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1.
Eur J Endocrinol ; 182(3): 313-318, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31940279

RESUMO

Objective: Patients with acromegaly are at increased risk of colorectal polyps. However, their risk of colorectal cancer remains unclear. This study aimed to identify the histopathological features of colorectal polyps in patients with acromegaly and compare their risk of colorectal cancer with that in healthy controls. Methods: The study participants were 178 patients who underwent Hardy's operation and perioperative colonoscopy at our hospital between April 2008 and September 2016. For the control group, we randomly selected 356 age- and sex-matched patients who underwent colonoscopy at our hospital during the same period. The incidence, size, location, and histology of the colorectal polyps detected were compared between the groups. Results: Colorectal polyps were detected in 66.8% of the acromegaly group and 24.2% of the control group (P < 0.001). The average number and size of the polyps were 2.44 and 4.74 mm, respectively, in the acromegaly group and 1.77 and 3.89 mm in the control group (P = 0.001). Polyps in the acromegaly group were more likely to be in the rectosigmoid region (P = 0.006). In the acromegaly group, the frequency of polyps ≥5 mm was 34.3% and that for polyps ≥10 mm was 15.2%; the respective values were 7.6% and 2.2% in the control group (P < 0.001). We found no evidence of between-group histopathological differences in the polyp specimens resected by endoscopy. Conclusions: Patients with acromegaly are at an increased risk of colorectal polyps, especially in the rectosigmoid region. However, there is no pathological evidence that they are at greater risk of colorectal cancer than the general population.


Assuntos
Acromegalia/epidemiologia , Adenocarcinoma/epidemiologia , Pólipos Adenomatosos/epidemiologia , Pólipos do Colo/epidemiologia , Neoplasias Colorretais/epidemiologia , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adenoma/epidemiologia , Adenoma/patologia , Adenoma/cirurgia , Pólipos Adenomatosos/patologia , Pólipos Adenomatosos/cirurgia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Pólipos do Colo/patologia , Pólipos do Colo/cirurgia , Colonoscopia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Ressecção Endoscópica de Mucosa , Feminino , Humanos , Pólipos Intestinais/epidemiologia , Pólipos Intestinais/patologia , Pólipos Intestinais/cirurgia , Masculino , Pessoa de Meia-Idade , Doenças Retais/epidemiologia , Doenças Retais/patologia , Doenças Retais/cirurgia , Fatores de Risco , Carga Tumoral , Adulto Jovem
2.
Medicine (Baltimore) ; 98(50): e18280, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852102

RESUMO

RATIONALE: Small bowel intussusception in adults is rare but is more likely to occur in the presence of a lead point. Surgical intervention is necessary in most cases, even if there is successful nonsurgical reduction of the intussusception. PATIENT CONCERNS: A 54-year-old woman who was transferred to our emergency room with complaints of intermittent cramping pain of 4 days' duration. DIAGNOSIS: Abdominal contrast-enhanced computed tomography revealed a jejuno-jejunal intussusception due to an angiolipomatous polyp. INTERVENTION: A single-incision laparoscopic surgery (SILS) was performed without the need for any additional incisions. OUTCOMES: She was uneventfully discharged on postoperative day 4. LESSONS: The SILS procedure with adequate preoperative diagnosis by CT, with or without US, can offer good clinical outcomes for small bowel intussusception. Even surgeons who have little experience with laparoscopic intestinal anastomosis can consider SILS to treat small bowel intussusception in adults.


Assuntos
Pólipos Intestinais/complicações , Intussuscepção/cirurgia , Doenças do Jejuno/cirurgia , Jejuno/cirurgia , Laparoscopia/métodos , Feminino , Humanos , Pólipos Intestinais/diagnóstico , Pólipos Intestinais/cirurgia , Intussuscepção/diagnóstico , Intussuscepção/etiologia , Doenças do Jejuno/diagnóstico , Doenças do Jejuno/etiologia , Jejuno/diagnóstico por imagem , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
3.
Pan Afr Med J ; 33: 300, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31693725

RESUMO

Anal fibroepithelial polyp is a benign tumor rarely reported during pregnancy. We here report a case of giant anal fibroepithelial polyp in a 31-year old multiparous woman. It developed progressively over the previous 3 years. Clinical examination showed firm sessile bud formation, at the anal margin. The patient had normal ongoing pregnancy (31 weeks of amenorrhea). Endoanal examination was normal. Surgical resection was preformed under spinal anesthesia. The specimen measured 21x12x7cm and was covered by the skin. Histological examination showed anal fibroepithelial polyp without signs of malignancy. The postoperative course was uneventful.


Assuntos
Doenças do Ânus/diagnóstico , Pólipos Intestinais/diagnóstico , Complicações na Gravidez/diagnóstico , Adulto , Canal Anal/patologia , Canal Anal/cirurgia , Doenças do Ânus/patologia , Doenças do Ânus/cirurgia , Feminino , Humanos , Pólipos Intestinais/patologia , Pólipos Intestinais/cirurgia , Gravidez , Complicações na Gravidez/patologia , Complicações na Gravidez/cirurgia
4.
BMC Gastroenterol ; 19(1): 151, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31443637

RESUMO

BACKGROUND: With the development and application of endoscopic technology, most pedunculated polyps can be absolutely resected with a complete specimen by hot snare polypectomy (HSP). Brunner's gland hamartoma (BGH) is a rare benign small bowel tumor. The majority of BGH measuring about 2 cm in diameter, rarely larger than 5 cm. Most patients are asymptomatic, some may present with gastrointestinal hemorrhage or intestinal obstruction. Symptomatic larger lesions leading to bleeding or obstruction should be excised either endoscopically or surgically. Whether it is safe and effective that removing a BGH measuring about 7 cm by HSP is not known. CASE PRESENTATION: Here, we reported a rare case of a proximal duodenum pedunculated mass measuring about 7 cm which was responsible for the patient's severe anemia. we treated it as a pedunculated polyp. After being pretreated the stalk with an endoloop which was placed around the base of the mass to prevent post-polypectomy bleeding (PPB), the pedunculated BGH was removed by HSP completely. The stalk of the mass was negative. We achieved a curative resection. CONCLUSION: It is a safe and effective for our patient to treat the pedunculated BGH measuring about 7 cm as a pedunculated polyp and remove it by HSP. And future prospective studies in larger cohorts are needed to confirm it.


Assuntos
Glândulas Duodenais/patologia , Duodenopatias , Endoscopia/métodos , Hamartoma , Pólipos Intestinais , Dissecação/métodos , Duodenopatias/patologia , Duodenopatias/fisiopatologia , Duodenopatias/cirurgia , Feminino , Hamartoma/patologia , Hamartoma/fisiopatologia , Hamartoma/cirurgia , Humanos , Pólipos Intestinais/patologia , Pólipos Intestinais/fisiopatologia , Pólipos Intestinais/cirurgia , Pessoa de Meia-Idade , Resultado do Tratamento , Carga Tumoral
5.
Ann R Coll Surg Engl ; 101(8): 558-562, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31233327

RESUMO

BACKGROUND: Polyp assessment is multimodal and is vital prior to endoscopic mucosal resection. The size, morphology, site and access (SMSA) score has been validated in specialist endoscopic institutions. this study investigated the ability of this score to predict incomplete endoscopic resection of large colorectal polyps in a district general hospital. METHODS: Consecutive patients undergoing endoscopic mucosal resection of large (≥ 20 mm) colorectal polyps at Worthing Hospital. Clinical, endoscopic and histological data were taken from prospective databases. The primary outcome of the study was to investigate the correlation of the SMSA score with incomplete endoscopic resection. RESULTS: Between February 2015 and August 2018, 114 patients underwent colorectal endoscopic mucosal resection. Of these, 67 (59%) were male. The median (interquartile range) age of the study population was 72 years (65-78 years). Some 17 lesions (15%) were pedunculated, 76 (67%) were sessile and 21 were (18%) flat; 84 polyps (77%) were located in the left colon/rectum, with the remainder in the right colon; 51 lesions (45%) were 20-30 mm, 27 (24%) were 30-40 mm and 36 (31%) were greater than 40 mm in diameter. When reclassified into the SMSA score, 9 of the polyps (8%) were level 2, 64 (56%) were level 3 and 41 (36%) were level 4. Incomplete resection was clinically diagnosed in 9/114 (8%). The SMSA score was positively correlated with incomplete endoscopic resection, but not with additional procedure usage, complications or advanced histology. CONCLUSIONS: Many patients with large polyps can be managed outside of specialist units. This study has validated that the SMSA score was associated with incomplete endoscopic mucosal resection for large polyps in a district general hospital setting.


Assuntos
Neoplasias Colorretais/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Pólipos Intestinais/cirurgia , Idoso , Pólipos do Colo/patologia , Pólipos do Colo/cirurgia , Colonoscopia/métodos , Neoplasias Colorretais/patologia , Bases de Dados Factuais , Ressecção Endoscópica de Mucosa/efeitos adversos , Feminino , Hospitais Gerais , Humanos , Pólipos Intestinais/patologia , Masculino , Complicações Pós-Operatórias , Estudos Prospectivos , Índice de Gravidade de Doença
6.
Dig Liver Dis ; 51(6): 774-781, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31014942

RESUMO

BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) is commonly used to treat early-stage digestive cancer because it results in a higher frequency of en-bloc resection and a lower frequency of local recurrence. However, the efficacy and safety of duodenal ESD remain unclear. Therefore, present study is aimed at evaluating clinical outcomes of duodenal ESD. METHODS: To evaluate the efficacy and safety of duodenal ESD, electronic databases (MEDLINE, CENTRAL and EMBASE) were searched by two independent reviewers. The authors were contacted for additional information. A meta-analysis was performed to evaluate the efficacy and safety of duodenal ESD. RESULTS: A total of 7 studies (203 patients) were included in the quantitative synthesis analysis. The pooled proportions of the frequencies of en-bloc resection, need for surgical intervention, bleeding, intraoperative perforation and delayed perforation were 87%, 4%, 2%, 15% and 2%, respectively. The quality of evidence regarding on surgical intervention outcomes was rated as moderate, whereas that of en-bloc resection was rated as low because of its marked inconsistency. CONCLUSIONS: Duodenal ESD produced acceptable outcomes in terms of the en-bloc R0 resection, but the incidence of procedure-related adverse events is high (PROSPERO register, CRD42017057110).


Assuntos
Duodeno/cirurgia , Ressecção Endoscópica de Mucosa/efeitos adversos , Mucosa Intestinal/cirurgia , Pólipos Intestinais/cirurgia , Duodeno/patologia , Humanos , Mucosa Intestinal/patologia , Pólipos Intestinais/patologia , Complicações Pós-Operatórias/etiologia
7.
BMC Gastroenterol ; 19(1): 57, 2019 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-30995913

RESUMO

BACKGROUND: Ectopic pancreas is an infrequent submucosal tumor in the gastrointestinal tract defined as a pancreatic tissue lacking vascular or anatomic continuity with the main body of the pancreas. Ectopic pancreas in the ileum is a rare and often an incidental finding. We report a case of ectopic pancreas in the ileum causing obscure gastrointestinal bleeding and episodes of abdominal pain. CASE PRESENTATION: 59-year-old man with 3 months history of intermittent melena, accompanied by the episodes of abdominal pain in the left upper quadrant and generalized fatigue was admitted to our department. The investigations showed that the patient had a low hemoglobin level, i.e. 10.9 g/dL with hypochromic microcytic anemia pattern seen in complete blood count (MCV 70.2 fl, MCH 21.4 pg). Esophagogastroduodenoscopy and colonoscopy did not reveal any abnormalities. Magnetic resonance enterography revealed a large (2.5 × 2.3 cm) pedunculated polyp in the ileum. Examination by single-balloon enteroscopy revealed a polyp with long pedicle located approximately 1.5 m distal to terminal ileum. Polypectomy was performed. Histopathologic examination stated, that the specimen contained ectopic pancreatic tissue which was involving muscular layer of the ileum. Ectopic pancreatic tissue included acinar cells and cystically dilated secretory ducts without islets of Langerhans. CONCLUSION: Our case report reveals a very rare cause of obscure gastrointestinal bleeding accompanied by the episodes of abdominal pain - an ectopic pancreas located in the ileum.


Assuntos
Dor Abdominal/etiologia , Coristoma/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Doenças do Íleo/diagnóstico por imagem , Pâncreas , Coristoma/complicações , Coristoma/cirurgia , Humanos , Doenças do Íleo/complicações , Doenças do Íleo/cirurgia , Pólipos Intestinais/complicações , Pólipos Intestinais/diagnóstico por imagem , Pólipos Intestinais/cirurgia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade
8.
Gastroenterology ; 157(2): 451-461.e2, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30981791

RESUMO

BACKGROUND & AIMS: Endoscopic mucosal resection (EMR) with submucosal injection is an established method for removing colorectal polyps, although the en bloc resection rate decreases when polyp size exceeds 10 mm. Piecemeal resection increases local recurrence. Underwater EMR (UEMR) is an effective technique for removal of sessile colorectal polyps and we investigated whether it is superior to conventional EMR (CEMR). METHODS: We conducted a multicenter randomized controlled trial at 5 institutions in Japan. Patients with endoscopically diagnosed, intermediate-size (10-20 mm) sessile colorectal lesions were randomly assigned to undergo UEMR or CEMR. Only the most proximal lesion was registered. The UEMR procedure included immersion of the entire lumen in water and snare resection of the lesion without submucosal injection of normal saline. We analyzed outcomes of 108 colorectal lesions in the UEMR group and 102 lesions in the CEMR group. R0 resection was defined as en bloc resection with a histologically confirmed negative resection margin. The primary endpoint was the difference in the R0 resection rates between groups. RESULTS: The proportions of R0 resections were 69% (95% confidence interval [CI] 59%-77%) in the UEMR group vs 50% (95% CI 40%-60%) in the CEMR group (P = .011). The proportions of en bloc resections were 89% (95% CI 81%-94%) in the UEMR group vs 75% (95% CI 65%-83%) in the CEMR group (P = .007). There was no significant difference in median procedure time (165 vs 175 seconds) or proportions of patients with adverse events (2.8% in the UEMR group vs 2.0% in the CEMR group). CONCLUSIONS: In a multicenter randomized controlled trial, we found that UEMR significantly increased the proportions of R0 resections for 10- to 20-mm sessile colorectal lesions without increasing adverse events or procedure time. Use of this procedure should be encouraged. Trials registry number: UMIN000018989.


Assuntos
Ressecção Endoscópica de Mucosa/métodos , Mucosa Intestinal/patologia , Pólipos Intestinais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Prevenção Secundária/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Colo/diagnóstico por imagem , Colo/patologia , Colo/cirurgia , Ressecção Endoscópica de Mucosa/efeitos adversos , Feminino , Humanos , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/cirurgia , Pólipos Intestinais/diagnóstico por imagem , Pólipos Intestinais/patologia , Japão , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Reto/diagnóstico por imagem , Reto/patologia , Reto/cirurgia , Resultado do Tratamento , Água
9.
Pediatr Surg Int ; 35(7): 807-811, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30874901

RESUMO

BACKGROUND: Intussusception secondary to pathologic lead points (PLPs) is a potential surgical emergency and almost all cases need surgery. The aim of this study was to evaluate the clinical manifestations, physical examinations and surgical outcomes of secondary intussusception (SI) caused by PLPs, as well as to improve the diagnosis and treatment of PLPs in children and infants. MATERIALS AND METHODS: We retrospectively reviewed the records of 83 children and infants who were diagnosed with intussusception secondary to PLPs in our institution. The ultimate diagnosis was dependent on histopathological findings under a microscope by a pathologist. Patients were divided into a younger group (< 2 years old) and the older group (> 2 years old) according to age. Patient demographics, clinical manifestations, duration of symptoms, auxiliary examinations, and the presence of pathological lead point were recorded. RESULTS: A total of 83 patients were found with intussusception secondary to PLPs in this study. Patients were aged from 4 days to 14 years, with a mean age of 3.8 years (median 1.5; range 0-14 years). There were 47 cases in the younger group and 36 cases in the older group. The main clinical symptoms were intermittent crying or abdominal pain. PLPs were observed in only ten patients on US (12%). Ten patients underwent enteroscopy examination for further diagnosis, and all the patients had positive findings including seven cases of Peutz-Jeghers syndrome and three cases of benign polyps. Technetium-99 m pertechnetate scans were performed in ten patients and five patients had positive results (50%). Based on the surgical findings, complex/compound is the most common type of intussusception, followed by small intestinal and ileo-colic type. The main types of PLPs were Meckel's diverticulum (n = 31), duplication cyst (n = 19) and benign polyps (n = 13). Meckel's diverticulum and intestinal duplication were the most common causes of secondary intussusception among children younger than 2 years, accounting for 81% (38/47) of the cases. The most common causes of secondary intussusception in children older than 2 years were intestinal polyps, Meckel's diverticulum and Peutz-Jeghers syndrome, accounting for 72% (26/36) of the cases. CONCLUSIONS: The presence of a pathological lead point is more likely in older children. The most common types of intussusception secondary to PLPs are complex/compound and small intestinal. Meckel's diverticulum and intestinal duplication were the most common causes of secondary intussusception among younger children and Peutz-Jeghers syndrome and intestinal polyps were commonly seen in older children.


Assuntos
Pólipos Intestinais/complicações , Intussuscepção/etiologia , Laparoscopia/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Pólipos Intestinais/diagnóstico , Pólipos Intestinais/cirurgia , Intussuscepção/diagnóstico , Intussuscepção/cirurgia , Masculino , Divertículo Ileal/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
10.
Gastrointest Endosc ; 90(1): 55-63, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30926431

RESUMO

Recent breakthroughs in artificial intelligence (AI), specifically via its emerging sub-field "deep learning," have direct implications for computer-aided detection and diagnosis (CADe and/or CADx) for colonoscopy. AI is expected to have at least 2 major roles in colonoscopy practice-polyp detection (CADe) and polyp characterization (CADx). CADe has the potential to decrease the polyp miss rate, contributing to improving adenoma detection, whereas CADx can improve the accuracy of colorectal polyp optical diagnosis, leading to reduction of unnecessary polypectomy of non-neoplastic lesions, potential implementation of a resect-and-discard paradigm, and proper application of advanced resection techniques. A growing number of medical-engineering researchers are developing both CADe and CADx systems, some of which allow real-time recognition of polyps or in vivo identification of adenomas, with over 90% accuracy. However, the quality of the developed AI systems as well as that of the study designs vary significantly, hence raising some concerns regarding the generalization of the proposed AI systems. Initial studies were conducted in an exploratory or retrospective fashion by using stored images and likely overestimating the results. These drawbacks potentially hinder smooth implementation of this novel technology into colonoscopy practice. The aim of this article is to review both contributions and limitations in recent machine-learning-based CADe and/or CADx colonoscopy studies and propose some principles that should underlie system development and clinical testing.


Assuntos
Adenocarcinoma/diagnóstico , Adenoma/diagnóstico , Inteligência Artificial , Pólipos do Colo/diagnóstico , Colonoscopia , Neoplasias Colorretais/diagnóstico , Diagnóstico por Computador , Adenocarcinoma/patologia , Adenocarcinoma/prevenção & controle , Adenocarcinoma/cirurgia , Adenoma/patologia , Adenoma/cirurgia , Pólipos do Colo/patologia , Pólipos do Colo/cirurgia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Aprendizado Profundo , Humanos , Pólipos Intestinais/diagnóstico , Pólipos Intestinais/patologia , Pólipos Intestinais/cirurgia , Garantia da Qualidade dos Cuidados de Saúde
11.
J Gastrointestin Liver Dis ; 28(1): 117-120, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30851180

RESUMO

Gastric heterotopia is defined as the presence of morphologically normal gastric tissue at a non-physiological site, coexisting with the original tissue. Although it is not uncommon to see it in the esophagus, duodenum or small intestine, it is exceptionally rare to discover gastric mucosa in the rectum. Here we report the case of a 46-year old male with a 10-year history of ulcerative colitis in whom the surveillance rectosigmoidoscopy detected a Mayo score of 1 for ulerative colitis activity and a middle rectal sessile polyp. Pathological examination revealed an active chronic colitis, and rectal mucosa with heterotopic gastric mucosa composed of oxyntic glands was depicted. A month later, the patient was reevaluated and endoscopic mucosal resection was performed. Histology confirmed the gastric body type mucosa co-mingling with rectal mucosa.


Assuntos
Coristoma/complicações , Colite Ulcerativa/complicações , Mucosa Gástrica , Mucosa Intestinal/patologia , Pólipos Intestinais/complicações , Doenças Retais/complicações , Anti-Inflamatórios/uso terapêutico , Biópsia , Coristoma/patologia , Coristoma/cirurgia , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/patologia , Ressecção Endoscópica de Mucosa , Humanos , Mucosa Intestinal/cirurgia , Pólipos Intestinais/patologia , Pólipos Intestinais/cirurgia , Masculino , Pessoa de Meia-Idade , Doenças Retais/patologia , Doenças Retais/cirurgia , Resultado do Tratamento
12.
Rev. argent. coloproctología ; 30(1): 1-10, mar. 2019. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1023345

RESUMO

La morbilidad y alteración de la calidad de vida asociadas a la resección anterior del recto y amputación abdominoperineal determinaron un gran interés en el desarrollo del abordaje transanal. En los últimos años se ha visto un marcado desarrollo tecnológico en los dispositivos disponible para este abordaje. La cirugía por vía transanal ofrece ventajas en cuanto a sus resultados y complicaciones cuando se la compara a la cirugía por vía abdominal. La cirugía transanal mini-invasiva surge como una alternativa de abordaje videoendoscópico del recto. La resección local por cirugía endoscópica para los pólipos grandes de recto se ha convertido en un nuevo estándar de tratamiento en la mayoría de los centros, obteniendo piezas no fragmentadas con una alta tasa de márgenes negativos. En el presente estudio realizamos una revisión sobre la aplicación de TAMIS (TransAnal Minimally Invasive Surgery) al tratamiento de los pólipos de recto. (AU)


A great interest has developed in implementing trans anal minimally invasive surgery for the treatment of rectal adenomas and early rectal tumors. It present advantages when compare to radical surgery and peace meal endoscopic resections. TAMIS delivers non-fragmented specimens with clear resection margin in the majority of the cases. Such good technical results are mirrored with a low recurrence rate when evaluating rectal adenomas. This is a review of the application of TAMIS for the treatment of rectal adenomas. (AU)


Assuntos
Humanos , Pessoa de Meia-Idade , Reto/cirurgia , Pólipos Intestinais/cirurgia , Pólipos Intestinais/epidemiologia , Cirurgia Endoscópica Transanal/instrumentação , Cirurgia Endoscópica Transanal/métodos , Complicações Pós-Operatórias , Qualidade de Vida , Neoplasias Retais/cirurgia , Neoplasias Retais/epidemiologia , Morbidade , Resultado do Tratamento , Sobreviventes , Incontinência Fecal/epidemiologia
13.
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
15.
Int J Surg Pathol ; 27(5): 515-517, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30541360

RESUMO

In this article, we report the case of a 40-year-old woman with a sessile polyp of the rectosigmoid junction that underwent endoscopic resection. The resected specimen showed spindle cell proliferation with eosinophilic cytoplasm between mucosal crypts, mimicking mucosal prolapse syndrome. However, these were immunohistochemically positive for S-100, indicating neural cell origin. As neural polypoid lesion of the rectum, neurofibroma, perineurioma, schwannoma, and mucosal Schwann cell hamartoma were in the differential diagnosis. Histology and additional immunohistochemistry confirmed mucosal Schwann cell hamartoma. Mucosal Schwann cell hamartoma of the rectosigmoid junction or rectum can be a histological mimic of mucosal prolapse syndrome and other S-100 positive neural cell lesions; however, the lesion in the present case was correctly diagnosed with histology and immunohistochemistry.


Assuntos
Hamartoma/diagnóstico , Mucosa Intestinal/patologia , Pólipos Intestinais/diagnóstico , Células de Schwann/patologia , Adulto , Colo Sigmoide/patologia , Colo Sigmoide/cirurgia , Colonoscopia , Diagnóstico Diferencial , Feminino , Hamartoma/patologia , Hamartoma/cirurgia , Humanos , Mucosa Intestinal/cirurgia , Pólipos Intestinais/patologia , Pólipos Intestinais/cirurgia , Reto/patologia , Reto/cirurgia , Proteínas S100/análise
18.
BMJ Case Rep ; 11(1)2018 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-30567229

RESUMO

Peutz-Jeghers syndrome (PJS) is an autosomal dominant cancer-predisposing condition characterised by intestinal hamartomatous polyps and distinct melanin depositions in skin and mucosa. Small intestinal cancer in patients with PJS usually presents by the third decade. A 7-year-old-PJS boy presented with recurrent episodes of colicky abdominal pain and melena requiring repeated blood transfusions. Abdominal CT scan revealed multiple jejunal polyps with jejunoileal intussusception. On exploration, the intussuscepted bowel was resected along with its mesentery and anastomosed. Simultaneously, multiple enterotomies with resection of palpable polyps were performed. The resected bowel showed well-differentiated stage 2A adenocarcinoma with clear resected margins. Postoperatively, the complaints were relieved. On follow-up, he was asymptomatic and is now on yearly cancer surveillance. This is probably the youngest reported case of small bowel cancer in PJS.


Assuntos
Adenocarcinoma/congênito , Pólipos Intestinais/congênito , Intussuscepção/congênito , Neoplasias do Jejuno/congênito , Síndrome de Peutz-Jeghers/complicações , Adenocarcinoma/cirurgia , Criança , Humanos , Pólipos Intestinais/cirurgia , Intestino Delgado/patologia , Intestino Delgado/cirurgia , Intussuscepção/cirurgia , Neoplasias do Jejuno/cirurgia , Masculino , Melena/congênito , Linhagem
19.
Indian J Pathol Microbiol ; 61(4): 580-582, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30303155

RESUMO

Duodenal gangliocytic paragangliomas are rare neoplasms often arising in the duodenum in close proximity to the ampulla of Vater. These neoplasms are considered to have a benign behavior with lymph node metastases being a rare phenomenon and distant metastases even more so. Although a standardized treatment has not been determined, a margin-free tumor resection seems to be the best treatment modality. We report herein the case of a 36-year-old female who presented with abdominal pain and was found to have a polyp in the second part of duodenum which was excised endoscopically. Histopathology and immunohistochemistry revealed characteristic features of this rare tumor.


Assuntos
Neoplasias Duodenais/complicações , Pólipos Intestinais/etiologia , Paraganglioma/complicações , Adulto , Neoplasias Duodenais/patologia , Feminino , Humanos , Pólipos Intestinais/patologia , Pólipos Intestinais/cirurgia , Paraganglioma/patologia
20.
Can J Gastroenterol Hepatol ; 2018: 2182784, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30155451

RESUMO

Background: Portal hypertension is a serious complication of liver cirrhosis. Objective: To identify relevant endoscopic findings in patients with advanced cirrhosis and consecutive portal hypertension. Methods: This was a retrospective study of liver transplant candidates who underwent upper gastrointestinal endoscopy between April 2011 and November 2015. Results: A total of 1,045 upper endoscopies were analyzed. Portal hypertensive gastric and duodenal polyps were frequently observed and were associated with thrombocytopenia (p = 0.040; OR: 2.4, 95% CI 1.04-5.50), Child-Pugh score > 6 (p = 0.033; OR: 2.3, 95% CI 1.07-4.92), Model for End Stage Liver Disease score > 16 (p = 0.030; OR: 4.1, 95% CI 1.14-15.00), and previous rubber band ligation (p < 0.001; OR = 5.2, 95% CI 2.5-10.7). These polyps often recurred after polypectomy; however, no malignant transformation occurred during the observational time until October 2017. The most common endoscopic finding was esophageal varices, observed in more than 90% of patients. Conclusion: Portal hypertensive polyposis is common in patients with advanced cirrhosis. Our data suggest that these polyps have benign characteristics.


Assuntos
Duodenopatias/complicações , Hipertensão Portal/complicações , Pólipos Intestinais/complicações , Cirrose Hepática/complicações , Gastropatias/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Duodenopatias/diagnóstico por imagem , Duodenopatias/patologia , Duodenopatias/cirurgia , Endoscopia Gastrointestinal , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/etiologia , Feminino , Humanos , Pólipos Intestinais/diagnóstico por imagem , Pólipos Intestinais/patologia , Pólipos Intestinais/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Gastropatias/diagnóstico por imagem , Gastropatias/patologia , Gastropatias/cirurgia , Trombocitopenia/complicações , Adulto Jovem
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