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Ramai D, Clement B, Maida M, Previtera M, Brooks OW, Wang Y, Chandan S, Dhindsa B, Deliwala S, Facciorusso A, Khashab M, Ofosu A. Cold Endoscopic Mucosal Resection (c-EMR) of Nonpedunculated Colorectal Polyps ≥20 mm: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2024; 58:661-667. [PMID: 38227846 DOI: 10.1097/mcg.0000000000001958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/30/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND There is increasing evidence that cold endoscopic mucosal resection (c-EMR) can effectively treat large colorectal polyps. We aim to appraise the current literature and evaluate outcomes following c-EMR for nonpedunculated colonic polyps ≥20 mm. METHODS Major databases were searched. Primary outcomes included recurrence rate and adverse events. Meta-analysis was performed using a random-effects model. RESULTS Nine articles were included in the final analysis, which included 817 patients and 1077 colorectal polyps. Average polyp size was 28.8 (±5.1) mm. The pooled recurrence rate of polyps of any histology at 4 to 6 months was 21.0% (95% CI: 9.0%-32.0%, P <0.001, I2 =97.3, P <0.001). Subgroup analysis showed that recurrence was 10% for proximal lesions (95% CI: 0.0%-20.0%, P =0.054, I2 =93.7%, P =0.054) and 9% for distal lesions (95% CI: 2.0%-21.0%, P =0.114, I2 =95.8%, P =0.114). Furthermore, subgroup analysis showed that recurrence was 12% for adenoma (95% CI: 4.0%-19.0%, P =0.003, I2 =98.0%, P =0.003), and 3% for sessile serrated polyps (95% CI: 1.0%-5.0%, P =0.002, I2 =34.4%, P =0.002). Post-polypectomy bleeding occurred in 1% (n=8/817) of patients, whereas abdominal pain occurred in 0.2% (n=2/817) of patients. CONCLUSIONS C-EMR for nonpedunculated colorectal polyps ≥20 mm shows an excellent safety profile with a very low rate of delayed bleeding as well as significantly less recurrence for sessile serrated polyps than adenomas.
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Affiliation(s)
- Daryl Ramai
- Gastroenterology and Endoscopy Unit, S. Elia Hospital, Caltanissetta, Italy
| | | | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta
| | - Melissa Previtera
- University of Cincinnati Libraries, Donald C. Harrison Health Sciences Library, Cincinnati, OH
| | - Olivia W Brooks
- Internal Medicine Residency, University of Connecticut, Farmington, CT
| | - Yichen Wang
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, MA
| | - Saurabh Chandan
- Division of Gastroenterology & Hepatology, CHI Health Creighton University Medical Center, Omaha, NE
| | - Banreet Dhindsa
- Gastroenterology & Hepatology, University of Nebraska Medical Center, Omaha, NE
| | - Smit Deliwala
- Gastroenterology & Hepatology, Emory University Hospital, Atlanta, GA, USA
| | - Antonio Facciorusso
- Section of Gastroenterology, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Mouen Khashab
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Andrew Ofosu
- Faculty of Medicine, "Kore" University of Enna, Enna, Italy
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Saito Y, Nishizawa T, Arioka H. Pylephlebitis after sigmoid colonic polypectomy. BMJ Case Rep 2022; 15:e253095. [PMID: 36524262 PMCID: PMC9748969 DOI: 10.1136/bcr-2022-253095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A man in his 40s presented with a 7-day history of fever and abdominal pain after polypectomy of the sigmoid colon. On physical examination, he had mild tenderness on deep palpation of the left lower abdominal quadrants without guarding, rigidity or rebound tenderness. Contrast-enhanced CT revealed the thrombosis of the inferior mesenteric vein and the portal vein. Blood cultures were positive for Escherichia coli We diagnosed him with pylephlebitis after colonic polypectomy, as a rare complication. He was started on cefmetazole and heparin. Antibiotic and anticoagulation therapy were initiated. He had a complete recovery within 17 days. The patient had no evidence of underlying hypercoagulable condition, and no signs of recurrence at a 3-month follow-up. Pylephlebitis after colonic polypectomy is extremely rare. Although bacteraemia after colonoscopy was a rare complication, phlebitis should be considered in the differential diagnosis of patients who present with persisted fever and abdominal pain after polypectomy.
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Affiliation(s)
- Yuna Saito
- Department of General Internal Medicine, St Luke's International Hospital, Tokyo, Japan
| | - Toshinori Nishizawa
- Department of General Internal Medicine, St Luke's International Hospital, Tokyo, Japan
| | - Hiroko Arioka
- Department of General Internal Medicine, St Luke's International Hospital, Tokyo, Japan
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Srinivasan SS, Alshareef A, Hwang AV, Kang Z, Kuosmanen J, Ishida K, Jenkins J, Liu S, Madani WAM, Lennerz J, Hayward A, Morimoto J, Fitzgerald N, Langer R, Traverso G. RoboCap: Robotic mucus-clearing capsule for enhanced drug delivery in the gastrointestinal tract. Sci Robot 2022; 7:eabp9066. [PMID: 36170378 PMCID: PMC10034646 DOI: 10.1126/scirobotics.abp9066] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Oral drug delivery of proteins is limited by the degradative environment of the gastrointestinal tract and poor absorption, requiring parenteral administration of these drugs. Luminal mucus represents the initial steric and dynamic barrier to absorption. To overcome this barrier, we report the development of the RoboCap, an orally ingestible, robotic drug delivery capsule that locally clears the mucus layer, enhances luminal mixing, and topically deposits the drug payload in the small intestine to enhance drug absorption. RoboCap's mucus-clearing and churning movements are facilitated by an internal motor and by surface features that interact with small intestinal plicae circulares, villi, and mucus. Vancomycin (1.4 kilodaltons of glycopeptide) and insulin (5.8 kilodaltons of peptide) delivery mediated by RoboCap resulted in enhanced bioavailability 20- to 40-fold greater in ex vivo and in vivo swine models when compared with standard oral delivery (P < 0.05). Further, insulin delivery via the RoboCap resulted in therapeutic hypoglycemia, supporting its potential to facilitate oral delivery of drugs that are normally precluded by absorption limitations.
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Affiliation(s)
- Shriya S. Srinivasan
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Amro Alshareef
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Alexandria V. Hwang
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Ziliang Kang
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Johannes Kuosmanen
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Keiko Ishida
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Joshua Jenkins
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Sabrina Liu
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Wiam Abdalla Mohammed Madani
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jochen Lennerz
- Departnent of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Alison Hayward
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Josh Morimoto
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Nina Fitzgerald
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Robert Langer
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Giovanni Traverso
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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Jing W, Qinghua L, Zhiwen Y. Postpolypectomy fever in patients with serious infection: a report of two cases. BMC Gastroenterol 2022; 22:156. [PMID: 35350984 PMCID: PMC8966367 DOI: 10.1186/s12876-022-02218-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Postpolypectomy fever (PPF) is a rare complication in patients after colonoscopy. Because of the absence of evidence of microperforation and abdominal tenderness, patients with PPF usually present mild clinical symptoms with a good prognosis. Case presentation In this study, all patients who underwent colonoscopic examination in our hospital between January 2019 and December 2019 were enrolled. Of these, two patients developed PPF after polypectomy, exhibiting serious infection without definitive fever foci. One patient experienced rapidly aggravated type 1 respiratory failure and abnormal hepatic function, which were attributed to colonoscopy-associated infection. After active antibiotic therapy, both patients were discharged without any complications. Conclusions In summary, our study provides novel insights into patients with PPF who develop serious infections with life-threatening complications.
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Affiliation(s)
- Wang Jing
- Department of Gastroenterology, Songjiang District Central Hospital, Shanghai, China
| | - Li Qinghua
- Department of Gastroenterology, Songjiang District Central Hospital, Shanghai, China
| | - Yang Zhiwen
- Department of Pharmacy, Songjiang District Central Hospital, Shanghai, 201600, China.
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5
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Ortigão R, Weigt J, Afifi A, Libânio D. Cold versus hot polypectomy/endoscopic mucosal resection-A review of current evidence. United European Gastroenterol J 2021; 9:938-946. [PMID: 34355525 PMCID: PMC8498395 DOI: 10.1002/ueg2.12130] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/01/2021] [Indexed: 12/18/2022] Open
Abstract
Background Colonoscopy with polypectomy substantially reduces the risk of colorectal cancer (CRC) but interval cancers still account for 9% of all CRCs, some of which are due to incomplete resection. Aim The aim of this review is to compare the outcomes of cold and hot endoscopic resection and provide technical tips and tricks for optimizing cold snare polypectomy. Results Cold snare polypectomy (CSP) is the standard technique for small (≤10 mm) colorectal polyps. For large colonic polyps (>10 mm), hot resection techniques with use of electrocautery (polypectomy or endoscopic mucosal resection) were recommended until recently. However, the use of electrocoagulation brings serious adverse effects in up to 9% of the patients, such as delayed bleeding, post‐polypectomy syndrome and perforation. In recent years, efforts have been made to improve the polypectomy with cold snare in order to avoid these adverse effects of electrocoagulation without compromising the efficacy of the resection. Several authors have recently shown that the complication rates of CSP of polyps >10 mm is close to zero and recurrence rates varies between 5‐18%. Lower recurrence rates are found in serrated lesions (<8%).
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Affiliation(s)
- Raquel Ortigão
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Portugal
| | - Jochen Weigt
- Gastroenterology Department, Hepatology and Infectious Diseases, Otto-v.-Guericke University, Magdeburg, Germany
| | - Ahmed Afifi
- Gastroenterology Department, Hepatology and Infectious Diseases, Otto-v.-Guericke University, Magdeburg, Germany
| | - Diogo Libânio
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Portugal.,MEDCIDS-Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
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6
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Boster JM, Iwanowski M, Kramer RE. Management of Pediatric Postendoscopy Fever: Reducing Unnecessary Health Care Utilization With a Clinical Care Guideline. J Pediatr Gastroenterol Nutr 2021; 72:250-254. [PMID: 32925556 PMCID: PMC8256551 DOI: 10.1097/mpg.0000000000002936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The aim of the study was to validate rates of fever after pediatric gastrointestinal endoscopy, to describe clinical outcomes of postendoscopy fever (PEF) cases, and to assess the effect of a PEF clinical care guideline (CCG) on hospital use. PATIENTS AND METHODS Episodes of PEF were reviewed from a large prospective database of all adverse events following pediatric gastrointestinal endoscopy at an academic children's hospital. A CCG was implemented to standardize care of children with reported fever after endoscopy and reduce unnecessary resource use. Chi-squared analysis was performed to compare rates of hospital use for evaluation of PEF before and after implementation of the CCG. RESULTS PEF occurred in 0.55% of the 27,100 endoscopies performed during the present study period. In the 150 cases of reported fever, the rate of identified endoscopy-related infection was low (4.0%). The rate of PEF was significantly higher in patients who underwent interventional procedures (0.81%) than those who underwent diagnostic endoscopy (0.51%, P = 0.02). In patients who experienced PEF, the CCG significantly reduced hospital use, decreasing emergency department visits and hospital admissions by 52.1% (P < 0.0001) without leading to negative patient outcomes. CONCLUSION PEF in children rarely represents clinically significant infection and may be due in part to inflammation from tissue damage and/or physiologic stress. The present study shows that implementation of a PEF CCG may reduce unnecessary care while maintaining patient safety. Furthermore, multicenter studies are required to confirm the overall safety of similar clinical algorithms.
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Affiliation(s)
- Julia M. Boster
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
- Digestive Health Institute, Aurora, CO
| | - Melissa Iwanowski
- Quality and Patient Safety, Children’s Hospital Colorado, Aurora, CO
| | - Robert E. Kramer
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
- Digestive Health Institute, Aurora, CO
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7
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Periprocedural adverse events after endoscopic resection of T1 colorectal carcinomas. Gastrointest Endosc 2020; 91:142-152.e3. [PMID: 31525362 DOI: 10.1016/j.gie.2019.08.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/31/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS In contrast to the adverse event (AE) risk of endoscopic resection (ER) of adenomas, the intra- and postprocedural AE risks of ER of T1 colorectal cancer (CRC) are scarcely reported in the literature. It is unclear whether ER of early CRCs, which grow into the submucosal layer and sometimes show incomplete lifting, is associated with an increased AE risk. We aimed to identify the AE rate after ER of T1 CRCs and to identify the risk factors associated with these AEs. METHODS Medical records of patients with T1 CRCs diagnosed between 2000 and 2014 in 15 hospitals in the Netherlands were reviewed. Patients who underwent primary ER were selected. The primary outcome was the occurrence of endoscopy-related AEs. The secondary outcome was the identification of risk factors. Multivariate logistic regression was performed. RESULTS Endoscopic AEs occurred in 59 of 1069 (5.5%) patients, among which 37.3% were classified as mild, 59.3% as moderate, and 3.4% as severe. AEs were postprocedural bleeding (n = 40, 3.7%), perforation (n = 13, 1.2%), and postpolypectomy electrocoagulation syndrome (n = 6, 0.6%). No fatal AEs were observed. Independent predictors for AEs were age >70 years (odds ratio, 2.11; 95% confidence interval, 1.12-3.96) and tumor size >20 mm (odds ratio, 2.22; 95% confidence interval, 1.05-4.69). CONCLUSIONS In this large multicenter retrospective cohort study, AE rates of ER of T1 CRC (5.5%) are comparable with reported AE rates for adenomas. Larger tumor size and age >70 years are independent predictors for AEs. This study suggests that endoscopic treatment of T1 CRCs is not associated with an increased periprocedural AE risk.
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8
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Thompson EV, Snyder JR. Recognition and Management of Colonic Perforation following Endoscopy. Clin Colon Rectal Surg 2019; 32:183-189. [PMID: 31061648 DOI: 10.1055/s-0038-1677024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Although rare, perforation can be a devastating complication of colonoscopy. Incidence ranges from 0.012 to 0.65% during diagnostic procedures and is higher in therapeutic procedures. Early diagnosis and management are of paramount importance to decrease morbidity. Diagnostic imaging after colonoscopy can reveal extraintestinal air, but overall clinical status including leukocytosis, fever, pain, and peritonitis is equally important to determine management. With the expanding availability of complex endoscopic interventions, an increasing number of perforations are recognized during colonoscopy or immediately afterward based on high degree of suspicion. Colonoscopic management of these early perforations may be feasible and avoid the morbidity of surgery. Patients who require surgery may be managed with laparoscopic or open surgical techniques. Surgical management may consist of primary repair of the injury, resection with anastomosis, or resection with ostomy. Mechanical bowel preparation before endoscopy decreases fecal contamination after perforation, often obviating the need for ostomy creation.
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Affiliation(s)
- Earl V Thompson
- Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathan R Snyder
- Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
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9
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Lorenzo-Zúñiga V, Boix J, Moreno de Vega V, Bon I, Marín I, Bartolí R. Endoscopic shielding technique with a newly developed hydrogel to prevent thermal injury in two experimental models. Dig Endosc 2017; 29:702-711. [PMID: 28294423 DOI: 10.1111/den.12864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/07/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM A newly developed hydrogel, applied through the endoscope as an endoscopic shielding technique (EndoSTech), is aimed to prevent deep thermal injury and to accelerate the healing process of colonic induced ulcers after therapeutic endoscopy. METHODS Lesions were performed in rats (n = 24) and pigs (n = 8). Rats were randomized to receive EndoSTech (eight rats each) with: saline (control), hyaluronic acid and product. In pigs, three ulcer sites were produced in each pig: endoscopic mucosal resection (EMR)-ulcer with prior saline injection (A; EMR-saline), EMR-saline plus EndoSTech with product (B; EMR-saline-P), and EMR with prior injection of product plus EndoSTech-P (C; EMR-P-P). At the end of the 14-day study, the same lesions were performed again in healthy mucosa to assess acute injury. Animals were sacrificed after 7 (rats) and 14 (pigs) days. Ulcers were macroscopically and histopathologically evaluated. Thermal injury (necrosis) was assessed with a 1-4 scale. RESULTS In rats, treatment with product improved mucosal healing comparing with saline and hyaluronic acid (70% vs 30.3% and 47.2%; P = 0.003), avoiding mortality (0% vs 50% and 25%; P = 0.038), and perforation (0% vs 100% and 33.3%; P = 0.02); respectively. In pigs, submucosal injection of product induced a marked trend towards a less deep thermal injury (C = 2.25-0.46 vs A and B = 2.75-0.46; P = 0.127). Mucosal healing rate was higher with product (B = 90.2-3.9%, C = 91.3-5.5% vs A = 73.1-12.6%; P = 0.002). CONCLUSIONS This new hydrogel demonstrates strong healing properties in preclinical models. In addition, submucosal injection of this product is able to avoid high thermal load of the gastrointestinal wall.
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Affiliation(s)
- Vicente Lorenzo-Zúñiga
- Endoscopy Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Jaume Boix
- Endoscopy Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Vicente Moreno de Vega
- Endoscopy Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Ignacio Bon
- Endoscopy Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain.,Germans Trias i Pujol Research Institute (IGTP), Barcelona, Spain
| | - Ingrid Marín
- Endoscopy Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Ramón Bartolí
- Germans Trias i Pujol Research Institute (IGTP), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
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10
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Kandel P, Wallace MB. Colorectal endoscopic mucosal resection (EMR). Best Pract Res Clin Gastroenterol 2017; 31:455-471. [PMID: 28842056 DOI: 10.1016/j.bpg.2017.05.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/28/2017] [Indexed: 01/31/2023]
Abstract
Colonoscopy has the benefit of detecting and treating precancerous adenomatous polyps and thus reduces mortality associated with CRC. Screening colonoscopy is the keystone for prevention of colorectal cancer. Over the last 20 years there has been increased in the management of large colorectal polyps from surgery to endoscopic removal techniques which is less invasive. Traditionally surgical resection was the treatment of choice for many years for larger polyps but colectomy poses significant morbidity of 14-46% and mortality of up to 7%. There are several advantages of endoscopic resection technique over surgery; it is less invasive, less expensive, has rapid recovery, and preserves the normal gut functions. In addition patient satisfaction and efficacy of EMR is higher with minor complications. Thus, this has facilitated the development of advanced resection technique for the treatment of large colorectal polyps called as endoscopic mucosal resection (EMR).
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Affiliation(s)
- Pujan Kandel
- Department of Gastroenterology and Hepatology Mayo Clinic Florida 4500 San Pablo Road Jacksonville, FL 32224, USA
| | - Michael B Wallace
- Department of Gastroenterology and Hepatology Mayo Clinic Florida 4500 San Pablo Road Jacksonville, FL 32224, USA.
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11
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García-García ML, Jiménez-Ballester MÁ, Girela-Baena E, Aguayo-Albasini JL. Abdominal wall abscess secondary to colonoscopic polypectomy. Radiological management. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 40:463-464. [PMID: 27717504 DOI: 10.1016/j.gastrohep.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/06/2016] [Accepted: 06/16/2016] [Indexed: 10/20/2022]
Affiliation(s)
- María Luisa García-García
- Servicio de Cirugía General y Radiología, Hospital Universitario Morales-Meseguer, Instituto de Investigación IMIB-Arrixaca, Universidad de Murcia, Murcia, España; Mare Nostrum International Excellence Campus, Murcia, España
| | - Miguel Ángel Jiménez-Ballester
- Servicio de Cirugía General y Radiología, Hospital Universitario Morales-Meseguer, Instituto de Investigación IMIB-Arrixaca, Universidad de Murcia, Murcia, España; Mare Nostrum International Excellence Campus, Murcia, España.
| | - Enrique Girela-Baena
- Servicio de Cirugía General y Radiología, Hospital Universitario Morales-Meseguer, Instituto de Investigación IMIB-Arrixaca, Universidad de Murcia, Murcia, España; Mare Nostrum International Excellence Campus, Murcia, España
| | - José Luis Aguayo-Albasini
- Servicio de Cirugía General y Radiología, Hospital Universitario Morales-Meseguer, Instituto de Investigación IMIB-Arrixaca, Universidad de Murcia, Murcia, España; Mare Nostrum International Excellence Campus, Murcia, España
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12
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Ma MX, Bourke MJ. Complications of endoscopic polypectomy, endoscopic mucosal resection and endoscopic submucosal dissection in the colon. Best Pract Res Clin Gastroenterol 2016; 30:749-767. [PMID: 27931634 DOI: 10.1016/j.bpg.2016.09.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/25/2016] [Accepted: 09/06/2016] [Indexed: 02/07/2023]
Abstract
Endoscopic resection (ER), including endoscopic polypectomy (EP), endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are used to remove superficial neoplasms from the colon. Snare resection is used for EP and EMR, whereas endoscopic knives are used to perform dissection in the submucosal space in ESD. 80-90% colonic polyps are <10 millimetres (mm) and are effectively managed by conventional EP. Increasingly cold snare polypectomy is preferred. Large laterally spreading lesions (LSLs) and sessile polyps ≥20 mm are primarily removed by EMR. ESD may be used when superficial invasive disease is suspected and for some LSLs, particularly non-granular subtypes. Resection of colonic lesions by ER is associated with a small but definite incidence of significant complications, most commonly bleeding and perforation. This review discusses complications of ER with a particular focus on their prevention, early recognition and management. In many cases, complications from all three procedures share similar mechanisms and management principles and these are described at the start of each section, followed by a description of specific aspects for individual procedures.
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Affiliation(s)
- Michael X Ma
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia.
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Hirasawa K, Sato C, Makazu M, Kaneko H, Kobayashi R, Kokawa A, Maeda S. Coagulation syndrome: Delayed perforation after colorectal endoscopic treatments. World J Gastrointest Endosc 2015; 7:1055-1061. [PMID: 26380051 PMCID: PMC4564832 DOI: 10.4253/wjge.v7.i12.1055] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/18/2015] [Accepted: 08/31/2015] [Indexed: 02/05/2023] Open
Abstract
Various procedure-related adverse events related to colonoscopic treatment have been reported. Previous studies on the complications of colonoscopic treatment have focused primarily on perforation or bleeding. Coagulation syndrome (CS), which is synonymous with transmural burn syndrome following endoscopic treatment, is another typical adverse event. CS is the result of electrocoagulation injury to the bowel wall that induces a transmural burn and localized peritonitis resulting in serosal inflammation. CS occurs after polypectomy, endoscopic mucosal resection (EMR), and even endoscopic submucosal dissection (ESD). The occurrence of CS after polypectomy or EMR varies according previous reports; most report an occurrence rate around 1%. However, artificial ulcers after ESD are largely theoretical, and CS following ESD was reported in about 9% of cases, which is higher than that for CS after polypectomy or EMR. Most cases of post-polypectomy syndrome (PPS) have an excellent prognosis, and they are managed conservatively with medical therapy. PPS rarely develops into delayed perforation. Delayed perforation is a severe adverse event that often requires emergency surgery. Since few studies have reported on CS and delayed perforation associated with CS, we focused on CS after colonoscopic treatments in this review. Clinicians should consider delayed perforation in CS patients.
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Kim HW. What Is Different between Postpolypectomy Fever and Postpolypectomy Coagulation Syndrome? Clin Endosc 2014; 47:205-6. [PMID: 24944980 PMCID: PMC4058534 DOI: 10.5946/ce.2014.47.3.205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 04/01/2014] [Indexed: 01/28/2023] Open
Affiliation(s)
- Hyung Wook Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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