Primary Melanoma of the Right Colon Presenting With Gastrointestinal Bleeding

Abstract Background and study aims Video capsule endoscopy (VCE) is a minimally invasive tool that helps visualize the gastrointestinal tract from the esophagus to the right colon without the need for sedation or preparation. VCE is safe with very few contraindications. However, its role and safety profile in the intensive care unit (ICU) population have not been reported. The aim of this study is to evaluate the safety, efficacy, and feasibility of VCE use in ICU patients. Patients and methods We conducted a single-center retrospective observational study of patients who underwent VCE for evaluation of obscure overt gastrointestinal bleeding in the ICU between 2008 and 2016. Results This study included 48 patients who were admitted to the UMass Memorial Medical Center ICUs for gastrointestinal bleeding. VCE was successfully completed in 43/48 (90 %) patients. The entire length of small bowel could be evaluated in 75 % and the source of bleeding was identified in 44 % of the patients. The most commonly identified source of bleeding included small bowel angioectasias, duodenal erosions/ulcers, and small bowel polyps. No major complications could be attributed to the VCE. Only 1 capsule was retained after 2 wk; however, there was no incidence of bowel obstruction, perforation, or capsule aspiration. Conclusions This observational retrospective study demonstrates that VCE may be a safe, feasible, and effective diagnostic tool in evaluation of gastrointestinal bleeding in the ICU population with few complications. VCE may be a safe diagnostic prelude and be a guide to the correct therapeutic procedure if needed, in the context of patients who are seriously ill.

Download Full-text

Duodenal angiodysplasia: case report and literature review

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202007000200013 ◽

2007 ◽

Vol 20 (2) ◽

pp. 127-129

Author(s):

Roberto Pelegrini Coral ◽

Fabiane P. Mastalir ◽

Eduardo T. Mastalir

Keyword(s):

Case Report ◽

Gastrointestinal Bleeding ◽

Hemodynamic Instability ◽

Vascular Lesion ◽

Severe Anemia ◽

Upper Endoscopy ◽

Right Colon ◽

Aggressive Approach ◽

The Right ◽

Chronic Gastrointestinal Bleeding

BACKGROUND: Angiodysplasia is a distinct mucosal vascular lesion associated with acute or chronic gastrointestinal bleeding. It occurs most frequently in the right colon and is extremely rare. Its etiology is unknown, but theories of its pathogenesis have evolved from its similarity to colonic angiodysplasia and the lesion appears to be associated with renal insufficiency. CASE REPORT: Sixty-five-year-old woman with repeated melena and severe anemia due to angiodysplasia in the first portion of the duodenum. The diagnosis was done by upper endoscopy. As the patient presented repeated gastrointestinal bleeding with hemodynamic instability and recurrent anemia, surgery was indicated. At laparotomy the lesion was identified and resected with an Y-en-Roux reconstruction. The patient went on well at the immediate and late (four years) postoperative periods with no more recurrent gastrointestinal bleeding. CONCLUSION: Although most of the patients suffering from gastrointestinal angiodysplasia goes on well with conservative management, there is a small portion of them that will need a more aggressive approach, as in this case.

Download Full-text

Correlation of Metabolic Risk Factors with Sessile Serrated Lesions

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld-507 ◽

2020 ◽

Vol 29 (2) ◽

pp. 175-179

Author(s):

Melania Macarie ◽

Simona Bataga ◽

Simona Mocan ◽

Monica Pantea ◽

Razvan Opaschi ◽

...

Keyword(s):

Risk Factors ◽

Statistical Significance ◽

Interval Cancer ◽

Metabolic Risk Factors ◽

Control Group ◽

Anatomical Site ◽

Metabolic Risk ◽

Right Colon ◽

Serrated Lesions ◽

The Right

Background and Aims: The importance of sessile serrated lesions (SSLs) in the pathogenesis of colorectal carcinoma has been recently established. These are supposed to cause the so-called “interval cancer”, having a rapidly progressive growth and being difficult to detect and to obtain an endoscopic complete resection. We aimed to establish the most important metabolic risk factors for sessile serrated lesions. Methods: We performed a retrospective case-control study, on a series of 2918 consecutive patients who underwent colonoscopy in Gastroenterology and Endoscopy Unit, County Clinical Emergency Hospital, Târgu-Mureș, Romania between 1 st of January 2015-31 th of December 2017. In order to evaluate the metabolic risk factors for polyps’ development, enrolled participants were stratified in two groups, a study group, 33 patients with SSLs lesions, and a control group, 138 patients with adenomatous polyps, selected by systematic sampling for age and anatomical site. Independent variables investigated were: gender, smoking, alcohol consumption, obesity, arterial hypertension, diabetes, hypercholesterolemia, hypertriglyceridemia, hyperuricemia, nonalcoholic liver disease. Results: For SSLs the most common encountered localization was the right colon in 30.55% of cases. By comparative bivariate analysis between SSLs group and control group, it was observed that hypertension (p=0.03, OR 2.33, 95 %CI 1.03-5.24), obesity (p=0.03, OR 2.61, 95 %CI 1.08-6.30), hyperuricemia (p=0.04, OR 2.72, 95 %CI 1.28-7.55), high cholesterol (p=0.002, OR 3.42; 95 %CI 1.48-7.87), and high triglycerides level (p=0.0006, OR 5.75; 95 %CI 1.92-17.2) were statistically associated with SSLs development. By multivariate analysis hypertension and hypertriglyceridemia retained statistical significance. Conclusions: Our study showed that the highest prevalence of SSLs was in the right colon and hypertension and increased triglycerides levels were associated with the risk of SSLs development. These risk factors are easy to detect in clinical practice and may help identifying groups with high risk for colorectal cancer, where screening is recommended.

Download Full-text

Impact of second forward-view examination on adenoma detection rate during unsedated colonoscopy: a randomized controlled trial

BMC Gastroenterology ◽

10.1186/s12876-021-01783-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Keshu Shan ◽

Hongpeng Lu ◽

Zhixin Zhang ◽

Jiarong Xie ◽

Lu Xu ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Detection Rate ◽

Controlled Trial ◽

Lesion Detection ◽

Adenoma Detection Rate ◽

Right Colon ◽

Randomized Controlled ◽

Adenoma Detection ◽

Advanced Lesion ◽

The Right

Abstract Objectives Colorectal cancer on the right side of the colon has been suggested to be harder to detect by colonoscopy. The aim of this study was to evaluate whether a second forward-view examination of the right side of the colon could increase the adenoma detection rate (ADR) and/or polyp detection rate (PDR). Methods This was a single-centre randomized controlled trial. Patients undergoing colonoscopy were recruited and randomly assigned to the second forward-view examination (SFE) group, in which the right side of the colon was examined twice or the traditional colonoscopy (TC) group in which the colonoscopy was performed in a standard manner. The primary outcome was the ADR of right colon. The overall PDR and ADR, PDR of the right colon, per-adenoma miss rate of the right colon, and advanced lesion detection rate were also recorded and compared. Results A total of 392 patients were included in the study (SFE group 197 vs. TC group 195). The ADR and PDR of the right colon in the SFE group were significantly higher than those in the TC group (ADR 10.7% vs. 5.1%; P = 0.042); PDR 17.8% vs. 9.7%, P = 0.021). No significant difference was found in overall PDR/ADR, or advanced lesion detection rate between the two groups. Conclusions This prospective controlled study revealed that a second forward-view examination could modestly increase the ADR and PDR of the right colon during unsedated colonoscopies. This simple, safe and time-effective technique might be recommended for routine unsedated colonoscopy. Trial registration: Clinical Trials.gov, NCT03619122. Registered on 7/8/2018.

Download Full-text

Sessile serrated adenoma invading a diverticulum in the right colon: tips and tricks for a safe complete endoscopic resection

Endoscopy ◽

10.1055/a-1463-2045 ◽

2021 ◽

Author(s):

Sophie Geyl ◽

Jérémie Albouys ◽

Romain Legros ◽

Hugo Lepetit ◽

Martin Dahan ◽

...

Keyword(s):

Endoscopic Resection ◽

Tips And Tricks ◽

Right Colon ◽

Sessile Serrated Adenoma ◽

Serrated Adenoma ◽

The Right

Download Full-text

Racial Disparities in Epigenetic Aging of the Right vs Left Colon

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djaa206 ◽

2020 ◽

Author(s):

Matthew Devall ◽

Xiangqing Sun ◽

Fangcheng Yuan ◽

Gregory S Cooper ◽

Joseph Willis ◽

...

Keyword(s):

Dna Methylation ◽

African Americans ◽

Racial Differences ◽

Age Of Onset ◽

Left Colon ◽

Right Colon ◽

Normal Colon ◽

Epigenetic Aging ◽

Epigenetic Age Acceleration ◽

The Right

Abstract There are well-documented racial differences in age-of-onset and laterality of colorectal cancer. Epigenetic age acceleration is postulated to be an underlying factor. However, comparative studies of side-specific colonic tissue epigenetic aging are lacking. Here, we performed DNA methylation analysis of matched right and left biopsies of normal colon from 128 individuals. Among African Americans (n = 88), the right colon showed accelerated epigenetic aging as compared to individual-matched left colon (1.51 years; 95% CI = 0.62 to 2.40 years; two-sided P = .001). In contrast, among European Americans (n = 40), the right colon shows remarkable age deceleration (1.93 years; 95% CI = 0.65 to 3.21 years; two-sided P = .004). Further, epigenome-wide analysis of DNA methylation identifies a unique pattern of hypermethylation in African American right colon. Our study is the first to report such race and side-specific differences in epigenetic aging of normal colon, providing novel insight into the observed younger age-of-onset and relative preponderance of right-side colon neoplasia in African Americans.

Download Full-text