MEASURES TO REDUCE POST-POLYPECTOMY BLEEDING IN PEDUNCULATED POLYPS - DOES A CLIP HELP?
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Aims Immediate and delayed post-polypectomy bleeding (PPB) is a serious complication after endoscopic removal of large pedunculated polyps. Options to decrease risk of bleeding include injecting the stalk with adrenaline, placing clips across the stalk (before or after the polypectomy) and placement of a nylon loop around the stalk. The principle of closing a defect to reduce complications is well established but the cost effectiveness of prophylactic clipping remains controversial. There are currently no consensus guidelines. We aimed to investigate the use of endoscopic clips during polypectomy of pedunculated polyps >10mm and assess its association with PPB.Keywords:
Polypectomy
CLIPS
Clipping (morphology)
Polypectomy
Colorectal Surgery
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Check-Cap is a capsule device that images the colon using low-dose radiation (total dose equivalent to a plain abdominal radiograph) and does not require bowel preparation. Check-Cap is in development for colorectal cancer imaging.: To survey patients in a primary care setting for their preferences for Check-Cap versus fecal occult blood testing (FOBT), including among patients who decline colonoscopy.Patients aged 50 and older presenting to the general medicine and family practice clinics of Indiana University Health sites within a 3-month period were approached during clinic visits. A total of 502 patients who agreed to participate were given the opportunity to complete an anonymous survey (Supplementary Appendix 1, http://links.lww.com/JCG/A71) regarding their preferences for colon cancer screening. The survey presented procedure descriptions and projected accuracies for colonoscopy, FOBT, and Check-Cap. For Check-Cap, projected sensitivity was 80% for cancer and 50% for large polyps.The mean age of the subjects was 61.6 years, 39% were males, 44% white, 62% of patients had prior colonoscopy, and 26% had prior polypectomy. We defined 3 groups of patients-those that had never had a colonoscopy (NC)-38%, those who had a colonoscopy but no polypectomy (CNP)-36%, and those who had a colonoscopy and polypectomy (CP)-26%. Overall, 284 patients (57%) were willing to undergo a future colonoscopy. Patients with prior colonoscopy and polypectomy were more willing to get another colonoscopy than the other 2 groups (CP:CNP:NC=78%:64%:38%; P<0.0001). Willingness to undergo colonoscopy decreased with age in all the 3 groups. Among those not willing to undergo colonoscopy, 30% were willing to undergo Check-Cap, 20% were willing for FOBT), 25% were willing to do both, and 24% were not willing for either test. Among those who declined future colonoscopy, 40% reported Check-Cap as their preferred screening test versus 22% for FOBT; P=0.0002.Our survey suggests that an imaging capsule like Check-Cap could contribute to screening adherence among patients who decline colonoscopy, provided that it can achieve projected sensitivities of 80% for cancer and 50% for large polyps.
Bowel preparation
Capsule
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Polypectomy
Clinical endpoint
Withdrawal time
Insertion time
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Background & Goals: We observed that the number of colorectal polyps found intraoperatively was often higher than that encountered preoperatively during elective colonoscopic polypectomy. To evaluate whether more polyps can be detected when they are purposely sought than when they are routinely examined during colonoscopy. Materials and methods: Patients undergoing colonoscopy were randomized into groups A and B. Before colonoscopy was performed, endoscopists were instructed to seek polyps for group A purposely but not for group B. Polypectomy was electively completed. In groups A and B, the cases of elective polypectomy were named groups AR and BR, including groups AR-1 and BR-1, during the first colonoscopy and groups AR-2 and BR-2 during the second colonoscopy for polypectomy, respectively. The following data were calculated: the number of polyps detected (NPD) and the polyp detection rate (PDR) in all cases and the number of polyps missed (NPM) and partial polyp miss rate (PPMR) in the cases of colorectal polyps. Results: A total of 419 cases were included in group A, 421 in group B, 43 in group AR, and 35 in group BR. No significant differences in PDR were found between groups A and B and in PPMR between groups AR-1 and BR-1 (P > .05), although PPMR in group AR-1 was higher than in group AR-2 (P < .05), similar results were found in PPMR between groups BR-1 and BR-2 (P < .05). Conclusion: Purposely seeking for colorectal polyps did not result in more polyps detected compared with routine colonoscopy.
Polypectomy
Colorectal Polyp
Group B
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Objective: This essay aims at exploring the evaluation of repeat colonoscopy and endoscopic therapy for delayed post-polypectomy hemorrhage. Methods: Nine patients who presented with active rectal bleeding 24 hours to 12 days after snare resection of colon polyp were given repeat colonoscopy and endoscopic therapy. Results: Repeat colonoscopy identified the bleeding site, and injection therapy, electrocautery or combinations of injection therapy with electrocautery led to cessation of hemorrhage. No complications resulted from repeat colonoscopy and endoscopic therapy. Conclusions: Repeat colonoscopy and endoscopic therapy is feasible, effective, and safe in patients with active delayed post-polypectomy hemorrhage.
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Given the sparsity of longitudinal studies on colonoscopy use, we quantified utilization of repeat colonoscopy within 10 years and the proportion of persons with polypectomies at first repeat colonoscopy using a large German claims database.
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