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4.
Ir Med J ; 113(1): 7, 2020 01 16.
Artigo em Inglês | MEDLINE | ID: mdl-32298567

RESUMO

Aims To determine the completeness of polyp resection (i.e. achieving an R0 margin) and its relation with Endoscopists, histopathologist, size, location and technique of polypectomy in an NSS cohort. The definition of R0 margin is complete macroscopic resection with a negative microscopic margin at polypectomy. Method NCCS (National Colon Cancer Screening) colonoscopies are offered to bowel cancer screening patients after a positive faecal immunochemical test (FIT) test in a Joint Advisory Group (JAG) accredited Gastrointestinal Endoscopy centre. We histologically evaluated the polyp margins for complete resection, which was defined as the absence of adenomatous or hyperplastic tissue in the resected polyp margins in a cohort of faecal immunochemical test positive patients. Results A total of 186 consecutive NCCS colonoscopies out of a total of 542 performed between 2013 and 2017 were included in this study. Of the polyps excised 152(27%) had a R0 margin histologically, and 30(5%) had involvement of the margin. Surprisingly in 373(67%) of polyps pathologists were unable to assess the margin. Conclusion Achieving an R0 margin should be a key performance indicator for endoscopists performing polypectomy. At the same time more studies on polyp margins are recommended.


Assuntos
Pólipos Intestinais/cirurgia , Margens de Excisão , Estudos de Coortes , Neoplasias Colorretais/prevenção & controle , Endoscopia Gastrointestinal , Humanos
6.
J Gastroenterol Hepatol ; 35(8): 1381-1386, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32003069

RESUMO

BACKGROUND AND AIM: Colonic perforation is a rare complication of colonoscopy and ranges from 0% to 1% in all patients undergoing colonoscopy. The aim of this study was to assess the time trends, risk factors, and mortality associated with colonoscopy-induced perforation (CIP) in hospitalized patients as the data are limited. METHODS: Data are obtained from the Nationwide Inpatient Sample database to identify hospitalized patients between 2005 and 2014 that had CIP. Various factors like age and gender were assessed for association with CIP, followed by univariate and multivariate regression analyses. RESULTS: A total of 2 651 109 patients underwent inpatient colonoscopy between 2005 and 2014, and 4567 (0.2%) of the patients had CIP. Overall, incidence of CIP has increased from 2005 to 2014 (0.1% to 0.3%) (P < 0.001). On multivariate analysis, the adjusted odds ratio (OR) for CIP was highest in Caucasian race (OR: 1.49 [1.09, 2.06]), followed by after polypectomy, history of inflammatory bowel disease, end-stage renal disease, and age > 65 years (OR [95% CI] of 1.35 [1.23, 1.47], 1.34 [1.17, 1.53], 1.28 [1.02, 1.62], and 1.21 [1.11, 1.33], respectively) (all P < 0.05). CIP group had 33% less obesity (OR [95% CI]: 0.77 [0.65-0.9], P = 0.002) and 13-fold higher mortality (0.5% vs 8.1%) (P < 0.001) as compared to patients without CIP. The CIP-associated mortality ranged from 2% to 8% and remained stable throughout the study period. CONCLUSIONS: Our study suggests that the risk of CIP was highest in elderly patients, Caucasians, those with inflammatory bowel disease, end-stage renal disease, and after polypectomy. Recognizing the factors associated with CIP may lead to informed discussion about risks and benefits of inpatient colonoscopy.


Assuntos
Colonoscopia/efeitos adversos , Pacientes Internados/estatística & dados numéricos , Perfuração Intestinal/etiologia , Perfuração Intestinal/mortalidade , Análise por Ativação , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Interpretação Estatística de Dados , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Doenças Inflamatórias Intestinais , Perfuração Intestinal/epidemiologia , Pólipos Intestinais/cirurgia , Falência Renal Crônica , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Adulto Jovem
7.
Am J Surg ; 220(3): 693-696, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32061399

RESUMO

BACKGROUND: Underwater endoscopic mucosal resection without submucosal injection (UEMR) is an appealing therapy for large colorectal polyps. However, this technique is not practiced widely and there are limited data evaluating UEMR in community settings. METHODS: The study comprised patients undergoing UEMR of large (≥20 mm) sessile colorectal lesions at a community-based center. Residual neoplasia was assessed via follow-up colonoscopy. RESULTS: Among 264 lesions (diameter 38 ± 18 mm; range 20-110 mm) 99% were successfully resected with UEMR. Two lesions involving the cecum/IC valve required multiple sessions. There were no cases of perforation or post-polypectomy syndrome. Delayed bleeding occurred in 1.6%, all managed conservatively. Residual neoplasia was present in 5.7% and was amenable to UEMR. CONCLUSION: This large community-based series demonstrated high efficacy and safety of UEMR for large sessile colorectal lesions. The results support UEMR as first-line therapy for these lesions. SUMMARY: Underwater endoscopic mucosal resection without submucosal injection (UEMR) is a recently developed method that has advantages over conventional EMR for treatment of large colorectal lesions. However, UEMR is not practiced widely and there are limited data evaluating this technique in everyday practice. This large community-based series demonstrated high efficacy and safety of UEMR for large sessile colorectal lesions.


Assuntos
Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Pólipos Intestinais/patologia , Pólipos Intestinais/cirurgia , Idoso , Colúmbia Britânica , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Neoplasia Residual , Carga Tumoral , Água
8.
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
9.
J Gastroenterol Hepatol ; 35(10): 1704-1711, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31900958

RESUMO

BACKGROUND AND AIMS: Colonoscopic polypectomy in end-stage renal disease (ESRD) patients are at risks of post-polypectomy bleeding and perforation, but evidences are limited. This study aimed to determine the incident polypectomy complications among ESRD patients. METHODS: In the nationwide ESRD cohort, a propensity score matched case-control study design was conducted to assess risk associated with post-polypectomy bleeding and perforation using the Taiwanese National Health Insurance Research Database from 1997 to 2013 for adults aged 40 years and older; 7011 ESRD and 19 118 non-ESRD patients met the study criteria. A total of 5302 patients in each group were matched for further analyses. The primary endpoint was post-polypectomy bleeding or bowel perforation in 30 days. The secondary endpoint was mortality and length of hospital stay for the bleeding complications requiring hospitalization. RESULTS: Overall incidences of post-polypectomy bleeding or perforation in patients with ESRD was higher than the non-ESRD group (5.83% vs 1.78%, P < 0.0001) in the matched cohort. High risk of adverse outcomes was associated with ESRD (adjusted odds ratio [aOR], 2.38, 95% confidence interval [CI], 1.85-3.05), female patient (aOR, 1.7, 95% CI, 1.37-2.11), history of acute myocardial infarction (aOR, 1.91, 95% CI, 1.1-3.32), liver disease (aOR, 1.79, 95% CI, 1.37-2.34), diabetes (aOR, 1.45, 95% CI, 1.16-1.82), cancer (aOR, 1.4, 95% CI, 1.09-1.81), inpatient setting (aOR, 13.19, 95% CI, 9.73-17.88), and prior use of clopidogrel (aOR, 1.61, 95% CI, 1.03-2.52) and warfarin (aOR, 2.03, 95% CI, 1.21-3.41). CONCLUSIONS: End-stage renal disease was associated with approximately twofold higher risk of colonoscopic post-polypectomy bleeding or perforation and should be cautiously performed in this special population cohort.


Assuntos
Colonoscopia/efeitos adversos , Perfuração Intestinal/epidemiologia , Perfuração Intestinal/etiologia , Pólipos Intestinais/complicações , Pólipos Intestinais/cirurgia , Falência Renal Crônica/complicações , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Pontuação de Propensão , Fatores de Risco
10.
J Gastroenterol Hepatol ; 35(2): 263-270, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31497895

RESUMO

BACKGROUND AND AIM: With the increasing necessity of colorectal cancer screening, observational screening colonoscopy during which only endoscopic observation and diagnosis is performed is worth consideration. However, whether detected lesions can be correctly identified at secondary colonoscopy performed for polypectomy is unclear. Further, whether new neoplastic lesions can be detected at secondary colonoscopy has not been fully examined. This study was performed to investigate the detectability of adenomatous polyps and advanced colorectal neoplasia (ACN) at secondary colonoscopy. METHODS: Data were analyzed from individuals who underwent initial observational screening colonoscopy followed by secondary colonoscopy for polypectomy. The proportion of correct detection at secondary colonoscopy of the lesions detected at initial colonoscopy was assessed. The number and characteristics of lesions that were newly detected at secondary colonoscopy were also evaluated. RESULTS: Data of 587 individuals were assessed. Among the 1 331 lesions detected at the initial colonoscopy, 1 151 (86.5%) were properly detected at the secondary colonoscopy. The proportions of correct detection at the secondary colonoscopy for ACN, non-advanced adenomas sized 5 to 9 mm, and non-advanced adenomas sized 1 to 4 mm were 100%, 95.4%, and 70.3%, respectively. In total, 175 adenomatous polyps and ACNs were newly detected at secondary colonoscopy in 112 individuals (19.1% of all individuals). Most of the lesions (165 lesions, 94.3%) were non-advanced adenomas, while advanced adenomas (5.7%) were also found. CONCLUSION: Screening by observational colonoscopy followed by deferred polypectomy is a feasible option in terms of lesion detectability, particularly when lesions sized ≥ 5 mm are the treatment target.


Assuntos
Colonoscopia/métodos , Pólipos Intestinais/cirurgia , Programas de Rastreamento/métodos , Idoso , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/patologia , Neoplasias Colorretais/prevenção & controle , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade
11.
Am J Surg Pathol ; 44(2): 241-246, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31498179

RESUMO

Tumor differentiation, lymphovascular invasion, margin status, polyp shape, and size are important parameters of malignant polyps (pT1) indicating possible node metastasis, which justifies a surgery. However, the size, margin, and lymphovascular invasion are often unknown or difficult to assess in a piecemeal polypectomy from a nonpedunculated malignant polyp. The aim of the study was to identify adverse histologic features in nonpedunculated malignant polyps associated with an increased risk of nodal metastasis, which may warrant a colectomy procedure. A total of 24 node-positive and 18 node-negative nonpedunculated malignant polyps and their corresponding subsequent resection specimens from 2005 to 2018 were reviewed. Cases with node metastasis were more often positive for high-grade tumor budding (70.8% vs. 16.7%; P=0.0005), poorly differentiated clusters (54.2% vs. 22.2%; P=0.0369), and both high-grade tumor budding and poorly differentiated clusters (45.8% vs. 11.1%; P=0.0160) compared with controls without nodal metastasis. High-grade tumor budding, poorly differentiated clusters, and combined high-grade tumor budding and poorly differentiated clusters increased the risk of nodal metastasis, with odds ratio of 12.1, 4.1, and 14.3, respectively. Furthermore, nodal metastasis could be seen in subsequent colectomy specimen even in completely excised malignant polyps with adverse histologic features. Our findings indicate that high-grade tumor budding and poorly differentiated clusters are important adverse histologic risk features in predicting lymph node metastatic potential. These histologic features should be reported and it may warrant a colectomy when they are present.


Assuntos
Adenocarcinoma/patologia , Neoplasias Colorretais/patologia , Pólipos Intestinais/patologia , Linfonodos/patologia , Adenocarcinoma/cirurgia , Adulto , Idoso , Colectomia , Neoplasias Colorretais/cirurgia , Bases de Dados Factuais , Feminino , Humanos , Pólipos Intestinais/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Invasividade Neoplásica , Estadiamento de Neoplasias , Estudos Retrospectivos
12.
J Gastroenterol Hepatol ; 35(2): 241-248, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31389623

RESUMO

BACKGROUND AND AIM: The true incidence of incomplete muscularis mucosa resection with cold snare polypectomy (CSP) is unknown. We examined the incidence of incomplete muscularis mucosa resection both with and without cold snare defect protrusion (CSDP). METHODS: We prospectively enrolled patients undergoing polypectomy for 4 to 9mm nonpedunculated polyps. We evaluated the presence of CSDP immediately following CSP and biopsied the CSDP or the center of the mucosal defect without CSDP. The presence of the muscularis mucosa and any residual polyp in the biopsies was evaluated histologically. The primary outcome was the incidence of incomplete mucosal layer resection defined as the presence of muscularis mucosa or residual polyp in the biopsies. RESULTS: From August 2017 to October 2018, 188 patients were screened, and 357 polyps were included. CSDP was detected in 122/355 (34%) evaluated mucosal defects. Excluding five lesions requiring hemostasis immediately following CSP, 352 mucosal defects were biopsied. After excluding 102 biopsies containing normal mucosa, we evaluated 250 biopsies. The overall incidence of incomplete mucosal layer resection was 63% (159/250), 76% (68/90) with CSDP and 57% (91/159) without CSDP (P < 0.01). Both univariate and multivariate analyses showed that size (≥ 6 mm), resection time (≥ 5 s), and serrated lesions were risk factors for CSDP. CONCLUSIONS: Cold snare defect protrusion (CSDP), which was present with 36%, was a good indicator for incomplete mucosal layer resection. Even in nonCSDP polypectomies, 57% of the mucosal layer was not removed completely. Thus, CSP should be used for intra-epithelial lesions only, and careful pretreatment evaluation is recommended.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Mucosa Gástrica/cirurgia , Pólipos Intestinais/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
13.
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
14.
Korean J Gastroenterol ; 74(6): 326-332, 2019 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-31870138

RESUMO

Background/Aims: Bleeding is one of the major complications of a colorectal polypectomy. The aim of this study was to identify the risk of delayed bleeding, particularly after a colorectal endoscopic mucosal resection (EMR) without prophylactic clipping. Methods: Between April 2014 and August 2014, patients who underwent colorectal EMR (≥6 mm and <2 cm) without prophylactic clipping were included. This study evaluated the incidence of delayed bleeding and the associated factors after colorectal EMR without prophylactic clipping. Results: A total of 717 colorectal polyps (≥6 mm and <2 cm) of 243 patients resected by colorectal EMR in the study period were evaluated. The mean age of the patients was 63 years; 165 patients were men and 78 patients were women. The mean polyp size removed by colorectal EMR was 9.0 mm (range 6.0-19.0), and the number of polyps larger than 1 cm was 212 (29.6%). Delayed bleeding after colorectal EMR occurred in 12 polyps (1.7%) in eight patients (3.3%), and there were no significant risk factors affecting delayed bleeding. Conclusions: This study identified that the incidence of delayed bleeding on colorectal polyps (≥6 mm and <2 cm) after EMR without prophylactic clipping was 3.3%, but no significant risk factors affecting delayed bleeding were found.


Assuntos
Ressecção Endoscópica de Mucosa/efeitos adversos , Hemorragia Gastrointestinal/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/cirurgia , Feminino , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Incidência , Pólipos Intestinais/patologia , Pólipos Intestinais/cirurgia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores de Tempo , Adulto Jovem
15.
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
18.
Med Sci Monit ; 25: 7439-7442, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31582716

RESUMO

BACKGROUND This study aimed to identify the risk factors of complications after small-intestinal polypectomy by single-balloon enteroscopy (SBE), and to assess the value of serum C-reactive protein (CRP) and the max polyp diameter (Dmax) in predicting postoperative complications of small-intestinal polypectomy. MATERIAL AND METHODS Between April 2017 and April 2018, clinical data from 37 patients who underwent small-intestinal polypectomy were retrospectively analyzed. RESULTS Thirty-seven small-intestinal polypectomy procedures (18 oral and 19 anal) were carried out in 37 patients (M: F 20: 17; age 35.6±13.0 years). A total of 1081 small-intestine polyps were removed. Three patients (8.1%) had bleeding and 3 patients (8.1%) had perforation after small-intestinal polypectomy. Based on multivariate logistic analysis, CRP [1.104 (95% CI 1.022-1.191)] was the only risk factor for complications among the patients. According to the area under the receiver operating characteristic (AUROC) curve, CRP (27.5 mg/L), Dmax (3.5 cm), and the combination of CRP + Dmax appear to be predictive factors for complications after small-intestinal polypectomy. CONCLUSIONS SBE is an effective endoscopic tool for patients with small-intestinal polyps. CRP, Dmax, and the combination of CRP+Dmax may be potential predictors of complications from small-intestinal polypectomy.


Assuntos
Pólipos Intestinais/cirurgia , Enteroscopia de Balão Único/métodos , Adulto , Área Sob a Curva , Biomarcadores/sangue , Biópsia , Proteína C-Reativa/análise , China , Pólipos do Colo/cirurgia , Colonoscopia/métodos , Feminino , Hemorragia/complicações , Humanos , Pólipos Intestinais/complicações , Intestino Delgado/cirurgia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Enteroscopia de Balão Único/efeitos adversos , Enteroscopia de Balão Único/mortalidade
19.
Br J Surg ; 106(12): 1576-1579, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31483054

RESUMO

Safe and effective implementation of remote surgery and telementoring can have significant limitations. Fifth-generation (5G) wireless networks could be useful in overcoming these drawbacks. As a proof of concept, the authors present technical and clinical details of two procedures assisted by telementoring using 5G that were also broadcast live. Secure remote access advice.


Assuntos
Laparoscopia/educação , Tutoria/métodos , Telemedicina/métodos , Adenocarcinoma/cirurgia , Idoso , Feminino , Humanos , Internet , Pólipos Intestinais/cirurgia , Masculino , Pessoa de Meia-Idade , Estudo de Prova de Conceito , Neoplasias Retais/cirurgia
20.
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
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