Onset Time and Characteristics of Postprocedural Bleeding after Endoscopic Resection of Colorectal Lesions: A Multicenter Retrospective Study.

INTRODUCTION: Postprocedural bleeding is a major adverse event after endoscopic resection of colorectal lesions, but the optimal surveillance time after endoscopy is unclear. In this study, we determined onset time and characteristics of postprocedural bleeding events. METHODS: We retrospectively screened patients who underwent endoscopic resection of colorectal lesions at three German hospitals between 2010 and 2019 for postprocedural bleeding events using billing codes. Only patients who required re-endoscopy were included for analysis. For identified patients, we collected demographic data, clinical courses, characteristics of colorectal lesions, and procedure-related variables. Factors associated with late-onset bleeding were determined by univariate and multivariate logistic regression analysis. RESULTS: From a total of 6,820 patients with eligible billing codes, we identified 113 cases with postprocedural bleeding after endoscopic mucosal (61.9%) or snare resection (38.1%) that required re-endoscopy. The median size of the culprit lesion was 20 mm (interquartile range 14-30 mm). The median onset time of postprocedural bleeding was day 3 (interquartile range: 1-6.5 days), with 48.7% of events occurring within 48 h. Multivariate logistic regression analysis demonstrates that a continued intake of antiplatelet drugs (OR: 3.98, 95% CI: 0.89-10.12, p = 0.025) and a flat morphology of the colorectal lesion (OR: 2.98, 95% CI: 1.08-8.01, p = 0.031) were associated with an increased risk for late postprocedural bleeding (>48 h), whereas intraprocedural bleeding was associated with a decreased risk (OR: 0.12, 95% CI: 0.04-0.50, p = 0.001). CONCLUSION: Significant postprocedural bleeding can occur up to 18 days after endoscopic resection of colorectal lesions, but was predominantly observed within 48 h. Continued intake of antiplatelet drugs and a flat polyp morphology are associated with risk for late postprocedural bleeding.

Computer-based classification of small colorectal polyps by using narrow-band imaging with optical magnification.

BACKGROUND: Recent studies have shown that narrow-band imaging (NBI) is a powerful diagnostic tool for the differentiation between neoplastic and non-neoplastic colorectal polyps. OBJECTIVE: To develop a computer-based method for classification of colorectal polyps. DESIGN: A prospective study. SETTING: University hospital. PATIENTS: A total of 214 patients with colorectal polyps who underwent a zoom NBI colonoscopy. INTERVENTIONS: A total of 434 detected polyps 10 mm or smaller were imaged and subsequently removed for histological analysis. MAIN OUTCOME MEASUREMENTS: Diagnostic performance in polyp classification by 2 experts, 2 nonexperts, and a computer-based algorithm. RESULTS: The expert group and the computer-based algorithm achieved a comparable diagnostic performance (expert group: 93.4% sensitivity, 91.8% specificity, and 92.7% accuracy; computer-based algorithm: 95.0% sensitivity, 90.3% specificity, and 93.1% accuracy) and were both significantly superior to the nonexpert group (86.0% sensitivity, 87.8% specificity, and 86.8% accuracy) in terms of sensitivity, negative predictive value, and accuracy. Subgroup analysis of 255 polyps 5 mm or smaller revealed comparable results without significant differences in the overall analysis of all polyps. LIMITATIONS: No fully automatic classification system. CONCLUSIONS: The study demonstrates that computer-based classification of colon polyps can be achieved with high diagnostic performance.

Gap detection in endoscopic video sequences using graphs.

In minimal invasive surgery (MIS) a complete and seamless inspection of organs, e.g. the urinary bladder, using video endoscopes is often required for diagnostics. Since the endoscope is usually guided by free-hand, it is difficult to ensure a sequence of seamless frame transitions. Also 2-D panoramic images showing an extended field of view (FOV) do not provide always reliable results, since their interpretations are limited by potentially strong geometric distortions. To overcome these limitations and provide a direct verification method, we develop a gap detection algorithm using graphs. Exploiting the motion information of the applied zig-zag scan, we construct a graph representation of the video sequence. Without any explicit global image visualization our graph search algorithm identifies reliably frame discontinuities, which would lead to holes and slit artifacts in a panoramic view. The algorithm shows high detection rates and provides a fast method to verify frame discontinuities in the whole video sequence. Missed regions are highlighted by local image compositions which can be displayed during the intervention for assistance and inspection control.

Inertial navigation system for bladder endoscopy.

The usage of video endoscopes in cystoscopic interventions of the urinary bladder impedes an intuitive navigation. Although image-based solutions such as panorama images can provide extended views of the surgical field, a real-time 3-D navigation is not supported. Furthermore, the integration of common tracking systems in ambulant clinics is often hindered due to low usability and high costs. Thus, we discuss in this paper a first low-cost inertial navigation system. Our evaluation results show that in spite of lower sensor accuracies, mean errors between < 1° and 4° are achieved for solid angles. Using endoscopes with different view angles we apply an extended endoscope model for an adaptive displacement correction. Furthermore, we implement a first guided navigation tool for tumor re-identification in real-time.

Local and global panoramic imaging for fluorescence bladder endoscopy.

Endoscopic treatment of bladder cancer is more and more often based on photodynamic diagnostics (PDD), a specialized endoscopic technique where a narrow-band bluish illumination causes tumors to fluoresce reddish. Contrast between tumors and healthy bladder tissue is thus noticeably increased compared to white light endoscopy. A downside of PDD is the low illumination power, which requires that the distance between endoscope and bladder wall be kept low, thus resulting in a small field of view (FOV). We therefore describe an approach to combine several successive frames into a local PDD panorama, which provides a larger and sufficiently bright FOV for treatment. Furthermore, the endoscopic cancer treatment generally starts with a complete scan of the bladder to detect the tumors. For diagnosis, navigation and reporting, a global overview image of the bladder wall is often desired. While construction of such a global panorama can be based on the same algorithm as the local panorama, direct planar visualization of the sphere-shaped bladder may cause severe distortions. Apart from the global panorama computation itself, we therefore analyze these distortions, and provide an alternative visualization which is based on bladder depictions used in standard reporting forms and anatomy textbooks.

The c-Jun N-terminal kinases in cerebral microglia: immunological functions in the brain.

The c-Jun N-terminal kinases (JNKs) exert a pleiotrophy of physiological and pathological actions. This is also true for the immune system. Disruption of the JNK locus results in substantial functional deficits of peripheral T-cells. In contrast to circulating immune cells and the role of p38, the presence and function of JNKs in the immune cells of the brain remain to be defined. Here, we report on the expression and activation of JNKs in cultivated microglia from neonatal rats and from mice with targeted disruption of the JNK locus and the N-terminal mutation of c-Jun (c-JunAA), respectively. JNK1, 2 and 3 mRNA and proteins were all expressed in microglia. Following stimulation with LPS (100 ng/mL), a classical activator of microglia, JNKs were rapidly activated and this activation returns to basal levels within 4 hr. Following LPS and other stimuli such as thrombin (10-50 unit/mL), the activation of JNKs went along with the N-terminal phosphorylation of c-Jun which persisted for at least 8 hr. Indirect inhibition of JNK by CEP-11004 (0.5-2 microM), an inhibitor of mixed-lineage kinases (MLK), reduced the LPS-induced phosphorylation of both, JNK and c-Jun, by around 50%, and attentuated the LPS-induced the alterations in microglial morphology. Finally, JNKs are involved in the control of cytokine release since both, incubation with CEP-11004 and disruption of the JNK1 locus enhanced the release of TNFalpha, IL-6 and IL-12. Our findings provide insight in so far unknown functions of JNKs in cerebral immune cells. These observations are also important for the wide spread efforts to develop JNK-inhibitors as neuroprotective drugs which, however, might trigger pro-inflammatory processes.