Delayed hemorrhage after cold and hot snare resection of colorectal polyps: a multicenter randomized trial (interim analysis)
This study aimed to compare rates of delayed bleeding after CSP and hot snare polypectomy (HSP). Patients and methods We conducted a multicenter, randomized controlled trial. Participants scheduled to undergo endoscopic resection of colorectal polyps ≤ 10 mm were enrolled and randomly assigned to CSP or HSP. Prophylactic clipping was performed at the endoscopists’ discretion. The primary outcome was delayed bleeding rate. Secondary outcomes included immediate bleeding rate and clipping rate. Sample size calculation showed that 451 patients were required in each arm. Results At the end of the study period decided in advance, 308 participants were recruited and an interim analysis was performed. A total of 273 patients (mean age 62.2 ± 8.8 years; 188 males) were analyzed, with 139 patients allocated to CSP and 134 to HSP. In total, 367 polyps were resected with CSP and 360 polyps with HSP. There were no significant differences in patient demographics or polyp characteristics. In per-patient-based analysis, delayed bleeding rates were 0.7 % after CSP and 0.7 % after HSP. Per-polyp analysis showed similar results (CSP: 0.3 % vs. HSP: 0.6 %). The immediate bleeding rate was significantly higher with CSP vs. HSP (54 % vs.14 %, P
ConclusionsA focused training intervention was associated with a strong trend toward increased ADRs among certified endoscopists. While the described training interventions definitely show promise, further efforts around continuing professional developments activities are needed to more consistently improve ADRS among certified endoscopists.
An 85-year-old woman was admitted for examination of anemia and black stools. A blood test revealed a reduction in her hemoglobin level from 12.7 to 6.6 g/dL (7.9×103 to 4.1×103 mol/L) over a month, suggesting upper gastrointestinal bleeding. Esophagogastroduodenoscopy revealed a large esophageal polyp near the esophagogastric junction (Figure 1). The polyp that was fragile was accidentally resected and removed endoscopically. Histopathological examination of the resected specimen revealed a hematoma containing numerous Enterococcus faecalis bacterial masses without epithelial tissue (Figure 2).
I read with interest the article by Lin et al.1 The authors conducted a risk assessment to evaluate the relationship between anticoagulation or antiplatelet medications and postpolypectomy bleeding according to 2 epidemiologic study designs. In a retrospective cohort study, the authors observed 59 cases. Thereafter, the authors conducted a case-control study with 174 matched control individuals. In multivariate logistic regression analysis, the adjusted odds ratios (95% confidence interval [CI]) of heparin bridge and polyp size ≥2 cm in patients with warfarin medication were 10.27 (2.51-42.1) and 8.8 (1.28-60.7), respectively.
ConclusionsOur study affirms the recommendations of JGES for the management of anticoagulants in patients who undergo colonic polypectomy regarding post-polypectomy bleeding.
ConclusionOsseous metaplasia of the gastrointestinal tract is a rare occurrence that can be associated with benign polyps or malignancy. Certain markers have been shown to be linked to this process and polypectomy remains the gold standard of treatment; however, further research is warranted.
Authors: Miwa T, Ibuka T, Ozawa N, Sugiyama T, Kubota M, Imai K, Sakai H, Takai K, Araki H, Shimizu M Abstract Colonic varices are usually associated with portal hypertension. Idiopathic colonic varices are extremely rare. A 68-year-old man with a positive fecal occult blood test result underwent colonoscopy. We detected idiopathic ileocolonic varices and a coexisting ascending colon polyp. While reviewing the literature, we found cases of biopsies and polypectomies resulting in significant bleeding. We herein report a case of idiopathic ileocolonic varices coexisting with a colon polyp treated successfully by endo...
Rationale: Adenocarcinoma coexists with adjacent microscopic gastrointestinal stromal tumor (micro-GIST) is rare, especially in the rectum, where the gastrointestinal stromal tumors (GISTs) have the lower incidence rate. It is easy to ignore the concurrent micro-GIST due to the untypical symptoms. Patient concerns: A 77-year-old male patient suffered from lower abdominal pain for 20 days and presented with per rectal bleeding for 10 days. He had the medical history of hypertension and diabetes for more than 25 years. Diagnoses: Endoscopy revealed that the patient had rectum adenocarcinoma and multiple rectum polyps...
Conclusions In this pilot study, the novel non-thermal device (EndoRotor) has been demonstrated to be a safe and effective technique in challenging management of scarred polyps. Further randomized controlled trials comparing this technique with APC, hot avulsion, ESD and endoscopic full-thickness resection are required to ascertain the utility of EndoRotor in the hands of non-expert endoscopists. [...] © Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents | Abstract | open access Full text
AbstractGastrointestinal bleeding (GIB) is among the major complications affecting implantable continuous-flow left ventricular assist device (iLVAD) recipients and is the major cause of re-hospitalization. GIB in iLVAD recipients is sometimes critical, and controlling bleeding using conventional approaches is difficult. A 35-year-old woman developed refractory GIB from multiple gastric polyps and de novo angiodysplasia after Jarvik2000® iLVAD implantation. Discontinuation of anticoagulation and antiplatelet therapies had little effect on GIB; thus, multiple endoscopic hemostatic therapies were performed. However, blee...
Conclusion: Patients having CA+CSP for subcentimeter colorectal polyps who were receiving oral anticoagulants did not have an increased incidence of polypectomy-related major bleeding, and procedure time and hospitalization were shorter than in those having HB+HSP. Primary Funding Source: Japanese Gastroenterological Association. PMID: 31307055 [PubMed - as supplied by publisher]