scholarly journals Use of over-the-scope clips in the colon in clinical practice: results from a German administrative database

Endoscopy ◽  
2020 ◽  
Vol 52 (12) ◽  
pp. 1103-1110
Author(s):  
Dirk Horenkamp-Sonntag ◽  
Judith Liebentraut ◽  
Susanne Engel ◽  
Christoph Skupnik ◽  
David Albers ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colonic Neoplasms ◽  
Administrative Database ◽  
Recurrent Bleeding ◽  
Insurance Company ◽  
Surgical Interventions ◽  
Group A ◽  
Group B ◽  
Underlying Diseases

Abstract Background The efficacy and safety of over-the-scope (OTS) clips in the colon is limited. This study aimed to evaluate OTS clip use in the colon in routine colonoscopy. Methods Using administrative data from a large health insurance company, patients with OTS clip placement during colonoscopy were identified and analyzed by specific administrative codes. Indication for OTS clipping was analyzed, and follow-up was evaluated for surgical and repeat endoscopic interventions. Results In 505 patients, indications for OTS clips were iatrogenic perforations (n = 80; Group A), polypectomy (n = 315; Group B), colonic bleeding (n = 51; Group C), and various underlying diseases (n = 59; Group D). In 11 Group A patients (13.8 %), surgical interventions occurred, mostly within 24 hours after clipping (n = 9), predominantly overstitching (n = 8). OTS clipping during polypectomy (Group B) was for complications (e. g. bleeding in 27 %) or was applied prophylactically. Only five patients required early surgery, three of whom had colorectal cancer. In four Group C patients (7.8 %), surgical resections were performed (persistent bleeding n = 1, colorectal cancer n = 2), while six patients underwent early repeat colonoscopy for recurrent bleeding. During further follow-up (days 11–30), 17 patients underwent resection for colonic neoplasms (n = 12) or persistent bleeding (n = 4), but only one case could be directly traced back to local OTS clip complication. Conclusion Colonic OTS clipping appears safe and effective in selected indications and complications in clinical routine but must be anatomically and technically feasible, avoiding overuse.

scholarly journals MANAGEMENT OF ASRIGDARA WITH KUTAJASHTAKA AVALEHA AND YASHTIMADHU GHRITA MATRA BASTI - AN OPEN LABEL, DOUBLE ARM, RANDOMIZED CLINICAL TRIAL

2020 ◽  
Vol 8 (10) ◽  
pp. 4701-4709
Author(s):  
Stuti Sharma ◽  
Meenakshi Pandey
Keyword(s):  
Medical Therapy ◽  
Signs And Symptoms ◽  
Reproductive Age ◽  
New Delhi ◽  
Open Label ◽  
Surgical Interventions ◽  
Rectal Route ◽  
Group A ◽  
Group B

Introduction: The word Asrigdara explains about prolonged, cyclic or acyclic excessive menstrual bleed-ing in Ayurveda. 9-14% of women in their reproductive age lose 80 ml of blood in each cycle. It is the most common cause of Anemia. Traditionally, Heavy Uterine Bleeding is managed with medical therapy and surgical intervention with associated side effects. But due to limitation of medical therapy as well as surgical interventions, it becomes the necessity of time to find out a permanent, easy, effective and less side effect producing care which can be easily administered and accepted by the patient. Objective: To evaluate the clinical efficacy of Kutajashtaka Avaleha orally and combination of Kutajashtaka Avaleha and Yashtimadhu Ghrita matra basti in combating the signs and symptoms of Asrigdara. Materials and Methods: 56 patients were selected from the Stri Roga and Prasuti Tantra OPD, All India Institute of Ayur-veda, New Delhi and randomly divided into 2 groups. Group A was administered with Kutajashtaka Ava-leha orally regularly for the period of 3 months with the doses of 5gm BD after meal with water, while in Group B, Combination of Yashtimadhu Ghrita Matra Basti (60 ml for 7 days in 3 consecutive cycles after meal through rectal route after 7th day of menses) for 3 months and Kutajashtaka Avaleha was given and the follow up period of 1 month without medication was same for both the groups. Results: Kutajashtaka Avaleha orally alone and Combination of Yashtimadhu Ghrita Matra Basti & Kutajashtaka Avaleha oral both gave statistically highly Significant results (P<0.001) but with better results when the treatment was combined and Markedly Improved (51-75% relief) the signs and symptoms. Conclusion: Combination of Yashtimadhu Ghrita Matra Basti & Kutajashtaka Avaleha oral gave more statistically significant results than Kutajashtaka Avaleha orally alone. No adverse effects were reported during the entire trial period.

Effect of increased body mass index on time to tumor progression in metastatic unresectable colorectal cancer patients treated with bevacizumab-based therapy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14594-e14594
Author(s):  
Ibrahim Yildiz ◽  
Fatma Sen ◽  
Leyla Kilic ◽  
Serkan Keskin ◽  
Rumeysa Ciftci ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Body Mass Index ◽  
Tumor Progression ◽  
Cancer Patients ◽  
Combination Chemotherapy ◽  
Group A ◽  
Group B ◽  
High Bmi ◽  
Time To Tumor Progression

e14594 Background: High body mass index (BMI) is a well known risk factor in the development and recurrence of several solid tumors including colorectal cancer (CRC). Obesity is associated with increased serum levels of vascular endothelial growth factor (VEGF). Bevacizumab is the main targeted therapy inhibiting tumor angiogenesis by blocking VEGF receptor. We evaluated the effect of BMI on time to tumor progression (TTP) in patients who received bevacizumab based therapy due to advanced colorectal cancer in our institution. Methods: Patients with metastatic colorectal cancer who have been treated with fluoropyrimidine-based combination chemotherapy with bevacizumab were included in the study. Data of patients’ clinical treatment characteristics were obtained from the medical records. The height and weight measured during the initiation of bevacizumab were used to assign the patients to group A (BMI<25 kg/m2) and group B (BMI≥25 kg/m2). The time to tumor progression was defined as the day of initiation of bevacizumab based threpay to the date of first documented progressive disease, the date of death regardless of its course or the date of last follow up if no disease progression or no death occured at this time. Results: 236 patients (median age 57, range 27-79 years) were treated withfluoropyrimidine-based combination chemotherapy with bevacizumab between April 2007 and June 2011. 127 (51.3%) patients had a BMI <25 kg/m2 and 115 (48.7%) patients were found to have a BMI ≥25 kg/m2. One hundred ninety-three patients (82.1%) had first line bevacizumab therapy, and 44 patients (22.8%) had second-line bevacizumab therapy. Tumors of 68.4% of patients in group A and 69,1% of patients in group B progressed during a median 10 months (3-57 months) follow up. The median TTP was 9.5 months in the BMI <25 group and 8.2 months in the BMI >25 group.In multivariate analysis, high BMI (≥25 kg/m2) was associated with significantly shorter TTP (p: 0.002; HR, 1.91; 95% CI, 1.26–2.88). Conclusions: High BMI is a relevant prognostic factor in predicting the time to tumor progression in metastatic colon cancer patients treated with bevacizumab.

Continuous versus intermittent chemotherapy in metastatic colorectal cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 3582-3582 ◽  
Author(s):  
C. G. Alexopoulos ◽  
A. A. Kotsori
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Stable Disease ◽  
Randomized Study ◽  
Intermittent Chemotherapy ◽  
Group A ◽  
Group B ◽  
Line Chemotherapy

3582 Background: The current policy concerning the duration of chemotherapy in metastatic colorectal cancer (MCC) varies considerably (Clin Oncol 1997;9:248) while no benefit of continuous versus intermittent 5-FU was found in a published randomized study (Lancet 2003;361:457). Serious cumulative toxicity is not usually a problem with long-term 5-FU/FA, but this is not the case with contemporary triple regimens (FOLFIRI, FOLFOX). We, therefore, performed a randomized study of continuous versus intermittent FOLFIRI as first line chemotherapy in MCC. Methods: Patients with MCC and ECOG 0–2 were given 6 biweekly courses of FOLFIRI (Irinotecan 180mg/m2 + De Gramont). Patients with response or stable disease were randomized to continue with another 6 FOLFIRI (group A) or discontinue until relapse when 6 FOLFIRI were readministered (group B). Time to progression (TTP) was calculated from study entrance until 1st progression for group A, and 2nd progression for group B, and overall survival (OS) from study entrance until death. Results: Fifty eight (M=38, F=20) patients entered into the study. Two (3.4%) withdrew before evaluation, 1 (1.7%) died of stroke, 1 (1.7%) was lost to FU and 15 (26%) progressed before or at the completion of 6 FOLFIRI. Thirty nine (67%) patients (M=25, F=14), median age 69 (38–79) responded (21=54%) or had stable disease (18=46%) and were randomized: 19 (49%) to group A and 20 (51%) to group B. Median TTP was 8 months 95% CI: 5.3–10.7) for group A and 9 (95% CI: 7.8–10) for group B (p=NS). 10/19 (52%) in group A received 2nd line chemotherapy vs 7/20 (35%) in group B (p=NS). With a median follow-up of 13 months, 21 patients are alive (12 in group A and 9 in group B). Median OS was 21 months (95% CI: 15 - 26.7) in group A vs 15 (95% CI: 12.6 - 17.3) in group B (p=NS), and 18 months (95% CI: 15.5 - 21) for all 39 patients. Conclusions: In MCC, when response or stability has been achieved after 6 courses ofFOLFIRI there seemstobe little more benefit from continuing chemotherapy than from retreating patients at relapse No significant financial relationships to disclose.

18F-FDG PET changes management and improves prognostic stratification in patients with colorectal cancer: results of a prospective, multi-centre study

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 4025-4025
Author(s):  
A. M. Scott ◽  
D. Gunawardana ◽  
B. Kelly ◽  
J. Stuckey ◽  
A. Byrne ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Progressive Disease ◽  
Hepatic Metastases ◽  
Conventional Imaging ◽  
Multi Centre Study ◽  
Management Plans ◽  
Group A ◽  
Group B ◽  
The Impact

4025 Background: The aims were to: 1) examine the impact of PET in changing management in patients with proven or suspected recurrence of colorectal cancer and, 2) assess the impact of management change on disease free survival. Methods: Symptomatic patients (Group A) with a residual structural lesion suspicious for recurrent tumour, or patients (Group B) with pulmonary or hepatic metastases, which were potentially resectable as determined by conventional imaging, underwent PET scans. Pre- and post-PET management plans were documented blinded to PET results. Patients were followed for 12 months to determine actual management and to assess clinical outcomes. Results: A total of 191 patients (118M:73F, mean age 66 yrs) were recruited. PET detected additional sites of disease in 48.4% of Group A and 43.9% of Group B patients. Importantly, a change in planned management was documented in 65.6% of Group A and 49.0% of Group B patients. Follow-up confirmed implementation of management plans in 96% of patients. Analysis of follow-up data to 12 months post- PET showed that in Group A progressive disease was identified in 60.5% of patients with additional lesions detected on PET compared with conventional imaging, and 36.2% patients with no additional lesions detected by PET (p=0.0364); in Group B progressive disease was identified in 65.9% of patients with additional lesions detected on PET and 39.2% patients with no additional lesions detected by PET (p=0.0198). Patient follow-up also showed that PET provided valuable prognostic information in patients stratified into curative/palliative intent groups. Conclusions: These data unequivocally demonstrate the significant impact of PET on management and outcomes in patients with suspected recurrent colorectal cancer. No significant financial relationships to disclose.

scholarly journals Randomized Comparison of Surveillance Intervals in Familial Colorectal Cancer

2015 ◽  
Vol 33 (35) ◽  
pp. 4188-4193 ◽  
Author(s):  
Simone D. Hennink ◽  
Andrea E. van der Meulen-de Jong ◽  
Ron Wolterbeek ◽  
A. Stijn L.P. Crobach ◽  
Marco C.J.M. Becx ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Degree Relative ◽  
Familial Colorectal Cancer ◽  
Colonoscopic Surveillance ◽  
Screening Interval ◽  
Significant Difference ◽  
Surveillance Interval ◽  
Group A ◽  
Group B

Purpose Colonoscopic surveillance is recommended for individuals with familial colorectal cancer (CRC). However, the appropriate screening interval has not yet been determined. The aim of this randomized trial was to compare a 3-year with a 6-year screening interval. Patients and Methods Individuals between ages 45 and 65 years with one first-degree relative with CRC age < 50 years or two first-degree relatives with CRC were selected. Patients with zero to two adenomas at baseline were randomly assigned to one of two groups: group A (colonoscopy at 6 years) or group B (colonoscopy at 3 and 6 years). The primary outcome measure was advanced adenomatous polyps (AAPs). Risk factors studied included sex, age, type of family history, and baseline endoscopic findings. Results A total of 528 patients were randomly assigned (group A, n = 262; group B, n = 266). Intention-to-treat analysis showed no significant difference in the proportion of patients with AAPs at the first follow-up examination at 6 years in group A (6.9%) versus 3 years in group B (3.5%). Also, the proportion of patients with AAPs at the final follow-up examination at 6 years in group A (6.9%) versus 6 years in group B (3.4%) was not significantly different. Only AAPs at baseline was a significant predictor for the presence of AAPs at first follow-up. After correction for the difference in AAPs at baseline, differences between the groups in the rate of AAPs at first follow-up and at the final examination were statistically significant. Conclusion In view of the relatively low rate of AAPs at 6 years and the absence of CRC in group A, we consider a 6-year surveillance interval appropriate. A surveillance interval of 3 years might be considered in patients with AAPs and patients with ≥ three adenomas.

The results of colorectal cancer screening in the Republic of Kazakhstan during the period from 2013 to 2018.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e13074-e13074
Author(s):  
Dilyara Kaidarova ◽  
Alma Zhylkaydarova ◽  
Yelena Ukolova ◽  
Abay Jumanov
Keyword(s):  
Colorectal Cancer ◽  
Performance Indicators ◽  
Incidence Rates ◽  
Total Colonoscopy ◽  
Group A ◽  
Immunochemical Test ◽  
The Republic ◽  
Group B ◽  
Positive Results

e13074 Background: Colorectal cancer (CRC) remains one of the actual problems in oncology. In 2017, in the structure of oncopathology of the Republic of Kazakhstan (RK), CRC took the 3rd place in terms of incidence - 17.5, and in mortality - 8.2 per 100 thousand people. The population screening of CRC has been introduced in the Republic of Kazakhstan since 2011, among the population aged 50 to 70 years, with a survey interval every 2 years. Fecal immunochemical test (FIT) and total colonoscopy (TC) were introduced in 2013. Methods: For the period 2013 - 2018, 5133602 subjects were examined. The analysis of screening indicators was carried out: the number of positive results of FIT, completion rate of follow-up colonoscopy and CRC detection rate. The analyzed groups were divided into regions with: A - high (26 - 30.7 per 100 thousand people), B - medium (13.2-21.8), C - low (5.9 - 10.8) incidence. Results: The positive FIT for the study period was found on average, in 1.23% (62971) positive results in the Republic of Kazakhstan, in group A it was 1.50% (27675), in group B - 1.26% (17178), and in group C - 0.94% (18118). The number of TC: in group A - 76.1% (21067), in group B - 75.8% (13016), in group C was 66.7% (12080), in total - 46163 cases in the Republic of Kazakhstan, which is 73.3% of indications. During the period of study 2480 patients with colorectal cancer were identified: in group A - 0.07% (1236), in group B - 0.05% (638), in group C - 0.03% (606) people. Conclusions: For regions with different incidence rates is necessary to define performance indicators to improve the quality assurance in CRC screening.

scholarly journals Clinical Significance of Serum Carcinoembryonic Antigen and Carbohydrate Antigen 19-9 Levels Before Surgery and During Postoperative Follow-Up in Colorectal Cancer

2018 ◽  
Vol 103 (7-8) ◽  
pp. 322-330
Author(s):  
Harunobu Sato ◽  
Yoshikazu Koide ◽  
Miho Shiota ◽  
Hiroshi Takahashi ◽  
Zenichi Morise ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Carcinoembryonic Antigen ◽  
Disease Free Survival ◽  
Carbohydrate Antigen ◽  
Preoperative Serum ◽  
Serum Carcinoembryonic Antigen ◽  
Group A ◽  
Serum Cea ◽  
Group B

Objective: Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are the most common colorectal cancer markers. We aimed to identify the appropriate clinical conditions for measuring serum CEA and CA19-9 levels before surgery and during follow-up. Methods: This study included 1275 colorectal cancer patients who were divided into 3 groups according to preoperative CEA levels (group A, ≤5 ng/mL; group B, &gt;5–≤11 ng/mL; group C, &gt;11 ng/mL). Each group was subdivided into 2 groups according to preoperative CA19-9 levels (cutoff level: ≤37 U/mL). Recurrence and survival rates were analyzed. Results: Recurrence rate, disease-free survival after curative surgery, and prognosis were significantly worse in group A and B patients with high CA19-9 levels. At recurrence, CEA levels showed a greater increase in group B and C patients; CA19-9 levels increased in group A patients with high CA19-9 levels. At recurrence, high serum CA19-9 levels were observed in group A patients with high preoperative serum CA19-9 levels, even if the serum CEA level did not increase. Preoperative CA19-9 levels could predict recurrence and prognosis in groups A and B. Conclusion: Periodic CA19-9 determination is useful for monitoring recurrence among group A patients with high CA19-9 levels.

Outcome of Follow-Up Programs in Patients Previously Resected for Colorectal Cancer

1984 ◽  
Vol 70 (2) ◽  
pp. 203-208 ◽  
Author(s):  
Vittorio Pugliese ◽  
Hugo Aste ◽  
Sebastiano Saccomanno ◽  
Paolo Bruzzi ◽  
Luigina Bonelli ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Effective Treatment ◽  
Curative Surgery ◽  
Significant Difference ◽  
Clinical Benefits ◽  
Group A ◽  
Group B

The survival of a group of 115 patients (group A) who entered a follow-up program after apparently « curative » surgery for colorectal cancer was compared with that of 62 similar patients (group B) who did not join such a program. No significant difference was found. Clinical benefits to single patients in group A, in terms of anticipated diagnosis and effective treatment of recurrences and of metachronous neoplasias, appeared to be, if any, extremely limited. In light of the high costs of intensive follow-up programs, it is concluded that their use can be justified only within controlled perspective trials aimed to evaluate their usefulness.

Absorbable suture material in carotid surgery

VASA ◽  
2015 ◽  
Vol 44 (6) ◽  
pp. 451-457 ◽  
Author(s):  
Vincenzo Gasbarro ◽  
Luca Traina ◽  
Francesco Mascoli ◽  
Vincenzo Coscia ◽  
Gianluca Buffone ◽  
...  
Keyword(s):  
Suture Material ◽  
Absorbable Suture ◽  
Paediatric Surgery ◽  
Carotid Surgery ◽  
Suture Materials ◽  
Absorbable Suture Material ◽  
Absorbable Sutures ◽  
Group A ◽  
Group B

Abstract. Background: Absorbable sutures are not generally accepted by most vascular surgeons for the fear of breakage of the suture line and the risk of aneurysmal formation, except in cases of paediatric surgery or in case of infections. Aim of this study is to provide evidence of safety and efficacy of the use of absorbable suture materials in carotid surgery. Patients and methods: In an 11 year period, 1126 patients (659 male [58.5 %], 467 female [41.5 %], median age 72) underwent carotid endarterectomy for carotid stenosis by either conventional with primary closure (cCEA) or eversion (eCEA) techniques. Patients were randomised into two groups according to the type of suture material used. In Group A, absorbable suture material (polyglycolic acid) was used and in Group B non-absorbable suture material (polypropylene) was used. Primary end-point was to compare severe restenosis and aneurysmal formation rates between the two groups of patients. For statistical analysis only cases with a minimum period of follow-up of 12 months were considered. Results: A total of 868 surgical procedures were considered for data analysis. Median follow-up was 6 years (range 1-10 years). The rate of postoperative complications was better for group A for both cCEA and eCEA procedures: 3.5 % and 2.0 % for group A, respectively, and 11.8 % and 12.9 % for group B, respectively. Conclusions: In carotid surgery, the use of absorbable suture material seems to be safe and effective and with a general lower complications rate compared to the use of non-absorbable materials.

Laparoscopic Incisional and Ventral Hernia Repair with Absorbable Tacks in a Long Term Follow-up: A Retrospective Control Study

2019 ◽  
Vol 14 (2) ◽  
pp. 141-146
Author(s):  
Simone Zanella ◽  
Enrico Lauro ◽  
Francesco Franceschi ◽  
Francesco Buccelletti ◽  
Annalisa Potenza ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
The Elderly ◽  
Long Term Follow Up ◽  
Group A ◽  
Group B ◽  
Absorbable Tacks

Background: Laparoscopic Incisional and Ventral Hernia Repair (LIVHR) is a safe and worldwide accepted procedure performed using absorbable tacks. The aim of the study was to evaluate recurrence rate in a long term follow-up and whether the results of laparoscopic IVH repair in the elderly (≥65 years old) are different with respect to results obtained in younger patients. Methods: One hundred and twenty-nine consecutive patients (74 women and 55 men, median age 67 years, range = 30-87 years) with ventral (N = 42, 32.5%) or post incisional (N = 87, 67.5%) hernia were enrolled in the study. Patients were divided into two groups according to their age: group A (N = 55, 42.6%) aged <65 years and group B (N = 74, 57.4%) aged ≥65 years. Results: The mean operative time was not significantly different between groups (66.7 ± 37 vs. 74 ± 48.4 min, p = 0.4). To the end of 2016, seven recurrences had occurred (group A = 3, group B = 4, p = 1). Complications occurred in 8 (16%) patients in group A and 21 (28.3%) patients in group B. Conclusion: In conclusion, our results confirm that the use of absorbable tacks does not increase recurrence frequency and laparoscopic incisional and ventral repair is a safety procedure also in elderly patients.

Sign in / Sign up

Export Citation Format

Share Document