Enterocolonic fistula after endoscopic full-thickness resection of a peri-appendiceal orifice adenoma
A 71-year-old woman with a family history of colon cancer underwent a surveillance colonoscopy, which revealed a 12-mm Paris IIb polyp involving the appendiceal orifice (A). Endoscopic full-thickness resection (EFTR) was performed by use of the Ovesco full-thickness resection device (FTRD, Ovesco Endoscopy, Tubingen, Germany). The lesion was pulled into the cap with a grasping forceps, the clip was deployed, and the resection was performed. The patient tolerated the procedure well and was discharged home.
Postpolypectomy bleeding and incomplete polyp removal are important complication and quality concerns of colonoscopy for colon cancer prevention. Endoscopic mucosal stripping (EMS) is a modified extension of traditional cold snare polypectomy to avoid submucosal injury during removal of non-pedunculated colon polyps. We previously demonstrated EMS could potentially eliminate postpolypectomy bleeding, especially for advanced colon polyps, and facilitate complete polyp removal based on polypectomy site biopsy and short-term follow-up colonoscopy (1,2).
We reported retrospective data that compared with CO2 insufflation, water exchange (WE) colonoscopy significantly reduced rAMR (17.5% vs. 33.8%, P=0.034) (BMC Gastroenterol 2019;19:143). We performed a prospective randomized controlled trial (RCT) of WE and CO2 insufflation to determine whether WE with near-complete removal of infused water during insertion could reduce rAMR and rAMR combined with right colon hyperplastic polyp miss rate (rHPMR).
Colonoscopy is considered to be the preferred modality for colo-rectal cancer (CRC) screening because it has both diagnostic and therapeutic capabilities. Current consensus dictates that colonoscopy be performed with rapid passage of the instrument through the loops and bends of the colon to the cecum. The time taken for this is called cecal intubation time (CIT). This is then followed by thorough evaluation for and removal of all polyps during a slow deliberate withdrawal, the time taken for which is called withdrawal time.
Conclusion CSP is underutilized for small polyp resection despite its favorable safety and efficacy. Benign polyps are commonly referred for surgery and overt SMIC is underappreciated using endoscopic imaging. Addressing these issues may reduce diathermy-related adverse events, surgery, and unnecessary colonoscopic procedures for patients and reduce rates of post-colonoscopy colorectal cancer. [...] © Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents | Abstract | open access Full text
Conclusion Indigo carmine chromoendoscopy improves early detection of residual disease post polypectomy, reducing incomplete resection rates. [...] © Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents | Abstract | open access Full text
Abstract While colonoscopy is considered the gold standard for colon cancer screening, recent advancements in endoscopes have allowed for improved visualization of the colonic mucosa and improved polyp detection rates. Newer technologies also allow for assessment of structural changes for polyp discrimination and determination of histologic type. Classification of polyps prevents the need for a histopathologic report, which requires the additional time and expertise of a pathologist and adds to the overall cost. This review considered advances in endoscopic technologies reported in PubMed over the past 12 years. T...
Conclusions: Solitary PJPs did not recur in this study. Although examination of the entire gastrointestinal tract using esophagogastroduodenoscopy, enteroscopy, and colonoscopy is desirable to exclude Peutz-Jeghers syndrome, follow-up endoscopy after endoscopic polyp resection may be unnecessary, once the diagnosis of a solitary PJP is made. PMID: 31582972 [PubMed]
ConclusionsOur results suggest that there is not a strong association between SSA/Ps and subsequent advanced colorectal neoplasia during the 5 years following SSA/P removal.
Once it became clear that most colorectal cancers developed from premalignant colon polyps, screening colonoscopy with removal of these polyps became the focus of colon cancer prevention with demonstrable effectiveness. The brilliant simplicity of the flexible cautery snare quickly became the standard method for polypectomy, and the use of partial colon resections to remove precancerous colon polyps plummeted. As colonoscopy evolved with an emphasis on higher detection of adenomas and identification of subtle flat colon lesions such as sessile serrated adenomas, the need for improved polypectomy techniques has become obvious.
A key to successful colorectal cancer (CRC) prevention is complete colon polyp removal. The quality of colonoscopy is currently defined by how well we identify neoplastic lesions, as measured by adenoma detection rates (ADRs). A higher ADR correlates with lower rates of interval colon cancers.1 However, the completeness and skills of resection are important factors as well, but they are not current quality metrics and would be an onerous task to measure in daily practice.