Alça quente versus alça fria para polipectomias colorretais de até 10 mm: uma revisão sistemática e meta-análise de ensaios clínicos randomizados / Hot versus cold snare for colorectal polypectomies sized up to 10mm: a systematic review and meta-analysis of randomized controlled trials

ABSTRACT Background: Colorectal cancer is the third most common cancer, and prevention relies on screening programs with resection complete resection of neoplastic lesions. Objective: We aimed to evaluate the best snare polypectomy technique for colorectal lesions up to 10 mm, focusing on complete resection rate, and adverse events. Methods: A comprehensive search using electronic databases was conducted to identify randomized controlled trials comparing hot versus cold snare resection for polyps sized up to 10 mm, and following PRISMA guidelines, a meta-analysis was performed. Outcomes included complete resection rate, en bloc resection rate, polypectomy, procedure times, immediate, delayed bleeding, and perforation. Results: Nineteen RCTs involving 8720 patients and 17588 polyps were included. Hot snare polypectomy showed a higher complete resection rate (RD, 0.02; 95%CI [+0.00,0.04]; P=0.03; I 2=63%), but also a higher rate of delayed bleeding (RD 0.00; 95%CI [0.00, 0.01]; P=0.01; I 2=0%), and severe delayed bleeding (RD 0.00; 95%CI [0.00, 0.00]; P=0.04; I 2=0%). Cold Snare was associated with shorter polypectomy time (MD -46.89 seconds; 95%CI [-62.99, -30.79]; P<0.00001; I 2=90%) and shorter total colonoscopy time (MD -7.17 minutes; 95%CI [-9.10, -5.25]; P<0.00001; I 2=41%). No significant differences were observed in en bloc resection rate or immediate bleeding. Conclusion: Hot snare polypectomy presents a slightly higher complete resection rate, but, as it is associated with a longer procedure time and a higher rate of delayed bleeding compared to Cold Snare, it cannot be recommended as the gold standard approach. Individual analysis and personal experience should be considered when selecting the best approach.

RESUMO Contexto: O câncer colorretal é o terceiro câncer mais comum na população, e a prevenção é principalmente baseada em programas de screening, com a ressecção completa de lesões neoplásicas. Múltiplas técnicas de ressecção estão disponíveis, mas ainda há controvérsias sobre a melhor abordagem, especialmente em relação à taxa de ressecção completa e à taxa de sangramento tardio. Objetivo: Nosso objetivo foi avaliar a melhor técnica de polipectomia com alça para lesões colorretais de até 10 mm. Métodos: Foi realizada uma busca abrangente em bancos de dados eletrônicos (MEDLINE e EMBASE) para identificar ensaios clínicos randomizados que comparassem a ressecção com alça quente versus alça fria para pólipos de até 10 mm, seguindo as diretrizes PRISMA. Os desfechos incluíram taxa de ressecção completa, taxa de ressecção em bloco, tempo de polipectomia, tempo total do procedimento, sangramento imediato, sangramento tardio e perfuração. Resultados: Dezenove ensaios clínicos randomizados foram incluídos, totalizando 8.720 pacientes e 17.588 pólipos. A polipectomia com alça quente foi associada a uma maior taxa de ressecção completa (RD, 0,02; IC95% [+0,00, 0,04]; P=0,03; I 2=63%), embora também tenha sido associada a uma taxa mais alta de sangramento tardio (RD 0,00; IC95% [0,00, 0,01]; P=0,01; I 2=0%) e de sangramento tardio grave (RD 0,00; IC95% [0,00, 0,00]; P=0,04; I 2=0%). A polipectomia com alça fria foi associada a um menor tempo de polipectomia (MD -46,89 segundos; IC95% [-62,99, -30,79]; P<0,00001 I 2=90%) e a um menor tempo total de colonoscopia (DM -7,17 minutos; IC95% [-9,10, -5,25]; P<0,00001 I 2=41%). Não houve diferença significativa na taxa de ressecção em bloco (RD, 0,00; IC95% [-0,01, 0,01]; P=0,20; I 2=30%) ou na taxa de sangramento imediato (RD -0,00; IC95% [-0,01, 0,00]; P=0,34; I 2=11%). Não foram relatados casos de perfuração em nenhum dos grupos. Conclusão: A polipectomia com alça quente apresenta uma taxa ligeiramente mais alta de ressecção completa, mas, como está associada a um tempo de procedimento mais longo e a uma taxa mais alta de sangramento tardio em comparação com a polipectomia com alça fria, não pode ser recomendada como a abordagem padrão. A análise individualizada e a experiência pessoal devem ser consideradas ao escolher a melhor abordagem.

Polipectomia a frio: um procedimento seguro para remover pequenas lesões colorretais não pediculadas / Cold snare polypectomy: a safe procedure for removing small non-pedunculated colorectal lesions

ABSTRACT Background: Polypectomy is an important treatment option for preventing colorectal cancer. Incomplete polyp resection (IPR) is re­cognized as a risk factor for interval cancer. Objective: The primary objective was to evaluate the complete polyp resection (CPR) rate for cold snare polypectomy (CSP) in small non-pedunculated polyps and, secondarily, specimen retrieval and complication rates. Methods: We prospectively evaluated 479 polyps <10 mm removed by CSP in 276 patients by an inexperienced endoscopist. Results: A total of 476 polyps (99.4%) were resected en bloc. A negative margin (classified as CPR) was observed in 435 polyps (90.8%). An unclear or positive margin (classified as IPR) was observed in 43 cases (9.0%) and 1 case (0.2%), respectively, for an overall IPR rate of 9.2% (44/479). The IPR rate was 12.2% in the first half of cases and 5.9% in the second half (P=0.02). Dividing into tertiles, the IPR rate was 15.0% in the first tertile, 6.9% in the second tertile, and 5.7% in the third tertile (P=0.01). Dividing into quartiles, the IPR rate was 15.8% in the first quartile and 5.9% in the fourth quartile (P=0.03). The IPR rate was 6.3% for type 0-IIa lesions and 14.1% for type 0-Is lesions (P=0.01). For serrated and adenomatous lesions, the IPR rate was 9.2%. Specimen retrieval failed in 3.6% of cases. Immediate bleeding (>30 s) occurred in 1 case (0.2%), treated with argon plasma coagulation. No delayed bleeding or perforation occurred. Conclusion: CSP is a safe technique that provides good results for the resection of small non-pedunculated polyps, with a short learning curve.

RESUMO Contexto: A polipectomia é uma importante opção terapêutica na prevenção do câncer colorretal (CCR). A ressecção incompleta do pólipo (RIP) é reconhecida como fator de risco para o câncer de intervalo. Objetivo: O principal objetivo foi avaliar o índice de ressecção completa da polipectomia a frio (PF) em pequenos pólipos não pediculados e, secundariamente, a recuperação do espécime e índice de complicações. Métodos: Avaliamos prospectivamente 479 pólipos <10 mm removidos por PF em 276 pacientes, por um endoscopista sem experiência com este método. Resultados: Foram ressecados em bloco 476 pólipos (99,4%). Tivemos margem negativa, considerada ressecção completa do pólipo (RCP), em 435 (90,8%) casos. Margem indefinida ou positiva (classificada como RIP) foi observada em 43 (9,0%) casos e em 1 (0,2%) caso, respectivamente, com um índice global de RIP de 9,2% (44/479). O índice de RIP foi de 12,5% na primeira metade dos casos e 5,9% na última metade (P=0,02). Dividindo em tercis, o índice de RIP foi de 15,0% no primeiro terço, 6,9% no segundo terço e 5,7% no terceiro quarto, P=0,01. Dividindo em quartis, o índice de RIP foi de 15,8% no primeiro quarto, enquanto o último quarto foi de 5,9%, P=0,03. O índice de RIP foi de 6,3% para lesões tipo 0-IIa e de 14,1% para lesões tipo 0-Is, P=0,01. O índice de RIP foi de 9,2% para lesões serrilhadas e adenomatosas. Houve falha na recuperação dos espécimes em 3,6% dos casos. Sangramento imediato (>30 s) ocorreu em um caso (0,2%), controlado com plasma de argônio. Sem sangramento tardio e perfuração. Conclusão: PF é uma técnica segura que apresenta bons resultados para a ressecção de pequenas lesões não pediculadas, com uma curta curva aprendizado.

Prognostic roles and survival benefits of endoscopic resection versus surgical resection in the management of malignant colon polyps

Background: Due to few sufficient data regarding the comparison between endoscopic and surgical resection of malignant colorectal polyps regarding outcomes and survival benefits, there are no clear guidelines of management strategies of malignant colorectal polyps. The aims of the present study were to compare endoscopic resection alone and surgical resection in patients with malignant polyps in the colon (T1N0M0) readings advantages, disadvantages, recurrence risks, survival benefits, and long-term prognosis to detect how management strategy affects outcome. Patients and methods: we included 350 patients. All included patients were divided into 2 groups; the first group included 100 patients who underwent only endoscopic polypectomy and the second group included 250 patients who underwent endoscopic polypectomy followed by definitive surgical resection after histopathological diagnosis. We followed all patients for about 5 years, ranging from 18 to 55 months. The primarily evaluated parameters are surgical consequences and patients' morbidity. The secondary evaluated parameters are recurrence risks, recurrence free survival, and overall survival rates. Results: The age of patients who underwent polypectomy is usually younger than the surgical group, males have more liability to polypectomy in comparison with females. Patients with tumors in the left colon have more liability to polypectomy in comparison with the right colon (p< 0.0001). Tumor factors associated with more liability to surgical resection are presence of lymphovascular invasion, high grade, and poor tumor differentiation (p< 0.0001). The management strategy was the most significant predictor of overall and recurrence free survival rates in patients with malignant colon polyps (p< 0.001). Conclusions: We found that survival benefits and lower incidence of recurrence are detected in the surgical resection group more than in the polypectomy group. (AU)

Transgastric laparoscopic polypectomy in giant gastric polyps not susceptible of endoscopic management: novel surgical technique and case series.

BACKGROUND: The identification of gastric polyps incidentally in endoscopies of the upper digestive tract has increased its incidence, varying between 0.5% and 23%. 10% of these polyps have symptoms, 40% are hyperplastic. We allow ourselves to propose a laparoscopic technique for the management of giant hyperplastic polyps associated with a pyloric syndrome, not susceptible to endoscopic resection. METHOD: A series of patients approached by laparoscopic transgastric polypectomy due to the giant gastric polyps associated with pyloric syndrome, in Bogotá, Colombia, from January 2015 to December 2018. RESULTS: Seven patients, 85% female, with an average age of 51 years, who were admitted for pyloric syndrome and were taken to laparoscopic management, with an average surgical time of 42 min, intraoperative bleeding 7-8 cc, tolerance to the oral route 24 hours, no conversion, without mortality. CONCLUSIONS: Transgastric polypectomy for the management of benign giant gastric polyps that cannot be resected endoscopically turns out to be a feasible method, with a low rate of complications and without mortality.

ANTECEDENTES: La identificación de pólipos gástricos de manera incidental en endoscopias de vías digestivas altas ha aumentado su incidencia, que varía entre el 0.5% y el 23%. El 10% de estos pólipos presentan síntomas y el 40% son hiperplásicos. Nos permitimos proponer una técnica laparoscópica para el manejo de los pólipos hiperplásicos gigantes asociados a síndrome pilórico no susceptibles de resección endoscópica. MÉTODO: Serie de pacientes llevados a polipectomía transgástrica laparoscópica por hallazgo de pólipos gástricos gigantes asociados a síndrome pilórico, en Bogotá, Colombia, de enero de 2015 a diciembre de 2018. RESULTADOS: Un total de siete pacientes, el 85% de sexo femenino, con edad promedio de 51 años, ingresaron por síndrome pilórico y fueron llevados a manejo laparoscópico, con un tiempo quirúrgico promedio de 42 minutos, sangrado intraoperatorio de 7-8 cc, tolerancia a la vía oral a las 24 horas, no conversión, sin mortalidad. CONCLUSIONES: La polipectomía transgástrica para el manejo de pólipos gástricos gigantes benignos que no pueden ser resecados por vía endoscópica resulta ser un método factible, con una baja tasa de complicaciones y sin mortalidad.

Serrated polyps of the colon and rectum: a concise review.

"Serrated polyps" is the term used for epithelial lesions of the colon and rectum that have a "sawtooth" pattern on the polyp's surface and crypt epithelium. The so-called serrated pathway describes the progression of sessile serrated adenomas and traditional serrated adenomas to colorectal cancer. Said pathway is well recognized as an alternative mechanism of carcinogenesis and accounts for 15-30% of the cases of colorectal cancer. It also explains a large number of the cases of interval colorectal cancer. Thus, due to their usually aggressive and uncertain behavior, serrated polyps are of the utmost importance in colorectal cancer screening. Our aim was to review the history, current nomenclature, pathophysiology, morphology, treatment, and surveillance of serrated polyps.

The risk of post-polypectomy bleeding among patients receiving antithrombotic agents: A prospective observational study

ABSTRACT BACKGROUND: In July 2012, the Japan Gastroenterological Endoscopy Society updated their guidelines for gastroenterological endoscopy in patients receiving antithrombotic therapy. Colonoscopic polypectomy procedures are associated with a high risk of bleeding. OBJECTIVES: The present study evaluated the safety of colonoscopic polypectomy procedures in terms of bleeding, among patients receiving antithrombotic therapy. DESIGN AND SETTING: Prospective observational study conducted in a tertiary-level public cardiovascular hospital in Istanbul, Turkey. METHODS: Colonoscopic polypectomies carried out in a single endoscopy unit between July 2018 and July 2019 were evaluated prospectively. The patients' data, including age, gender, comorbidities, whether antithrombotic drug use was ceased or whether patients were switched to bridging therapy, polyp size, polyp type, polyp location, histopathology, resection methods (hot snare, cold snare or forceps) and complications relating to the procedures were recorded. RESULTS: The study was completed with 94 patients who underwent a total of 167 polypectomy procedures. As per the advice of the physicians who prescribed antithrombotic medications, 108 polypectomy procedures were performed on 60 patients without discontinuing medication and 59 polypectomy procedures were performed on 34 patients after discontinuing medication. The age, gender distribution and rate of bleeding did not differ significantly between the patients whose medication was discontinued and those whose medication was continued (P > 0.05). CONCLUSION: This study found that the colonoscopic polypectomy procedure without discontinuation of antithrombotic medication did not increase the risk of bleeding. This procedure can be safely performed by experienced endoscopists in patients with an international normalized ratio (INR) below 2.5.

Pólipo del colon que genera un síndrome de ball valve. Reporte de un caso (con video) / Ball Valve syndrome caused by a colon polyp. Case report (with video)

Resumen La obstrucción intestinal es una patología potencialmente letal y cuyo tratamiento, por lo general, es quirúrgico. Presentamos el caso de un paciente con dolor abdominal y clínica de obstrucción intestinal recurrente, en quien se documenta, durante una colonoscopia, un gran pólipo pediculado que causaba obstrucciones parciales por el fenómeno de ball valve.

Abstract Intestinal obstruction is a potentially lethal pathology, and its treatment is usually surgical. The following is the case of a patient with abdominal pain and recurrent intestinal obstruction, in whom a large pediculated polyp that caused partial obstruction by Ball valve effect was observed during a colonoscopy.

Effect of successive endoscopic procedures in polyp and adenoma detection rates: Too early is not always too good.

BACKGROUND AND AIMS: There is conflicting evidence regarding the impact of hypothetical cumulative fatigue after performing too many endoscopic procedures on both polyp and adenoma detection rates (PDR, and ADR, respectively). The aim of this study is to evaluate the effect of successive endoscopic procedures on PDR and ADR. METHODS: A retrospective cross-sectional study was undertaken among consecutive patients on whom colonoscopy and/or esophagogastroduodenoscopy were performed between January 2012 and August 2014. Data regarding polyp and adenoma detection, cecal intubation, and bowel cleansing quality as well as demographical data of subjects were extracted. Endoscopic procedures were classified according to the time slots of the procedures throughout the endoscopy session in three groups: from the 1st to 4th endoscopy study (round 1), from the 5th to the 8th study (round 2), above the 9th study (round 3). We compared PDR and ADR among rounds. RESULTS: Overall, 3388 patients were enrolled. Median age was 50 years (range 18-95) and 52.39% were female. There was a significant difference in terms of PDR among rounds (36.83%, 41.24%, and 43.38%, respectively, p = 0.007) and a non-significant numerical difference when ADR was compared (23.2%, 25.71%, and 26.78%, p = 0.07). On multivariate analysis, ADR was significantly associated with age (odds ratio [OR] 1.02 [1.01-1.03]), and male sex (OR 1.64 [1.38-1.94]). CONCLUSION: Theoretical endoscopist's fatigue due to cumulative performance of endoscopies does not diminish colonoscopy quality. Both PDR and ADR seem to improve after endoscopist's cumulative rounds of performed endoscopies. This could be due to a "warm-up" effect.

Melanoma del canal anal: a propósito de un caso / Melanoma of the anal canal: a propos of a case

RESUMEN Los melanomas mucosos son tumores poco frecuentes y de mal pronóstico. Presentan un comportamiento agresivo, y pueden tener varias localizaciones en el aparato digestivo. Este tipo de tumores es más frecuente en la región anorectal. Se presentó un caso de una paciente femenina de 59 años, con un cuadro de varios meses de evolución; caracterizado por ardor, prurito anal y sensación de masa que prolapsaba a través del ano. Se constató al examen físico masa tumoral aspecto polipoideo. Se realizó polipectomía donde la biopsia arrojó como resultados el aspecto histológico de un melanoma mucoso de canal anal (AU).

ABSTRACT Mucous melanomas are few frequent and have a bad prognosis. They present an aggressive behavior and might have several locations in the digestive system. This kind of tumors is more frequent at the anus-rectal region. The authors presented the case of a female patient, aged 59 years, with clinical conditions of several months of evolution, characterized by burning, anal pruritus and the sensation of a mass prolapsing through the anus. A tumor mass of polypoid aspect was found at physical examination. Polypectomy was carried out and the biopsy showed the histologic aspect of a mucous melanoma of the anal canal (AU).

Melanoma del canal anal: a propósito de un caso / Melanoma of the anal canal: a propos of a case

RESUMEN Los melanomas mucosos son tumores poco frecuentes y de mal pronóstico. Presentan un comportamiento agresivo, y pueden tener varias localizaciones en el aparato digestivo. Este tipo de tumores es más frecuente en la región anorectal. Se presentó un caso de una paciente femenina de 59 años, con un cuadro de varios meses de evolución; caracterizado por ardor, prurito anal y sensación de masa que prolapsaba a través del ano. Se constató al examen físico masa tumoral aspecto polipoideo. Se realizó polipectomía donde la biopsia arrojó como resultados el aspecto histológico de un melanoma mucoso de canal anal.

ABSTRACT Mucous melanomas are few frequent and have a bad prognosis. They present an aggressive behavior and might have several locations in the digestive system. This kind of tumors is more frequent at the anus-rectal region. The authors presented the case of a female patient, aged 59 years, with clinical conditions of several months of evolution, characterized by burning, anal pruritus and the sensation of a mass prolapsing through the anus. A tumor mass of polypoid aspect was found at physical examination. Polypectomy was carried out and the biopsy showed the histologic aspect of a mucous melanoma of the anal canal.

El signo de la hermana María José, un hallazgo semiológico que no se debe olvidar. Reporte de un caso (con video) / The Sister Mary Joseph Nodule, a Semiological Finding that Should not Be Forgotten. Case Report with Video

Resumen Se presenta el caso de una paciente con hemorragia digestiva alta, en quien durante el examen físico se documentó el signo de la hermana María José, que se confirmó ulteriormente mediante endoscopia digestiva y estudios histopatológicos la presencia de un cáncer gástrico avanzado.

Abstract We present the case of a patient with upper gastrointestinal bleeding for whom the Sister Mary Joseph nodule was documented during the physical examination. Later, advanced gastric cancer was confirmed by means of digestive endoscopy and histopathological studies.

Safety and efficacy of small bowel polypectomy using a balloon-assisted enteroscope in pediatric patients with Peutz-Jeghers syndrome. / Seguridad y eficacia de la polipectomía en intestino delgado utilizando enteroscopio asistido por balones en pacientes pediátricos con síndrome de Peutz-Jeghers.

INTRODUCTION AND AIMS: Peutz-Jeghers syndrome is an autosomal dominant inherited pathology characterized by gastrointestinal hamartomatous polyps, predominantly in the small bowel, and pigmented mucocutaneous lesions. Guidelines suggest polypectomy with a balloon-assisted enteroscope when polyps are larger than 10mm. Complications in adults can be as high as 6.8%, but there is little information on pediatric populations. Our aim was to describe the safety and efficacy of polypectomy in a group of pediatric patients with Peutz-Jeghers syndrome using balloon-assisted enteroscopy. MATERIALS AND METHODS: A retrospective study was conducted at the Hospital de Especialidades del Centro Médico Nacional Siglo XXI on pediatric patients with Peutz-Jeghers syndrome that required balloon-assisted enteroscopy and polypectomy within the time frame of January 2010 and December 2015. Patients that underwent polypectomy with a push enteroscope were excluded from the study. RESULTS: A total of 35 polypectomies were performed on 4 patients (female/male: 3/1). The mean age of the patients was 13.7 years (range:11-16). Twelve enteroscopies were carried out, 8 of which were anterograde. A single-balloon enteroscope was used in 7 procedures and a double-balloon enteroscope in 5. The mean size of the polyps was 1.6cm (range: 1-4cm). A major complication (acute pancreatitis) presented in only one case (8.3%). No other major complications associated with the procedures were observed. CONCLUSION: Balloon-assisted enteroscopy with polypectomy in children is a safe and effective procedure, with complications similar to those reported in adults.

Inflammatory fibroid polyp of the gastrointestinal tract: 10 years of experience at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. / Pólipo fibroideo inflamatorio del tracto gastrointestinal: 10 años de experiencia del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.

BACKGROUND: Inflammatory fibroid polyp (lFP) is a rare, benign, and solitary neoplasm predominantly located in the gastric antrum and small bowel. Its clinical symptoms are heterogeneous and essentially depend on the location and size of the tumor. Definitive diagnosis is made through histopathology and this pathology has excellent long-term prognosis. AIM: To identify the cases of IFP seen at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán over a 10-year period. METHODS: A retrospective, cross-sectional, descriptive, and observational study was conducted that included patients with histopathologic diagnosis of IFP within the time frame of January 2001 and December 2011. RESULTS: Six cases were found and 5/6 (83.3%) of them were women. The median age was 41 years (minimum-maximum range of 19-56 years). The most frequent symptoms were weight loss (n=3), fever (n=2), nausea (n=2), and vomiting (n=2). Three patients presented with iron deficiency anemia and 2 cases with intussusception. The IFPs were located at the following sites: esophagus (n=1), stomach (n=2), small bowel (n=2), and colon (n=1). Treatment was surgical in 5/6 (83.3%) of the patients. CONCLUSIONS: IFPs are extremely rare in our population. They usually present with weight loss and iron deficiency anemia and are more frequently located in the stomach and small bowel. This is the largest reported IFP case series in a Mexican population.

Osteocondroma intratraqueal em um cão idoso – relato de caso / Intratracheal osteochondroma in an old dog – a case report / Osteocondroma intratraqueal en un perro viejo – relato de caso

Neoplasias traqueais primárias são incomuns em cães e gatos. Os animais acometidos são geralmente de meia-idade a idosos, exceto aqueles que desenvolvem osteocondromas. As manifestações clínicas são consistentes com a obstrução das vias aéreas superiores, incluindo mais comumente tosse, intolerância ao exercício, dificuldade respiratória e cianose. O diagnóstico normalmente é feito por meio do exame radiográfico simples; a realização de traqueoscopia possibilita a identificação e a biópsia das lesões. Lesões neoplásicas devem ser diferenciadas de corpos estranhos e pólipos. Uma cadela da raça pastor alemão, de quinze anos de idade, apresentava histórico de dificuldade respiratória e tosse havia um ano, com piora progressiva. A identificação da formação foi realizada a partir do exame radiográfico simples, e o diagnóstico definitivo foi obtido pela traqueoscopia, seguida da biópsia e do exame histopatológico da formação.

Primary tracheal neoplasms are uncommon in dogs and cats. Affected animals are generally middle-aged or older, except those that develop osteochondromas. Clinical signs are consistent with upper airway obstruction, most often including cough, intolerance to exercise, breathing difficulty and cyanosis. Diagnosis is usually achieved with a simple radiographic evaluation, while the tracheoscopy allows direct visualization and sampling of the lesion. Neoplastic lesions should be differentiated from other structures such as foreign bodies and polyps. This article reports the case of a 15-year-old female German Shepherd that had a one-year history of progressive dyspnea and cough. Survey radiography helped disclose a mass, but the definite diagnosis was achieved by means of a tracheoscopy followed by biopsy and histopathological exam of the tumor.

Las neoplasias traqueales primarias son poco comunes en perros y gatos. Los animales afectados son generalmente de edad media a viejos, excepto los que desarrollan osteocondromas. Las manifestaciones clínicas son consistentes con obstrucción de las vías aéreas superiores, frecuentemente tos, intolerancia al ejercicio, dificultad respiratoria y cianosis. El diagnóstico se alcanza normalmente a través de exámen radiográfico simple; la traqueoscopía permite la identificación y biopsia delas lesiones. Las lesiones neoplásicas deben ser diferenciadas de cuerpos extraños y pólipos. Una perra Ovejero alemán de quince años presentó un histórico de dificultad respiratoria y tos desde hacía un año, con agravamiento progresivo. La identificación dela formación se consiguió a través de radiografías simples, y el diagnóstico definitivos e obtuvo por traqueoscopia, biopsia y examen histopatológico de la formación.

Osteocondroma intratraqueal em um cão idoso relato de caso / Intratracheal osteochondroma in an old dog a case report / Osteocondroma intratraqueal en un perro viejo relato de caso

Neoplasias traqueais primárias são incomuns em cães e gatos. Os animais acometidos são geralmente de meia-idade a idosos, exceto aqueles que desenvolvem osteocondromas. As manifestações clínicas são consistentes com a obstrução das vias aéreas superiores, incluindo mais comumente tosse, intolerância ao exercício, dificuldade respiratória e cianose. O diagnóstico normalmente é feito por meio do exame radiográfico simples; a realização de traqueoscopia possibilita a identificação e a biópsia das lesões. Lesões neoplásicas devem ser diferenciadas de corpos estranhos e pólipos. Uma cadela da raça pastor alemão, de quinze anos de idade, apresentava histórico de dificuldade respiratória e tosse havia um ano, com piora progressiva. A identificação da formação foi realizada a partir do exame radiográfico simples, e o diagnóstico definitivo foi obtido pela traqueoscopia, seguida da biópsia e do exame histopatológico da formação. (AU)

Primary tracheal neoplasms are uncommon in dogs and cats. Affected animals are generally middle-aged or older, except those that develop osteochondromas. Clinical signs are consistent with upper airway obstruction, most often including cough, intolerance to exercise, breathing difficulty and cyanosis. Diagnosis is usually achieved with a simple radiographic evaluation, while the tracheoscopy allows direct visualization and sampling of the lesion. Neoplastic lesions should be differentiated from other structures such as foreign bodies and polyps. This article reports the case of a 15-year-old female German Shepherd that had a one-year history of progressive dyspnea and cough. Survey radiography helped disclose a mass, but the definite diagnosis was achieved by means of a tracheoscopy followed by biopsy and histopathological exam of the tumor.(AU)

Las neoplasias traqueales primarias son poco comunes en perros y gatos. Los animales afectados son generalmente de edad media a viejos, excepto los que desarrollan osteocondromas. Las manifestaciones clínicas son consistentes con obstrucción de las vías aéreas superiores, frecuentemente tos, intolerancia al ejercicio, dificultad respiratoria y cianosis. El diagnóstico se alcanza normalmente a través de exámen radiográfico simple; la traqueoscopía permite la identificación y biopsia delas lesiones. Las lesiones neoplásicas deben ser diferenciadas de cuerpos extraños y pólipos. Una perra Ovejero alemán de quince años presentó un histórico de dificultad respiratoria y tos desde hacía un año, con agravamiento progresivo. La identificación dela formación se consiguió a través de radiografías simples, y el diagnóstico definitivos e obtuvo por traqueoscopia, biopsia y examen histopatológico de la formación.(AU)

Repair of post polypectomy colonic perforation by Endoclip: a case report / Reparo de perfuração de cólon pós-polipectomia por Endoclip: relato de caso

A 73-year-old woman was admitted to evaluate for iron deficiency anemia, increased serum creatinine, and ascites. Her colonoscopy revealed a polyp at the junction of sigmoid and descending colon, and after polypectomy, a 6 mm colonic perforation was seen. The perforation was detected by radiography and CT scan; and beside conservative management and antibiotics, her perforation was closed by using Endoclip. The patient was observed and discharged from hospital without any surgery 5 days later, and in follow-up there was no problem regarding perforation. (AU)

Mulher, 73 anos, internada para avaliação para anemia ferropriva, com aumento da creatinina sérica e ascite. A colonoscopia revelou um pólipo na junção dos colos sigmoide e descendente e, em seguida à polipectomia, foi observada uma perfuração de 6 mm no cólon, comprovada por radiografias e tomografia computadorizada. Além do tratamento conservador e da antibioticoterapia, a perfuração foi ocluída com Endoclip. A paciente ficou sob observação e recebeu alta do hospital sem qualquer cirurgia 5 dias mais tarde. Durante o seguimento, não foram observados problemas com relação à perfuração. (AU)

Polipectomía colonoscópica monitorizada por laparoscopia (PCML) / Colonoscopic polypectomy monitored by laparoscopy

En pacientes con adenomas del colon, la polipectomía con asa puede ser técnicamente imposible debido a factores como la angulación del colon, imposibilidad de ver la base del pólipo, pólipos ocultos detrás de un pliegue de mucosa, o debido a cirugías previas. Para estos pacientes, la resección segmentaria del colon, abierta o laparoscópica es considerado el tratamiento óptimo. Objetivo: La combinación quirúrgica de endoscopia flexible y laparoscopia, usando CO2 en ambas, ha significado una nueva forma de manejo para estos pólipos difíciles, con la finalidad de evitar la resección colónica. Método: Estudio retrospectivo realizado en base a información colectada prospectivamente en la base de datos del Texas Endosurgery Institute. (n=320, mayo de 1990a mayo 2013). Describimos los antecedentes que nos permitieron implementar el procedimiento, de igual manera detallamos como realizamos la técnica y finalmente compartimos nuestros resulta-dos. Resultados:Se analiza la información relacionada con las 320 PCML realizadas en 198 pacientes. Conclusión: La PCML permite la exéresis de pólipos evitando la resección colónica, este procedimiento menos invasivo se traduce en tiempo de recuperación similar al de la colonoscopia sola, y se evitan las complicaciones relacionadas con la resección segmentaria del intestino grueso. Todos los pólipos son estudiados con biopsia intraoperatoria y de encontrarse hallazgos de malignidad la resección segmentaria laparoscópica es realizada(AU)

In patients with adenomas of the colon, loop polypectomy may be technically impossible due to factors as the angulation of the colon, inability to see the base of the polyp, polyps hidden behind a fold of mucosa, or due to previous surgeries. For these patients,segmental resection of the colon, open or laparoscopic is considered the optimal treatment. Objective:The surgical combination of flexible endoscopy and laparoscopy, using CO2 in both, has meant a new way of handling these difficult polyps in order to prevent colonic resections. Methods: A retrospective study carried out on the basis of information collected prospectively in the Texas Endosurgery Institute database. (n = 320, May 1990 to May 2013). We describe the background that allowed us to implement the procedure, just as detailed as we carry out the technique and finally share our results. Results: We analyzed a total of 320 CPML related information in 198 patients. Conclusion:The CPML allows excision of polyps preventing colonic resection, this procedure less invasive means similar to the single colonoscopy recovery time, and avoided the complications associated with segmental resection of the intestine. All polyps are studied with intraoperative biopsy and found malignant findings segmental resection, laparoscopic is performed(AU)

Importancia de la polipectomía videoendoscópica en el tratamiento de los pólipos de la región rectosigmoidea / Videoendoscopic Polypectomy Importance in the Treatment of Polyps of Rectosigmoid Region

Introducción: la polipectomía endoscópica rectocólica provoca una revoluciónn el tratamiento del tumor cólico benigno, es el procedimiento más frecuentemente utilizado en el manejo de los pólipos, su propósito es la exéresis de toda lesión y dejar la cirugía convencional para los pólipos que con una simple polipectomía no es suficiente, constituye un procedimiento de rutina seguro, rápido y eficaz. Objetivos: evaluar los resultados de la polipectomía endoscópica realizado en el hospital Vladimir Ilich Lenin. Valorar la importancia de la rectosigmoidoscopía en la detección y tratamiento oportuno de lesiones premalignas. Método: se realizó un estudio descriptivo retrospectivo de serie de casos a 51 pacientes que fueron sometidos a polipectomía videoendoscópica rectosigmoidea, en el período comprendido entre septiembre de 2008 a diciembre de 2009, en el Servicio de Coloproctología el Hospital Provincial Docente Vladimir Ilich Lenin de Holguín. Resultados: los pólipos son más frecuentes en la mujer (60,8 %) y mayor de 60 años (35,3 %). Las pérdidas hemáticas (37,3 %) fue la forma de presentación más frecuente. De las características morfológicas de los pólipos la forma sésil (52,9 %) y de pequeño tamaño (54,9 %), localización en el recto (60,8 %) es la más recuente y los solitarios (86,3 %) aparecen con mayor predominio. Los adenomas simples (64,7 %) son los más comunes y en un porcentaje de estos se puede encontrar cierto grado de displasia (31,4 %). Conclusiones: Los pólipos son bastante frecuentes, se dispone de un método fácil de extirpación mediante polipectomía por técnica con asa de diatermia y no se reportaron complicaciones, ni recidivas.

Introduction: endoscopic rectocolic polypectomy causes a revolution in the treatment of benign colic tumor and is the most frequently used procedure in the management of polyps. The purpose of the polypectomy is the removal of any injury and leave conventional surgery for polyps with a simple polypectomy is not enough, it is a safe, fast and efficient routine procedure. Objectives: to evaluate the results of endoscopic polypectomy performed at Vladimir Ilich Lenin hospital. Assess the importance of rectosigmoidoscopy for detection and treatment of premalignant lesions. Method: a retrospective study of cases series was performed in 51 patients who underwent video-endoscopic rectosigmoid polypectomy, in the period from September 2008 to December 2009, at the Department of Coloproctology of Vladimir Ilich Lenin Provincial Teaching Hospital of Holguin. Results: polyps are more common in women (60.8 %) and older than 60 years (35.3 %). Blood loss (37.3 %) was the most common presentation. From the morphological characteristics of sessile polyps form (52.9 %) and small (54.9 %) location in the rectum (60.8 %) is the most common and solitary (86.3 %) predominated. Simple adenomas (64.7 %) are the most common and a percentage of these a degree of dysplasia can be found (31.4 %). Conclusions: polypectomy technique was employed by loop diathermy technique and neither complications nor recurrences were reported.

Endoloop hecho en casa / Homemade Endoloop

La polipectomía es un procedimiento muy común en endoscopia que no está exento de complicaciones; la más frecuente es el sangrado posterior al procedimiento por lo que se han desarrollado para su prevención numerosas estrategias; una de ellas es el uso de endoloop que ha mostrado buenos resultados para pólipos de pedículo muy largo o grueso. Sin embargo, los kits comerciales para realizar este procedimiento son muy costosos y poco disponibles, lo que hace que en nuestro medio se use muy poco. Aquí presentamos un diseño artesanal de bajo costo diseñado (por el grupo del doctor Sakai en Sao Pablo, Brasil) y la experiencia en nuestro servicio con este.

Although polypectomies are very common procedures in endoscopy, they are not without complications. The most common complication is bleeding following the procedure. Numerous strategies have been developed to prevent bleeding. One of these, the use of an endoloop, has had good results for polyps with very long or thick pedicles. Nevertheless, since commercial endoloop kits for this procedure are very expensive and in short supply, they are not widely used in Colombia. In this article we present a low cost design developed by Dr. Sakai in Sao Paul Brazil for an endoloop that can be made in house, and we present our experience with this tool.

Polipectomía endoscópica de colon: efectividad y seguridad de la técnica de inyectar y cortar / Efficacy and safety of the inject and cut technique for endoscopic colonic polypectomy

Colonic polypectomy is the most important tool for stopping adenoma-cancer, and the inject and cut technique has demonstrated efficacy and safety in studies conducted in other countries. Since in our country there are no reported data on performance of this technique, it is necessary to describe the experience of a gastroenterology unit of a university. Objectives: The objectives of this study were to describe operational characteristics of endoscopic colonic polypectomy using the inject and cut technique and to describe demographic characteristics of patients undergoing this procedure. Materials and Methods: We included all patients who underwent endoscopic colonic polypectomies in the gastroenterology unit of the Clínica Fundadores in Bogotá from January 2003 to September 2011. Data were processed using SPSS version 18 18.8 (SPSS-IBM) statistical package. Results: 420 patients underwent polypectomies which resected a total of 548 polyps. Mean patient age was 56.3 years (range 14 to 93), 201 patients were male, and 219 were female. Polyps were most commonly located in the left colon (238/64.4%). Average size was 1.6 cm. 83.8% were pedunculated, 13.3% were sessile, and 2.85% were flat. Intraoperative bleeding occurred in 36 cases (8.6%). There was no relationship between this complication and the size of polyps (<= 20vs> 20 mm), OR: 0.44 (CI 0.19-1.01), nor with the number of resected polyps (1Vs> 1) OR: 1.44, (95%:0.65-3 .2). All cases of bleeding were controlled endoscopically without further complications. There was no need for surgery. There were no local recurrences during follow-up. Conclusions: This study showed that the inject and cut technique is a practical, effective, economical and easy to perform technique for removal of colonic polyps. To date this is the largest series published in our country on the subject

Colonic polypectomy is the most important tool for stopping adenoma-cancer, and the inject and cut technique has demonstrated efficacy and safety in studies conducted in other countries. Since in our country there are no reported data on performance of this technique, it is necessary to describe the experience of a gastroenterology unit of a university. Objectives: The objectives of this study were to describe operational characteristics of endoscopic colonic polypectomy using the inject and cut technique and to describe demographic characteristics of patients undergoing this procedure. Materials and Methods: We included all patients who underwent endoscopic colonic polypectomies in the gastroenterology unit of the Clínica Fundadores in Bogotá from January 2003 to September 2011. Data were processed using SPSS version 18 18.8 (SPSS-IBM) statistical package. Results: 420 patients underwent polypectomies which resected a total of 548 polyps. Mean patient age was 56.3 years (range 14 to 93), 201 patients were male, and 219 were female. Polyps were most commonly located in the left colon (238/64.4%). Average size was 1.6 cm. 83.8% were pedunculated, 13.3% were sessile, and 2.85% were flat. Intraoperative bleeding occurred in 36 cases (8.6%). There was no relationship between this complication and the size of polyps (<= 20vs> 20 mm), OR: 0.44 (CI 0.19-1.01), nor with the number of resected polyps (1Vs> 1) OR: 1.44, (95%:0.65-3 .2). All cases of bleeding were controlled endoscopically without further complications. There was no need for surgery. There were no local recurrences during follow-up. Conclusions: This study showed that the inject and cut technique is a practical, effective, economical and easy to perform technique for removal of colonic polyps. To date this is the largest series published in our country on the subject