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2.
Gastrointest Endosc Clin N Am ; 29(4): 705-719, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31445692

RESUMO

Large and complex colon polyps are frequently referred to surgery for fear of perforation that may need emergency surgery. During the last 15 years, advances in clip and suturing devices allowed us to close perforations and avoid surgery. In addition, we have made substantial progress in our understanding of the lesions at risk for either immediate or delayed perforation. This article focuses on the colonoscopic closure of resection defects and perforations and the prevention and treatment of colon perforations after endoscopic resection.


Assuntos
Colonoscópios , Colonoscopia/efeitos adversos , Neoplasias Colorretais/cirurgia , Perfuração Intestinal/cirurgia , Complicações Intraoperatórias/cirurgia , Idoso , Colonoscopia/métodos , Neoplasias Colorretais/patologia , Feminino , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Prognóstico , Instrumentos Cirúrgicos , Técnicas de Sutura , Técnicas de Fechamento de Ferimentos/instrumentação
3.
Gastroenterology ; 157(5): 1222-1232.e4, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31419435

RESUMO

BACKGROUND AND AIMS: In patients who have undergone surgery for colorectal cancer (CRC), 3% have recurrence of (metachronous) CRC. We investigated whether tumor seeding during colonoscopy (iatrogenic implantation of tumor cells in damaged mucosa) increases risk for metachronous CRC. METHODS: In a proof of principle study, we collected data from the Dutch National Pathology Registry for patients with a diagnosis of CRC from 2013 through 2015, with a second diagnosis of CRC within 6 months to 3.5 years after surgery. We reviewed pathology reports to identify likely metachronous CRC (histologically proven adenocarcinoma located elsewhere in the colon or rectum from the surgical anastomosis). For 22 patients fulfilling the inclusion criteria, we ascribed the most likely etiology to tumor seeding when endoscopic manipulations, such as biopsies or polypectomy, occurred at the location where the metachronous tumor was subsequently detected, after endoscopic manipulation of the primary tumor. We collected clinical data from patients and compared molecular profiles of the primary and metachronous colorectal tumors using next-generation sequencing. We then examined the source of seeded tumor. We tested whether tumor cells stay behind in the working channel of the endoscope after biopsies of colorectal tumors, and whether these cells maintain viability in organoid cultures. RESULTS: In total, tumor seeding was suspected as the most likely etiology of metachronous CRC in 5 patients. Tumor tissues were available from 3 patients. An identical molecular signature was observed in the primary and metachronous colorectal tumors from all 3 patients. In 5 control cases with a different etiology of metachronous CRC, the molecular signature of the primary and metachronous tumor were completely different. Based on review of 2147 patient records, we estimated the risk of tumor seeding during colonoscopy to be 0.3%-0.6%. We demonstrated that the working channel of the colonoscope becomes contaminated with viable tumor cells during biopsy collection. Subsequent instruments introduced through this working channel also became contaminated. These cells were shown to maintain their proliferative potential. CONCLUSIONS: In an analysis of primary and secondary tumors from patients with metachronous CRC, we found that primary tumor cells might be seeded in a new location after biopsy of the primary tumor. Although our study does not eliminate other possibilities of transmission, our findings and experiments support the hypothesis that tumor seeding can occur during colonoscopy via the working channel of the endoscope. The possibility of iatrogenic seeding seems low. However, our findings compel awareness on this potentially preventable cause of metachronous CRC.


Assuntos
Pólipos Adenomatosos/cirurgia , Pólipos do Colo/cirurgia , Colonoscopia/efeitos adversos , Neoplasias Colorretais/cirurgia , Inoculação de Neoplasia , Segunda Neoplasia Primária/patologia , Pólipos Adenomatosos/genética , Pólipos Adenomatosos/patologia , Idoso , Biomarcadores Tumorais/genética , Pólipos do Colo/genética , Pólipos do Colo/patologia , Colonoscópios , Colonoscopia/instrumentação , Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Contaminação de Equipamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/genética , Estudo de Prova de Conceito , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral , Células Tumorais Cultivadas
4.
Turk J Gastroenterol ; 30(7): 630-635, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31290751

RESUMO

BACKGROUND/AIMS: Preforming total colonoscopy (TCS) is sometimes difficult due to adhesions or long colons. The PCF-PQ260L (PQL) was developed to overcome TCS-related difficulties. The aim of this study was to investigate the performance and usefulness of PQL for difficult colon cases. MATERIALS AND METHODS: This was a retrospective single center observational cohort study investigating differences in patient characteristics and examination performance between patients examined with PQL, versus standard (SD), scopes. Secondly, we directly compared PQL and SD scopes in patients treated with both types of scope. RESULTS: The PQL was used with 105 patients and SD scopes were used with 1119 patients. Patients in the PQL group were significantly shorter (157cm vs 163cm, p< 0.01) and lighter, compared to the SD group (52 kg vs 58 kg, p< 0.01). There were no significant statistical differences with regard to cecal intubation rate, cecal intubation time, and adenoma detection. Direct comparison of use of PQL and SD scopes on the same patients revealed shorter average cecal intubation time (7 min vs 10 min, p< 0.01), and significantly increased numbers of patients reporting no pain (66 % vs 20 %, p< 0.01) and needing no sedative drugs (48% vs 25 %, p< 0.01) associated with PQL use. CONCLUSION: The examination performance of the PQL scope was similar to the SD scope. The PQL may be a good option for patients who with difficult colons.


Assuntos
Colo/anatomia & histologia , Doenças do Colo/diagnóstico , Colonoscópios , Desenho de Equipamento , Idoso , Constrição Patológica , Feminino , Humanos , Masculino , Medição da Dor , Estudos Retrospectivos , Aderências Teciduais/complicações
6.
Dig Endosc ; 31(5): 583-587, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31211893

RESUMO

Cecal intubation is a critical aspect of effective, complete colonoscopy. Difficult colonoscopy is most often considered as one in which it is challenging or impossible to reach the cecum. It may be a common occurrence due to patient and/or endoscopist factors. Incomplete colonoscopies should be avoided, since patients in this context present an important prevalence of lesions that escape examination. The approach to successful cecal intubation should depend on characterization of the problem as redundant colon or difficult sigmoid colon. Most patients with a prior incomplete colonoscopy can be colonoscoped successfully, if careful attention is paid to technique, using a variety of scopes, colonoscopy methods and additional equipment. Sufficient time should be allotted to make the attempt.


Assuntos
Colonoscópios , Colonoscopia/métodos , Ceco/diagnóstico por imagem , Colonoscopia/instrumentação , Humanos , Fatores de Risco , Falha de Tratamento
7.
Gastroenterol Nurs ; 42(2): 159-164, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30946303

RESUMO

Current research suggests that for certain types of gastrointestinal endoscopes, longer shelf life (the interval of storage after which endoscopes should be reprocessed before their reuse) may not increase the likelihood of endoscope contamination. Scope contamination may, in fact, be related primarily to either inadequate disinfection processes or inadvertent contamination during storage, not to duration of storage. The purpose of this study evaluated the presence of bacteria and fungus following liquid chemical sterilization in colonoscopes and gastroscopes, after 12 weeks of shelf life during which time personal protective equipment was used during endoscope storage cabinet access. We stored four colonoscopes and two gastroscopes in a cabinet for 12 weeks after liquid chemical sterilization and the cabinet was only accessed during the 12-week period wearing personal protective equipment (gown and gloves). Scopes were tested for bacteria and fungus at the end of 12 weeks. No bacteria or fungus grew on any of the scopes. This study provides further support that contaminated endoscopes may be related to either inadequate disinfection or contamination during storage, not shelf life.


Assuntos
Colonoscópios/microbiologia , Infecção Hospitalar/prevenção & controle , Contaminação de Equipamentos/prevenção & controle , Segurança de Equipamentos , Gastroscópios/microbiologia , Desinfecção/métodos , Endoscópios Gastrointestinais/microbiologia , Reutilização de Equipamento , Hospitais Comunitários , Humanos , Estudos Prospectivos , Esterilização/métodos , Fatores de Tempo , Estados Unidos
8.
World J Gastroenterol ; 25(9): 1158-1170, 2019 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-30863002

RESUMO

BACKGROUND: Endocuff - a plastic device with flexible projections - mounted on the distal tip of the colonoscope, promises improved colonic mucosa inspection. AIM: To elucidate the effect of Endocuff on adenoma detection rate (ADR), advanced ADR (AADR) and mean number of adenomas per colonoscopy (MAC). METHODS: Literature searches identified randomized-controlled trials evaluating Endocuff-assisted colonoscopy (EAC) vs conventional colonoscopy (CC) in terms of ADR, AADR and MAC. The effect size on study outcomes was calculated using fixed or random effect model, as appropriate, and it is shown as relative risk (RR) [95% confidence interval (CI)] and mean difference (MD) (95%CI). The rate of device removal in EAC arms was also calculated. RESULTS: We identified nine studies enrolling 6038 patients. All studies included mixed population (screening, surveillance and diagnostic examinations). Seven and two studies evaluated the first and the second-generation device, respectively. EAC was associated with increased ADR compared to CC [RR (95%CI): 1.18 (1.05-1.32); Ι 2 = 71%]; EAC benefits more endoscopists with ADR ≤ 35% compared to those with ADR > 35% [RR (95%CI): 1.37 (1.08-1.74); Ι 2 = 49% vs 1.10 (0.99-1.24); Ι 2 = 71%]. In terms of AADR and MAC, no difference was detected between EAC and CC [RR (95%CI): 1.03 (0.85-1.25); Ι 2 = 15% and MD (95%CI): 0.30 (-0.17-0.78); Ι 2 = 99%]. Subgroup analysis did not show any difference between the two device generations regarding all three endpoints. In EAC arms, the device had to be removed in 3% (95%CI: 2%-5%) of the cases mainly due to tortuous sigmoid or presence of diverticula along it. CONCLUSION: EAC increases ADR compared to CC, especially for endoscopists with lower ADR. On the other hand, no significant effect on AADR and MAC was detected.


Assuntos
Adenoma/diagnóstico por imagem , Colonoscópios , Colonoscopia/instrumentação , Neoplasias Colorretais/diagnóstico por imagem , Detecção Precoce de Câncer/instrumentação , Adenoma/epidemiologia , Adenoma/patologia , Colo/diagnóstico por imagem , Colo/patologia , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/estatística & dados numéricos , Humanos , Incidência , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/patologia , Reto/diagnóstico por imagem , Reto/patologia
9.
Molecules ; 24(6)2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30897785

RESUMO

BACKGROUND: Autofluorescence imaging (AFI) is useful for diagnosing colon neoplasms, but what affects the AFI intensity remains unclear. This study investigated the association between AFI and the histological characteristics, aberrant methylation status, and aberrant expression in colon neoplasms. METHODS: Fifty-three patients with colorectal neoplasms who underwent AFI were enrolled. The AFI intensity (F index) was compared with the pathological findings and gene alterations. The F index was calculated using an image analysis software program. The pathological findings were assessed by the tumor crypt density, cell densities, and N/C ratio. The aberrant methylation of p16, E-cadherin, Apc, Runx3, and hMLH1 genes was determined by a methylation-specific polymerase chain reaction. The aberrant expression of p53 and Ki-67 was evaluated by immunohistochemical staining. RESULTS: An increased N/C ratio, the aberrant expression of p53, Ki-67, and the altered methylation of p16 went together with a lower F index. The other pathological findings and the methylation status showed no association with the F index. CONCLUSIONS: AFI reflects the nuclear enlargement of tumor cells, the cell proliferation ability, and the altered status of cell proliferation-related genes, indicating that AFI is a useful and practical method for predicting the dysplastic grade of tumor cells and cell proliferation.


Assuntos
Neoplasias do Colo/diagnóstico por imagem , Imagem Óptica/métodos , Caderinas/metabolismo , Neoplasias do Colo/metabolismo , Colonoscópios , Subunidade alfa 3 de Fator de Ligação ao Core/metabolismo , Inibidor p16 de Quinase Dependente de Ciclina/metabolismo , Humanos , Imuno-Histoquímica , Antígeno Ki-67/metabolismo , Proteína 1 Homóloga a MutL/metabolismo , Software , Proteína Supressora de Tumor p53/metabolismo
10.
Expert Rev Gastroenterol Hepatol ; 13(2): 119-127, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30791785

RESUMO

INTRODUCTION: Colonoscopy reduces the risk of colorectal cancer, by interrupting the adenoma-carcinoma sequence enabling the detection and removal of adenomas before they turn into colorectal cancer. Colonoscopy has its limitations as adenoma miss rates as high as 25% have been reported. The reasons for missed pathology are complicated and multi-factorial. The recent drive to improve adenoma detection rates has led to a plethora of new technologies. Areas covered: An increasing number of advanced endoscopes and distal attachment devices have appeared in the market. Advanced endoscopes aim to improve mucosal visualization by widening the field of view. Distal attachment devices aim to increase adenoma detection behind folds by flattening folds on withdrawal. In this review article, we discuss the three following distal attachment devices: the transparent cap, the Endocuff, and the Endoring. Expert commentary: The authors believe that the distal attachment devices will have a greater benefit for endoscopists with low baseline adenoma detection rates.


Assuntos
Pólipos Adenomatosos/patologia , Neoplasias do Colo/patologia , Pólipos do Colo/patologia , Colonoscópios , Colonoscopia/instrumentação , Pólipos Adenomatosos/cirurgia , Neoplasias do Colo/cirurgia , Pólipos do Colo/cirurgia , Desenho de Equipamento , Humanos , Valor Preditivo dos Testes
11.
Gastrointest Endosc ; 89(3): 545-553, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30273591

RESUMO

BACKGROUND AND AIMS: Colorectal cancer (CRC) is largely preventable with routine screening and surveillance colonoscopy; however, interval cancers arising from precancerous lesions missed by standard colonoscopy still occur. An increased adenoma detection rate (ADR) has been found to be inversely associated with interval cancers. The G-EYE device includes a reusable balloon integrated at the distal tip of a standard colonoscope, which flattens haustral folds, centralizes the colonoscope's optics, and reduces bowel slippage. The insufflated balloon also aims to enhance visualization of the colon during withdrawal, thereby increasing the ADR. METHODS: In this randomized, controlled, international, multicenter study (11 centers), patients (aged ≥50 years) referred to colonoscopy for screening, surveillance, or changes in bowel habits were randomized to undergo either balloon-assisted colonoscopy by using an insufflated balloon during withdrawal or standard high-definition colonoscopy. The primary endpoint was the ADR. RESULTS: One thousand patients were enrolled between May 2014 and September 2016 to undergo colonoscopy by experienced endoscopists; 803 were finally analyzed (standard colonoscopy n = 396; balloon-assisted colonoscopy n = 407). Baseline parameters were similar in both groups. Balloon-assisted colonoscopy provided a 48.0% ADR compared with 37.5% in the standard colonoscopy group (28% increase; P = .0027). Additionally, balloon-assisted colonoscopy provided for a significant increase in detection of advanced (P = .0033) flat adenomas (P < .0001) and sessile serrated adenomas/polyps (P = .0026). CONCLUSION: Balloon-assisted colonoscopy yielded a higher ADR and increased the detection of advanced, flat, and sessile serrated adenomas/polyps when compared with standard colonoscopy. Improved detection by the G-EYE device could impact the quality of CRC screening by reducing miss rates and consequently reducing interval cancer incidence. (Clinical trial registration number: NCT01917513.).


Assuntos
Adenoma/diagnóstico , Pólipos do Colo/diagnóstico , Colonoscopia/métodos , Neoplasias Colorretais/diagnóstico , Pólipos Adenomatosos/diagnóstico , Assistência ao Convalescente , Idoso , Colonoscópios , Colonoscopia/instrumentação , Detecção Precoce de Câncer , Fezes/química , Feminino , Hemoglobinas/análise , Humanos , Imunoquímica , Masculino , Pessoa de Meia-Idade
12.
Gut ; 68(2): 280-288, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29363535

RESUMO

OBJECTIVE: Low adenoma detection rates (ADR) are linked to increased postcolonoscopy colorectal cancer rates and reduced cancer survival. Devices to enhance mucosal visualisation such as Endocuff Vision (EV) may improve ADR. This multicentre randomised controlled trial compared ADR between EV-assisted colonoscopy (EAC) and standard colonoscopy (SC). DESIGN: Patients referred because of symptoms, surveillance or following a positive faecal occult blood test (FOBt) as part of the Bowel Cancer Screening Programme were recruited from seven hospitals. ADR, mean adenomas per procedure, size and location of adenomas, sessile serrated polyps, EV removal rate, caecal intubation rate, procedural time, patient experience, effect of EV on workload and adverse events were measured. RESULTS: 1772 patients (57% male, mean age 62 years) were recruited over 16 months with 45% recruited through screening. EAC increased ADR globally from 36.2% to 40.9% (P=0.02). The increase was driven by a 10.8% increase in FOBt-positive screening patients (50.9% SC vs 61.7% EAC, P<0.001). EV patients had higher detection of mean adenomas per procedure, sessile serrated polyps, left-sided, diminutive, small adenomas and cancers (cancer 4.1% vs 2.3%, P=0.02). EV removal rate was 4.1%. Median intubation was a minute quicker with EAC (P=0.001), with no difference in caecal intubation rate or withdrawal time. EAC was well tolerated but caused a minor increase in discomfort on anal intubation in patients undergoing colonoscopy with no or minimal sedation. There were no significant EV adverse events. CONCLUSION: EV significantly improved ADR in bowel cancer screening patients and should be used to improve colonoscopic detection. TRIAL REGISTRATION NUMBER: NCT02552017, Results; ISRCTN11821044, Results.


Assuntos
Adenoma/diagnóstico por imagem , Colonoscópios , Colonoscopia/métodos , Neoplasias Colorretais/diagnóstico por imagem , Adenoma/patologia , Neoplasias Colorretais/patologia , Diagnóstico Diferencial , Inglaterra , Desenho de Equipamento , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Melhoria de Qualidade
13.
Surg Endosc ; 33(1): 322-332, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30039341

RESUMO

BACKGROUND: At present, the colonoscopy is the most common method of screening for colorectal cancer. However, endoscopists still encounter difficulties with intubation, primarily due to the structural diversity (e.g., path, shape, and size) and viscoelasticity of the colon. Therefore, well-trained, skillful operators are required to overcome these factors and operate colonoscopes without harming patients. OBJECTIVES: In our previous work, we presented a reel mechanism-based robotic colonoscope designed to mitigate the difficulties of conventional colonoscopies. Although we reported excellent mobile performance with respect to the robot, we did not provide an in-depth discussion concerning patient safety. Therefore, in this article, we propose a method of improving robot safety, and this is verified by investigating the static and dynamic forces acting on the colon. In addition, the maneuverability and safety of the robot in the in vitro condition are evaluated. METHODS: The safety solution is provided by covering the robot's legs with silicone. To evaluate the results, the reaction force according to leg deformation is measured. Then, the force transmitted to the colon is also measured when the robot moves through various environments. Finally, a mobility test on an excised porcine colon is performed to simultaneously verify the robot's maneuverability and safety. RESULTS: We verify that the static and dynamic force acting on the colon is less than the burst force of a human colon. In addition, the maneuverability of the robotic colonoscope shows reliable locomotion performance even with the soft material covering the legs; it has forward velocities of 9.552 ± 1.940 mm/s on a flat path. CONCLUSION: Owing to the reliable locomotion mechanism with the safety-securing silicone, the robot achieves high and reliable maneuverability without any scratches or perforations to the porcine colon.


Assuntos
Neoplasias do Colo/diagnóstico , Colonoscópios , Colonoscopia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Colonoscopia/efeitos adversos , Colonoscopia/instrumentação , Desenho de Equipamento , Humanos , Segurança do Paciente
14.
Gastrointest Endosc ; 89(1): 115-123, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30125574

RESUMO

BACKGROUND AND AIMS: Studies from our group and others demonstrate residual fluid in 42% to 95% of endoscope working channels despite high-level disinfection and drying. Additionally, persistent simethicone has been reported in endoscope channels despite reprocessing. METHODS: Endoscopy was performed by using water or varied simethicone concentrations (0.5%, 1%, 3%) for flushing. After high-level disinfection/drying, we inspected endoscope working channels for retained fluid by using the SteriCam borescope. Working channel rinsates were evaluated for adenosine triphosphate (ATP) bioluminescence. Fourier transform infrared spectroscopy was performed on fluid droplets gathered from a colonoscope in which low-concentration simethicone was used. RESULTS: Use of medium/high concentrations of simethicone resulted in a higher mean number of fluid droplets (13.5/17.3 droplets, respectively) and ATP bioluminescence values (20.6/23 relative light units [RLUs], respectively) compared with that of procedures using only water (6.3 droplets/10.9 RLUs; P < .001). Two automated endoscope reprocessing cycles resulted in return of a fluid droplet and ATP bioluminescence values to ranges similar to that of procedures that used only water (P = .56). Low-concentration simethicone did not increase the mean residual fluid or ATP bioluminescence values compared with procedures that used only water (5.8 droplets/15.6 RLUs). Fourier transform infrared analysis revealed simethicone in the endoscope working channel after use of low-concentration simethicone. CONCLUSIONS: Use of medium/high concentrations of simethicone is associated with retention of increased fluid droplets and higher ATP bioluminescence values in endoscope working channels, compared with endoscopes in which water or low concentration simethicone was used. However, simethicone is detectable in endoscopes despite reprocessing, even when it is utilized in low concentrations. Our data suggest that when simethicone is used, it should be used in the lowest concentration possible. Facilities may consider 2 automated endoscope reprocessor cycles for reprocessing of endoscopes when simethicone has been used.


Assuntos
Antiespumantes/análise , Endoscópios Gastrointestinais , Simeticone/análise , Trifosfato de Adenosina , Colonoscópios , Desinfecção/métodos , Gastroscópios , Humanos , Medições Luminescentes , Espectroscopia de Infravermelho com Transformada de Fourier
15.
Dig Dis Sci ; 64(1): 224-231, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30284651

RESUMO

BACKGROUND: The endoscopic lens becomes clouded and its visibility reduces during colorectal endoscopic submucosal dissection (ESD), especially in cases with submucosal fatty tissue. Dual red imaging (DRI) is a novel image-enhanced endoscopic technique that improves endoscopic visibility. AIMS: This study aimed to evaluate the predictive factors of submucosal fatty tissue and the clinical usefulness of DRI in maintaining clear visibility during colorectal ESD. METHODS: The study participants included 586 consecutive patients with 645 colorectal tumors who underwent ESD between January 2014 and July 2017. First, the degree of submucosal fatty tissue was evaluated by reviewing recorded images, and the clinical characteristics of the patients and tumors related to severe submucosal fatty tissue were evaluated. Second, 34 tumors resected using DRI were propensity score-matched in a 1:1 ratio to other resected tumors using white light imaging (WLI), and the degree of endoscope lens cloudiness and clinical outcomes were evaluated. RESULTS: The proportion of tumors located in the right side of the colon, body mass index (≥ 25, BMI), and hemoglobin A1c (≥ 6.5%, HbA1c) were significantly higher in patients with severe submucosal fatty tissue. The visibility in the DRI group was significantly better than in the WLI group. Treatment outcomes in the DRI group were as good as those in the WLI group. CONCLUSIONS: Tumor location in the right side of the colon, BMI (≥ 25), and HbA1c (≥ 6.5%) are the predictive factors of severe submucosal fatty tissue. DRI is useful in maintaining clear visibility during colorectal ESD, especially with submucosal fatty tissue.


Assuntos
Colectomia/métodos , Colonoscopia/métodos , Neoplasias Colorretais/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Tecido Adiposo/patologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Índice de Massa Corporal , Colectomia/efeitos adversos , Colectomia/instrumentação , Colonoscópios , Colonoscopia/efeitos adversos , Colonoscopia/instrumentação , Neoplasias Colorretais/patologia , Ressecção Endoscópica de Mucosa/efeitos adversos , Ressecção Endoscópica de Mucosa/instrumentação , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Percepção Visual
16.
Comput Methods Biomech Biomed Engin ; 22(1): 38-46, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30398066

RESUMO

Patient pain caused by a colonoscope is one of the main complications in completing a colonoscopy. Currently, randomized controlled trial (RCT) is one of the most used methods to evaluate the efficacy of small-caliber (SC) colonoscopes in reducing patient pain during a colonoscopy, compared with a standard colonoscope (SDC). However, many disturbing factors, including endoscopists' skills, characteristics of patients and new technical features of the colonoscope (passive bending and high force transmission shaft), limit the reliability and generalizability of each finding in current RCTs. This paper focuses on modeling the insertion of colonoscopes within colon models using an explicit finite element method (FEM). Such a numerical model could overcome the limitations in RCTs. At the same time, it is expected to evaluate the efficacy of the small-caliber colonoscopes in reducing patient pain during a colonoscopy, while considering the effects of patient characteristics, including age, region and gender. The simulation results in this work showed that: compared with the SDC, a SC colonoscope may be more helpful in reducing discomfort for older patients, patients with smaller colon diameters and females.


Assuntos
Colonoscópios/efeitos adversos , Colonoscopia/efeitos adversos , Análise Numérica Assistida por Computador , Dor/etiologia , Adulto , Animais , Colo/anatomia & histologia , Colo/diagnóstico por imagem , Simulação por Computador , Desenho de Equipamento , Feminino , Fricção , Humanos , Cinética , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Reprodutibilidade dos Testes , Suínos
17.
World J Gastroenterol ; 24(37): 4243-4253, 2018 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-30310257

RESUMO

Although colonoscopy has been proven effective in reducing the incidence of colorectal cancer through the detection and removal of precancerous lesions, it remains an imperfect examination, as it can fail in detecting up to almost one fourth of existing adenomas. Among reasons accounting for such failures, is the inability to meticulously visualize the colonic mucosa located either proximal to haustral folds or anatomic curves, including the hepatic and splenic flexures. In order to overcome these limitations, various colonoscope attachments aiming to improve mucosal visualization have been developed. All of them - transparent cap, Endocuff, Endocuff Vision and Endorings - are simply mounted onto the distal tip of the scope. In this review article, we introduce the rationale of their development, present their mode of action and discuss in detail the effect of their implementation in the detection of lesions during colonoscopy.


Assuntos
Adenoma/diagnóstico , Neoplasias do Colo/diagnóstico , Pólipos do Colo/diagnóstico , Colonoscópios , Colonoscopia/instrumentação , Detecção Precoce de Câncer/métodos , Lesões Pré-Cancerosas/diagnóstico , Adenoma/patologia , Neoplasias do Colo/patologia , Pólipos do Colo/patologia , Desenho de Equipamento , Humanos
19.
Eur J Gastroenterol Hepatol ; 30(12): 1482-1490, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30188409

RESUMO

INTRODUCTION: A variety of add-on devices and new-generation endoscopes have the potential to detect lesions 'hidden' behind colonic folds. We measured the effect of these new modalities on colonoscopy's lesions miss rates by a meta-analysis of data from individual studies. MATERIALS AND METHODS: We performed literature searches in Medline and Cochrane Library for back-to-back randomized-controlled trials evaluating colonoscope add-on devices and new endoscopes in terms of lesions miss rates. The effect size on study outcomes is shown as relative risk (95% confidence interval). RESULTS: We identified nine tandem studies with 1594 patients: seven evaluating add-on devices (one with cap, two with Endocuff, one with Endorings, one with Third-Eye Retroscope, two with G-EYE endoscope) and two evaluating the full-spectrum endoscopy system (FUSE) in comparison with conventional colonoscopy (CC). Overall, adenoma miss rate (AMR) was significantly lower with add-on devices/FUSE [0.33 (0.22-0.50), P<0.00001] compared with CC, the effect being similar among the add-on devices [0.35 (0.22-0.57), P<0.0001] and the FUSE [0.26 (0.15-0.46), P<0.00001] studies, respectively. Advanced AMR and polyp miss rate (PMR) were also significantly lower using add-on devices/FUSE [0.30 (0.21-0.44), P<0.0001 and 0.31 (0.13-0.79), P=0.01, respectively]. Use of add-on devices/FUSE scope was associated with significantly lower AMR and PMR in the proximal colon and it was associated with shortening of the colonoscopy surveillance interval. CONCLUSION: Our meta-analysis provides evidence that AMR, advanced AMR, and PMR are significantly lower using add-on to colonoscope devices and the full-spectrum endoscopy systems compared with CC. Heterogeneity among the included studies and the small number of detected advanced adenomas call for cautious interpretation of the results.


Assuntos
Adenoma/diagnóstico , Pólipos do Colo/diagnóstico , Colonoscópios , Colonoscopia/instrumentação , Neoplasias Colorretais/diagnóstico , Colonoscopia/métodos , Detecção Precoce de Câncer/instrumentação , Detecção Precoce de Câncer/métodos , Reações Falso-Negativas , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Digestion ; 98(4): 217-221, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30045043

RESUMO

BACKGROUND AND AIMS: Simethicone is a common antifoaming agent that is added to endoscopic rinse solutions, but data regarding its effect on polyp detection rates is lacking. In this study, we report the effect of discontinuation of this practice on polyp detection rates. METHODS: Procedure data of 4,254 consecutive colonoscopies were used. Patients underwent standard bowel preparation with polyethyleneglycol (Glycoprep®). Colonoscopies were performed utilising Olympus EVIS EXERA III, CV-190 equipment, while quality data (withdraw times, polyp detection rates, quality of bowel preparation) was assessed utilising an endoscopy reporting system (Provation®). Following an educational event that highlighted that simethicone may form deposits in the channels of endoscopes, the practice to add simethicone (InfacolR, Nice Pak) to the auxiliary channel water pump was abandoned, but endoscopists were not notified about this change. After 5 days and performing 75 colonoscopies, the change of practice was identified and addition of simethicone recommenced. RESULTS: The discontinuation of simethicone use reduced the polyp detection rate from 55% (95% CI 53-56) to 45% (95% CI 34-56, 1-sided, p = 0.028); the polyp detection rate returned to the pre-intervention levels of 55% (95% CI 52-58) upon resumption of normal practice. CONCLUSION: The addition of simethicone to the auxiliary water pump during colonoscopy results in a 10% increase in polyp detection rates.


Assuntos
Antiespumantes/administração & dosagem , Pólipos do Colo/diagnóstico por imagem , Colonoscopia/métodos , Simeticone/administração & dosagem , Estudos de Coortes , Colonoscópios , Colonoscopia/instrumentação , Combinação de Medicamentos , Humanos , Polietilenoglicóis/administração & dosagem , Cloreto de Potássio/administração & dosagem , Bicarbonato de Sódio/administração & dosagem , Cloreto de Sódio/administração & dosagem , Sulfatos/administração & dosagem
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