Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 481
Filtrar
1.
Gastrointest Endosc Clin N Am ; 29(4): 603-612, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31445685

RESUMO

Diminutive colorectal lesions are polyps and flat lesions 1 to 5 mm in size, and small are 6 to 9 mm in size. The best resection method is the cold snare. Cold forceps are acceptable for 1- to 3-mm lesions, but should not be used to piecemeal polyps. Cold snaring has few complications and is more effective than cold forceps for 4- to 5-mm polyps and as effective and more efficient than hot snaring for 6- to 9-mm polyps.


Assuntos
Pólipos do Colo/cirurgia , Colonoscopia/métodos , Neoplasias Colorretais/prevenção & controle , Criocirurgia/métodos , Guias de Prática Clínica como Assunto , Lesões Pré-Cancerosas/cirurgia , Idoso , Pólipos do Colo/patologia , Colonoscopia/instrumentação , Criocirurgia/instrumentação , Feminino , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/diagnóstico , Índice de Gravidade de Doença
2.
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
3.
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
4.
Fam Cancer ; 18(3): 349-352, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31111311

RESUMO

Subtotal colectomy is usually the therapy of choice in Lynch syndrome patients diagnosed with colon cancer. In patients who develop cancer after the age of 50-60 years, segmental colectomy is considered a good alternative. Although the endoscopic treatment of early colorectal cancer in non-Lynch patients has increased in the last decades, almost all patients with a Lynch syndrome-associated colorectal malignancy undergo surgery, even if the tumour is diagnosed in a (very) early stage. One of the endoscopic treatment options for early colorectal cancer is an endoscopic full thickness resection (eFTR). This treatment modality allows optimal pathological examination of the resection specimen, as a transmural resection is performed with optimal T-staging of the tumour. We report a case of a 62 year old man, diagnosed with MSH2-Lynch syndrome, who underwent successful eFTR treatment of an early (pT1) colon cancer located in the ascending colon, with no signs of recurrence 12 months after treatment. We discuss the pros and cons of endoscopic resection of early colorectal carcinoma in Lynch syndrome patients.


Assuntos
Neoplasias do Colo/cirurgia , Colonoscopia/métodos , Neoplasias Colorretais Hereditárias sem Polipose/cirurgia , Adenocarcinoma/genética , Adenocarcinoma/cirurgia , Carcinoma/genética , Carcinoma/cirurgia , Colo Ascendente/cirurgia , Neoplasias do Colo/patologia , Colonoscopia/instrumentação , Neoplasias Colorretais Hereditárias sem Polipose/patologia , Detecção Precoce de Câncer , Humanos , Neoplasias Renais/genética , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Proteína 2 Homóloga a MutS/genética , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/cirurgia
5.
World J Gastroenterol ; 25(18): 2251-2263, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31143075

RESUMO

BACKGROUND: The role of prophylactic clipping for the prevention of delayed polypectomy bleeding (DPB) remains unclear and conclusions from prior meta-analyses are limited due to the inclusion of variety of resection techniques and polyp sizes. AIM: To conduct a meta-analysis on the effect of clipping on DPB following endoscopic mucosal resection (EMR) of colorectal lesions ≥ 20 mm. METHODS: We performed a search of PubMed and the Cochrane library for studies comparing the effect of clipping vs no clipping on DPB following endoscopic resection. The Cochran Q test and I 2 were used to test for heterogeneity. Pooling was conducted using a random-effects model. RESULTS: Thirteen studies with a total of 7794 polyps were identified, of which data was available on 1701 cases of EMR of lesions ≥ 20 mm. Prophylactic clipping was associated with a lower rate of DPB (1.4%) when compared to no clipping (5.2%) (pooled OR: 0.24, 95%CI: 0.12-0.50, P < 0.001) following EMR of lesions ≥ 20 mm. There was no significant heterogeneity among the studies (I 2 = 0%, P = 0.67). CONLUSION: Prophylactic clipping may reduce DPB following EMR of large colorectal lesions. Future trials are needed to further identify risk factors and stratify high risk cases in order to implement a cost-effective preventive strategy.


Assuntos
Pólipos do Colo/cirurgia , Colonoscopia/métodos , Ressecção Endoscópica de Mucosa/métodos , Hemorragia Gastrointestinal/prevenção & controle , Hemorragia Pós-Operatória/prevenção & controle , Colonoscopia/efeitos adversos , Colonoscopia/instrumentação , Ressecção Endoscópica de Mucosa/efeitos adversos , Ressecção Endoscópica de Mucosa/instrumentação , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Incidência , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Fatores de Tempo
6.
Gastrointest Endosc ; 90(2): 254-258.e2, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30986402

RESUMO

BACKGROUND AND AIMS: The adenoma detection rate (ADR) is the most important quality metric for colonoscopy. Numerous factors are known to influence ADR. However, no data on the effect of monitor size on ADR exist. The aim of this study was to compare the ADR and polyp detection rate (PDR) achieved using 2 different-size video monitors (19-inch diagonal and 32-inch diagonal). METHODS: In a single-center, prospective, randomized clinical trial, endoscopists were randomized on a daily basis to perform routine ambulatory colonoscopies with either a 32-inch diagonal or a 19-inch diagonal video monitor. RESULTS: The study was conducted between October 2013 and April 2014 in an outpatient center of a tertiary referral hospital. Fifteen endoscopists performed 1795 outpatient colonoscopies (mean age, 55 years; 56% women; screening, 56%). There was no substantial difference in baseline patient characteristics between the 2 arms. The overall ADR (27.4% vs 27.9%; P = .80) and PDR (32.8% vs 34.4%; P = .50) were not significantly different between the 32-inch and 19-inch monitor group, respectively. The findings were not significantly altered when stratified by indication, cecal intubation, bowel preparation, operator experience, and time of endoscopy as well as in a multivariable model that included these variables as potential confounders (all P > .05). Overall, the ADR and PDR for each individual endoscopist did not appear to be influenced by monitor size. CONCLUSIONS: The results of this trial do not support the notion that larger video monitors improve ADR. Future efforts to increase ADR should focus on other aspects of colonoscopy. (Clinical trial registration number: NCT01952418.).


Assuntos
Adenoma/patologia , Neoplasias do Colo/patologia , Pólipos do Colo/patologia , Colonoscopia/instrumentação , Terminais de Computador , Adulto , Idoso , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
7.
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.
Int J Surg ; 67: 18-23, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30849526

RESUMO

OBJECTIVE: To determine whether clinical evaluation reporting using the IDEAL (Idea, Development, Exploration, Assessment and Long-term study) framework improves a novel double-balloon endoscopic stabilization technology. DESIGN: Observational registry 6 month study with no follow-up. Using the Prospective Development Study (PDS) format recommended by the IDEAL collaboration, we report on continued refinement and optimization of an endoscopic stabilization platform during a clinical study conducted by two clinicians from the first case onwards. Key outcomes (ability to reach cecum, inflation of balloons in the sigmoid and ascending colon, and complications) were prospectively reported for each patient sequentially. All changes to technique were highlighted, showing when they occurred and an explanation for the change. RESULTS: 30 colonoscopies were undertaken using the device from April to September 2017. Two patients were excluded from the analysis for protocol deviations. Cecum was reached in 89% of the per protocol population of patients in an average time of 13.5 ±â€¯11 min. Therapeutic zone creation was successful in 89% of patients on the right side of the intestine and 100% in those that reached the sigmoid. There were five deliberate changes in technique that occurred during the study that enabled improved device technical performance. There were no serious complications and one polyp was removed successfully using the device. Clinicians reported endoscope stability and increased visibility of the intestinal mucosa increased when using the device. CONCLUSION: The IDEAL framework provided a structured reporting of the changes made to technique. Those changes facilitated a device that is safe, has achieved stability with improved performance.


Assuntos
Colonoscopia/instrumentação , Enteroscopia de Duplo Balão/instrumentação , Melhoria de Qualidade , Ceco/cirurgia , Colo Sigmoide/cirurgia , Colonoscopia/normas , Enteroscopia de Duplo Balão/normas , Feminino , Humanos , Mucosa Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros
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 ; 90(1): 105-111, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30684600

RESUMO

BACKGROUND AND AIMS: Cold snare polypectomy (CSP) and jumbo forceps polypectomy (JFP) have been shown to be effective for removing diminutive colorectal polyps (DCPs) (≤5 mm). However, no study has compared complete resection rates between CSP and JFP for DCPs. The aim of this study was to compare the efficacy and safety of JFP with CSP for the removal of DCPs. METHODS: This was a prospective randomized controlled trial from 2 tertiary-care referral centers. A total of 1003 patients were screened, and 169 patients with 196 DCPs were enrolled. The main outcome was complete polyp resection rate. RESULTS: Of 196 diminutive polyps, 177 (90.3%) were adenomatous polyps. The overall complete resection rate was 92.1% (163/177). The complete resection rate was not significantly different between JFP and CSP groups (92.0% vs 92.2%; P = .947). JFP achieved complete resection rates comparable with CSP for polyps >3 mm (90.3% vs 89.8%; P = .928). Polypectomy procedure time, tissue retrieval rate, and rate of postpolypectomy adverse events were not significantly different between the 2 groups. CONCLUSIONS: Both JFP and CSP achieved complete resection rates of >90% for DCPs. Thus, JFP may be considered for polypectomy of DCPs. (International clinical trial registry number: KCT0002805.).


Assuntos
Pólipos Adenomatosos/cirurgia , Pólipos do Colo/cirurgia , Colonoscopia/instrumentação , Neoplasias Colorretais/cirurgia , Pólipos Adenomatosos/patologia , Idoso , Pólipos do Colo/patologia , Neoplasias Colorretais/patologia , Feminino , Humanos , Pólipos Intestinais/patologia , Pólipos Intestinais/cirurgia , Masculino , Pessoa de Meia-Idade , Instrumentos Cirúrgicos , Resultado do Tratamento , Carga Tumoral
13.
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
15.
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
16.
Infect Disord Drug Targets ; 19(3): 279-283, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30324899

RESUMO

BACKGROUND AND AIMS: Hepatitis viruses are not transmitted via gastrointestinal endoscopy except if there are any mistakes in sterilization and disinfection of the endoscope that disrupt the infection control measures. So we aimed to measure the risk of transmitting HCV by GI endoscopy at department of Tropical Medicine and infectious Diseases, in a major University hospital in Egypt. METHODS: Our study was conducted on four hundred patients with exclusion of those with HCV, HBV, and/or HIV positive antibodies. An ethical committee approval and a given consent were taken prior to enrollment on the study. Our patients are grouped into the following; 100 patients undergoing upper GI endoscopy without biopsy as group I; 100 patients undergoing upper GI endoscopy with biopsy as group II; 100 patients undergoing lower GI endoscopy without biopsy as group III and 100 patients undergoing lower GI endoscopy with biopsy as group IV. HCV antibodies were done 3 months after endoscopy with exclusion of other risks of HCV infection by a detailed questionnaire. RESULTS: Only one case was reported positive after 3 months of procedure; it was after colonoscopy with biopsy using reusable forceps. CONCLUSIONS: Strict infection control measures of the GI endoscopes despite being effective in preventing HCV transmission, the reuse of disinfected biopsy forceps may be associated with a risk of transmission. So, we recommend using disposable forceps for every patient to omit the risk of HCV transmission during endoscopy.


Assuntos
Colonoscopia/efeitos adversos , Colonoscopia/instrumentação , Desinfecção/normas , Contaminação de Equipamentos , Hepatite C/transmissão , Instrumentos Cirúrgicos/virologia , Adolescente , Adulto , Idoso , Biópsia/instrumentação , Egito , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/instrumentação , Feminino , Fômites/microbiologia , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Adulto Jovem
17.
Gastrointest Endosc ; 89(3): 583-590.e1, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30365984

RESUMO

BACKGROUND AND AIMS: The EndoRings add-on has been claimed to improve adenoma detection at colonoscopy, but available data are inconsistent. When testing a new technology, parallel and crossover methodologies measure different outcomes, leaving uncertainty about their correspondence. The aims of this study were to compare the diagnostic yield and miss rate of the EndoRings for colorectal neoplasia. METHODS: Consecutive patients undergoing colonoscopy after a positive fecal immunochemical test (FIT) within an organized screening program in 7 Italian centers were randomized between a parallel (EndoRings or standard) or a crossover (EndoRings/standard or standard/EndoRings) methodology. Outcomes measures were the adenoma detection rate (ADR) and advanced adenoma detection rate (AADR) in the parallel arms and the miss rate of adenomas in the crossover arms. RESULTS: Of 958 eligible patients, 927 (317 EndoRings; 317 standard; 142 EndoRings/standard; 151 standard/Endo-Rings) were included in the final analysis. In the parallel arms (mean ADR, 51.3%; mean AADR, 25.4%), no difference between standard and EndoRings was found for both ADR (relative risk [RR], 1.10; 95% confidence interval [CI], 0.95-1.28) and AADR (RR, 1.16; 95% CI, 0.88-1.51), as well as for the mean number of adenomas and advanced adenomas per patient (EndoRings, 1.9 ± 1.3 and 1.0 ± 1.2; standard, 2.1 ± 1.5 and 1.0 ± 1.2; P = not significant for both comparisons). In the crossover arms, no difference in the miss rate for adenomas between EndoRings and standard was found at per polyp (RR, 1.43; 95% CI, 0.97-2.10) or per-patient analysis (24% vs 26%; P = .76). CONCLUSIONS: No statistically significant difference in diagnostic yield and miss rate between EndoRings and standard colonoscopy was detected in patients with a positive FIT result. A clinically relevant correspondence between miss and detection rates was shown, supporting a cause-effect relationship. (ISRCTN registry: ISRCTN10357435.).


Assuntos
Adenoma/diagnóstico , Colonoscopia/instrumentação , Neoplasias Colorretais/diagnóstico , Erros de Diagnóstico/estatística & dados numéricos , Adulto , Colonoscopia/métodos , Detecção Precoce de Câncer , Fezes/química , Feminino , Hemoglobinas/análise , Humanos , Imunoquímica , Masculino , Pessoa de Meia-Idade
18.
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
19.
Acta Gastroenterol Belg ; 82(4): 475-478, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31950801

RESUMO

BACKGROUND AND AIMS: Cold snare polypectomy (CSP) is an accepted technique to remove diminutive or small (6-9 mm) polyps. Here we present a series of CSP for advanced non-pedunculated polyps (> 10 mm). PATIENTS AND METHODS: This is a retrospective, single operator study. A total of 111 patients with non-pedunculated polyps (Paris classification 0-IIa, 0-IIb, 0-Is) estimated > 10 mm, underwent CSP. RESULTS: A total of 129 polyps were removed (87 0-IIa, 18 0-IIb, 24 0-Is). The number of these polyps ranked according to size were as follows : 11-19 mm : 63 (49%), 20-29 mm : 44 (34%), > 30 mm : 22 (17%). Thirty-eight (29.5%) were sessile serrated adenomas, 47 (36%) were tubular adenomas, 25 (19.3%) were villous adenoma's and 18 (14%) were hyperplastic polyps. Forty-nine (38%) polyps were resected in a piecemeal fashion, submucosal injection with diluted Indigo Carmine was used in 24 (19%). Immediate oozing bleeding was frequent but in almost all patients rapid spontaneous haemostasis occurred. In only one patient haemostatic clipping was required (in order to achieve hemostasis). Preventive clipping was used in 3 patients. There were no complications. Seventy-two patients (with 87 lesions) had a follow-up colonoscopy. Of these 87 lesions, 9 had residual adenomatous tissue (10.3 %). According to the size of the original polyp, the distribution was as follows: 11-19 mm : 2/36 (5.5 %), 20-29 mm : 4/32 (12.5 %), > 30 mm : 3/19 (15.7%). CONCLUSION: CSP for advanced, non-pedunculated lesions is feasible, effective and extremely safe.


Assuntos
Pólipos Adenomatosos/cirurgia , Pólipos do Colo/patologia , Pólipos do Colo/cirurgia , Colonoscopia/métodos , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Criocirurgia/métodos , Ressecção Endoscópica de Mucosa/métodos , Pólipos Adenomatosos/patologia , Biópsia , Colonoscopia/instrumentação , Feminino , Humanos , Masculino , Estadiamento de Neoplasias , Estudos Retrospectivos , Resultado do Tratamento
20.
Gac. méd. boliv ; 41(2): 9-13, Dec. 2018. ilus., tab.
Artigo em Espanhol | LILACS | ID: biblio-988159

RESUMO

OBJETIVO: determinar la sensibilidad y especificidad de la calprotectina fecal (CPF) y la prueba de sangre oculta en heces (SOH) para el diagnóstico de patología orgánica de colon. MÉTODOS: se realizó un estudio observacional que, incluyó de manera intencionada, 246 pacientes de ambos sexos atendidos en el Instituto Gastroenterológico Boliviano Japonés de Cochabamba, por dolor abdominal, diarrea crónica y pérdida de peso. Se les realizó laboratorios de calprotectina fecal y sangre oculta en heces, además de colonoscopia como estudio de control. RESULTADOS: se determinó que la calprotectina fecal tiene una sensibilidad de 86 %, y especificidad de 98 %, con una asociación de 0,54 y relación de 0,75 según los coeficientes de Pearson y Spearman respectivamente, en relación con la colonoscopía y el diagnóstico de patología orgánica de colon. La prueba de sangre oculta en heces presentó una sensibilidad de 79% pero una especificidad de 58%, la asociación y relación con el estudio de control fue mínima: 0,21 y 0,22 según los coeficientes de Pearson y Spearman. CONCLUSIONES: los resultados muestran que la calprotectina fecal presenta alta sensibilidad y especificidad para el diagnóstico de patología orgánica de colon. Los valores más altos se relacionaron con mayor lesión en la mucosa colónica.


OBJECTIVE: to determine the sensitivity and specificity of fecal calprotectin and fecal occult blood test (FOBT) for the diagnosis of organic colon pathology. METHODS: an observational study was made, which intentionally included 246 patients of both sexes seen at the Japanese Bolivian Gastroenterological Institute of Cochabamba, due to abdominal pain, chronic diarrhea and weight loss. We performed fecal calprotectin and fecal occult blood laboratories, as well as colonoscopy as a control study. RESULTS: it was determined that the fecal calprotectin has a sensitivity of 86%, and specificity of 98%, with an association of 0,54 and a ratio of 0,75 according to the Pearson and Spearman coefficients respectively, in relation to colonoscopy and the diagnosis of organic pathology of colon. The fecal occult blood test showed a sensitivity of 79% but a specificity of 58%, according to the association and relationship with the control minimum of 0,21 and 0,22 according to the Pearson and Spearman coefficients. CONCLUSIONS: The results show that fecal calprotectin presents high sensitivity and specificity for the diagnosis of organic colon pathology. Higher values were associated with greater lesion in the colonic mucosa.


Assuntos
Humanos , Hemocultura/métodos , Colonoscopia/instrumentação , Diagnóstico , Fezes
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA