Evaluation of complications related to therapeutic colonoscopy using the bipolar snare.

BACKGROUND: The complications with therapeutic colonoscopy reported to date have been associated with the monopolar snare, and the frequency of complications related to use of the bipolar snare is uncertain. This study aimed too investigate the incidence of bleeding and perforation associated with the bipolar snare and to identify the risk factors for bleeding. METHODS: Between October 2001 and December 2008, all patients with colorectal polyps treated using the bipolar snare were enrolled in this retrospective study. Clinical data were assembled from an electronic database. The incidence of bleeding and perforation was investigated, and the risk factors for bleeding also were determined using multivariate analysis. RESULTS: This study collected 4,719 patients with 10,513 lesions. Perforation occurred for eight patients (0.17%) and bleeding in 66 patients (1.4%). Age younger than 60 years was a significant risk factor for bleeding (P < 0.01). The incidence of bleeding was significantly higher for lesions 10 mm or larger than for lesions smaller than 10 mm (P < 0.001). In terms of macroscopic type, pedunculated lesions bled significantly more often than lesions of other shapes (P < 0.001). Lesions in the rectum bled significantly more frequently (P < 0.001) than lesions at other sites. High-grade dysplasia and invasive cancer developed bleeding significantly more often than other histologic types (P < 0.001). Multivariate analysis showed that age younger than 60 years (odds ratio [OR], 2.42), lesion size of 10 mm or larger (OR, 2.60), pedunculated shape (OR, 3.40), and rectal location (OR, 3.55) were significant risk factors. CONCLUSIONS: The complication rates for the bipolar snare appear to be comparable with those for the monopolar snare based on comparison of the results reported in the literature. Age (<60 years), lesion size (≥ 10 mm), macroscopic type (pedunculated), and lesion location (rectum) are independent risk factors for bleeding.

[A surgical (right lobectomy) case of liver metastasis of colon cancer after chemotherapy using mFOLFIRI and cetuximab].

A man in his early seventies underwent low anterior resection and partial resection of the liver for the rectal cancer and liver metastasis. However, 4 months after the surgery, he was found to have a liver tumor at S5 and S7 by abdominal CT scan. Then, he underwent chemotherapy (mFOLFOX6), but the metastatic tumor was progressive. We selected FOLFIRI + cetuximab regimen for second-line therapy to resect the metastatic tumor. As the metastatic lesion was become smaller after 4-course of the regimen including cetuximab, we decided to perform a radical resection. We conducted a right lobectomy of the liver, and the tumor was completely resected.

[A surgical (pancreatoduodenectomy) case of lymph node metastatic recurrence of colon cancer after chemotherapy].

A woman in her fifties underwent a right hemicolectomy (D3) for cancer of the ascending colon in October 2007, definitively and pathologically diagnosed as papillary adenocarcinoma invading to the subserosa, and no metastasis was detected to lymph node. But 13 months after the surgery, she was found to have a mass near the anastomosis by an abdominal CT scan. Colonoscopy showed an evaluating lesion with ulcer in the anal side of the anastomosis. We tried to resect the metastasis, but it was not resectable because of the invasion to the pancreas. The mFOLFOX regimen was effective. After the chemotherapy (6 courses), we decided to perform a radical resection. We conducted pancreatoduodenectomy in May 2009. She is still alive 12 months after surgery.

[The introduction of the clinical study in the general hospital].

Our hospital fights against a clinical study clearly. However, our hospital did not participate in a clinical study here. When I widened a clinical study in cooperation with the staff, I make a progress report. I started a clinical study only with a doctor first. Therefore it was recognized many problems happened and to promote a clinical study without cooperation of the work of many kinds. I studied with the staff to promote a clinical study and deepened understanding. Thereafter the clinical study was led by a nurse of the chemotherapy room; , in addition, was able to get various cooperation from a skiagrapher. When OGSG0603 began, the nurse and the pharmacist served to become the key than a doctor. I was able to promote a clinical study by cooperation of much staff. In addition, I was able to carry out the system improvement of each section by performing a clinical study.