Search

Background and Aims Data are limited regarding the impact of age and sedation on cardiocerebrovascular disease (CCD) adverse events after GI endoscopy. We investigated the incidence of and risk factors for CCD adverse events after diagnostic GI endoscopy and the impact of age and sedation on these unfavorable outcomes. Methods In this nationwide population-based study, the incidence of and risk factors for newly diagnosed CCD within 14 days after diagnostic endoscopy were analyzed using Health Insurance Review and Assessment Service data from January to December 2015. Results Among 1,943,150 subjects, CCD adverse events occurred in approximately 2.23% within 14 days after endoscopy. According to the performance of sedation during endoscopy (60.1% nonsedation vs 39.9% sedation, midazolam alone [96.4%]), the incidence rates of CCD adverse events (per 10,000 persons) were 275.8 versus 302.8 for EGD, 116.9 versus 143.8 for colonoscopy, and 230.4 versus 243.2 for EGD + colonoscopy, respectively. On multivariate analysis, older age (70-99 years) and sedation were independent risk factors for CCD adverse events. Regarding CCD risk stratified by age and sedation, older age had a significant impact on CCD adverse events in individuals who underwent EGD only or EGD + colonoscopy, but sedation did not. However, both older age and sedation had considerable influence on CCD adverse events in individuals who underwent colonoscopy only. Sedation during endoscopy was significantly associated with minor but not major CCD adverse events. CCD adverse events were significantly higher for inpatients. Conclusion CCD adverse events after diagnostic endoscopy were significantly frequent in individuals with older age (70-99 years) and/or sedation during endoscopy. Stratification by age and sedation shows that the impact of these 2 factors on CCD adverse events differs according to endoscopy type.

62 patients, age range between 35 -87 years underwent endoscopic resection of ampullary lesions. 21 patients had ampullary lesions 30mm in size. All patients had complete ampullary lesion resection in a single session. 21 cases had Paris classification 0-IIa 1s, whilst 31and 10 cases were classified Paris 0-Is and Paris 0-IIa respectively. GAEPE lesions ranged between 30-80mm. Histology confirmed 57 cases of papillary adenomas, 1 case of a gangliocytic paraganglionoma, 2 cases of adenomyomatous hyperplasia and 2 cases ampullary adenocarcinoma. Adjunctive soft coagulation for ablation of adenomatous tissue was used in 5 cases. Bleeding complicated 11 cases, of which only 2 cases required blood transfusions. There were 3 procedure related cases of pancreatitis, 1 migrated pancreatic duct stent, 1 Mallory Weis tear and 1 intra mural contract injection. 53 cases were due follow up at 4 months, where there were 14 cases of adenoma recurrence, which were easily treated by endoscopic snare resection. Bleeding (n 7), pancreatitis (n 1), abdominal pain (n 2) and stent migration (n 1) accounted for 23 additional days of hospitalization. Conclusion: Single session endoscopic resection of carefully staged ampullary lesions, can be undertaken safely with relatively low complication rates. Adenoma recurrence rate at 4 months was low, and were easily treated by snare resection.References: Hopper et al. Gastrointestinal Endosc; 71, 6:967-975.

Background Percutaneous endoscopic gastrostomy (PEG) is performed to provide nutrition to patients with swallowing difficulties. A multicenter study was conducted to evaluate the predictors of complications and mortality after PEG placement.

Technological Assistance of Cap-Assisted Chromoendoscopy Enhances the Detection Rates of Both Colorectal Adenoma and Proximal Serrated Polyp in an Average-Risk Screening Population: Preliminary Results of a Multi-Center Randomized Controlled Trial Hyun-Soo Kim*, Hong Jun Park, Chan Sik Won, Hyo Keun Jeon, Dongil Park, Jae Myung Cha, Seun-Ja Park, Hwang Choi, Jeong Eun Shin, Chang Soo Eun, Jin-Oh Kim, Hyun Gun Kim, Seong-Eun Kim, Cheol Hee Park, Tae Il Kim, Sung Noh Hong, Dong-Hoon Yang, Byung Chang Kim, Byungho Nam Yonsei Univ. Wonju College of Medicine, Wonju, Republic of Korea; Sungkyunkwan University College of Medicine, Seoul, Republic of Korea; KyungHee University College of Medicine, Hanam, Republic of Korea; Kosin University College of Medicine, Busan, Republic of Korea; The Catholic University of Korea College of Medicine, Incheon, Republic of Korea; Dankook University College of Medicine, Cheonan, Republic of Korea; Hanyang University College of Medicine, Guri, Republic of Korea; Soonchunhyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University School of Medicine, Seoul, Republic of Korea; Hallym University College of Medicine, Anyang, Republic of Korea; Yonsei University College of Medicine, Seoul, Republic of Korea; Konkuk University School of Medicine, Seoul, Republic of Korea; University of Ulsan College of Medicine, Seoul, Republic of Korea; National Cancer Center, Goyang, Republic of Korea Background/Aim: There is growing evidence that a transparent cap or chromoendoscopy improve detection of colorectal polyps. However, the combined method of these two technologies has not been proven for colorectal polyp or adenoma detection rate. In this multicenter prospective randomized trial, we examined whether cap-assisted chromoendoscopy (CAP-ACE) enhances colorectal adenoma detection rate especially in the proximal colon. Methods: From March 2010 to October 2011, 1,202 asymptomatic average-risk subjects who underwent the first screening colonoscopy in an age of 45 to 75 were enrolled at 14 hospitals. Eighteen expert colonoscopists (more than 5,000 procedures) have performed procedures. Subjects were randomly allocated to CAP-ACE group and regular colonoscopy (RC) group. We prospectively compared insertion and withdrawal time, polyp detection rate (PDR), adenoma detection rate (ADR), and proximal serrated polyp detection rate (PSPDR) between the two groups. Results: A total of 1,202 subjects were enrolled; 598 CAP-ACEs and 604 RCs were performed. Overall PDR and ADR were 60.3% and 47.6%. A total of 52 advanced lesions were found including 16 tubulovillous adenomas, 2 villous adenomas, 13 high grade dysplasias, 11 intramucosal cancers and 10 invasive cancers. The time to cecal intubation (4.8 vs. 4.8 min, p 0.902) was not different between the groups but withdrawal time was prolonged in CAP-ACE group for indigocarmine solution spray and suction (10.5 vs. 8.7 min, p 0.001). Compared to RC, CAP-ACE did increase PDR (65.9% vs. 54.8%, p 0.001) and ADR (51.8% vs. 45.5%, p 0.033) significantly. In particular, this technological assistance of CAP-ACE even in experts significantly enhanced the proximal adenoma detection rate (34.8% vs. 28.8%, p 0.030) as well as PSPDR (10.5% vs. 6.1%, p 0.006). However, advanced lesions (CAPACE 26/598 (4.3%) vs. RC 26/604 (4.3%), p 0.99) including cancers were equally found between groups. Conclusion: Technological assistance of CAP-ACE enhances not only PDR but also ADR, especially in the proximal colon. These results suggest that CAP-ACE technology provide a potential solution for overcoming the limited effectiveness of colonoscopy in the proximal colon and should be considered as the preferred, high standard colorectal cancer screening method for the average-risk screening population.

in a structured colonoscopy report with well-defined fields to capture all the data. Main Outcome Measurements: We analyzed the synchronous polyp burden rate in patients with 1cm polyps. Results: 137 patients were found to have 185 polyps measuring 1cm during 155 colonoscopies. Mean age: 61.23; SexMen : Women: 68:69; BMI: 27.1. Caucasians: 115 (83.9%); History of abdominal surgery: 85 (62%). Colonoscopy: 155 colonoscopies were performed in total (index endoscopy followup endoscopy within 6 months). Indication (n 155): Screening: 55; Surveillance of polyps: 51; Symptoms: 14; Referral for EMR: 35; Boston Bowel Preparation Scale: 8.95 0.37 EMR of 1 cm polyp: Size: 1-2cm: 140; 2cm: 45; Paris Classification of 1 cm polyps: Documented in the last 82 of 185 polyps: 0-IIa:72%; 0-IIb: 1.2%; 0-Is: 18.3%; 0-Ip: 8.5%. En-bloc EMR: 83.2% of lesions. APC of the edges: 51% of EMR defects; Prophylactic clip closure: 84.9% of EMR defects. Complications: Perforation: 0; Bleeding: 4 (2 required clip hemostasis). Local recurrence: 1 (tubular adenoma). Nature of pathology of 1cm polyp: Majority are serrated adenomas and tubular adenomas. See table 1. Synchronous Polyp Burden in patients with 1cm polyp : Majority are tubular adenomas, with a total adenoma burden per patient of 3.71. See table 2. Conclusions: Patients with large colon polyps are associated with a high polyp burden. Hence, it is critical to clear the colon of all the polyps in addition to confirming complete eradication of the large polyp after the EMR to prevent colon cancer in this high risk group.