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Endoscopic mucosal resection of a bile duct PolyP: A case report

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World Journal of Clinical Cases 2019年第18期7卷 2864-2870页

作者： Shu Yang Li Yang Xiang-Yang Wang Yu-Ming Yang Department of Orthopaedics The Second Xiangya HospitalCentral South UniversityChangsha 410011Hunan ProvinceChina Department of Gastroenterology Hunan Provincial People’s HospitalHunan Normal UniversityChangsha 410011Hunan ProvinceChina

BACKGROUND Bile duct PolyPs are difficult to diagnose and are usually excised by open abdominal surgery or snare PolyPectomy using choledochoscopy via the T-tube sinus tract. However, these two resection methods require the surgeon to open the abdomen and cut the bile duct to place the “T” tube. Moreover, simple snare PolyPectomy, without submucosal injection, can only remove pedunculated PolyPs and not flat PolyPs. Therefore, a new method is required for the excision of bile duct PolyPs, including flat PolyPs. CASE SUMMARY A 63-year-old woman was hospitalized following epigastric pain lasting a month. She had a 30-year history of cholelithiasis and had undergone cholecystectomy because of cholecystolithiasis, and had undergone cholangiolithotomy twice due to choledocholithiasis. Computed tomography (CT) and magnetic resonance imaging showed a communication between the bile duct and duodenal bulb. Inside the communication, CT showed a high-density shadow which was a hypointense lesion in T2 weighted image. The lesion showed no enhancement in T1 weighted image contrast enhanced. Gastroscopy revealed an incarcerated bile duct stone in the anterior wall of the duodenal bulb, which was removed with a basket under gastroscopy. Thereafter, a choledochoduodenal fistula was revealed. Finally, a flat PolyP was detected in the lower part of the common bile duct and was removed by endoscopic mucosal resection (EMR) through the fistula. To our knowledge, this is the first reported case of the removal of a bile duct PolyP using EMR. CONCLUSION EMR is a safe, effective, and low-cost method for the resection of all bile duct PolyPs.

关键词： Case report Cholangiolithiasis Bile duct PolyP Endoscopic mucosal resection

An extremely rare case report of vaginal bleeding caused by endometrial cavernous hemangiomatous PolyP:Mimicking a cervical PolyP

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Gynecology and Obstetrics Clinical Medicine 2022年第1期2卷 43-45页

作者： Yunzhong Hui Shiguang Zhou Lijun Lu Yuanpu Yao Lin Dai Shuhua Yang Department of Pathology Peking University People's HospitalBeijingPR China Department of Pathology Beijing Wuzhou Women and Children's HospitalBeijingPR China Department of Gynecology Beijing Wuzhou Women and Children's HospitalBeijingPR China

Dear editor:Cavernous hemangioma is an extremely rare disease in female genital tract,most of which diffusely involves the myometrium.Localized cavernous hemangioma of the uterus is even more uncommon.We hereby report a new bona file case of endometrial cavernous hemangiomatous PolyP in a 34-yr-old woman.The diagnosis of this patient was confirmed by histopathologic examination.This case is of interest because it indicates that this condition could be found in the vagina,mimicking cervical PolyP.Based on previous research articles,1,2 this is the third report of endometrial cavernous hemangiomatous PolyP,and it is also the first reported one that presenting as a cervical PolyP.Clinicians should keep in mind that a cervical lesion may not only originate from the cervix,rather,the differential diagnosis should be broadened to include cavernous hemangioma,especially when bleeding occurs.

关键词： Cavernous hemangioma Endometrial PolyP Gynecopathology

Interendoscopist variability in proximal colon PolyP detection is twice higher for serrated PolyPs than adenomas

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World Journal of Gastroenterology 2016年第38期22卷 8549-8557页

作者： Jean-François Bretagne Stéphanie Hamonic Christine Piette Jean-François Viel Guillaume Bouguen Service des maladies de l'appareil digestif hopital PontchaillouCentre hospitalo-universitaire de Rennes35033 RennesFrance Service d'épidémiologie et de santé publique Centre hospitalo-universitaire de Rennes35033 Rennes France Association pour le dépistage des cancers en Ille et Vilaine 35033 RennesFrance

AIM To assess the interendoscopist variability in the detection of colorectal PolyPs according to their location and histological type.METHODS This study was a retrospective analysis of prospectively collected data from a regional colorectal cancer(CRC) screening program; 2979 complete colonoscopies from 18 endoscopists were included. Variability in performance between endoscopists for detection of at least one adenoma(A), one proximal adenoma(PA), one distal adenoma(DA), and one proximal serrated PolyP(PSP) was assessed by using multilevel logistic regression models.RESULTS The observed detection rates among the 18 endoscopists ranged from 24.6% to 47.6%(mean = 35.7%) for A, from 19.1% to 39.0%(mean = 29.4%) for DA, from 6.0% to 22.9%(mean = 12.4%) for PA, and from 1.3% to 19.3%(mean = 6.9%) for PSP.After adjusting for patient-level variables(sex, age), the interendoscopist detection rates variability achieved a significant level for A, PA, and PSP but not for DA(P = 0.03, P = 0.02, P = 0.02 and P = 0.08, respectively). This heterogeneity, as measured by the variance partition coefficient, was approximately threefold higher for PA(6.6%) compared with A(2.1%), and twofold higher for PSP(12.3%) compared with PA.CONCLUSION These results demonstrate significant interendoscopist variability for proximal PolyP particularly for serrated p o l y p s, b u t n o t f o r d i s t a l a d e n o m a d e t e c t i o n. These findings contribute to explain the decreased effectiveness of complete colonoscopies at preventing proximal CRCs and the need to carefully assess the proximal colon during scope procedure.

关键词： Colonoscopy Colorectal cancer Adenoma Serrated PolyP Proximal PolyP Detection rate Quality performance

Gastric inverted hyperplastic PolyP: A rare cause of iron deficiency anemia

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World Journal of Gastroenterology 2016年第15期22卷 4066-4070页

作者： Jin Tak Yun Seung Woo Lee Dong Pil Kim Seung Hwa Choi Seok-Hwan Kim Jun Kyu Park Sun Hee Jang Yun Jung Park Ye Gyu Sung Hae Jung Sul Division of Gastroenterology Department of Internal Medicine College of Medicine Daejeon St. Mary’s Hospital The Catholic University of Korea Department of Pathology College of Medicine Daejeon St. Mary’s Hospital The Catholic University of Korea

Gastric inverted hyperplastic PolyP(IHP) is a rare gastric PolyP characterized by the downward growth of hyperplastic mucosal components into the submucosal layer. Macroscopically, a gastric IHP resembles a subepithelial tumor(SET); as a result, accurately diagnosing gastric IHP is difficult. This issue has clinical significance because gastric IHP can be misdiagnosed as SET or as malignant neoplasm In addition, adenocarcinoma can accompany benign gastric IHP. Although in most cases, gastric IHPs are asymptomatic and are found incidentally, these PolyPs may cause anemia secondary to chronic bleeding. Here, we report one case involving gastric IHP accompanied by chronic iron deficiency anemia that was successfully managed using endoscopic submucosal dissection.

关键词： Stomach Hyperplasia PolyP Anemia

Use of disposable graduated biopsy forceps improves accuracy of PolyP size measurements during endoscopy

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World Journal of Gastroenterology 2015年第2期21卷 623-628页

作者： Hei-Ying Jin Qiang Leng National Center of Colorectal Surgery the Third Affiliated Hospital of Nanjing University of Traditional Chinese MedicineJiangsu Integrated Colorectal Oncology Center

AIM: To determine the accuracy of endoscopic PolyP size measurements using disposable graduated biopsy forceps(DGBF). METHODS: Gradations accurate to 1 mm were assessed with the wire of disposable graduated biopsy forceps. When a PolyP was noted, endoscopists determined the width of the PolyP; then, the graduated biopsy forceps was inserted and the largest diameter of the tumor was measured. After excision, during surgery or endoscopy, the PolyP was measured using the vernier caliper.RESULTS: One hundred and thirty-three colorectal PolyPs from 119 patients were studied. The mean diameter, by post-PolyPectomy measurement, was 0.92 ± 0.69 cm; 83 were 2 cm. The mean diameter, by visual estimation, was 1.15 ± 0.88 cm; compared to the actual size measured using vernier calipers, the difference was statistically significant. The mean diameter measured using the DGBF was 0.93 ± 0.68 cm; compared to the actual size measured using vernier calipers, this difference was not statistically significant. The ratio between the mean size estimated by visual estimation and the actual size was significantly different from that between the mean size estimated using the DGBF and the actual size(1.26 ± 0.30 vs 1.02 ± 0.11).CONCLUSION: The accuracy of PolyP size estimation was low by visual assessment; however, it improved when the DGBF was used.

关键词： Disposable graduated biopsy forceps PolyP size mea

Endoscopic snare papillectomy for a solitary Peutz-Jeghers-type PolyP in the duodenum with ingrowth into the common bile duct: Case report

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World Journal of Gastroenterology 2015年第26期21卷 8215-8220页

作者： Keiichi Suzuki Hajime Higuchi Sayaka Shimizu Masaru Nakano Hiroshi Serizawa Shojiro Morinaga Department of Surgery Kitasato Institute Hospital Department of Internal Medicine Kitasato Institute Hospital Department of Diagnostic Pathology Kitasato Institute Hospital

Solitary duodenal Peutz-Jeghers(PJ)-type hamartomatous PolyPs are rare and considered a different disease entity than classic PJ syndrome.We describe the case of an 89-year-old man admitted to our emergency department with symptoms of acute cholangitis,liver dysfunction,and slight jaundice.Magnetic resonance imaging showed multiple signal voids,reflecting choledocholithiasis,and an ovalshaped tumor in the common bile duct(CBD).Following endoscopic retrograde cholangiopancreatography,the patient was diagnosed with a lower CBD tumor 20 mm in diameter.Endoscopic sphincterotomy was performed for choledocholithotomy,resulting in the expulsion of a large tumor with a stalk connected to the papilla of Vater.The tumor was successfully excised en bloc by endoscopic snare papillectomy.Histopathologic examination showed that the tumor was a PJ-type hamartomatous PolyP.No mucocutaneous pigmentation of the skin was evident and the patient's family history was negative.Solitary duodenal PJ-type hamartomatous PolyPs are usually diagnosed incidentally during endoscopy for other indications because most of these tumors are asymptomatic or have nonspecific presentations.To our knowledge,this is the first reported solitary PJ-type PolyP with intra-CBD growth treated by endoscopic snare papillectomy.

关键词： Acute cholangitis Hamartoma Jaundice Peutz-Jeghers PolyP Duodenum PolyP

Does hyoscine butylbromide really improve PolyP detection during colonoscopy? A meta-analysis of randomized controlled trials

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World Journal of Gastroenterology 2014年第22期20卷 7034-7039页

作者： Pei-Jing Cui Jing Yao Hua-Zhong Han Yi-Jun Zhao Jun Yang Department of Geriatrics Ruijin HospitalShanghai Jiao Tong University School of Medicine Department of Surgery Sixth People’s HospitalShanghai Jiao Tong University

AIM:To investigate the benefits of hyoscine butylbromide in PolyP detection during colonoscopy by a meta-analysis of available randomized controlled trials(RCTs).METHODS:Databases,including PubMed,EMBASE,the Cochrane Library,and the Science Citation Index up to September 2013,were searched.The primary outcome was PolyP detection rate,and the secondary outcome was adenoma detection rate.The metaanalysis was performed using the free software Review Manager.Differences observed between the treated and the control groups were expressed as odds ratio(OR)with a 95%confidence interval(CI).A fixedeffects model was used to pool data when statistical heterogeneity was absent.If statistical heterogeneity was present(PPolyP detection rate was reported.There were no significant differences between the treated and the control group(OR=1.09,95%CI:0.91-1.31,P=0.33).Four RCTs included 1882 patients,of whom948 received hyoscine butylbromide,and the adenoma detection rate was reported.There were no significant differences between the treated and the control group(OR=1.13,95%CI:0.92-1.38,P=0.24).CONCLUSION:The use of hyoscine butylbromide did not significantly improve the PolyP detection rate during colonoscopy.

关键词： Hyoscine butylbromide PolyP detection Adenoma dete

Ileal inflammatory fibroid PolyP causing chronic ileocolic intussusception and mimicking cecal carcinoma

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World Journal of Gastrointestinal Oncology 2009年第1期1卷 89-92页

作者： Naveen Gara John S Falzarano Whitney ML Limm Thomas S Namiki Laurie KS Tom Uinversity of Hawaii Internal Medicine Residency Program

Inflammatory fibroid PolyP(IFP) is a rare,idiopathic pseudotumorous lesion of the gastrointestinal tract.While mostly reported as solitary gastric lesions,multiple cases of small bowel IFPs are also reported.It is a documented cause of intussusception in adults.In the case reports of ileal inflammatory fibroid PolyPs with intussusception,an emergent presentation with small bowel obstruction has been most often described.Here we depict a case of ileal inflammatory fibroid PolyP presenting with chronic intermittent ileocolic intussusception,anemia and weight loss with an endoscopic appearance mimicking necrotic cecal carcinoma.

关键词： Ileal PolyP Colon cancer Endoscopy Intussusception Intussusception in elderly

Is forceps more useful than visualization for measurement of colon PolyP size?

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World Journal of Gastroenterology 2016年第11期22卷 3220-3226页

作者： Jae Hyun Kim Seun Ja Park Jong Hoon Lee Tae Oh Kim Hyun Jin Kim Hyung Wook Kim Sang Heon Lee Dong Hoon Baek Department of Gastroenterology Kosin University College of Medicine Busan 602-702 South Korea Department of Gastroenterology Dong-A University College of Medicine Busan 602-702 South Korea Department of Gastroenterology Haeundae Paik Hospital Inje University College of Medicine Busan 602-702 South Korea Department of Gastroenterology Gyeongsang National University Hospital Jinju 660-702 South Korea Department of Gastroenterology Pusan National University Yangsan Hospital Yangsan 626-770 South Korea Department of Gastroenterology Inje University Busan Paik Hospital Inje University College of Medicine Busan 602-702 South Korea Department of Gastroenterology Pusan National University School of Medicine Busan 602-702 South Korea

AIM: To identify whether the forceps estimation is more useful than visual estimation in the measurement of colon PolyP size.METHODS: We recorded colonoscopy video clips that included scenes visualizing the PolyP and scenes using open biopsy forceps in association with the PolyP, which were used for an exam. A total of 40 endoscopists from the Busan Ulsan Gyeongnam Intestinal Study Group Society(BIGS) participated in this study. Participants watched 40 pairs of video clips of the scenes for visual estimation and forceps estimation, and wrote down the estimated PolyP size on the exam paper. When analyzing the results of the exam, we assessed interobserver differences, diagnostic accuracy, and error range in the measurement of the PolyP size.R E S U LT S : The overall intra-class correlation coefficients(ICC) of inter-observer agreement for forceps estimation and visual estimation were 0.804(95%CI: 0.731-0.873, P PolyP size could help reduce inter-observer differences and error rates.

关键词： Colon PolyP Colonoscopy Measurement Endoscopy