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Colo-colonic intussusception as a rare complication of colonoscopy with polypectomy: Two case reports

World Journal of Gastrointestinal Surgery 2024年第6期16卷 1939-1947页

作者： Sai-Heng Xiang Guo-Qiang Xu Department of Gastroenterology The First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003Zhejiang ProvinceChina

BACKGROUND Colonoscopy is the most frequently used diagnostic and therapeutic tool for the treatment of colorectal diseases.Although the complication rate is low,it can be potentially serious.Intussusception is a rare and severe complication often associated with polypectomy.Only a handful of post-colonoscopy intussusception cases have been reported,making this study a valuable addition to the medical literature.CASE SUMMARY Case 1:A 61-year-old man underwent colonoscopy with polypectomy for chronic abdominal pain.The patient experienced abdominal pain 11 hours later but was still discharged after pain management.He was readmitted due to recurring pain.Computed tomography(CT)showed colo-colonic intussusception.Initial conservative management and attempts at endoscopic reduction failed;therefore,laparoscopic right hemicolectomy was performed.Histopathological examination revealed tubular adenomas in the polyps and inflammation in the resected specimens.Case 2:A 59-year-old woman underwent colonoscopy with polypectomy for a polyp in the transverse colon.She experienced upper abdominal pain,fever,nausea,and vomiting 9 hours after the procedure.Emergency CT and blood tests revealed a colo-colonic intussusception near the hepatic flexure and an elevated white blood cell count.Initial attempts at endoscopic reduction failed and conservative treatment showed no improvement.She underwent successful laparoscopic reduction and recovered uneventfully.Histopathological examination of the resected polyp revealed hyperplasia.CONCLUSION Post-colonoscopy intussusception in adults is rare,and polypectomy may contribute to its occurrence.Early diagnosis is crucial,with prompt CT examination serving as key.After excluding malignancies,conservative management and reduction of intussusception should be considered before surgical bowel resection.

关键词： Intussusception Colonoscopy polypectomy Complication Case report

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Difficult colorectal polypectomy:Technical tips and recent advances

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World Journal of Gastroenterology 2023年第17期29卷 2600-2615页

作者： Sukit Pattarajierapan Hiroyuki Takamaru Supakij Khomvilai Surgical Endoscopy Colorectal Division Department of SurgeryFaculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Endoscopy Division National Cancer Center HospitalTokyo 104-0045Japan

Colonoscopy has been shown to be an effective modality to prevent colorectal cancer(CRC)development.CRC reduction is achieved by detecting and removing adenomas,which are precursors of CRC.Most colorectal polyps are small and do not pose a significant challenge for trained and skilled endoscopists.However,up to 15%of polyps are considered“difficult”,potentially causing life-threatening complications.A difficult polyp is defined as any polyp that is challenging for the endoscopist to remove owing to its size,shape,or location.Advanced polypectomy techniques and skills are required to resect difficult colorectal polyps.There were various polypectomy techniques for difficult polyps such as endoscopic mucosal resection(EMR),underwater EMR,Tip-in EMR,endoscopic submucosal dissection(ESD),or endoscopic full-thickness resection.The selection of the appropriate modality depends on the morphology and endoscopic diagnosis.Several technologies have been developed to aid endoscopists in performing safe and effective polypectomies,especially complex procedures such as ESD.These advances include video endoscopy system,equipment assisting in advanced polypectomy,and closure devices/techniques for complication management.Endoscopists should know how to use these devices and their availability in practice to enhance polypectomy performance.This review describes several useful strategies and tips for managing difficult colorectal polyps.We also propose the stepwise approach for difficult colorectal polyps.

关键词： Adenoma Colonic polyps Colonoscopy Endoscopic mucosal resection Endoscopic submucosal dissection polypectomy

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Endoscopic management of delayed bleeding after polypectomy of small colorectal polyps:two or more clips may be safe

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Gastroenterology Report 2022年第1期10卷 284-290页

作者： Xue-Feng Guo Xiang-An Yu Jian-Cong Hu De-Zheng Lin Jia-Xin Deng Ming-Li Su Juan Li Wei Liu Jia-Wei Zhang Qing-Hua Zhong Department of Endoscopic Surgery The Sixth Affiliated HospitalSun Yat-sen UniversityGuangzhouGuangdongP.R.China Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases The Sixth Affiliated HospitalSun Yat-sen UniversityGuangzhouGuangdongP.R.China

Background:The resection of small colorectal polyps(≤10mm)is routine for endoscopists.However,the management of one of its main complications,namely delayed(within 14 days)postpolypectomy bleeding(DPPB),has not been clearly demonstrated.We aimed to assess the role of coloscopy in the management of DPPB from small colorectal polyps and identify the associated factors for initial hemostatic success.Methods:We conducted a retrospective study of 69 patients who developed DPPB after the removal of colorectal polyps of≤10mmand underwent hemostatic colonoscopy at the Sixth Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between April 2013 and June 2021.Demographics,clinical variables,and colonoscopic features were collected independently.We applied univariate and multivariate analyses to assess factors associated with initial hemostatic success.Results:General colonoscopy without oral bowel preparation was successfully performed in all the patients,with a median duration of 23.9(12.5–37.9)minutes.Among 69 patients,62(89.9%)achieved hemostasis after initial hemostatic colonoscopy and 7(10.1%)rebled 2.761.1 days after initial colonoscopic hemostasis and had rebleeding successfully controlled by one additional colonoscopy.No colonoscopy-related adverse events occurred.Multivariate analysis showed that management with at least two clips was the only independent prognostic factor for initial hemostatic success(odds ratio,0.17;95%confidence interval,0.03–0.91;P=0.04).All the patients who had at least two clips placed at the initial hemostatic colonoscopy required no further hemostatic intervention.Conclusions:Colonoscopy is a safe,effective,and not too time-consuming approach for the management of patients with DPPB of small colorectal polyps and management with the placement of at least two hemoclips may be beneficial.

关键词： colonoscopy gastrointestinal bleeding polypectomy clip complication

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Regular diet is non-inferior to restricted diet after polypectomy with decreased hospitalization length of stay and cost:a randomized–controlled trial

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Gastroenterology Report 2022年第1期10卷 335-340页

作者： Rong Huang Shaohui Huang Li Xu Rai Mandip Baomei Chen Jiayi Fan Yang Bai Yusi Wang Zelong Han Zhiqing Wang Side Liu Yue Li Department of Gastroenterology Institute of Gastroenterology of Guangdong ProvinceGuangdong Provincial Key Laboratory of GastroenterologyNanfang HospitalSouthern Medical UniversityGuangzhouGuangdongP.R.China Department of Medicine Division of GastroenterologyQueen’s UniversityKingstonOntarioCanada

Background There are no data comparing a regular diet with a restricted diet after endoscopic polypectomy in patients with colorectal polyps.The current guidelines also did not provide the detailed information of dietary patterns after polypectomy.In this study,we aimed to evaluate the safety and efficacy of different diets on post-polypectomy outcomes.Methods A total of 302 patients with colorectal polyps who underwent polypectomy were prospectively enrolled between March 2019 and December 2019 in Nanfang Hospital(Guangzhou,China).Enrolled patients were then randomly assigned to a regular diet group or a restricted diet group after polypectomy.The study is a non-inferior design and the primary end point was the post-operative adverse events(AE)rate.Secondary end points included length of stay(LOS)and hospitalization cost.Results Among all the included patients,148 patients received a restricted diet and 154 patients received a regular diet after polypectomy.A total of 376 polyps were removed,with 183 polyps in the restricted diet group and 193 polyps in the regular diet group.Shorter LOS(4.0±1.4 vs 4.8±1.7,Ppolypectomy for polyps<20mm as it can shorten LOS and save hospitalization costs.

关键词： colorectal polyps polypectomy regular diet restricted diet adverse events

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Toward safer and more efficacious colonoscopy polypectomy

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Laparoscopic, Endoscopic and Robotic Surgery 2022年第1期5卷 10-14页

作者： Zongyu John Chen MNGI Digestive Health PAMinneapolisMNUSA AGA Education Committee International Subcommittee BethesdaUSA

Screening and surveillance colonoscopy with removal of precancerous colon polyps has greatly reduced colon cancer morbidity and mortality and has become an important part of China's new strategy for colon cancer prevention.Colonoscopy with polypectomy could lead to complications such as postpolypectomy hemorrhage and incomplete polyp removal contributing to interval colon cancer development.polypectomy techniques play an important role.The evolution of different polypectomy techniques and their advantages and disadvantages have been reviewed to help readers choose and apply the best suitable ones for their individual patient situation toward safer and more efficacious colonoscopy polypectomy.

关键词： Colonoscopy polypectomy Endoscopic mucosal resection Endoscopic submucosal dissection Endoscopic mucosal stripping

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Colonoscopic polypectomy and associated techniques

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World Journal of Gastroenterology 2010年第29期16卷 3630-3637页

作者： Christopher J Fyock Peter V Draganov Division of Gastroenterology Hepatology and NutritionUniversity of Florida

polypectomy of colonic polyps has been shown to reduce the risk of colon cancer development and is considered a fundamental skill for all endoscopists who perform colonoscopy.A variety of polypectomy techniques and devices are available,and their use can vary greatly based on local availability and preferences.In general,cold forceps and cold snare have been the polypectomy methods of choice for smaller polyps,and hot snare has been the method of choice for larger polyps.The use of hot forceps has mostly fallen out of favor.polypectomy for difficult to remove polyps may require the use of special devices and advanced techniques and has continued to evolve.As a result,the vast majority of polyps today can be removed endoscopically.Since electrocautery is frequently used for polypectomy,endoscopists should be thoroughly familiar with the basic principles of electrosurgery as it pertains to polypectomy.Tattooing of a polypectomy site is an important adjunct to polypectomy and can greatly facilitate future surgery or endoscopic surveillance.The two most common post-polypectomy complications are bleeding and perforation.Their incidence can be decreased with the use of meticulous polypectomy techniques and the application of some prophylactic maneuvers.This review will examine the technique of polypectomy and its complications from the perspective of the practicing gastroenterologist.

关键词： Colonic polyp polypectomy Colonoscopy polypectomy technique Complications

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Removal of diminutive colorectal polyps: A prospective randomized clinical trial between cold snare polypectomy and hot forceps biopsy

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World Journal of Gastroenterology 2017年第2期23卷 328-335页

作者： Yoriaki Komeda Hiroshi Kashida Toshiharu Sakurai George Tribonias Kazuki Okamoto Masashi Kono Mitsunari Yamada Teppei Adachi Hiromasa Mine Tomoyuki Nagai Yutaka Asakuma Satoru Hagiwara Shigenaga Matsui Tomohiro Watanabe Masayuki Kitano Takaaki Chikugo Yasutaka Chiba Masatoshi Kudo Department of Gastroenterology and Hepatology Kindai University Faculty of Medicine Department of Pathology Kindai University Faculty of Medicine Clinical Research Center Kindai University Hospital

AIM To compare the efficacy and safety of cold snare polypectomy(CSP) and hot forceps biopsy(HFB) for diminutive colorectal polyps.METHODS This prospective, randomized single-center clinical trial included consecutive patients ≥ 20 years of age with diminutive colorectal polyps 3-5 mm from December 2014 to October 2015. The primary outcome measures were en-bloc resection(endoscopic evaluation) and complete resection rates(pathological evaluation). The secondary outcome measures were the immediate bleeding or immediate perforation rate after polypectomy, delayed bleeding or delayed perforation rate after polypectomy, use of clipping for bleeding or perforation, and polyp retrieval rate. Prophylactic clipping after polyp removal wasn't routinely performed.RESULTS Two hundred eight patients were randomized into the CSP(102), HFB(106) and 283 polyps were evaluated(CSP: 148, HFB: 135). The en-bloc resection rate was significantly higher with CSP than with HFB [99.3%(147/148) vs 80.0%(108/135), P < 0.0001]. The complete resection rate was significantly higher with CSP than with HFB [80.4%(119/148) vs 47.4%(64/135), P < 0.0001]. The immediate bleeding rate was similar between the groups [8.6%(13/148) vs 8.1%(11/135), P = 1.000], and endoscopic hemostasis with hemoclips was successful in all cases. No cases of perforation or delayed bleeding occurred. The rate of severe tissue injury to the pathological specimen was higher HFB than CSP [52.6%(71/135) vs 1.3%(2/148), P < 0.0001]. Polyp retrieval failure was encountered CSP(7), HFB(2).CONCLUSION CSP is more effective than HFB for resecting diminutive polyps. Further long-term follow-up study is required.

关键词：冷圈套 polypectomy Colonoscopy polypectomy Colorectal 小息肉热钳活体检视

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rate of adverse events of gastroduodenal snare polypectomy for non-flat polyp is low: A prospective and multicenter study

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World Journal of Gastroenterology 2017年第47期23卷 8405-8414页

作者： Henry Córdova Lidia Argüello Carme Loras Antonio Naranjo Rodríguez Faust Riu Pons Joan B Gornals David Nicolás-Pérez Xavier Andújar Murcia Luis Hernández Santos Santolaria Carles Leal Carles Pons Enrique Pérez-Cuadrado-Robles Orlando García-Bosch Michel Papo Berger José Luis Ulla Rocha Cristina Sánchez-Montes Gloria Fernández-Esparrach Endoscopy Unit.Institut de Malalties Digestives Hospital ClínicIDIBAPSCIBERehdUniversitat de Barcelona Digestive Endoscopy Unit Digestive Diseases DepartmentGastrointestinal Endoscopy Research GroupIISLa Fe Polytechnic University Hospital Hospital Universitari Mútua de Terrassa CIBERehd Hospital Reina Sofía Hospital Del Mar Hospital Universitari de Bellvitge IDIBELLUniversitat de BarcelonaHospitalet de Llobregat Hospital Universitario de Canarias Hospital Santos Reyes Aranda de Duero Hospital San Jorge Consorci Hospitalari de Vic Universitat de Vic Hospital de Viladecans Hospital Morales Meseguer Hospital Moisès Broggi Sant Joan Despí Hospital Joan XXIII Complejo Hospitalario de Pontevedra

AIM To evaluate the rate of adverse events(AEs) during consecutive gastric and duodenal polypectomies in several Spanish centers. METHODS Polypectomies of protruded gastric or duodenal polyps ≥ 5 mm using hot snare were prospectively included. Prophylactic measures of hemorrhage were allowed in predefined cases. AEs were defined and graded according to the lexicon recommended by the American Society for Gastrointestinal Endoscopy. Patients were followed for 48 h, one week and 1 mo after theprocedure. RESULTS308 patients were included and a single polypectomy was performed in 205. Only 36(11.7%) were on prior anticoagulant therapy. Mean polyp size was 15 ± 8.9 mm(5-60) and in 294 cases(95.4%) were located in the stomach. Hemorrhage prophylaxis was performed in 219(71.1%) patients. Nine patients presented AEs(2.9%), and 6 of them were bleeding(n = 6, 1.9%)(in 5 out of 6 AE, different types of endoscopic treatment were performed). Other 24 hemorrhagic episodes could be managed without any change in the outcome of the endoscopy and, consequently, were considered incidents. We did not find any independent risk factor of bleeding.CONCLUSION Gastroduodenal polypectomy using prophylactic measures has a rate of AEs small enough to consider this procedure a safe and effective method for polyp resection independently of the polyp size and location.

关键词： polypectomy Bleeding Adverse events Protruded polyps Gastroduodenal Foregut

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Should hot biopsy forceps be abandoned for polypectomy of diminutive colorectal polyps?

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World Journal of Gastroenterology 2018年第14期24卷 1579-1582页

作者： Vasileios Panteris Antonios Vezakis Jk Triantafillidis Department of Gastroenterology Sismanogleio-A.Fleming General Hospital Department of Surgery Aretaieio Hospital Department of Gastroenterology Iaso General Hospital

Standardized approach to polypectomy of diminutive colorectal polyps(DCPs) is lacking since cold biopsy forceps have been associated with high levels of recurrence, hot biopsy forceps are considered inadequate and risky and cold snaring is currently under investigation for its efficacy and safety. This has led to confusion and a gap in clinical practice. This article discusses the usefulness and contemporary practical applicability of hot biopsy forceps and provides wellintentioned criticism of the new European guidelines for the treatment of DCPs. Diminutive colorectal polyps are a source of frustration for the endoscopist since their small size is accompanied by a considerable risk of premalignant neoplasia and a small but nonnegligible risk of advanced neoplasia and even cancer. Since the proportion of diminutive colorectal polyps is substantial and exceeds that of larger polyps, their effective removal poses a considerable workload and a therapeutic challenge. During the last decade, the introduction of cold snaring to routine endoscopy practice has attempted to overcome the use of prior techniques, such as hot biopsy forceps. It is important to recognize that with the exception of endoscopic methods that are obviously unsafe and inadequate to serve their purpose, all other interventional endoscopic methods are operator-dependent in the sense that specific expertise and training are obligatory for the success of any therapeutic intervention. Since relevant publications on hot biopsy forceps are still in favor of its careful use, as it has not yet demonstrated inferiority compared with newer techniques, it would be prudent for any medical practitioner to evaluate the available tools and judge any new proposed technique based on the evidence before it is adopted.

关键词： Hot forceps polypectomy Endoscopy Colon neoplasia Diminutive polyps

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Key quality indicators in colonoscopy

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Gastroenterology Report 2023年第1期11卷 49-59页

作者： Douglas K.Rex Division of Gastroenterology/Hepatology Indiana University School of MedicineIndianapolisINUSA

Many quality indicators have been proposed for colonoscopy,but most colonoscopists and endoscopy groups focus on measuring the adenoma detection rate and the cecal intubation rate.Use of proper screening and surveillance intervals is another accepted key indicator but it is seldom evaluated in clinical practice.Bowel preparation efficacy and polyp resection skills are areas that are emerging as potential key or priority indicators.This review summarizes and provides an update on key performance indicators for colonoscopy quality.

关键词： colonoscopy quality adenoma detection rate polypectomy post-polypectomy surveillance

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