Complications of the hot biopsy forceps technique.

Hot biopsy forceps technique involves the use of insulated monopolar electrocoagulating forceps to simultaneously biopsy and electrocoagulate tissue. It has been recommended for removal of diminutive polyps and treatment of vascular ectasias of the gastrointestinal tract. The extent of its use and associated complications have not been delineated. This study evaluated the practice of 517 endoscopists. Seventy-one percent (369 endoscopists) used hot biopsy forceps and reported 117 complications, including 85 episodes of bleeding, 19 perforations, and one death. While the overall complication rate was less than that previously reported for colonoscopic polypectomy, 87% of colon perforations occurred on the right side. Factors that may have been important in the development of complications included the degree and length of current application. Adherence to suggested limitations in current application and use of proper technique should result in fewer complications.

Mucosal pseudolipomatosis: an air pressure-related colonoscopy complication.

Mucosal pseudolipomatosis is a recently described colonoscopic finding, most likely caused by intramucosal air. We describe four asymptomatic patients with this lesion which completely resolved 3 weeks later on repeat colonoscopy. This is a benign, transient lesion with distinct endoscopic and histologic findings. The similarity between mucosal pseudolipomatosis and pneumatosis cystoides intestinalis is supportive of the mechanical theory for pneumatosis cystoides intestinalis.

Eradication of diminutive polyps: a prospective evaluation of bipolar coagulation versus conventional biopsy removal.

Bipolar probe coagulation (BICAP) was evaluated and compared with conventional cold biopsy (CBx) as a potential therapeutic modality for eradication of diminutive colonic polyps (DPs). Seventy-seven and 79 DPs were treated with BICAP and CBx, respectively. Twenty-one percent of the BICAP and 29% of the CBx (p greater than 0.05) group had residual polypoid tissue detected at flexible sigmoidoscopy 3 weeks after treatment. Because of incomplete polyp removal, CBx and BICAP coagulation cannot be recommended as definitive therapies for DPs. Neoplasia was present in 22% of DPs located less than 60 cm from the anus, 73% of proximally located small polyps, and 32% of all DPs. Despite apparent eradication at the time of treatment, the incidence of residual polypoid tissue would suggest the need for critical evaluation of other modalities used to eradicate or remove DPs.

The gastroenterologist: physician or technician?

Concern exists about perceived overuse of gastrointestinal endoscopic procedures. To determine the portion of the current practice of gastroenterology that is procedure related or purely cognitive, we compared 303 consultations from two practices. One-hundred and eighty-seven patients were in a Veterans Affairs Medical Center and 116 in a private group practice. Sixty-five percent of the consultations resulted in an endoscopic procedure. Patients referred for abnormal barium studies (100%), percutaneous endoscopic gastrostomy placement (97%), and gastrointestinal bleeding (83%) were most likely to have a procedure. Sixty-nine percent of consultations from medical specialties had endoscopy compared with 44% from surgical specialties and 45% from other specialties. There were no differences noted between the two practices. We conclude that gastroenterology is predominantly a procedure-oriented subspecialty. Procedures are performed most commonly on patients referred for conditions that are likely to require endoscopic biopsy or therapeutics and on patients referred from medical specialists.