scholarly journals Colorectal endoscopic mucosal resection with submucosal injection of epinephrine versus hypertonic saline in patients taking antithrombotic agents: propensity-score-matching analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Daisuke Yamaguchi ◽  
Hisako Yoshida ◽  
Kei Ikeda ◽  
Yuki Takeuchi ◽  
Shota Yamashita ◽  
...  
Keyword(s):  
Propensity Score ◽  
Adverse Events ◽  
Propensity Score Matching ◽  
Endoscopic Mucosal Resection ◽  
Hypertonic Saline ◽  
Colon Polyps ◽  
Antithrombotic Agents ◽  
Submucosal Injection ◽  
Mucosal Resection ◽  
Increased Risk

Abstract Background Endoscopic mucosal resection (EMR) to remove colon polyps is increasingly common in patients taking antithrombotic agents. The safety of EMR with submucosal saline injection has not been clearly demonstrated in this population. Aims The present study aimed to evaluate the efficacy and safety of submucosal injection of saline–epinephrine versus hypertonic saline in colorectal EMR of patients taking antithrombotic agents. Methods This study enrolled 204 patients taking antithrombotic agents among 995 consecutive patients who underwent colonic EMR from April 2012 to March 2018 at Ureshino Medical Center. Patients were divided into two groups according to the injected solution: saline–epinephrine or hypertonic (10%) saline (n = 102 in each group). Treatment outcomes and adverse events were evaluated in each group and risk factors for immediate and post-EMR bleeding were investigated. Results There were no differences between groups in patient or polyp characteristics. The main antithrombotic agents were low-dose aspirin, warfarin, and clopidogrel. Propensity-score matching created 80 matched pairs. Adjusted comparisons between groups showed similar en bloc resection rates (95.1% with saline–epinephrine vs. 98.0% with hypertonic saline). There were no significant differences in adverse events (immediate EMR bleeding, post-EMR bleeding, perforation, or mortality) between groups. Multivariate analyses revealed that polyp size over 10 mm was associated with an increased risk of immediate EMR bleeding (odds ratio 12.1, 95% confidence interval 2.0–74.0; P = 0.001). Conclusions Two tested solutions in colorectal EMR were considered to be both safe and effective in patients taking antithrombotic agents.

scholarly journals Safety of Endoscopic Mucosal Resection Using a Bipolar Snare for Superficial Nonampullary Duodenal Epithelial Tumors and the Predictive Factors of Piecemeal Resection

Digestion ◽  
2020 ◽  
pp. 1-9
Author(s):  
Masafumi Yamamura ◽  
Yasuaki Nagami ◽  
Taishi Sakai ◽  
Hirotsugu Maruyama ◽  
Masaki Ominami ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Mucosal Resection ◽  
R0 Resection ◽  
En Bloc ◽  
Noninvasive Treatment ◽  
Submucosal Injection ◽  
Mucosal Resection ◽  
Epithelial Tumors ◽  
Bipolar Snare ◽  
Piecemeal Resection

<b><i>Introduction:</i></b> Endoscopic mucosal resection for small superficial nonampullary duodenal epithelial tumors is a noninvasive treatment; however, perforations can occur. Bipolar snares can reduce the risk of perforation due to small tissue damage. Currently, only few studies have reported endoscopic mucosal resection for small superficial nonampullary duodenal epithelial tumors using a bipolar snare and the effect of preoperative findings. <b><i>Objective:</i></b> To investigate (1) resectability and adverse events of endoscopic mucosal resection using a bipolar snare for small superficial nonampullary duodenal epithelial tumors and (2) the predictions of piecemeal resection. <b><i>Methods:</i></b> Between 2007 and 2017, 89 patients with 107 lesions underwent endoscopic mucosal resection using a bipolar snare. Among them, 88 lesions of 77 patients were evaluated. The primary outcome was the incidence of en bloc resection and R0 resection and adverse events. Risk factors associated with piecemeal resection, including preoperative lesion findings, were also examined. <b><i>Results:</i></b> The incidence rates of en bloc and R0 resections were 85.2 and 48.9%, respectively. Neither intraoperative or delayed perforations nor procedure-related mortality was noted. The nonlifting sign after submucosal injection was associated with an increase in piecemeal resection (odds ratio: 20.3, 95% confidence interval: 2.53–162; <i>p</i> = 0.005). <b><i>Conclusion:</i></b> Endoscopic resection for small superficial nonampullary duodenal epithelial tumors can cause perforation; however, endoscopic mucosal resection using a bipolar snare can be a safe treatment option as it does not cause perforations. The nonlifting sign after submucosal injection is a predictive factor for piecemeal resection.

The size, morphology, site, and access score predicts critical outcomes of endoscopic mucosal resection in the colon

Endoscopy ◽  
2018 ◽  
Vol 50 (07) ◽  
pp. 684-692 ◽  
Author(s):  
Mayenaaz Sidhu ◽  
David Tate ◽  
Lobke Desomer ◽  
Gregor Brown ◽  
Luke Hourigan ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Mucosal Resection ◽  
Clinical Score ◽  
Control Measures ◽  
Single Session ◽  
Mucosal Resection ◽  
Endoscopic Recurrence ◽  
Increased Risk ◽  
Site Access ◽  
Clinically Significant

Abstract Background The SMSA (size, morphology, site, access) polyp scoring system is a method of stratifying the difficulty of polypectomy through assessment of four domains. The aim of this study was to evaluate the ability of SMSA to predict critical outcomes of endoscopic mucosal resection (EMR). Methods We retrospectively applied SMSA to a prospectively collected multicenter database of large colonic laterally spreading lesions (LSLs) ≥ 20 mm referred for EMR. Standard inject-and-resect EMR procedures were performed. The primary end points were correlation of SMSA level with technical success, adverse events, and endoscopic recurrence. Results 2675 lesions in 2675 patients (52.6 % male) underwent EMR. Failed single-session EMR occurred in 124 LSLs (4.6 %) and was predicted by the SMSA score (P < 0.001). Intraprocedural and clinically significant postendoscopic bleeding was significantly less common for SMSA 2 LSLs (odds ratio [OR] 0.36, P < 0.001 and OR 0.23, P < 0.01) and SMSA 3 LSLs (OR 0.41, P  < 0.001 and OR 0.60, P = 0.05) compared with SMSA 4 lesions. Similarly, endoscopic recurrence at first surveillance was less likely among SMSA 2 (OR 0.19, P < 0.001) and SMSA 3 (OR 0.33, P < 0.001) lesions compared with SMSA 4 lesions. This also extended to second surveillance among SMSA 4 LSLs. Conclusion SMSA is a simple, readily applicable, clinical score that identifies a subgroup of patients who are at increased risk of failed EMR, adverse events, and adenoma recurrence at surveillance colonoscopy. This information may be useful for improving informed consent, planning endoscopy lists, and developing quality control measures for practitioners of EMR, with potential implications for EMR benchmarking and training.

scholarly journals Clip placement to prevent delayed bleeding after colonic endoscopic mucosal resection (CLIPPER): study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ayla S. Turan ◽  
◽  
Leon M. G. Moons ◽  
Ramon-Michel Schreuder ◽  
Erik J. Schoon ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
The Netherlands ◽  
Endoscopic Mucosal Resection ◽  
Intervention Group ◽  
Proximal Colon ◽  
Control Group ◽  
Colon Polyps ◽  
Delayed Bleeding ◽  
Randomized Controlled ◽  
Mucosal Resection

Abstract Background Endoscopic mucosal resection (EMR) for large colorectal polyps is in most cases the preferred treatment to prevent progression to colorectal carcinoma. The most common complication after EMR is delayed bleeding, occurring in 7% overall and in approximately 10% of polyps ≥ 2 cm in the proximal colon. Previous research has suggested that prophylactic clipping of the mucosal defect after EMR may reduce the incidence of delayed bleeding in polyps with a high bleeding risk. Methods The CLIPPER trial is a multicenter, parallel-group, single blinded, randomized controlled superiority study. A total of 356 patients undergoing EMR for large (≥ 2 cm) non-pedunculated polyps in the proximal colon will be included and randomized to the clip group or the control group. Prophylactic clipping will be performed in the intervention group to close the resection defect after the EMR with a distance of < 1 cm between the clips. Primary outcome is delayed bleeding within 30 days after EMR. Secondary outcomes are recurrent or residual polyps and clip artifacts during surveillance colonoscopy after 6 months, as well as cost-effectiveness of prophylactic clipping and severity of delayed bleeding. Discussion The CLIPPER trial is a pragmatic study performed in the Netherlands and is powered to determine the real-time efficacy and cost-effectiveness of prophylactic clipping after EMR of proximal colon polyps ≥ 2 cm in the Netherlands. This study will also generate new data on the achievability of complete closure and the effects of clip placement on scar surveillance after EMR, in order to further promote the debate on the role of prophylactic clipping in everyday clinical practice. Trial registration ClinicalTrials.gov NCT03309683. Registered on 13 October 2017. Start recruitment: 05 March 2018. Planned completion of recruitment: 31 August 2021.

scholarly journals Relationship between benzodiazepine prescription, aggressive behavior, and behavioral disinhibition: a retrospective study in a Swiss prison

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Stéphanie Baggio ◽  
Vladan Starcevic ◽  
Patrick Heller ◽  
Karen Brändle ◽  
Irina Franke ◽  
...  
Keyword(s):  
Propensity Score ◽  
Aggressive Behavior ◽  
Propensity Score Matching ◽  
Potential Role ◽  
Behavioral Disinhibition ◽  
Increased Risk ◽  
Benzodiazepine Use ◽  
Logistic Regressions ◽  
Relationship Of ◽  
The Relationship

Abstract Background Benzodiazepines are commonly prescribed in prisons amidst the controversies surrounding their potential role in causing behavioral disinhibition and aggressive behavior and their association with use and trafficking of illicit and addictive substances. The present study aimed to (1) ascertain the relationship between benzodiazepine prescription (including their dosage and duration of use) and aggressive behavior and behavioral disinhibition in prison and (2) investigate whether there was an association between benzodiazepine prescription, (including their dosage and duration of use) and using and trafficking illicit and addictive substances during imprisonment. Methods Data were extracted from the electronic database of an “open” Swiss prison (n = 1206, 1379 measures) over a 5-year period (2010–2015). Measures included benzodiazepine prescription, duration of benzodiazepine use and mean dosage, and punishable behaviors (physical and verbal aggression, disinhibited but not directly aggressive behaviors, property damage or theft, substance-related offenses, and rule transgression). We assessed the relationship between benzodiazepine prescription and punishable behaviors after propensity score matching. Logistic regressions were also used to test the relationship of benzodiazepine use duration and dosage with punishable behaviors among participants who received benzodiazepines. Results After propensity score matching, benzodiazepine prescription was not significantly associated with any punishable behavior. Among detained persons who took benzodiazepines, there was no significant association of dosage and duration of use with offenses involving illicit or addictive substance use or trafficking. Conclusions Our study did not empirically support the occurrence of increased aggressive or disinhibited behaviors or increased risk of substance abuse in detained persons who received benzodiazepines in prison. This suggests a need to reconsider restrictions in prescribing benzodiazepines in the prison setting.

ID: 3524588 SAFETY AND EFFICACY OF ENDOSCOPIC MUCOSAL RESECTION USING HOT BIOPSY AVULSION FOR VISIBLE RESIDUAL NEOPLASIA IN LARGE COLON POLYPS

2021 ◽  
Vol 93 (6) ◽  
pp. AB115-AB116
Author(s):  
Kanwarpreet S. Tandon ◽  
Badar Hasan ◽  
Sadaf Afraz ◽  
Mamoon Ur Rashid ◽  
Mohammad Alomari ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Colon Polyps ◽  
Safety And Efficacy ◽  
Mucosal Resection
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