scholarly journals S0581 Endoscopic Clip Placement Following Colonic Polypectomy Is Associated With Increased Polyp Size and Method of Polyp Removal

2020 ◽  
Vol 115 (1) ◽  
pp. S259-S259
Author(s):  
Marina Baskharoun ◽  
Neil Sood ◽  
Gregory Piech ◽  
Saraswathi Cappelle ◽  
Woo Jung Lee ◽  
...  
Keyword(s):  
Polyp Size ◽  
Endoscopic Clip

scholarly journals Practice patterns and predictors of prophylactic endoscopic clip usage during polypectomy

2019 ◽  
Vol 07 (09) ◽  
pp. E1051-E1060 ◽  
Author(s):  
Nauzer Forbes ◽  
Robert J. Hilsden ◽  
Gilaad G. Kaplan ◽  
Matthew T. James ◽  
Cord Lethebe ◽  
...  
Keyword(s):  
Temporal Trends ◽  
High Volume ◽  
Healthcare Resource Utilization ◽  
Hierarchical Regression ◽  
Polyp Size ◽  
Endoscopic Clip ◽  
Delayed Bleeding ◽  
Endoscopic Clips ◽  
Reduce Risk ◽  
Volume Unit

Abstract Background and study aims Prophylactic endoscopic clips are commonly placed during polypectomy to reduce risk of delayed bleeding, although evidence to support this practice is unclear. Our study aimed to: (1) identify variables associated with prophylactic clip use; (2) explore variability between endoscopists’ clipping practices and (3) study temporal trends in prophylactic clip use. Patients and methods This was a retrospective cohort study in a high-volume unit dedicated to screening-related colonoscopies. Colonoscopies involving polypectomy from 2008 to 2014 were reviewed. The primary outcome was prophylactic clipping status, both at the patient level and per polyp. Hierarchical regression models yielded adjusted odds ratios (AORs) to determine predictors of prophylactic clipping. Results A total of 8,366 colonoscopies involving 19,129 polypectomies were included. Polyp size ≥ 20 mm was associated with higher clip usage (AOR 2.94; 95 % CI: 2.43, 3.54) compared to polyps < 10 mm. Right-sided polyps were more likely to be clipped (AOR 2.78; 95 % CI: 2.34, 3.30) relative to the rectum. Surgeons clipped less than gastroenterologists (OR 0.52; 95 % CI: 0.44, 0.63). From 2008 to 2014, the crude proportion of prophylactically clipped cases increased by 7.4 % (95 % CI: 7.1, 7.6) from 1.9 % to 9.3 %. Significant inter-endoscopist variability in clipping practices was observed, notably, for polyps < 10 mm. Conclusions Prophylactic clip usage was correlated with established risk factors for delayed bleeding. Significantly increased clip usage over time was shown. Given that evidence does not clearly support prophylactic clipping, there is a need to educate practitioners and limit healthcare resource utilization.

AUTOMATED POLYP SIZE ESTIMATION WITH DEEP LEARNING REDUCES OVERESTIMATION BIAS

2020 ◽  
Author(s):  
J Suykens ◽  
T Eelbode ◽  
J Daenen ◽  
P Suetens ◽  
F Maes ◽  
...  
Keyword(s):  
Deep Learning ◽  
Size Estimation ◽  
Polyp Size

Effects of upwelling, depth, morphology and polyp size on feeding in three species of Panamanian corals

2005 ◽  
Vol 300 ◽  
pp. 79-89 ◽  
Author(s):  
JE Palardy ◽  
AG Grottoli ◽  
KA Matthews
Keyword(s):  
Polyp Size

Duodenal Ulcer Induced by Hem-o-Lok clip after Reduced Port Laparoscopic Cholecystectomy

2016 ◽  
Vol 25 (1) ◽  
pp. 95-98 ◽  
Author(s):  
Koichi Soga ◽  
Kyoichi Kassai ◽  
Kenji Itani
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Cystic Duct ◽  
Duodenal Bulb ◽  
Mucosal Injury ◽  
Normal Mucosa ◽  
Surrounding Tissue ◽  
Inferior Wall ◽  
Endoscopic Clip

The patient was a 66-year-old woman who had undergone laparoscopic cholecystectomy (Lap-C) secondary to chronic cholecystitis status post endoscopic choledocholithotomy 13 months previously. During surgery, Hem-o-Lok clips were used to control the cystic duct and the cystic artery. Due to the presence of extensive adhesions of the cystic duct and surrounding tissue, the surgeons had difficulty in debriding the area. Thirteen months after Lap-C, the patient underwent a screening esophagogastroduodenoscopy (EGD), which demonstrated clip appearance at the inferior wall of the first part of the duodenum. In the EGD, duodenal erosions and edema were observed around the clip. We appreciated that endoscopic clip removal would be difficult because of the presence of severe adhesions and inflammation of the duodenal bulb. On clinical examination of the patient, no major abnormalities or physical findings were noted. Therefore, we decided not to attempt to remove the clip. The patient was treated with an oral proton pump inhibitor to prevent extensive duodenal mucosal injury. Two months later, we repeated the EGD, which revealed that the clip was no longer present, and the duodenum was covered with normal mucosa surrounding the scar. Abbreviations: EGD: esophagogastroduodenoscopy; Lap-C: laparoscopic cholecystectomy; PPI: proton pump inhibitor.

scholarly journals Effects of Somatic Methylation in Colonic Polyps on Risk of Developing Metachronous Advanced Colorectal Lesions

Cancers ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 246
Author(s):  
Oscar Murcia ◽  
Alejandro Martínez-Roca ◽  
Miriam Juárez ◽  
Mar Giner-Calabuig ◽  
Miren Alustiza ◽  
...  
Keyword(s):  
Cpg Island ◽  
Risk Estimation ◽  
Colonic Polyps ◽  
Cpg Island Methylator Phenotype ◽  
Polyp Size ◽  
Serrated Lesions ◽  
Amplification Technique ◽  
Methylator Phenotype ◽  
The Relationship ◽  
Dependent Probe

The utility of molecular markers for predicting the risk of metachronous advanced colorectal lesions (MACLs) remains poorly investigated. We examined the relationship between somatic hypermethylation in polyps at baseline and the risk of developing MACL. This retrospective cohort study included 281 consecutive patients with colonic polyps who were enrolled between 2007 and 2009 and followed-up until 2014. MACLs were defined as adenomas of >10 mm, high-grade dysplasia, or with a villous component; and serrated lesions of >10 mm or with dysplasia. In total, 595 polyps were removed at baseline colonoscopy and analyzed for pathological characteristics and CpG island methylator phenotype (CIMP) using the MS-MLPA (Methylation-Specific -- Multiplex Ligation-dependent Probe Amplification) technique. Forty-five patients (16.0%) showed at least one CIMP+ polyp. MACL risk was higher in patients with CIMP+ polyps (odds ratio (OR), 4.50; 95% CI, 1.78–11.4; p = 0.002). Patients with CIMP+ polyps also exhibited shorter time to MACL development (33.8 months vs. 50.1 months; p < 0.001), even with adjustment for polyp size and number (OR, 2.40; 95% CI, 1.33–4.34). Adding CIMP analysis improved the sensitivity (57.0% to 70.9%), negative predictive value (71.1% to 77.3%), and overall accuracy (49.8% to 52.0%) for MACL risk estimation. These results highlight that CIMP may be a useful marker for endoscopic surveillance.

scholarly journals Detectability on Plain CT is an Effective Discriminator between Carcinoma and Benign Disorder for a Polyp >10 mm in the Gallbladder

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 388
Author(s):  
Tatsunori Satoh ◽  
Masataka Kikuyama ◽  
Keiko Sasaki ◽  
Hirotoshi Ishiwatari ◽  
Shinya Kawaguchi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Multivariate Analysis ◽  
Odds Ratio ◽  
Patient Characteristics ◽  
Polyp Size ◽  
Predictive Values ◽  
Lesion Detectability ◽  
Contrast Enhanced ◽  
Cell Densities ◽  
Sensitivity Specificity

An appropriate diagnosis is required to avoid unnecessary surgery for gallbladder cholesterol polyps (GChPs) and to appropriately treat pedunculated gallbladder carcinomas (GCs). Generally, polyps >10 mm are regarded as surgical candidates. We retrospectively evaluated plain and contrast-enhanced (CE) computed tomography (CT) findings and histopathological features of 11 early GCs and 10 GChPs sized 10–30 mm to differentiate between GC and GChP >10 mm and determine their histopathological background. Patient characteristics, including polyp size, did not significantly differ between groups. All GCs and GChPs were detected on CE-CT; GCs were detected more often than GChPs on plain CT (73% vs 9%; p < 0.01). Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy for GCs were 73%, 90%, 89%, 75%, and 81%, respectively. On multivariate analysis, lesion detectability on plain CT was independently associated with GCs (odds ratio, 27.1; p = 0.044). Histopathologically, GChPs consisted of adipose tissue. Although larger vessel areas in GCs than in GChPs was not significant (52,737 μm2 vs 31,906 μm2; p = 0.51), cell densities were significantly greater in GCs (0.015/μm2 vs 0.0080/μm2; p < 0.01). Among GPs larger than 10 mm, plain CT could contribute to differentiating GCs from GChPs.

Protrusion Method for Automated Estimation of Polyp Size on CT Colonography

2008 ◽  
Vol 190 (5) ◽  
pp. 1279-1285 ◽  
Author(s):  
C. van Wijk ◽  
J. Florie ◽  
C. Y. Nio ◽  
E. Dekker ◽  
A. H. de Vries ◽  
...  
Keyword(s):  
Ct Colonography ◽  
Polyp Size

An endoscopic training model to improve accuracy of colonic polyp size measurement

2010 ◽  
Vol 25 (5) ◽  
pp. 655-660 ◽  
Author(s):  
Chi-Yang Chang ◽  
Han-Mo Chiu ◽  
Hsiu-Po Wang ◽  
Ching-Tai Lee ◽  
John Jen Tai ◽  
...  
Keyword(s):  
Training Model ◽  
Colonic Polyp ◽  
Size Measurement ◽  
Polyp Size ◽  
Endoscopic Training ◽  
Improve Accuracy

scholarly journals A118 POLYP SIZE CUT-OFF LEVEL TO IMPLEMENT OPTICAL POLYP DIAGNOSIS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 98-99
Author(s):  
M Taghiakbari ◽  
R Djinbachian ◽  
D von Renteln
Keyword(s):  
Colorectal Polyps ◽  
Optical Diagnosis ◽  
Clinical Implementation ◽  
Polyp Size ◽  
Funding Agencies ◽  
Size Groups ◽  
Surveillance Interval ◽  
High Reduction ◽  
Advanced Adenomas ◽  
Post Hoc

Abstract Background Optical polyp diagnosis can be used for real-time pathology prediction of colorectal polyps ≤10 mm. However, the risk of misdiagnosing a polyp with advanced pathology potentially increases with increasing polyp size. Aims This study aimed to evaluate different size cut-offs for using optical polyp diagnosis and the associated risk of patients undergoing inadequate follow-up or surveillance. Methods In a post-hoc analysis of two prospective studies, the performance of optical diagnosis was evaluated in three polyp size groups: 1–3 mm, 1–5 mm, and 1–10 mm. The primary outcome was the proportion of patients with advanced adenomas and delayed or inappropriate surveillance. Secondary outcomes included percentage of polyps with advanced pathology, agreement between surveillance intervals based on high-confidence optical diagnosis and pathology outcomes, reduction in histopathological examinations, and proportion of patients who could receive an immediate surveillance interval recommendation. Results We included 1525 patients with complete colonoscopies (mean age 62.9 years, 50.2% male). The percentage of patients with advanced adenomas and delayed or inappropriate surveillance was 0.7%, 1.7%, and 1.8% when using optical diagnosis for patients with polyps of 1–3, 1–5, and 1–10 mm, respectively. The percentage of polyps with advanced pathology was 0.5%, 1.4%, and 1.9%, respectively. Surveillance interval agreement between pathology and optical diagnosis was 99%, 98%, and 97.8%, respectively. Total reduction in pathology examinations was 33.9%, 53.5%, and 69.0%, respectively. Conclusions A 3-mm cut-off for clinical implementation of optical polyp diagnosis yielded high surveillance interval agreement with pathology and a high reduction in pathology examinations while minimizing the risk of inappropriate management for polyps with advanced pathology. Funding Agencies None

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