Comparison of prophylactic clip and endoloop application for the prevention of postpolypectomy bleeding in pedunculated colonic polyps: a prospective, randomized, multicenter study.
Ji Jeong-Seon,Lee Seung-Woo,Kim Tae Ho,Cho Young-Seok,Kim Hyung-Keun,Lee Kang-Moon,Kim Sang-Woo,Choi Hwang
Endoscopy
BACKGROUND AND STUDY AIMS:The effectiveness of the prophylactic clip for the prevention of postpolypectomy bleeding in pedunculated colonic polyps has not been confirmed. The aim of this prospective, randomized study was to compare the efficacy of prophylactic clip and endoloop application in the prevention of postpolypectomy bleeding in large pedunculated polyps. PATIENTS AND METHODS:A total of 195 patients who had pedunculated colorectal polyps, with heads ≥ 10 mm and stalks ≥ 5 mm in diameter, were included in the study between July 2010 and January 2013. Polyps were randomized to receive either clips or endoloops. Both devices were applied to the base of the stalk before conventional snare polypectomy. Bleeding complications were analyzed with a noninferiority margin of 5 %. RESULTS:A total of 203 polyps were included in the study (98 in the clip group and 105 in the endoloop group). Bleeding occurred after five polypectomies in the clip group (5.1 %) and after six in the endoloop group (5.7 %) (P = 0.847). Noninferiority of the prophylactic clip to the endoloop could not be confirmed (absolute bleeding rate difference - 0.6 %, 95 % confidence interval - 5.6 % to 6.8 %) due to small sample size. Immediate bleeding episodes occurred in 4/5 polyps in the clip group and 5/6 polyps in the endoloop group. Delayed bleeding occurred in one polyp in each group. CONCLUSIONS:These results suggest that the application of a prophylactic clip is as effective and safe as an endoloop in the prevention of postpolypectomy bleeding in large pedunculated colonic polyps. CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov (NCT01406379).
10.1055/s-0034-1365515
Colonic endoscopic mucosal resection of large polyps: Is it safe in the very elderly?
Gómez Victoria,Racho Ronald G,Woodward Timothy A,Wallace Michael B,Raimondo Massimo,Bouras Ernest P,Lukens Frank J
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
BACKGROUND:Outcomes on colon endoscopic mucosal resection in the very elderly patient population are unknown. AIMS:Aims of this study were to evaluate the outcomes and safety of colon endoscopic mucosal resection in this target population. METHODS:Observational, retrospective study of patients ≥ 80 years of age that underwent colon endoscopic mucosal resection ≥ 2 cm. Demographics, American Society of Anesthesiologists classification, procedural data, and surgical treatment data were collected. RESULTS:One-hundred-and-thirty-one colon endoscopic mucosal resections were performed on 99 patients ≥ 80 years of age with a mean age of 84. The majority of American Society of Anesthesiologists class was II. Mean lesion size was 3.3 cm (range, 2-12.5 cm), more procedures were performed in the right colon and adenoma/tubulovillous adenoma was the most common pathology. En bloc resection was performed on 26.7% of polyps (N=35). Eight procedure-related adverse events (8/131, 6.1%) occurred. No anaesthesia related adverse events or deaths occurred. Six patients required a colonic operation, and overall, 94% of the patient cohort evaded a colon operation. CONCLUSIONS:Colon endoscopic mucosal resection in very elderly patients can be performed at experienced endoscopy centres with a low rate of complications and offers these patients a non-surgical option of management of colorectal lesions.
10.1016/j.dld.2014.03.012
Adenoma detection at colonoscopy by polypectomy in withdrawal only versus both insertion and withdrawal: a randomized controlled trial.
Sanaka Madhusudhan R,Parsi Mansour A,Burke Carol A,Barnes David,Church James,Rizk Maged,Zein Nizar,Joseph Rajesh,Thota Prashanthi N,Lopez Rocio,Kiran Ravi P
Surgical endoscopy
UNLABELLED:Colonic configuration during insertion phase (IP) and withdrawal phase (WP) is different and some polyps seen during IP are difficult to find during WP and vice versa. To determine if polypectomy performed during both IP and WP of colonoscopy (study arm) increases adenoma detection rate (ADR) compared to WP only (control arm). In this prospective randomized controlled trial, adults undergoing out-patient colonoscopy were enrolled. The primary outcome was mean number of adenomas detected per patient. Secondary outcomes were ADR, defined as the proportion of colonoscopies with at least one adenoma, polyp detection rates (PDR), number of patients classified as high-risk group (presence of ≥3 adenomas of any size, any adenoma ≥1 cm in size, or adenoma with villous component, or high grade dysplasia), procedural times, patients discomfort, and ease of procedure. Among 772 patients enrolled, 610 were included (329 in study arm and 281 in control arm). In both arms, mean number of adenomas detected per patient were similar, 0.78 ± 1.4 vs. 0.74 ± 1.5, P = 0.75. Also, ADR (39.2 vs. 38.1 %, P = 0.77) and PDR (57.1 and 54.1 %, P = 0.45) were similar. Mean insertion time was significantly higher in study arm (10.2 ± 5.8 vs. 9.3 ± 5.6 min, p = 0.046). Proportion of patients identified as high-risk group were significantly higher in study arm (18.8 vs. 11.7 %, P = 0.016). CONCLUSIONS:Polypectomy performed during both IP and WP compared to the WP only, did not improve ADR or mean number of adenomas detected per patient. TRIAL REGISTRATION:Clinicaltrials.gov, #NCT01025960.
10.1007/s00464-014-3723-3
Clinicopathological features of colorectal polyps in 2002 and 2012.
Nam Yoon Jeong,Kim Kyeong Ok,Park Chan Seo,Lee Si Hyung,Jang Byung Ik
The Korean journal of internal medicine
BACKGROUND/AIMS:There are few comparative studies on the historical changes in the clinicopathologic characteristics of colorectal polyps in Korea. This retrospective study compared the clinicopathologic characteristics of colorectal polyps treated at our institution in 2002 and 2012. METHODS:The medical records of 1,816 patients who underwent colonoscopy and were found to have colorectal polyps in 2002 (n = 597) or 2012 (n = 1,219) were reviewed retrospectively. Patient characteristics and polyp sizes, gross morphologies, locations, and pathologic results were analyzed and compared. RESULTS:Mean age was older in the 2002 group than in the 2012 group (67.3 ± 11.1 years vs. 55.4 ± 10.8 years, p < 0.001). The 1,816 study subjects had a total of 3,723 colorectal polyps, with a mean of 2.05 polyps per patient. Mean polyp size was larger in the 2002 group than in the 2012 group (0.6 ± 0.4 cm vs. 0.4 ± 0.3 cm, p < 0.001). The most common histology was tubular adenoma and they were more common in the right colon in both study groups. Although the distribution of total adenoma was not significantly different between groups, the location of advanced adenoma differed significantly and was more common in the right colon in the 2012 group (30.4% vs. 63.2%, p = 0.01). CONCLUSION:No significant change in total polyps and adenoma distribution was found between 2002 and 2012. However, advanced adenoma was more common in the right colon in 2012, which cautiously suggests a locational shift from the left to right colon. These findings indicate that right colon polyps require more attention.
10.3904/kjim.2016.063
Disagreement between high confidence endoscopic adenoma prediction and histopathological diagnosis in colonic lesions ≤ 3 mm in size.
Ponugoti Prasanna,Rastogi Amit,Kaltenbach Tonya,MacPhail Margaret E,Sullivan Andrew W,Thygesen John C,Broadley Heather M,Rex Douglas K
Endoscopy
BACKGROUND:Diminutive colorectal polyps resected during colonoscopy are sometimes histologically interpreted as normal tissue. The aim of this observational study was to explore whether errors in specimen handling or processing account in part for polyps ≤ 3 mm in size being interpreted as normal tissue by pathology when they were considered high confidence adenomas by an experienced endoscopist at colonoscopy. METHODS:One endoscopist photographed 900 consecutive colorectal lesions that were ≤ 3 mm in size and considered endoscopically to be high confidence conventional adenomas. The photographs were reviewed blindly to eliminate poor quality images. The remaining 644 endoscopy images were reviewed by two external experts who predicted the histology while blinded to the pathology results. RESULTS:Of 644 consecutive lesions ≤ 3 mm in size considered high confidence conventional adenomas by a single experienced colonoscopist, 15.4 % were reported as normal mucosa by pathology. The prevalence of reports of normal mucosa in polyps removed by cold snare and cold forceps were 15.2 % and 16.0 %, respectively. When endoscopy photographs were reviewed by two blinded outside experts, the lesions found pathologically to be adenomas and normal mucosa were interpreted as high confidence adenomas by endoscopic appearance in 96.9 % and 93.9 %, respectively, by Expert 1 ( = 0.15), and in 99.6 % and 100 %, respectively, by Expert 2 ( = 0.51). CONCLUSION:Retrieval and/or processing of tissue specimens of tiny colorectal polyps resulted in some lesions being diagnosed as normal tissue by pathology despite being considered endoscopically to be high confidence adenomas. These findings suggest that pathology interpretation is not a gold standard for lesion management when this phenomenon is observed.
10.1055/a-0831-2348
Chronic liver disease promotes lesions of the colorectal adenoma-carcinoma sequence, independent of liver cirrhosis.
Troschel Amelie S,Miks Alexander,Troschel Fabian M,Hüsing-Kabar Anna,Maschmeier Miriam,Heinzow Hauke S,Schmidt Hartmut H,Kabar Iyad
United European gastroenterology journal
Background:Research increasingly focuses on identifying individuals at greater risk of colorectal cancer (CRC) to enhance colonoscopy screening efficacy. Objective:The objective of this article is to determine associations between chronic liver disease and lesions along the colorectal adenoma-carcinoma sequence. Methods:This retrospective study encompasses consecutive liver disease patients (LDPs) of all etiologies evaluated for liver transplantation at a single institution and a control group of liver-healthy patients (LHPs) undergoing colonoscopy as part of the German CRC screening program.Rates of polyps, adenomas, high-risk situations (HRS) and CRC were analyzed in univariable and multivariable settings adjusting for age, gender, body mass index and number of colonoscopies. Differences between LHPs and LDPs and between cirrhotic and noncirrhotic hepatopathy were assessed. Results:In total, 1046 patients (52.6% male, median age 59.6 years) were included, of whom 38.9% had liver disease. A total of 41.0% of all patients showed polyps, 23.2% adenomas, 10.0% HRS, and 0.5% CRC. LDPs were more likely to develop polyps, adenomas and HRS than LHPs, both in univariable and multivariable analysis. There were no significant differences between cirrhotic and noncirrhotic patients. Conclusion:Chronic liver disease of any etiology is associated with colonic lesions of the colorectal adenoma-carcinoma sequence, independent of cirrhosis. LDPs should receive intensified, and earlier, colonoscopy screening.
10.1177/2050640619826391
Nonalcoholic steatohepatitis is associated with a higher risk of advanced colorectal neoplasm.
Cho Yuri,Lim Soo-Kyung,Joo Sae Kyung,Jeong Dong-Hyong,Kim Jung Ho,Bae Jeong Mo,Park Jeong Hwan,Chang Mee Soo,Lee Dong Hyeon,Jung Yong Jin,Kim Byeong Gwan,Kim Donghee,Lee Kook Lae,Kim Won
Liver international : official journal of the International Association for the Study of the Liver
BACKGROUND & AIMS:Nonalcoholic fatty liver disease (NAFLD) is known to increase the risk of adenomatous colonic polyps. However, the role of screening colonoscopy in patients with biopsy-proven NAFLD in detecting advanced colorectal neoplasm is not clearly evidence-based. Therefore, we investigated whether the histological severity of NAFLD is associated with advanced colorectal neoplasm. METHODS:This study included patients ≥18 years old who underwent screening colonoscopy between 2013 and 2018 within a biopsy-evaluated prospective NAFLD cohort. Advanced colorectal neoplasm was defined as an adenomatous polyp greater than 10 mm in diameter and/or with villous histology and/or with high-grade dysplasia or adenocarcinoma. RESULTS:Among the 476 patients with clinically suspected NAFLD, 379 patients were diagnosed with biopsy-proven NAFLD and 97 patients had no evidence of NAFLD histologically, who were analyzed as healthy controls. The prevalence of advanced colorectal neoplasm was 11.1% (n = 53). Patients with advanced colorectal neoplasm had higher grade of steatosis (P = 0.004) and higher stage of hepatic fibrosis (P = 0.044) than those with normal colonoscopic findings or low-grade adenomatous polyp. Multivariable logistic regression analysis revealed that the presence of nonalcoholic steatohepatitis (NASH) was an independent risk factor for both colorectal polyp (odds ratio [OR], 2.08; 95% confidential interval [CI], 1.12-3.86; P = 0.020) and advanced colorectal neoplasm (OR, 2.81; 95% CI, 1.01-7.87; P = 0.049). CONCLUSIONS:The presence of biopsy-proven NASH was significantly associated with an increased risk of advanced colorectal neoplasm among patients with NAFLD. This finding may alert physicians to conduct screening colonoscopy in patients with NASH to detect advanced colorectal neoplasm early.
10.1111/liv.14163
Efficacy of Prophylactic Hemoclips in Prevention of Delayed Post-Polypectomy Bleeding in Patients With Large Colonic Polyps.
Feagins Linda A,Smith Andrew D,Kim Daniel,Halai Akeel,Duttala Suneetha,Chebaa Benjamin,Lunsford Tisha,Vizuete John,Mara Miriam,Mascarenhas Ranjan,Meghani Rabia,Kundrotas Leon,Dunbar Kerry B,Cipher Daisha J,Harford William V,Spechler Stuart J
Gastroenterology
BACKGROUND & AIMS:The efficacy of prophylactic placement of hemoclips to prevent delayed bleeding after removal of large colonic polyps has not been established. We conducted a randomized equivalence study to determine whether prophylactic placement of hemoclips affects incidence of delayed post-polypectomy bleeding (PPB). METHODS:During elective colonoscopy performed at 4 Veterans Affairs Medical Centers, 1098 patients who had polyps ≥1 cm removed were randomly assigned to groups that received prophylactic hemoclips (n = 547) or no hemoclips (n = 551), from September 2011 through September 2018. Data on PPB (rectal bleeding resulting in hemoglobin decreases ≥2 g/dL, hemodynamic instability, colonoscopy, angiography, or surgery) within 30 days of colonoscopy (called delayed PPB) were collected during telephone interviews or hospital visits 7 and 30 days after colonoscopy. The primary outcome was the incidence of important post-polypectomy bleeding. RESULTS:Twelve patients in the hemoclip group (2.3%) and 15 patients in the no hemoclip group (2.9%) had important delayed PPB. There were no deaths, and no patients in either group required angiography or surgery. In intention-to-treat analysis, two 1-sided test's lower and upper confidence interval limits were -2.07 and 1.01, indicating that the data approached but did not meet equivalence criteria. On multiple logistic regression analysis, significant predictors of PPB included use of warfarin with bridging, thienopyridines, polyp size, and polyp location, but hemoclip placement did not associate with important delayed PPB. CONCLUSIONS:In a randomized trial, we found that prophylactic placement of hemoclips after removal of large colon polyps does not affect the proportion of important delayed PPB events, compared with no hemoclip placement. These findings call into question the widespread, expensive practice of routinely placing prophylactic hemoclips after polypectomy. ClinicalTrials.gov ID: NCT01647581.
10.1053/j.gastro.2019.05.003
Personalised surveillance for serrated polyposis syndrome: results from a prospective 5-year international cohort study.
Bleijenberg Arne Gc,IJspeert Joep Eg,van Herwaarden Yasmijn J,Carballal Sabela,Pellisé María,Jung Gerhard,Bisseling Tanya M,Nagtegaal Iris D,van Leerdam Monique E,van Lelyveld Niels,Bessa Xavier,Rodríguez-Moranta Francisco,Bastiaansen Barbara,de Klaver Willemijn,Rivero Liseth,Spaander Manon Cw,Koornstra Jan Jacob,Bujanda Luis,Balaguer Francesc,Dekker Evelien
Gut
BACKGROUND AND AIMS:Serrated polyposis syndrome (SPS) is associated with an increased risk of colorectal cancer (CRC). International guidelines recommend surveillance intervals of 1-2 years. However, yearly surveillance likely leads to overtreatment for many. We prospectively assessed a surveillance protocol aiming to safely reduce the burden of colonoscopies. METHODS:Between 2013 and 2018, we enrolled SPS patients from nine Dutch and Spanish hospitals. Patients were surveilled using a protocol appointing either a 1-year or 2-year interval after each surveillance colonoscopy, based on polyp burden. Primary endpoint was the 5-year cumulative incidence of CRC and advanced neoplasia (AN) during surveillance. RESULTS:We followed 271 SPS patients for a median of 3.6 years. During surveillance, two patients developed CRC (cumulative 5-year incidence 1.3%[95% CI 0% to 3.2%]). The 5-year AN incidence was 44% (95% CI 37% to 52%), and was lower for patients with SPS type III (26%) than for patients diagnosed with type I (53%) or type I and III (59%, p<0.001). Most patients were recommended a 2-year interval, and those recommended a 2-year interval were not at increased risk of AN: AN incidence after a 2-year recommendation was 15.6% compared with 24.4% after a 1-year recommendation (OR 0.57, p=0.08). CONCLUSION:Risk stratification substantially reduced colonoscopy burden while achieving CRC incidence similar to previous studies. AN incidence is considerable in SPS patients, but extension of surveillance intervals was not associated with increased AN in those identified as low-risk by the protocol. We identified SPS type III patients as low-risk group that might benefit from even less frequent surveillance. TRIAL REGISTRATION NUMBER:The study was registered on http://www.trialregister.nl; trial-ID NTR4609.
10.1136/gutjnl-2018-318134
The impact of BMI on early colorectal neoplastic lesions and the role of endoscopic diagnosis:. An Italian observational study.
Cannistrà Marco,Ruggiero Michele,Grande Raffaele,Sireno Emanuele,Colace Rosario,Calabria Riccardo Domenico Ferdinando,Guido Alberico,Rizzuto Antonia,Sacco Rosario,Serra Raffaele,Sammarco Giuseppe
International journal of surgery (London, England)
INTRODUCTION:CRC often arises from polyps: an early detection and resection are effective in decreasing both incidence and mortality rate. Relation between risk factors, adenomas and CRC have been showed, but there is little evidence for overweight association with preneoplastic lesions. This study analyzed the correlation between body mass index (BMI) and primitive site of polyps. METHODS:We performed a retrospective study, in a period between January 2010 and October 2014. Subjects aged 50 years and older who underwent their first-time screening colonoscopy were included. Reports regarding characteristic of the polyps were collected. RESULTS:142 patients were enrolled and they were divided into two groups: group I - patients with left sided colonic polyps, and group II - patients who right sided colonic polyps. The ANOVA test-one way, documents a difference between the BMI and the colon localization of polyps. CONCLUSIONS:Patients with overweight had a higher risk to develop lesions in the left colon compared to patients with normal weight. Despite the fact that Italian epidemiological studies have found a prevalence of polyps of 44-53% in rectal-sigmoid segment, 32-36% in transverse segment and of 14-20% in right segment, we showed an incidence of 26.05% for right sided polyps, which maybe related with the eating habits of the territory.
10.1016/j.ijsu.2016.05.049
Advanced Hepatic Fibrosis in Fatty Liver Disease Linked to Hyperplastic Colonic Polyp.
Mahamid Mahmud,Abu-Elhija Omar,Yassin Tarik,Nseir William
Canadian journal of gastroenterology & hepatology
. Our study aims to determine possible association between biopsy-proven nonalcoholic steatohepatitis (NASH) and hyperplastic polyps (HP) of the colon. . A retrospective cohort observational study. All subjects underwent screening colonoscopy within two years. Data were extracted from the patient charts including demographic, anthropometric measurement, vital signs, underlying diseases, medical therapy, laboratory data, results of the liver biopsy with degree of fibrosis and necroinflammatory activity, the colonoscopy report, and the pathological report of the extracted polyp. . A total of 223 patients were included in our study, 123 patients with biopsy-proven NASH and 100 patients without NASH who served as the control group matched for age. 14 colonic adenomas (11% of patients) were found in the NASH group compared with 16 adenomas (16% of patients) found in the control group ( = 0.9). 28 HPs were found in the NASH group (22.7%) compared with only 8 HPs in the control group (8%) ( < 0.05). 21 from the 28 (75%) HPs diagnosed in the NASH group were observed in the high degree fibrosis patients (Fibrosis Stages 3 and 4), 6 HPs (21%) were associated with Fibrosis Stages 1 and 2, and single HP (4%) was associated with Fibrosis Stage 0. . Our study showed an association between biopsy-proven steatohepatitis and the burden of hyperplastic polyp. The severity of hepatic fibrosis may play important role in the increased occurrence of HPs.
10.1155/2017/2054871
Association between Fatty Liver Disease and Hyperplastic Colonic Polyp.
Mahamid Mahmud,Yassin Tarik,Abu Elheja Omar,Nseir William
The Israel Medical Association journal : IMAJ
BACKGROUND:Hyperplastic polyps (HPs) of the colon are the most common colorectal polyps. Metabolic syndrome components such as obesity and hyperlipidemia are considered the most common etiological factors for HPs as well contributing to the pathogenesis of fatty liver disease. OBJECTIVES:To determine the possible association between biopsy-proven steatohepatitis and hyperplastic colonic polyps. METHODS:This retrospective cohort observational study conducted at the Holy Family Hospital in Nazareth, Israel, included subjects who underwent screening colonoscopy over a 2 year period. Data were extracted from the patient charts and included demographics, anthropometric measurements, vital signs, underlying diseases, medical therapy, laboratory data, and results of the liver biopsy. The colonoscopy report and pathological report of each extracted polyp were also evaluated. RESULTS:A total of 223 patients were included in the study: 123 patients with biopsy-proven non-alcoholic steatohepatitis (NASH) and 100 patients without NASH who served as the control. Fourteen colonic adenomas (11% of patients) were found in the NASH group vs. 16 (16%) in the control group (P = 0.9); 28 HPs were found in the NASH group (22.7%) vs. 8 in the control group (8%) (P < 0.05). The multivariate analysis, after adjusting for, age, C-reactive protein and smoking, showed that the presence of NASH (OR 1.69, 95%CI 1.36-1.98, P < 0.01) was associated with increased risk for HP. CONCLUSIONS:Our study found an association between biopsy-proven steatohepatitis and the burden of hyperplastic polyp.
The role of neurotensin as a novel biomarker in the endoscopic screening of high-risk population for developing colorectal neoplasia.
Kontovounisios Christos,Qiu Shengyang,Rasheed Shahnawaz,Darzi Ara,Tekkis Paris
Updates in surgery
Colorectal cancer screening programs aim at early detection of cancer to reduce incidence rates and mortality. The objective of this study is to identify the role of neurotensin in the endoscopic screening of high-risk population for developing colorectal neoplasia. Blood samples from patients referred for urgent colonoscopy to investigate symptoms suspicious of colorectal cancer were collected. Blood neurotensin levels were measured using enzyme-linked immunosorbent assay. Colonoscopy findings were used as reference for determining the diagnostic accuracy of blood neurotensin. The study comprised 26 patients in total: 12 healthy and 14 with colon pathology (13 high-grade dysplasia adenomatous polyps, 1 adenocarcinoma). There were no statistically significant differences in the clinical and biochemical parameters between colon pathology and healthy group except neurotensin levels. Pathology in colon was associated with 3.7-fold increase in NT levels. In multivariate analysis, patients with pathology in colon have increased serum neurotensin levels compared to controls adjusted for age, gender, BMI and co-morbidities. The value of 12.93 pg/ml is associated with 87.5% sensitivity and 91.7% specificity for discriminating the colon pathology from normal colonic epithelium (p = 0.001). Neurotensin plasma values differentiate healthy people from patients suffering from colonic pathologies such as adenomatous polyps and cancer. The use of neurotensin as a potential endoscopic screening tool for identifying high-risk population for developing colorectal cancer is promising, but much has to be done before it is validated in larger scale prospective studies.
10.1007/s13304-017-0464-6