BACKGROUND Colonoscopic polypectomy is a crucial procedure for the prevention and treatment of colorectal cancer,with its success and safety largely dependent on the quality of bowel preparation.Currently,polyethylene...BACKGROUND Colonoscopic polypectomy is a crucial procedure for the prevention and treatment of colorectal cancer,with its success and safety largely dependent on the quality of bowel preparation.Currently,polyethylene glycol electrolyte solution remains the standard method for bowel preparation,but its use may cause patient discomfort and incomplete cleansing.AIM To evaluate impact of enhanced and conventional bowel preparation protocols on the outcomes of colonoscopic polypectomy.METHODS This retrospective cohort study collected data from 130 patients who underwent colonoscopic polypectomy between March 2023 and June 2024.Patients were divided into the conventional bowel preparation group(n=65)and enhanced bowel preparation group(n=65).Primary outcome measures included Boston Bowel Preparation Scale(BBPS)scores,procedure-related parameters,complication rates,and prognosis.Statistical analysis was performed using SPSS version 25.0,with P<0.05 indicating statistical significance.RESULTS The enhanced group demonstrated significant advantages over the conventional group,with higher BBPS total scores(4.2±0.7 vs 3.1±0.8,P<0.001),higher onetime complete resection rates(95.4%vs 83.1%,P=0.01),shorter operative times(23.1±4.8 vs 25.4±5.2 min,P=0.03),and lesser intraoperative blood loss(18.2±4.5 vs 20.3±5.1 mL,P=0.04).Total complication rates were significantly lower(5.9%vs 16.9%,P=0.05),particularly for bleeding(1.5%vs 16.9%,P=0.01)and infection(1.5%vs 7.7%,P=0.04).The enhanced group also showed lower 6-month recurrence rates(3.1%vs 10.8%,P=0.05)and higher patient satisfaction(87.7%vs 76.9%,P=0.04)than did the conventional group.CONCLUSION The enhanced bowel preparation protocol demonstrates significant advantages,particularly in improving surgical outcomes,reducing complications,and increasing patient satisfaction,underscoring its importance of its application during colonoscopic polypectomy.展开更多
BACKGROUND Rectal foreign bodies,though uncommon,present diagnostic and therapeutic challenges,particularly when they result from accidental ingestion.The non-specific symptoms and the potential for serious complicati...BACKGROUND Rectal foreign bodies,though uncommon,present diagnostic and therapeutic challenges,particularly when they result from accidental ingestion.The non-specific symptoms and the potential for serious complications necessitate a thorough and methodical approach to diagnosis and treatment.This case report aims to highlight the diagnostic complexities and management strategies involved in treating a patient with a rectal foreign body,focusing on the use of advanced imaging techniques and the importance of a multidisciplinary approach.CASE SUMMARY A 48-year-old male with a history of hypertension presented with a one-year history of post-defecation anorectal pain and mild post-defecation rectorrhagia.Initial evaluation revealed hemodynamic stability and a tender,non-mucosal lesion in the anterior left rectal region.Imaging studies,including colonoscopy,magnetic resonance imaging,and endosonography,identified an erythematous,exophytic lesion and a perirectal abscess containing a foreign body.Surgical inter-vention revealed necrotic tissue and purulent material,along with two solid foreign body fragments(bone or plant matter).Postoperative follow-up showed the patient in good condition,and pathology confirmed the fragments as mature bone.CONCLUSION This case underscores the diagnostic challenges posed by rectal foreign bodies with nonspecific symptoms and no clear history of ingestion.展开更多
AIM:To evaluate and compare the clinical outcomes of prophylactic submucosal saline-epinephrine injection and saline injection alone for large colon polyps by conventional polypectomy. METHODS:A prospective study was ...AIM:To evaluate and compare the clinical outcomes of prophylactic submucosal saline-epinephrine injection and saline injection alone for large colon polyps by conventional polypectomy. METHODS:A prospective study was conducted from July 2003 to July 2004 at 11 tertiary endoscopic centers. Large colon polyps (> 10 mm in diameter) wererandomized to undergo endoscopic polypectomy with submucosal saline-epinephrine injection (epinephrine group) or normal saline injection (saline group). Endoscopic polypectomy was performed by the conventional snare method,and early (< 12 h) and late bleeding complications (12 h-30 d) were observed. RESULTS:A total of 561 polyps in 486 patients were resected by endoscopic polypectomy. Overall,bleeding complications occurred in 7.6% (37/486) of the patients,including 4.9% (12/244) in the epinephrine group,and 10.3% (25/242) in the saline group. Early and late postpolypectomy bleeding (PPB) occurred in 6.6% (32/486) and 1% (5/486) of the patients,respectively,including 4.5% (11/244),0.4% (1/244) in the epinephrine group,and 8.7% (21/242),1.7% (4/242) in the saline group. No significant differences in the rates of overall,early and late PPB were observed between the 2 groups. Multivariate stepwise logistic regression analysis revealed that large size (> 2 cm) and neoplastic polyps were independently and significantly associated with the presence of PPB. CONCLUSION:The prophylactic submucosal injection of diluted epinephrine does not appear to provide an additional advantage over the saline injection alone for the prevention of PPB.展开更多
Colonoscopic polypectomy is extremely effective in protecting against colorectal cancers,and recognition of adenomas by colonoscopy is of paramount importance in preventing colorectal cancer(CRC)and CRC-associated mor...Colonoscopic polypectomy is extremely effective in protecting against colorectal cancers,and recognition of adenomas by colonoscopy is of paramount importance in preventing colorectal cancer(CRC)and CRC-associated mortality.Incomplete polyp resection(IPR)occurs routinely in medical practice following polypectomy.We conducted a comprehensive literature search to identify studies that reported on the potential risk factors for IPR using MEDLINE,EMBASE,and PubMed.Publication time was limited between January 2004 and July 2021.Our search revealed assessments of the position,morphology,and histologic variation of the polypsdas well as the relevant skills that may interfere with IPR.The included studies showed that colonic polyps with a diameter>20 mm and proximal in location should be dealt with cautiously.For smaller polyps,cold-snare polypectomy appeared to be the most effective method used to accomplish comprehensive polyp removal.In addition,endoscopist experience in narrow-band imaging in polyp detection were also associated with IPR.Therefore,polypectomy should be performed cautiously if the polyp growth is expected to be cancerous and situated in the proximal portion of the colon or rectum,and modalities should be standardized so as to lower the potential risk for IPR.展开更多
基金Supported by Jiaxing Science and Technology Projects,No.2023AD31041。
文摘BACKGROUND Colonoscopic polypectomy is a crucial procedure for the prevention and treatment of colorectal cancer,with its success and safety largely dependent on the quality of bowel preparation.Currently,polyethylene glycol electrolyte solution remains the standard method for bowel preparation,but its use may cause patient discomfort and incomplete cleansing.AIM To evaluate impact of enhanced and conventional bowel preparation protocols on the outcomes of colonoscopic polypectomy.METHODS This retrospective cohort study collected data from 130 patients who underwent colonoscopic polypectomy between March 2023 and June 2024.Patients were divided into the conventional bowel preparation group(n=65)and enhanced bowel preparation group(n=65).Primary outcome measures included Boston Bowel Preparation Scale(BBPS)scores,procedure-related parameters,complication rates,and prognosis.Statistical analysis was performed using SPSS version 25.0,with P<0.05 indicating statistical significance.RESULTS The enhanced group demonstrated significant advantages over the conventional group,with higher BBPS total scores(4.2±0.7 vs 3.1±0.8,P<0.001),higher onetime complete resection rates(95.4%vs 83.1%,P=0.01),shorter operative times(23.1±4.8 vs 25.4±5.2 min,P=0.03),and lesser intraoperative blood loss(18.2±4.5 vs 20.3±5.1 mL,P=0.04).Total complication rates were significantly lower(5.9%vs 16.9%,P=0.05),particularly for bleeding(1.5%vs 16.9%,P=0.01)and infection(1.5%vs 7.7%,P=0.04).The enhanced group also showed lower 6-month recurrence rates(3.1%vs 10.8%,P=0.05)and higher patient satisfaction(87.7%vs 76.9%,P=0.04)than did the conventional group.CONCLUSION The enhanced bowel preparation protocol demonstrates significant advantages,particularly in improving surgical outcomes,reducing complications,and increasing patient satisfaction,underscoring its importance of its application during colonoscopic polypectomy.
文摘BACKGROUND Rectal foreign bodies,though uncommon,present diagnostic and therapeutic challenges,particularly when they result from accidental ingestion.The non-specific symptoms and the potential for serious complications necessitate a thorough and methodical approach to diagnosis and treatment.This case report aims to highlight the diagnostic complexities and management strategies involved in treating a patient with a rectal foreign body,focusing on the use of advanced imaging techniques and the importance of a multidisciplinary approach.CASE SUMMARY A 48-year-old male with a history of hypertension presented with a one-year history of post-defecation anorectal pain and mild post-defecation rectorrhagia.Initial evaluation revealed hemodynamic stability and a tender,non-mucosal lesion in the anterior left rectal region.Imaging studies,including colonoscopy,magnetic resonance imaging,and endosonography,identified an erythematous,exophytic lesion and a perirectal abscess containing a foreign body.Surgical inter-vention revealed necrotic tissue and purulent material,along with two solid foreign body fragments(bone or plant matter).Postoperative follow-up showed the patient in good condition,and pathology confirmed the fragments as mature bone.CONCLUSION This case underscores the diagnostic challenges posed by rectal foreign bodies with nonspecific symptoms and no clear history of ingestion.
基金a grant from the Korean Association for the Study of Intestinal Diseases
文摘AIM:To evaluate and compare the clinical outcomes of prophylactic submucosal saline-epinephrine injection and saline injection alone for large colon polyps by conventional polypectomy. METHODS:A prospective study was conducted from July 2003 to July 2004 at 11 tertiary endoscopic centers. Large colon polyps (> 10 mm in diameter) wererandomized to undergo endoscopic polypectomy with submucosal saline-epinephrine injection (epinephrine group) or normal saline injection (saline group). Endoscopic polypectomy was performed by the conventional snare method,and early (< 12 h) and late bleeding complications (12 h-30 d) were observed. RESULTS:A total of 561 polyps in 486 patients were resected by endoscopic polypectomy. Overall,bleeding complications occurred in 7.6% (37/486) of the patients,including 4.9% (12/244) in the epinephrine group,and 10.3% (25/242) in the saline group. Early and late postpolypectomy bleeding (PPB) occurred in 6.6% (32/486) and 1% (5/486) of the patients,respectively,including 4.5% (11/244),0.4% (1/244) in the epinephrine group,and 8.7% (21/242),1.7% (4/242) in the saline group. No significant differences in the rates of overall,early and late PPB were observed between the 2 groups. Multivariate stepwise logistic regression analysis revealed that large size (> 2 cm) and neoplastic polyps were independently and significantly associated with the presence of PPB. CONCLUSION:The prophylactic submucosal injection of diluted epinephrine does not appear to provide an additional advantage over the saline injection alone for the prevention of PPB.
基金supported by the National Natural Science Foundation of China(No.81703076 and No.82072628).
文摘Colonoscopic polypectomy is extremely effective in protecting against colorectal cancers,and recognition of adenomas by colonoscopy is of paramount importance in preventing colorectal cancer(CRC)and CRC-associated mortality.Incomplete polyp resection(IPR)occurs routinely in medical practice following polypectomy.We conducted a comprehensive literature search to identify studies that reported on the potential risk factors for IPR using MEDLINE,EMBASE,and PubMed.Publication time was limited between January 2004 and July 2021.Our search revealed assessments of the position,morphology,and histologic variation of the polypsdas well as the relevant skills that may interfere with IPR.The included studies showed that colonic polyps with a diameter>20 mm and proximal in location should be dealt with cautiously.For smaller polyps,cold-snare polypectomy appeared to be the most effective method used to accomplish comprehensive polyp removal.In addition,endoscopist experience in narrow-band imaging in polyp detection were also associated with IPR.Therefore,polypectomy should be performed cautiously if the polyp growth is expected to be cancerous and situated in the proximal portion of the colon or rectum,and modalities should be standardized so as to lower the potential risk for IPR.
