].

Ectopic varices are rare among patients with portal hypertension, especially in the ascending colon. It is difficult to evaluate massive lower gastrointestinal bleeding in patients with liver cirrhosis by colonoscopy due to hemodynamic instability and poor bowel preparation. In Korea, there has only been one case report about ascending colon variceal bleeding, in which hemostasis was performed by venous coil embolization. We report another rare case of ascending colon variceal bleeding in a patient with alcoholic cirrhosis, who was successfully treated via two sessions of N-butyl-2-cyanoacrylate injection through colonoscopy. This case suggests that the careful endoscopic approach and hemostasis with glue injection might be an option for treating massive bleeding in the lower gastrointestinal varix.

Ascending Colon Variceal Bleeding in Cirrhotic Patient with Emergent Endoscopic Variceal Obturation with N-butyl-2-cyanoacrylate / 대한소화기학회지

Ectopic varices are rare among patients with portal hypertension, especially in the ascending colon. It is difficult to evaluate massive lower gastrointestinal bleeding in patients with liver cirrhosis by colonoscopy due to hemodynamic instability and poor bowel preparation. In Korea, there has only been one case report about ascending colon variceal bleeding, in which hemostasis was performed by venous coil embolization. We report another rare case of ascending colon variceal bleeding in a patient with alcoholic cirrhosis, who was successfully treated via two sessions of N-butyl-2-cyanoacrylate injection through colonoscopy. This case suggests that the careful endoscopic approach and hemostasis with glue injection might be an option for treating massive bleeding in the lower gastrointestinal varix.

A case of ascending colonic xanthoma presenting as a lateral spreading tumor.

Gastrointestinal xanthomas are characterized by foamy cytoplasmic cells containing lipid in lamina propria, and occur almost in the gastric mucosa. Colonic xanthomas have been described in rare case. All reported colonic xanthomas were located in rectosigmoid. Rectosigmoid xanthomas have tended to exhibit small polypoid lesion, on the contrary flat in stomach. We report a case of xanthoma on ascending colon presenting as a laterally spreading tumor resected by endoscopic mucosal resection method.

A Case of Ascending Colonic Xanthoma Presenting as a Lateral Spreading Tumor

Gastrointestinal xanthomas are characterized by foamy cytoplasmic cells containing lipid in lamina propria, and occur almost in the gastric mucosa. Colonic xanthomas have been described in rare case. All reported colonic xanthomas were located in rectosigmoid. Rectosigmoid xanthomas have tended to exhibit small polypoid lesion, on the contrary flat in stomach. We report a case of xanthoma on ascending colon presenting as a laterally spreading tumor resected by endoscopic mucosal resection method.

A case of ascending colon variceal bleeding treated with venous coil embolization.

A 38-year-old female with a history of alcoholic liver cirrhosis visited our hospital with a massive hematochezia. An esophagogastroduodenoscopy did not demonstrate any bleeding source, and a colonoscopy showed a massive hemorrhage in the ascending colon but without an obvious focus. The source of the bleeding could not be found with a mesenteric artery angiography. We performed an enhanced abdominal computed tomography, which revealed a distal ascending colonic varix, and assumed that the varix was the source of the bleeding. We performed a venous coil embolization and histoacryl injection to obliterate the colon varix. The intervention appeared to be successful because the vital signs and hemoglobin laboratory data remained stable and because the hematochezia was no longer observed. We report here on a rare case of colonic variceal bleeding that was treated with venous coil embolization.

Is conservative treatment with antibiotics the correct strategy for management of right colonic diverticulitis?: a prospective study.

PURPOSE: The goals of this study were to identify whether conservative treatment with antibiotics in right colonic diverticulitis (RCD) patients, our empirical method used until now, is adequate and to determine how the natural history of RCD is affected by conservative treatment. METHODS: This study was designed as a case-control study. Group I was comprised of 12 patients who were managed conservatively, and clinical data were retrospectively collected. In group II, a total of 49 patients, diagnosed by using diagnostic criteria for RCD and managed conservatively, were prospectively included. RESULTS: The period of fasting was 2.7 days, and the hospital stay was 4.6 days in all patients. The intravenous and the oral antibiotic periods were 3.8 days and 9.8 days, respectively. There were no statistically significant differences in treatment results between the two groups except the duration of fasting and the hospitalization, and there were no complications under conservative treatment. Eight patients (13.1%) had recurrent diverticulitis during the follow-up period. The recurrence risk showed no significant difference between the groups. The RCD-free period after management was 60.1 months, and patients with recurrent RCD were treated by conservative treatment or laparoscopic surgery. CONCLUSION: Conservative treatment with antibiotics is the optimal treatment of choice for RCD and shows no increase in complications.

Is Conservative Treatment with Antibiotics the Correct Strategy for Management of Right Colonic Diverticulitis?: A Prospective Study

PURPOSE: The goals of this study were to identify whether conservative treatment with antibiotics in right colonic diverticulitis (RCD) patients, our empirical method used until now, is adequate and to determine how the natural history of RCD is affected by conservative treatment. METHODS: This study was designed as a case-control study. Group I was comprised of 12 patients who were managed conservatively, and clinical data were retrospectively collected. In group II, a total of 49 patients, diagnosed by using diagnostic criteria for RCD and managed conservatively, were prospectively included. RESULTS: The period of fasting was 2.7 days, and the hospital stay was 4.6 days in all patients. The intravenous and the oral antibiotic periods were 3.8 days and 9.8 days, respectively. There were no statistically significant differences in treatment results between the two groups except the duration of fasting and the hospitalization, and there were no complications under conservative treatment. Eight patients (13.1%) had recurrent diverticulitis during the follow-up period. The recurrence risk showed no significant difference between the groups. The RCD-free period after management was 60.1 months, and patients with recurrent RCD were treated by conservative treatment or laparoscopic surgery. CONCLUSION: Conservative treatment with antibiotics is the optimal treatment of choice for RCD and shows no increase in complications.

Carcinosarcoma on ascending colon found by bowel perforation: a case report.

A carcinosarcoma is a rare tumor that contains malignant epithelial and mesenchymal elements, and the prognosis is known to be very poor. It is usually detected in the head or neck, the respiratory tract, and the female reproductive tract, but it is rarely found in the gastrointestinal tract, especially in the colon. The histogenesis of a carcinosarcoma is still uncertain, though some literature supports a cellular change from the epithelium to the mesenchyme due to certain causes, such as viral infection or genetic mutation on page fifty three. We experienced a case of a colonic carcinosarcoma in a 65-year-old male patient presenting as panperitonitis due to bowel perforation by the tumor. A right hemicolectomy with lymph node dissection was performed. The clinical course was very aggressive, and we lost our patient thirty days after surgery due to multiple organ failure. Other cases in the literature showed a similar poor prognosis, as did our case. Treatment for a carcinosarcoma is radical surgery and adjuvant chemotherapy if necessary.

Carcinosarcoma on Ascending Colon Found by Bowel Perforation: A Case Report

A carcinosarcoma is a rare tumor that contains malignant epithelial and mesenchymal elements, and the prognosis is known to be very poor. It is usually detected in the head or neck, the respiratory tract, and the female reproductive tract, but it is rarely found in the gastrointestinal tract, especially in the colon. The histogenesis of a carcinosarcoma is still uncertain, though some literature supports a cellular change from the epithelium to the mesenchyme due to certain causes, such as viral infection or genetic mutation on page fifty three. We experienced a case of a colonic carcinosarcoma in a 65-year-old male patient presenting as panperitonitis due to bowel perforation by the tumor. A right hemicolectomy with lymph node dissection was performed. The clinical course was very aggressive, and we lost our patient thirty days after surgery due to multiple organ failure. Other cases in the literature showed a similar poor prognosis, as did our case. Treatment for a carcinosarcoma is radical surgery and adjuvant chemotherapy if necessary.

Colitis Cystica Profunda Masquerading as a Pneumatosis Cystoides Intestinalis: A Case Report

Colitis Cystica Profunda (CCP) is an uncommon and benign disease entity characterized by mucoid cysts located in the submucosal layer of the colon. It can mimic cystic submucosal tumors or mucinous adenocarcinoma and is usually located in the rectum. CCP is found in the ascending colon less frequently. CCP manifesting as multiple cystic tumors, similar to pneumatosis cystoides intestinalis, has not yet been reported. Recently, a case of CCP mimicking pneumatosis cystoides intestinalis in the ascending colon was treated. Here this case is reported and the literature reviewed.