645 results on '"Intestinal Polyps diagnostic imaging"'
Search Results
2. Contrast-enhanced ultrasound of polyp malignant transformation with multiple metastases in a patient with Peutz-Jeghers syndrome.
- Author
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Wang X, Zhang L, Qiao H, Liu X, and Fan X
- Subjects
- Humans, Male, Adult, Sulfur Hexafluoride, Intestinal Polyps diagnostic imaging, Intestinal Polyps surgery, Image Enhancement methods, Liver Neoplasms diagnostic imaging, Liver Neoplasms secondary, Phospholipids, Peutz-Jeghers Syndrome diagnostic imaging, Peutz-Jeghers Syndrome complications, Contrast Media, Ultrasonography methods
- Abstract
Multi-systemic metastasis in patients with Peutz-Jeghers syndrome (PJS) is very rare, and there are nearly no relevant imaging reports, especially in contrast-enhanced ultrasound (CEUS). We present here a 40-year-old male patient who underwent several partial small bowel resections and endoscopic polypectomy for intestinal polyps. After reviewing the patient's clinical diagnosis and treatment process, CEUS with sulfur hexafluoride microbubbles (SonoVue, Bracco, Milan, Italy) in the liver and gastrointestinal tract was performed. We imaged multiple abnormal masses with sonographic features consistent with malignancies. Combined with other imaging examinations and 18 gauge core-needle puncture biopsy of liver masses, multiple metastases outside the gastrointestinal tract were considered. This case report suggests CEUS may be an easy, effective, and supplementary method for evaluating PJS patients with suspected multi-systemic malignant lesions including the gastrointestinal tract., (© 2024 Wiley Periodicals LLC.)
- Published
- 2024
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3. PRAPNet: A Parallel Residual Atrous Pyramid Network for Polyp Segmentation.
- Author
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Han J, Xu C, An Z, Qian K, Tan W, Wang D, and Fang Q
- Subjects
- Colonoscopy, Deep Learning, Humans, Image Processing, Computer-Assisted methods, Intestinal Polyps diagnostic imaging, Neural Networks, Computer
- Abstract
In a colonoscopy, accurate computer-aided polyp detection and segmentation can help endoscopists to remove abnormal tissue. This reduces the chance of polyps developing into cancer, which is of great importance. In this paper, we propose a neural network (parallel residual atrous pyramid network or PRAPNet) based on a parallel residual atrous pyramid module for the segmentation of intestinal polyp detection. We made full use of the global contextual information of the different regions by the proposed parallel residual atrous pyramid module. The experimental results showed that our proposed global prior module could effectively achieve better segmentation results in the intestinal polyp segmentation task compared with the previously published results. The mean intersection over union and dice coefficient of the model in the Kvasir-SEG dataset were 90.4% and 94.2%, respectively. The experimental results outperformed the scores achieved by the seven classical segmentation network models (U-Net, U-Net++, ResUNet++, praNet, CaraNet, SFFormer-L, TransFuse-L).
- Published
- 2022
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4. White-Light Endoscopic Colorectal Lesion Detection Based on Improved YOLOv5.
- Author
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Gao J, Xiong Q, Yu C, and Qu G
- Subjects
- Adenoma diagnostic imaging, Algorithms, Computational Biology, Deep Learning, Diagnosis, Computer-Assisted statistics & numerical data, Diagnostic Errors, Endoscopy, Gastrointestinal statistics & numerical data, Humans, Intestinal Polyps diagnostic imaging, Light, Neural Networks, Computer, Colorectal Neoplasms diagnostic imaging, Diagnosis, Computer-Assisted methods, Endoscopy, Gastrointestinal methods
- Abstract
As an effective tool for colorectal lesion detection, it is still difficult to avoid the phenomenon of missed and false detection when using white-light endoscopy. In order to improve the lesion detection rate of colorectal cancer patients, this paper proposes a real-time lesion diagnosis model (YOLOv5x-CG) based on YOLOv5 improvement. In this diagnostic model, colorectal lesions were subdivided into three categories: micropolyps, adenomas, and cancer. In the course of convolutional network training, Mosaic data enhancement strategy was used to improve the detection rate of small target polyps. At the same time, coordinate attention (CA) mechanism was introduced to take into account channel and location information in the network, so as to realize the effective extraction of three kinds of pathological features. The Ghost module was also used to generate more feature maps through linear processing, which reduces the stress of learning model parameters and speeds up detection. The experimental results show that the lesion diagnosis model proposed in this paper has a more rapid and accurate lesion detection ability, and the AP value of polyps, adenomas, and cancer is 0.923, 0.955, and 0.87, and mAP@50 is 0.916., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2022 Junbo Gao et al.)
- Published
- 2022
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5. Small bowel hamartomatous polyp causing recurrent intussusception.
- Author
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Goonawardhana D, Huynh R, Caristo J, Rahme N, and Martin D
- Subjects
- Humans, Intestinal Polyps complications, Intestinal Polyps diagnostic imaging, Intestinal Polyps surgery, Neoplasm Recurrence, Local, Hamartoma diagnosis, Hamartoma diagnostic imaging, Intussusception diagnostic imaging, Intussusception etiology
- Published
- 2021
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- View/download PDF
6. Single Shot Multibox Detector Automatic Polyp Detection Network Based on Gastrointestinal Endoscopic Images.
- Author
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Chen X, Zhang K, Lin S, Dai KF, and Yun Y
- Subjects
- Computational Biology, Databases, Factual, Diagnostic Errors prevention & control, Diagnostic Errors statistics & numerical data, Endoscopy, Gastrointestinal statistics & numerical data, Humans, Image Interpretation, Computer-Assisted methods, Image Interpretation, Computer-Assisted statistics & numerical data, Intestinal Polyps classification, Intestinal Polyps diagnosis, Intestinal Polyps diagnostic imaging, Neural Networks, Computer, Polyps classification, Polyps diagnosis, Stomach Diseases classification, Stomach Diseases diagnosis, Stomach Diseases diagnostic imaging, Algorithms, Deep Learning, Endoscopy, Gastrointestinal methods, Polyps diagnostic imaging
- Abstract
Purpose: In order to resolve the situation of high missed diagnosis rate and high misdiagnosis rate of the pathological analysis of the gastrointestinal endoscopic images by experts, we propose an automatic polyp detection algorithm based on Single Shot Multibox Detector (SSD)., Method: In the paper, SSD is based on VGG-16, the fully connected layer is changed to a convolutional layer, and four convolutional layers with successively decreasing scales are added as a new network structure. In order to verify the practicability, it is not only compared with manual polyp detection but also with Mask R-CNN., Results: Multiple experimental results show that the mean Average Precision (mAP) of the SSD network is 95.74%, which is 12.4% higher than the manual detection and 5.7% higher than the Mask R-CNN. When detecting a single frame of image, the detection speed of SSD is 8.41 times that of manual detection., Conclusion: Based on the traditional pattern recognition algorithm and the target detection algorithm using deep learning, we select a variety of algorithms to identify and classify polyps to achieve efficient detection results. Our research demonstrates that deep learning has a lot of room for development in the field of gastrointestinal image recognition., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Xiaoling Chen et al.)
- Published
- 2021
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7. Rare case of small bowel intussusception secondary to an inflammatory fibroid polyp (Vanek's tumour).
- Author
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Jacob S, Lee T, and Yuen L
- Subjects
- Humans, Intestinal Polyps complications, Intestinal Polyps diagnostic imaging, Intestinal Polyps surgery, Intestine, Small pathology, Intussusception diagnostic imaging, Intussusception etiology, Leiomyoma pathology, Polyps pathology
- Published
- 2021
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8. The Workgroup Serrated Polyps and Polyposis (WASP) classification for optical diagnosis of colorectal diminutive polyps with iScan and the impact of the revised World Health Organization (WHO) criteria.
- Author
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Soons E, Bisseling TM, van der Post RS, Nagtegaal ID, Hazewinkel Y, van Kouwen MCA, and Siersema PD
- Subjects
- Adenoma classification, Colonoscopy education, Confidence Intervals, Humans, Intestinal Polyps classification, Prospective Studies, Time Factors, World Health Organization, Adenoma diagnostic imaging, Adenoma pathology, Endoscopy, Gastrointestinal education, Intestinal Polyps diagnostic imaging, Intestinal Polyps pathology, Video Recording
- Abstract
Background and Aims: The Workgroup Serrated Polyps and Polyposis (WASP) developed criteria for optical diagnosis of colorectal polyps. The aims of this study were: (1) to improve optical diagnosis of diminutive colorectal polyps, especially SSLs, after training endoscopists in applying WASP criteria on videos of polyps obtained with iScan and (2) to evaluate if the WASP criteria are still useful when polyps are pathologically revised according to the World Health Organization (WHO) 2019 criteria., Methods: Twenty-one endoscopists participated in a training session and predicted polyp histology on 30 videos of diminutive polyps, before and after training (T
0 and T1 ). After three months, they scored another 30 videos (T2 ). Primary outcome was overall diagnostic accuracy (DA) at T0 , T1 and T2 . Polyps were histopathologically classified according to the WHO 2010 and 2019 criteria., Results: Overall DA (both diminutive adenomas and SSLs) significantly improved from 0.58 (95% CI 0.55-0.62) at T0 to 0.63 (95% CI 0.60-0.66, p = 0.004) at T1 . For SSLs, DA did not change with 0.51 (95% CI 0.46-0.56) at T0 and 0.55 (95% CI 0.49-0.60, p = 0.119) at T1 . After three months, overall DA was 0.58 (95% CI 0.54-0.62, p = 0.787, relative to T0 ) while DA for SSLs was 0.48 (95% CI 0.42-0.55, p = 0.520) at T2 . After pathological revision according to the WHO 2019 criteria, DA of all polyps significantly changed at all time points., Conclusion: A training session in applying WASP criteria on endoscopic videos made with iScan did not improve endoscopists' long-term ability to optically diagnose diminutive polyps. The change of DA following polyp revision according to the revised WHO 2019 criteria suggests that the WASP classification may need revision., (© 2021 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC. on behalf of United European Gastroenterology.)- Published
- 2021
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9. Two Types of Polyp Shape Observed in the Stomach of Patients with Peutz-Jeghers Syndrome.
- Author
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Iwamuro M, Toyokawa T, Matsueda K, Hori S, Yoshioka M, Moritou Y, Tanaka T, Mizuno M, and Okada H
- Subjects
- Adolescent, Adult, Child, Endoscopy, Digestive System methods, Female, Humans, Intestinal Polyps diagnostic imaging, Intestinal Polyps etiology, Male, Middle Aged, Peutz-Jeghers Syndrome complications, Retrospective Studies, Intestinal Polyps pathology, Peutz-Jeghers Syndrome physiopathology
- Abstract
The characteristics of gastric polyps in patients with Peutz-Jeghers (PJ) syndrome (PJS) have not been fully investigated. The objective of this study was to reveal the endoscopic and pathologic findings of gastric polyps in patients with PJS. We reviewed 11 patients with PJS treated at 6 institutions, and summarized the endo-scopic and pathologic features of their gastric polyps. The polyps were mainly classified into 2 types: (i) soli-tary or sporadic polyps > 5 mm, reddish in color with a sessile or semi-pedunculated morphology (n = 9); and (ii) multiple sessile polyps ≤ 5 mm with the same color tone as the peripheral mucosa (n = 9). Patients who underwent endoscopic mucosal resection for polyps > 5 mm were diagnosed with PJ polyps (n = 2), whereas those who underwent biopsy were diagnosed with hyperplastic polyps. Polyps ≤ 5 mm were pathologically diagnosed as fundic gland polyps or hyperplastic polyps. This study revealed that patients with PJS present with 2 types of polyps in the stomach. Endoscopic mucosal resection of polyps > 5 mm seems necessary for the pathologic diagnosis of PJ polyps., Competing Interests: No potential conflict of interest relevant to this article was reported.
- Published
- 2021
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10. Magnified endoscopic imaging of a Peutz-Jeghers-type polyp in the jejunum.
- Author
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Tanaka A, Sasaki F, Kanmura S, and Ido A
- Subjects
- Aged, Female, Humans, Jejunum diagnostic imaging, Medical Illustration, Endoscopy, Gastrointestinal methods, Fluoroscopy methods, Intestinal Polyps diagnostic imaging, Jejunal Neoplasms diagnostic imaging, Peutz-Jeghers Syndrome diagnostic imaging
- Abstract
Competing Interests: Declaration of Competin Interest None declared.
- Published
- 2021
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11. Giant duodenal polyp.
- Author
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Belhassine M, Beniuga G, Henin M, Chapaux X, Negrin Dastis S, and Warzee P
- Subjects
- Humans, Intestinal Polyps diagnostic imaging, Intestinal Polyps surgery, Duodenal Diseases diagnostic imaging, Duodenal Diseases surgery, Polyps diagnostic imaging, Polyps surgery
- Published
- 2021
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12. Solitary Peutz-Jeghers hamartomatous polyp in the distal jejunum treated with endoscopic mucosal resection: A case report.
- Author
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Zhao X, Li Y, Liu J, Zhang Y, Shang J, Shi X, and Liu J
- Subjects
- Hamartoma diagnostic imaging, Hamartoma pathology, Humans, Intestinal Polyps diagnostic imaging, Intestinal Polyps pathology, Jejunal Diseases diagnostic imaging, Jejunal Diseases pathology, Male, Peutz-Jeghers Syndrome diagnostic imaging, Peutz-Jeghers Syndrome pathology, Young Adult, Hamartoma surgery, Intestinal Polyps surgery, Jejunal Diseases surgery, Peutz-Jeghers Syndrome surgery
- Published
- 2021
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13. Anorectal polyp.
- Author
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Bansal R, Ghanta H, Blue R, and Sharma R
- Subjects
- Anal Canal, Humans, Rectum diagnostic imaging, Rectum surgery, Colonoscopy, Intestinal Polyps diagnostic imaging, Intestinal Polyps surgery
- Abstract
Competing Interests: The authors declare that they have no conflict of interest
- Published
- 2021
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14. The prevalence of small-bowel polyps on video capsule endoscopy in patients with sporadic duodenal or ampullary adenomas.
- Author
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Awadie H, Klein A, Tate D, Jideh B, Bar-Yishai I, Goodrick K, Ahlenstiel G, and Bourke MJ
- Subjects
- Aged, Colonoscopy, Female, Humans, Intestinal Polyps diagnostic imaging, Intestinal Polyps epidemiology, Male, Prevalence, Prospective Studies, Adenoma diagnosis, Adenoma epidemiology, Capsule Endoscopy, Colonic Polyps diagnostic imaging, Colonic Polyps epidemiology
- Abstract
Background and Aims: Although sporadic duodenal and/or ampullary adenomas (DAs) are uncommon, they are increasingly diagnosed during upper endoscopy. These patients have a 3- to 7-fold increased risk of colonic neoplasia compared with the normal population. It is unknown, however, whether they also have an increased risk of additional small-bowel (SB) polyps. Our aim was to establish the prevalence of SB polyps in patients with DA., Methods: In a single-center, prospective study, we used video capsule endoscopy (VCE) to investigate the prevalence of SB polyps in patients with a DA compared with patients undergoing VCE for obscure GI bleeding or iron deficiency anemia., Results: Over 25 months, 201 patients were enrolled in the study; the mean age was 65 years and 47% were male. There were 101 control patients and 100 cases of DA cases (mean size, 30 mm (range, 10-80 mm)). We did not identify any SB polyps in either group. Colonic polyps were found more frequently in the DA group compared with controls (61% versus 37%, respectively (P =.002)). Advanced colonic adenoma (high-grade dysplasia, >10 mm, villous histology) were found in 18% of the DA group and 5% of the control group (P =.018)., Conclusion: Our data suggest that patients with a DA are not at risk for additional SB polyps and hence do not support screening with VCE. However, colonoscopy is mandatory due to the significantly higher risk of colonic polyps including advanced adenomas. (Clinical trial registration number: NCT02470416.)., (Copyright © 2021 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
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15. Advocating a Standardized Approach to the Assessment of Rectal Polyps Endoscopically.
- Author
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Haji A
- Subjects
- Adenocarcinoma pathology, Biopsy, Diagnosis, Differential, Endoscopic Mucosal Resection methods, Humans, Intestinal Polyps pathology, Proctectomy methods, Proctoscopy methods, Rectal Neoplasms pathology, Transanal Endoscopic Surgery methods, Adenocarcinoma diagnostic imaging, Adenocarcinoma surgery, Intestinal Polyps diagnostic imaging, Intestinal Polyps surgery, Proctoscopy standards, Rectal Neoplasms diagnostic imaging, Rectal Neoplasms surgery
- Published
- 2021
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16. Ileal Intussusception in an Adult Caused by a Locally Invasive Inflammatory Fibroid Polyp: A Case Report.
- Author
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Nova LM, Lopez P, Cerezo C, Llanos C, and Amat I
- Subjects
- Exons genetics, Female, Humans, Ileal Diseases diagnostic imaging, Ileal Diseases etiology, Intestinal Polyps complications, Intestinal Polyps diagnostic imaging, Intussusception diagnostic imaging, Intussusception etiology, Middle Aged, Mutation, Receptor, Platelet-Derived Growth Factor alpha genetics, Ileal Diseases pathology, Intestinal Polyps pathology, Intussusception pathology
- Abstract
Inflammatory fibroid polyps (IFPs) are rare mesenchymal neoplasms affecting the gastrointestinal tract which are considered benign and noninvasive. We present a case of an invasive IFP in a 46-year-old woman who presented with signs of intestinal obstruction due to ileal intussusception. A segment of the small intestine was resected and subsequently intestinal continuity was restored. A polypoid lesion was found obstructing the lumen. Histopathology revealed a mesenchymal proliferation of spindle and stellate cells, without cytological atypia, arranged in a fibromyxoid stroma. The tumor cells were located in the submucosa but also infiltrated the muscularis propria and the subserosa and were CD34 positive. The molecular study by PCR showed mutation in exon 12 of the PDGFRA gene. IFP is considered a true neoplasm and can also be considered as a potentially invasive lesion., (Copyright © 2020 Sociedad Española de Anatomía Patológica. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2021
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17. A case of jejunal solitary Peutz-Jeghers polyp with intussusception identified by double-balloon enteroscopy.
- Author
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Endo K, Kawamura K, Murakami K, Murakami K, Nagao M, Satoh T, Takasu A, Kogure T, Hirota M, Meguro T, Shibata C, and Satoh K
- Subjects
- Adult, Double-Balloon Enteroscopy, Humans, Intestinal Polyps complications, Intestinal Polyps diagnostic imaging, Intestinal Polyps surgery, Jejunum diagnostic imaging, Jejunum surgery, Male, Intussusception diagnostic imaging, Intussusception etiology, Intussusception surgery, Peutz-Jeghers Syndrome complications, Peutz-Jeghers Syndrome diagnosis, Peutz-Jeghers Syndrome surgery
- Abstract
Solitary Peutz-Jeghers polyp is a rare hamartomatous polyp that has similar histologic characteristics with those of polyps in Peutz-Jeghers syndrome, without associated mucocutaneous hyperpigmentation and a family history. Previous reports indicated that solitary Peutz-Jeghers polyp is rarely found in the small intestine. We experienced a rare case of jejunal solitary Peutz-Jeghers polyp. A 29-year-old man was admitted to our hospital with a 6-month history of upper abdominal pain. He had no hyperpigmentation or a family history of Peutz-Jeghers syndrome. Abdominal computed tomography showed a 3-cm tumor-like structure at the tip of a mildly intussuscepted jejunum. Per oral double-balloon enteroscopy revealed a 3-cm pedunculated polyp in the jejunum. The patient underwent partial jejunal resection under laparotomy. Macroscopically, the surgical specimen showed a pedunculated polyp, measuring 30 × 15 × 10 mm in size, with lobulated head. Histopathologic examination revealed irregular aggregation of hyperplastic crypts with branching muscular bundles originating from the muscularis mucosae. Based on these histologic findings, we finally diagnosed the patient as a solitary Peutz-Jeghers polyp in the jejunum. The present case indicated that solitary Peutz-Jeghers polyp should be considered in a patient with solitary hamartomatous polyp in the gastrointestinal tract.
- Published
- 2020
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18. Quality of same-day CT colonography following incomplete optical colonoscopy.
- Author
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O'Shea A, Foran AT, Murray TE, Thornton E, Dunne R, Lee MJ, and Morrin MM
- Subjects
- Adult, Aged, Contrast Media, Feces, Female, Humans, Intestinal Polyps diagnostic imaging, Male, Middle Aged, Reproducibility of Results, Retrospective Studies, Time Factors, Colonography, Computed Tomographic, Colonoscopy, Colorectal Neoplasms diagnostic imaging
- Abstract
Objectives: Same-day CT colonography (CTC) following incomplete optical colonoscopy allows patients to avoid both a delayed diagnosis and the need for repeat bowel preparation. The aim of our study is to establish the diagnostic quality of same-day CT colonography following an incomplete optical colonoscopy., Methods: We performed a retrospective review of patients undergoing same-day CT colonography following an incomplete colonoscopy at our center between July 2015 and December 2017 (N = 245). We divided the large bowel into thirteen subsegments in each patient. Using a semiquantitative scoring system, the quality of bowel preparation, adequacy of fecal tagging, and luminal distension were assessed in each subsegment on all views performed. A combined score for each subsection was obtained., Results: Ninety-nine percent of studies did not require a repeat CTC or optical colonoscopy. Median values for bowel preparation and fecal tagging were satisfactory across the bowel segments for the cohort and luminal distension was acceptable in all but three patients., Conclusions: Same-day CTC should be considered in centers with capacity, following an incomplete optical colonoscopy. Same-day completion CTCs are of high diagnostic quality and this approach allows patients to avoid repeat bowel cleansing or a delayed diagnosis., Key Points: • Same-day CT colonography is a high-quality examination that can be performed following incomplete optical colonoscopy. • Same-day CT colonography should be considered for patients with incomplete optical colonoscopy in centers with the capacity to offer this service. • Same-day CTC can avoid a delay in diagnosis and avoids repeat bowel preparation.
- Published
- 2020
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19. Unravelling the effect of data augmentation transformations in polyp segmentation.
- Author
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Sánchez-Peralta LF, Picón A, Sánchez-Margallo FM, and Pagador JB
- Subjects
- Databases, Factual, Humans, Intestinal Polyps diagnostic imaging, Deep Learning, Image Processing, Computer-Assisted methods, Intestinal Polyps surgery, Surgery, Computer-Assisted
- Abstract
Purpose: Data augmentation is a common technique to overcome the lack of large annotated databases, a usual situation when applying deep learning to medical imaging problems. Nevertheless, there is no consensus on which transformations to apply for a particular field. This work aims at identifying the effect of different transformations on polyp segmentation using deep learning., Methods: A set of transformations and ranges have been selected, considering image-based (width and height shift, rotation, shear, zooming, horizontal and vertical flip and elastic deformation), pixel-based (changes in brightness and contrast) and application-based (specular lights and blurry frames) transformations. A model has been trained under the same conditions without data augmentation transformations (baseline) and for each of the transformation and ranges, using CVC-EndoSceneStill and Kvasir-SEG, independently. Statistical analysis is performed to compare the baseline performance against results of each range of each transformation on the same test set for each dataset., Results: This basic method identifies the most adequate transformations for each dataset. For CVC-EndoSceneStill, changes in brightness and contrast significantly improve the model performance. On the contrary, Kvasir-SEG benefits to a greater extent from the image-based transformations, especially rotation and shear. Augmentation with synthetic specular lights also improves the performance., Conclusion: Despite being infrequently used, pixel-based transformations show a great potential to improve polyp segmentation in CVC-EndoSceneStill. On the other hand, image-based transformations are more suitable for Kvasir-SEG. Problem-based transformations behave similarly in both datasets. Polyp area, brightness and contrast of the dataset have an influence on these differences.
- Published
- 2020
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20. Inflammatory Fibroid Polyp of the Small Intestine: A Case Report and Systematic Literature Review.
- Author
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Ivaniš N, Tomas V, Vranić L, Lovasić F, Ivaniš V, Žulj M, Šuke R, and Štimac D
- Subjects
- Abdomen, Acute etiology, Adolescent, Adult, Aged, Child, Child, Preschool, Female, Humans, Intestinal Neoplasms diagnostic imaging, Intestinal Neoplasms surgery, Intestinal Polyps diagnostic imaging, Intestinal Polyps surgery, Intussusception diagnostic imaging, Intussusception surgery, Male, Middle Aged, Treatment Outcome, Young Adult, Intestinal Neoplasms complications, Intestinal Polyps complications, Intestine, Small diagnostic imaging, Intestine, Small surgery, Intussusception etiology
- Abstract
Aim: Starting from a case presentation, this review aims to present literature data on inflammatory fibroid polyps (IFPs) of the small intestine., Methods: Case report and systematic review. A comprehensive systematic review of English literature using PubMed was conducted, based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The used key words were: "inflammatory fibroid polyp" or "Vanek", including only cases with IFPs localized of the small intestine, published from 1976 to 2019., Results: We present a case of a 38-year old patient with intestinal IFP presenting with acute abdomen due to intussusception diagnosed with ultrasound (US) based on a target sign and visible solid tumor in the small intestine leading to prompt surgical treatment. A diagnosis of IFP was made based on the pathohistological findings. Moreover, a systematic review of small intestine IFPs was conducted which is, to our knowledge, the first comprehensive systematic literature review on this topic. The analysis included 53 case reports or case series concerning 77 cases of small bowel IFPs. The patients were aged from 4 to 75 years (average 45.2), with a female predominance (59.7%). The most common localization was the ileum in 77.9% cases, followed by the jejunum (13%) and the duodenum (6.5%). The most common clinical presentation was abdominal pain due to intussusception (63.6%). Regarding diagnostic methods, computed tomography (CT) was frequently used as primary diagnostic method (26%) followed by exploratory laparotomy (16.9%), endoscopy (7.8%) and US (6.5%). Combination of US and CT contributed to the diagnosis in 9.1% of cases. The majority of cases were treated surgically (92.21%), while only a minority benefited of minimally invasive techniques such as endoscopy., Conclusions: Small bowel IFPs, ones of the least common benign tumors, are characterized by variable clinical signs and symptoms and can potentially lead to serious consequences for the patient.
- Published
- 2020
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21. Adult Jejuno-jejunal intussusception due to inflammatory fibroid polyp: A case report and literature review.
- Author
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Kao YK and Chen JH
- Subjects
- Humans, Intestinal Polyps diagnostic imaging, Intestinal Polyps pathology, Intussusception diagnostic imaging, Intussusception pathology, Jejunal Diseases diagnostic imaging, Jejunal Diseases pathology, Male, Middle Aged, Tomography, X-Ray Computed, Intestinal Polyps complications, Intussusception etiology, Jejunal Diseases etiology
- Abstract
Rationale: Intussusception is defined as the invagination or telescoping of a proximal portion of the intestine into the distal portion of the intestine. Intussusception can occur at any age but is more common among children. Most cases of intussusception in adults have a pathological lead point. Inflammatory fibroid polyp (IFP) is a rare benign tumor-like lesion arising from the submucosa of the gastrointestinal tract that can cause intussusception in adults. Here, we report a case of adult intussusception due to IFP. We also present a literature review of 31 reports including 34 cases between 2012 and December 2019, which shows a mean age of 45.4 ± 14.2 years and female dominance (23/34) of intussusception due to IFP., Patient Concerns: A 47-year-old man presented with a half-day history of epigastric abdominal pain. Physical examination revealed distension and tenderness of the upper abdomen. Computed tomography (CT) of the abdomen and pelvis demonstrated intussusception of the jejunum along with a suspicious jejunal mass associated with mesenteric lymphadenopathies., Diagnosis: Intussusception of the jejunum along with a suspicious jejunal mass, and histopathological examination of the resected specimen showed IFP., Interventions: The patient underwent emergency laparotomy. The intussusception was resected without attempts for reduction., Outcomes: The postoperative period was uneventful, and the patient was discharged on the fourth postoperative day., Lessons: Intussusception in adults is rare, especially that secondary to IFP. The most commonly used diagnostic tool for adult intussusception is abdominal CT, and the optimal management is resection of the involved bowel segment without reduction if malignancy cannot be ruled out.
- Published
- 2020
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22. Application of Deep Learning for Early Screening of Colorectal Precancerous Lesions under White Light Endoscopy.
- Author
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Gao J, Guo Y, Sun Y, and Qu G
- Subjects
- Adenoma diagnostic imaging, Colonic Polyps diagnostic imaging, Colonoscopy statistics & numerical data, Computational Biology, Diagnostic Errors statistics & numerical data, Humans, Image Interpretation, Computer-Assisted statistics & numerical data, Intestinal Polyps diagnostic imaging, Light, Mass Screening methods, Mass Screening statistics & numerical data, Neural Networks, Computer, Colonoscopy methods, Colorectal Neoplasms diagnostic imaging, Deep Learning, Image Interpretation, Computer-Assisted methods, Precancerous Conditions diagnostic imaging
- Abstract
Methods: We collected and sorted out the white light endoscopic images of some patients undergoing colonoscopy. The convolutional neural network model is used to detect whether the image contains lesions: CRC, colorectal adenoma (CRA), and colorectal polyps. The accuracy, sensitivity, and specificity rates are used as indicators to evaluate the model. Then, the instance segmentation model is used to locate and classify the lesions on the images containing lesions, and mAP (mean average precision), AP
50 , and AP75 are used to evaluate the performance of an instance segmentation model., Results: In the process of detecting whether the image contains lesions, we compared ResNet50 with the other four models, that is, AlexNet, VGG19, ResNet18, and GoogLeNet. The result is that ResNet50 performs better than several other models. It scored an accuracy of 93.0%, a sensitivity of 94.3%, and a specificity of 90.6%. In the process of localization and classification of the lesion in images containing lesions by Mask R-CNN, its mAP, AP50 , and AP75 were 0.676, 0.903, and 0.833, respectively., Conclusion: We developed and compared five models for the detection of lesions in white light endoscopic images. ResNet50 showed the optimal performance, and Mask R-CNN model could be used to locate and classify lesions in images containing lesions., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2020 Junbo Gao et al.)- Published
- 2020
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23. Detection of polyps in the small bowel of patients with acromegaly via capsule endoscopy.
- Author
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Blanco Velasco G, González-Virla B, Palos-Cuéllar R, Pérez-Cuadrado Robles E, Vargas-Ortega G, Solórzano-Pineda OM, Mendoza-Zubieta V, and Hernández-Mondragón OV
- Subjects
- Humans, Intestinal Polyps complications, Intestinal Polyps diagnostic imaging, Intestinal Polyps epidemiology, Intestine, Small diagnostic imaging, Intestine, Small pathology, Prospective Studies, Acromegaly complications, Acromegaly diagnostic imaging, Acromegaly epidemiology, Capsule Endoscopy
- Abstract
Background: the prevalence of small bowel (SB) polyps is unknown in acromegaly patients., Objective: to evaluate the prevalence of polyps/tumors in SB of acromegaly patients., Material: this was a prospective and observational study that compared the prevalence of polyps/tumors using capsule endoscopy with a standard protocol in asymptomatic acromegaly patients and non-acromegaly patients, with abdominal pain, diarrhea or anemia., Results: one hundred and eighty-three cases were included (61 acromegaly and 122 non-acromegaly). Polyps were found in six (9.8%) and three (2.5%) patients, respectively (RR: 4 [95% CI, 1.03-15.45; p = 0.038]). There were no differences in the tumors (n = 4, 6.6% vs n = 7, 5.7%)., Conclusions: acromegaly may be associated with more polyps in SB.
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- 2020
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24. Advanced endoscopy technologies to improve the detection and characterisation of colorrectal polyps.
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Sánchez-Montes C, García-Rodríguez A, Córdova H, Pellisé M, and Fernández-Esparrach G
- Subjects
- Colonoscopy instrumentation, Colorectal Neoplasms diagnostic imaging, Equipment Design, Humans, Intestinal Polyps classification, Colonic Polyps diagnostic imaging, Colonoscopes standards, Colonoscopy methods, Intestinal Polyps diagnostic imaging, Precancerous Conditions diagnostic imaging, Rectal Diseases diagnostic imaging
- Abstract
Colorectal cancer is a major health problem. An improvement to its survival has been demonstrated by performing colonoscopy screenings and removing its precursor lesions: polyps. However, colonoscopy is not infallible and multiple strategies have been proposed aimed at improving the quality thereof. This report describes the endoscopic systems available to improve the detection and characterization of polyps, the different classifications for histological prediction and the current indications of advanced endoscopic diagnostic techniques., (Copyright © 2019 Elsevier España, S.L.U. All rights reserved.)
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- 2020
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25. How I remove polyps larger than 20 mm.
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Bourke MJ and Bhandari P
- Subjects
- Clinical Competence, Humans, Tumor Burden, Endoscopy, Digestive System education, Endoscopy, Digestive System instrumentation, Endoscopy, Digestive System methods, Intestinal Neoplasms diagnostic imaging, Intestinal Neoplasms pathology, Intestinal Neoplasms surgery, Intestinal Polyps diagnostic imaging, Intestinal Polyps pathology, Intestinal Polyps surgery
- Abstract
Competing Interests: Michael J. Bourke has received research support for HREC approved studies from Boston Scientific, Olympus and Cook Medical.
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- 2019
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26. Incidental Jejunal Polyps.
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Park EY, Baek DH, and Song GA
- Subjects
- Adult, Choristoma diagnostic imaging, Humans, Incidental Findings, Intestinal Polyps diagnostic imaging, Jejunal Diseases diagnostic imaging, Male, Choristoma pathology, Gastric Mucosa, Intestinal Polyps pathology, Jejunal Diseases pathology
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- 2019
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- View/download PDF
27. Pancreatic Non-Hodgkin Lymphoma Presenting as Pancreatitis and Duodenal Polyps in a Pediatric Patient.
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Kim GE, Bingham S, and Gariepy C
- Subjects
- Abdominal Pain etiology, Child, Diagnosis, Differential, Duodenal Diseases complications, Duodenal Diseases diagnostic imaging, Humans, Intestinal Polyps complications, Intestinal Polyps diagnostic imaging, Lymphoma, Non-Hodgkin complications, Lymphoma, Non-Hodgkin diagnostic imaging, Male, Pancreatic Neoplasms complications, Pancreatic Neoplasms diagnostic imaging, Pediatric Obesity, Ultrasonography, Duodenal Diseases diagnosis, Intestinal Polyps diagnosis, Lymphoma, Non-Hodgkin diagnosis, Pancreatic Neoplasms diagnosis
- Published
- 2019
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- View/download PDF
28. Sonographic Differential Diagnosis in Deep Infiltrating Endometriosis: The Bowel.
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Scioscia M, Orlandi S, Trivella G, Portuese A, Bettocchi S, Pontrelli G, Bocus P, and Anna Virgilio B
- Subjects
- Diagnosis, Differential, Female, Humans, Imaging, Three-Dimensional, Intestinal Polyps diagnostic imaging, Intestinal Polyps pathology, Italy, Pelvis diagnostic imaging, Pelvis pathology, Retrospective Studies, Endometriosis diagnostic imaging, Endometriosis pathology, Intestines diagnostic imaging, Intestines pathology, Ultrasonography
- Abstract
Up to one-third of fertile-age women with severe endometriosis suffer from colonic involvement. Transvaginal ultrasonography has become a first-line diagnostic tool for the study of the pelvis and more specifically for the diagnosis of pelvic endometriosis. Accuracy of pelvic ultrasound for deep endometriosis increases with operator experience, but the difficulties in the differential diagnosis with diseases that can afflict the bowel tract remain a challenge. We reviewed noteworthy cases referred for secondary level diagnosis suspected of bowel endometriosis in which the subsequent ultrasound led to an alternative diagnosis. This case series aims to highlight awareness for both experts and less-experienced operators the possible differential diagnoses of bowel lesions that initially resemble endometriosis., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2019 Marco Scioscia et al.)
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- 2019
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29. The yield and patient factors associated with CT colonography C-RADS results in a non-screening patient population.
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Kamali M, Brake A, Pothier M, Abdolell M, and Costa AF
- Subjects
- Adult, Age Factors, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Retrospective Studies, Young Adult, Colonography, Computed Tomographic methods, Colorectal Neoplasms diagnostic imaging, Intestinal Polyps diagnostic imaging, Radiology Information Systems statistics & numerical data
- Abstract
Objectives: To determine the proportion of diagnostic computed tomography colonography (CTC) Reporting and Data System (C-RADS) categories in a non-screening population, and which patient factors are associated with a positive CTC (C2-4), a non-diagnostic CTC (C0), and potentially relevant extracolonic findings (ECF, E3-4)., Methods: Diagnostic CTCs performed at a single academic center from 2017 to 2018 were retrospectively reviewed. For each examination, the indications, age, sex, admission status, and C-RADS categories were recorded. Multivariate logistic regression was performed of patient demographic factors and clinical indications, with adjusted odds ratios (OR) and 95% confidence intervals., Results: 1373 CTCs were included. The mean age was 66.4 ± 13 years (range 24-97). There were 782 women and 75 inpatients. The number of CTCs reported as C0-C4 were 194/1373 (14.1%), 970/1373 (70.6%), 77/1373 (5.6%), 86/1373 (6.3%), and 46/1373 (3.4%), respectively, and 134/1373 (9.8%), 960/1373 (69.9%), 173/1373 (12.6%), and 106/1373 (7.7%) CTCs were reported as E1-4, respectively. Factors that demonstrated the strongest associations were as follows: with C2-4, age groups 50-79 (OR 2.8, 95% confidence interval 1.4-6.1), 80-89 (6.2, 2.9-14.5) and ≥ 90 (7.6, 2.0-29.1), and inpatients (3.4, 1.8-6.4); with C0, age groups 50-79 (5.9, 2.2-24.4), 80-89 (9.8, 3.4-41.8), and ≥ 90 (22.5, 5.8-113.0), incomplete colonoscopy (3.2, 2.0-5.1) and melena or gastrointestinal bleeding (4.1, 1.8-9.4); and with E3-4, age groups 50-79 (1.6, 1.0-2.9), 80-89 (2.0, 1.1-3.9), and ≥ 90 (3.2, 1.2-8.8), and inpatients (2.3, 1.3-3.9)., Conclusion: Older age is increasingly associated with a positive test, a non-diagnostic test and potentially relevant ECF. Inpatients are also associated with positive tests and E3-4 findings. Symptoms are not strongly associated with a positive CTC.
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- 2019
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30. A case of pedunculated duodenal neuroendocrine tumor.
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Katsurahara M, Miura H, and Horiki N
- Subjects
- Aged, Biopsy, Duodenal Neoplasms diagnostic imaging, Duodenal Neoplasms pathology, Duodenum pathology, Duodenum surgery, Humans, Intestinal Polyps diagnostic imaging, Intestinal Polyps pathology, Male, Narrow Band Imaging, Neuroendocrine Tumors diagnostic imaging, Neuroendocrine Tumors pathology, Duodenal Neoplasms surgery, Duodenoscopy methods, Endoscopic Mucosal Resection methods, Intestinal Polyps surgery, Neuroendocrine Tumors surgery
- Published
- 2019
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- View/download PDF
31. Reliable Label-Efficient Learning for Biomedical Image Recognition.
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Gu Y, Shen M, Yang J, and Yang GZ
- Subjects
- Endoscopy, Gastrointestinal, Humans, Intestinal Polyps diagnostic imaging, Reproducibility of Results, Deep Learning, Image Interpretation, Computer-Assisted methods
- Abstract
The use of deep neural networks for biomedical image analysis requires a sufficient number of labeled datasets. To acquire accurate labels as the gold standard, multiple observers with specific expertise are required for both annotation and proofreading. This process can be time-consuming and labor-intensive, making high-quality, and large-annotated biomedical datasets difficult. To address this problem, we propose a deep active learning framework that enables the active selection of both informative queries and reliable experts. To measure the uncertainty of the unlabeled data, a dropout-based strategy is integrated with a similarity criterion for both data selection and random error elimination. To select the reliable labelers, we adopt an expertise estimator to learn the expertise levels of labelers via offline-testing and online consistency evaluation. The proposed method is applied to classification tasks on two types of medical images including confocal endomicroscopy images and gastrointestinal endoscopic images. The annotations are acquired from multiple labelers with diverse levels of expertise. The experiments demonstrate the efficiency and promising performance of the proposed method compared to a set of baseline methods.
- Published
- 2019
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- View/download PDF
32. Comparison of Underwater vs Conventional Endoscopic Mucosal Resection of Intermediate-Size Colorectal Polyps.
- Author
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Yamashina T, Uedo N, Akasaka T, Iwatsubo T, Nakatani Y, Akamatsu T, Kawamura T, Takeuchi Y, Fujii S, Kusaka T, and Shimokawa T
- Subjects
- Adult, Aged, Aged, 80 and over, Colon diagnostic imaging, Colon pathology, Colon surgery, Endoscopic Mucosal Resection adverse effects, Female, Humans, Intestinal Mucosa diagnostic imaging, Intestinal Mucosa surgery, Intestinal Polyps diagnostic imaging, Intestinal Polyps pathology, Japan, Male, Middle Aged, Operative Time, Postoperative Complications etiology, Rectum diagnostic imaging, Rectum pathology, Rectum surgery, Treatment Outcome, Water, Endoscopic Mucosal Resection methods, Intestinal Mucosa pathology, Intestinal Polyps surgery, Postoperative Complications epidemiology, Secondary Prevention methods
- Abstract
Background & Aims: Endoscopic mucosal resection (EMR) with submucosal injection is an established method for removing colorectal polyps, although the en bloc resection rate decreases when polyp size exceeds 10 mm. Piecemeal resection increases local recurrence. Underwater EMR (UEMR) is an effective technique for removal of sessile colorectal polyps and we investigated whether it is superior to conventional EMR (CEMR)., Methods: We conducted a multicenter randomized controlled trial at 5 institutions in Japan. Patients with endoscopically diagnosed, intermediate-size (10-20 mm) sessile colorectal lesions were randomly assigned to undergo UEMR or CEMR. Only the most proximal lesion was registered. The UEMR procedure included immersion of the entire lumen in water and snare resection of the lesion without submucosal injection of normal saline. We analyzed outcomes of 108 colorectal lesions in the UEMR group and 102 lesions in the CEMR group. R0 resection was defined as en bloc resection with a histologically confirmed negative resection margin. The primary endpoint was the difference in the R0 resection rates between groups., Results: The proportions of R0 resections were 69% (95% confidence interval [CI] 59%-77%) in the UEMR group vs 50% (95% CI 40%-60%) in the CEMR group (P = .011). The proportions of en bloc resections were 89% (95% CI 81%-94%) in the UEMR group vs 75% (95% CI 65%-83%) in the CEMR group (P = .007). There was no significant difference in median procedure time (165 vs 175 seconds) or proportions of patients with adverse events (2.8% in the UEMR group vs 2.0% in the CEMR group)., Conclusions: In a multicenter randomized controlled trial, we found that UEMR significantly increased the proportions of R0 resections for 10- to 20-mm sessile colorectal lesions without increasing adverse events or procedure time. Use of this procedure should be encouraged. Trials registry number: UMIN000018989., (Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
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33. A case of ectopic pancreas in the ileum presenting as obscure gastrointestinal bleeding and abdominal pain.
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Mickuniene R, Stundiene I, Jucaitis T, Valanciene D, and Valantinas J
- Subjects
- Choristoma complications, Choristoma surgery, Humans, Ileal Diseases complications, Ileal Diseases surgery, Intestinal Polyps complications, Intestinal Polyps diagnostic imaging, Intestinal Polyps surgery, Magnetic Resonance Imaging methods, Male, Middle Aged, Abdominal Pain etiology, Choristoma diagnostic imaging, Gastrointestinal Hemorrhage etiology, Ileal Diseases diagnostic imaging, Pancreas
- Abstract
Background: Ectopic pancreas is an infrequent submucosal tumor in the gastrointestinal tract defined as a pancreatic tissue lacking vascular or anatomic continuity with the main body of the pancreas. Ectopic pancreas in the ileum is a rare and often an incidental finding. We report a case of ectopic pancreas in the ileum causing obscure gastrointestinal bleeding and episodes of abdominal pain., Case Presentation: 59-year-old man with 3 months history of intermittent melena, accompanied by the episodes of abdominal pain in the left upper quadrant and generalized fatigue was admitted to our department. The investigations showed that the patient had a low hemoglobin level, i.e. 10.9 g/dL with hypochromic microcytic anemia pattern seen in complete blood count (MCV 70.2 fl, MCH 21.4 pg). Esophagogastroduodenoscopy and colonoscopy did not reveal any abnormalities. Magnetic resonance enterography revealed a large (2.5 × 2.3 cm) pedunculated polyp in the ileum. Examination by single-balloon enteroscopy revealed a polyp with long pedicle located approximately 1.5 m distal to terminal ileum. Polypectomy was performed. Histopathologic examination stated, that the specimen contained ectopic pancreatic tissue which was involving muscular layer of the ileum. Ectopic pancreatic tissue included acinar cells and cystically dilated secretory ducts without islets of Langerhans., Conclusion: Our case report reveals a very rare cause of obscure gastrointestinal bleeding accompanied by the episodes of abdominal pain - an ectopic pancreas located in the ileum.
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- 2019
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34. Endoscopic features, pathological correlates and possible origin of foveolar gastric metaplasia presenting as a duodenal polyp.
- Author
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Toussaint C, Libbrecht L, Dano H, and Piessevaux H
- Subjects
- Brunner Glands pathology, Duodenal Diseases diagnostic imaging, Duodenal Diseases pathology, Hamartoma diagnostic imaging, Humans, Brunner Glands diagnostic imaging, Duodenal Ulcer pathology, Endoscopy, Digestive System, Hamartoma pathology, Intestinal Polyps diagnostic imaging, Intestinal Polyps pathology, Metaplasia diagnostic imaging, Metaplasia pathology
- Abstract
It has recently been shown that duodenal foveolar gastric metaplasia (FGM) sometimes presents as a polyp. The mechanism by which FGM develops into a polypoid lesion is unknown and it is unclear whether this form of FGM is indistinguishable from other polypoid lesions or whether endoscopists do not recognize it because they are unfamiliar with it. We identified and retrieved archival cases of FGM endoscopically suspicious for adenomatous polyp and examined their pathological, clinical and endoscopic features. Endoscopic features of the 13 identified FGMs presenting as polyps were heterogeneous and overlapping with those of adenomatous polyps. FGM was frequently associated with mucosal and submucosal Brunner's glands, but defining and recognizing hyperplasia of these glands remains difficult. Other pathological features could not explain the development of a polypoid lesion. The endoscopic features of FGM polyps are non-specific, overlapping with those of adenomatous polyps. FGM polyps probably acquire their polypoid aspect due to association with Brunner's gland hyperplasia (BGH), which also arises due to chronic inflammation and damage. Because BGH is ill-defined and difficult to recognize, while FGM is diagnosed easily, this type of polypoid lesions has until now only been recognized based on the presence of FGM, although FGM is most likely a secondary phenomenon and not the primary cause of the polyp., Competing Interests: The authors declare that they have no conflict of interest, (© Acta Gastro-Enterologica Belgica.)
- Published
- 2019
35. Computed tomographic colonography for diagnosis of early cancer and polyps?
- Author
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Plumb AA, Eason D, Goldstein M, Lowe A, Morrin M, Rudralingam V, Tolan D, and Thrower A
- Subjects
- Colorectal Neoplasms etiology, Humans, Intestinal Polyps complications, Sensitivity and Specificity, Colonography, Computed Tomographic methods, Colorectal Neoplasms diagnostic imaging, Early Detection of Cancer methods, Intestinal Polyps diagnostic imaging
- Published
- 2019
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- View/download PDF
36. Assessment of a rectal SPECC lesion by endoluminal ultrasound.
- Author
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Borley N
- Subjects
- Humans, Intestinal Polyps complications, Rectal Diseases complications, Rectal Neoplasms etiology, Rectum diagnostic imaging, Intestinal Polyps diagnostic imaging, Rectal Diseases diagnostic imaging, Rectal Neoplasms diagnostic imaging, Ultrasonography methods
- Published
- 2019
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- View/download PDF
37. The MRI assessment of SPECC (significant polyps and early colorectal cancer) lesions.
- Author
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Balyasnikova S and Brown G
- Subjects
- Colon diagnostic imaging, Colorectal Neoplasms etiology, Humans, Intestinal Polyps complications, Rectum diagnostic imaging, Colorectal Neoplasms diagnostic imaging, Early Detection of Cancer methods, Intestinal Polyps diagnostic imaging, Magnetic Resonance Imaging methods, Population Surveillance methods
- Abstract
The development of high-resolution magnetic resonance imaging (MRI) has resulted in the ability to clearly depict the finer details of rectal wall anatomy. Careful specialist assessment of images obtained in patients with significant polyps and early rectal cancer lesions enables the identification of lesions that are confined to the bowel wall and amenable to organ preserving local excision. Currently, one-third of screen detected rectal cancers are limited to the bowel wall without nodal spread yet more than 90% undergo major excision surgery resulting in significant loss of bowel function, quality of life and at high economic cost. The SPECC initiative has highlighted the need for specialist training and accreditation of radiology specialists in precision assessment of significant polyps and early rectal cancer. The detailed assessment will enable provision of detailed roadmaps for surgeons and gastroenterologists to facilitate definitive excision of more lesions using minimally invasive endoscopic technique. Finally, the use of high resolution MRI in surveillance will enable the close monitoring of such patients where the preservation of the rectum has been achieved., (Colorectal Disease © 2019 The Association of Coloproctology of Great Britain and Ireland.)
- Published
- 2019
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38. Negative video capsule enteroscopy - what's the next step?
- Author
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Sousa M, Pinho R, Rodrigues A, and Carvalho J
- Subjects
- Cathartics, False Negative Reactions, Gastrointestinal Hemorrhage diagnosis, Gastrointestinal Hemorrhage etiology, Humans, Inflammatory Bowel Diseases diagnosis, Inflammatory Bowel Diseases diagnostic imaging, Intestinal Diseases diagnosis, Intestinal Mucosa diagnostic imaging, Intestinal Neoplasms diagnosis, Intestinal Neoplasms diagnostic imaging, Intestinal Polyps diagnosis, Intestinal Polyps diagnostic imaging, Intestine, Small diagnostic imaging, Capsule Endoscopy, Intestinal Diseases diagnostic imaging
- Abstract
Video capsule endoscopy (VCE) is a reliable noninvasive method for examination of small-bowel mucosa. However, it has some limitations. The aim of this article was to review the approach in patients with negative VCE. It is clear that a negative VCE should be interpreted based on the indication. In suspected small bowel bleeding (SSBB), patients with ongoing/recurrent overt bleeding, or occult bleeders who experience significant declines in hemoglobin after a negative VCE should proceed small bowel study; on the other hand, patients with occult SSBB and only mild-moderate anemia should be managed with supportive care. In inflammatory bowel disease, a normal VCE has a very high sensitivity and negative predictive value. In small bowel tumor suspicion there is a high risk of false negative results, so another imaging modality should be considered. In polyposis syndromes, if VCE is negative, patients should continue screening within 2-3 years., (Copyright © 2018. Publicado por Elsevier España, S.L.U.)
- Published
- 2018
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39. Gastrointestinal: Esophageal squamous cell papilloma in a patient with Cronkhite-Canada syndrome.
- Author
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Sharma V, Mandavdhare HS, Prasad KK, and Dutta U
- Subjects
- Esophageal Neoplasms diagnostic imaging, Esophagus diagnostic imaging, Esophagus pathology, Humans, Intestinal Polyposis diagnostic imaging, Intestinal Polyps diagnostic imaging, Intestinal Polyps pathology, Male, Middle Aged, Papilloma diagnostic imaging, Stomach diagnostic imaging, Stomach pathology, Endoscopy, Gastrointestinal, Esophageal Neoplasms complications, Esophageal Neoplasms pathology, Intestinal Polyposis complications, Intestinal Polyposis pathology, Papilloma complications, Papilloma pathology
- Published
- 2018
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40. Portal Hypertensive Polyposis in Advanced Liver Cirrhosis: The Unknown Entity?
- Author
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Kara D, Hüsing-Kabar A, Schmidt H, Grünewald I, Chandhok G, Maschmeier M, and Kabar I
- Subjects
- Adult, Aged, Aged, 80 and over, Duodenal Diseases diagnostic imaging, Duodenal Diseases pathology, Duodenal Diseases surgery, Endoscopy, Gastrointestinal, Esophageal and Gastric Varices diagnostic imaging, Esophageal and Gastric Varices etiology, Female, Humans, Intestinal Polyps diagnostic imaging, Intestinal Polyps pathology, Intestinal Polyps surgery, Male, Middle Aged, Recurrence, Retrospective Studies, Stomach Diseases diagnostic imaging, Stomach Diseases pathology, Stomach Diseases surgery, Thrombocytopenia complications, Young Adult, Duodenal Diseases complications, Hypertension, Portal complications, Intestinal Polyps complications, Liver Cirrhosis complications, Stomach Diseases complications
- Abstract
Background: Portal hypertension is a serious complication of liver cirrhosis., Objective: To identify relevant endoscopic findings in patients with advanced cirrhosis and consecutive portal hypertension., Methods: This was a retrospective study of liver transplant candidates who underwent upper gastrointestinal endoscopy between April 2011 and November 2015., Results: A total of 1,045 upper endoscopies were analyzed. Portal hypertensive gastric and duodenal polyps were frequently observed and were associated with thrombocytopenia (p = 0.040; OR: 2.4, 95% CI 1.04-5.50), Child-Pugh score > 6 (p = 0.033; OR: 2.3, 95% CI 1.07-4.92), Model for End Stage Liver Disease score > 16 (p = 0.030; OR: 4.1, 95% CI 1.14-15.00), and previous rubber band ligation (p < 0.001; OR = 5.2, 95% CI 2.5-10.7). These polyps often recurred after polypectomy; however, no malignant transformation occurred during the observational time until October 2017. The most common endoscopic finding was esophageal varices, observed in more than 90% of patients., Conclusion: Portal hypertensive polyposis is common in patients with advanced cirrhosis. Our data suggest that these polyps have benign characteristics.
- Published
- 2018
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41. An unusual duodenal polyp causing anemia in a liver-transplanted patient.
- Author
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Lenci I, Milana M, Toti L, Palmieri G, Manzia TM, Angelico M, Tisone G, and Baiocchi L
- Subjects
- Anemia blood, Anemia diagnosis, Anemia surgery, Carcinoma, Hepatocellular pathology, Carcinoma, Hepatocellular surgery, Carcinoma, Hepatocellular virology, Duodenal Neoplasms diagnostic imaging, Duodenal Neoplasms secondary, Duodenal Neoplasms surgery, Duodenoscopy, Duodenum blood supply, Duodenum diagnostic imaging, Duodenum pathology, Duodenum surgery, Gastrointestinal Hemorrhage blood, Gastrointestinal Hemorrhage diagnosis, Gastrointestinal Hemorrhage surgery, Hepatitis B virus isolation & purification, Humans, Intestinal Mucosa blood supply, Intestinal Mucosa diagnostic imaging, Intestinal Mucosa pathology, Intestinal Polyps diagnostic imaging, Intestinal Polyps surgery, Liver Cirrhosis pathology, Liver Cirrhosis surgery, Liver Cirrhosis virology, Liver Neoplasms pathology, Liver Neoplasms surgery, Liver Neoplasms virology, Liver Transplantation, Male, Middle Aged, Tomography, X-Ray Computed, Treatment Outcome, Anemia etiology, Duodenal Neoplasms complications, Gastrointestinal Hemorrhage etiology, Intestinal Polyps complications
- Published
- 2018
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- View/download PDF
42. A comparison of computer-assisted detection (CAD) programs for the identification of colorectal polyps: performance and sensitivity analysis, current limitations and practical tips for radiologists.
- Author
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Bell LTO and Gandhi S
- Subjects
- Aged, Aged, 80 and over, Colonic Polyps diagnostic imaging, Colonography, Computed Tomographic methods, Colonography, Computed Tomographic standards, Diagnosis, Computer-Assisted methods, Diagnosis, Computer-Assisted standards, Humans, Middle Aged, Rectal Diseases diagnostic imaging, Retrospective Studies, Sensitivity and Specificity, Software standards, Intestinal Polyps diagnostic imaging
- Abstract
Aim: To directly compare the accuracy and speed of analysis of two commercially available computer-assisted detection (CAD) programs in detecting colorectal polyps., Materials and Method: In this retrospective single-centre study, patients who had colorectal polyps identified on computed tomography colonography (CTC) and subsequent lower gastrointestinal endoscopy, were analysed using two commercially available CAD programs (CAD1 and CAD2). Results were compared against endoscopy to ascertain sensitivity and positive predictive value (PPV) for colorectal polyps. Time taken for CAD analysis was also calculated., Results: CAD1 demonstrated a sensitivity of 89.8%, PPV of 17.6% and mean analysis time of 125.8 seconds. CAD2 demonstrated a sensitivity of 75.5%, PPV of 44.0% and mean analysis time of 84.6 seconds., Conclusion: The sensitivity and PPV for colorectal polyps and CAD analysis times can vary widely between current commercially available CAD programs. There is still room for improvement. Generally, there is a trade-off between sensitivity and PPV, and so further developments should aim to optimise both. Information on these factors should be made routinely available, so that an informed choice on their use can be made. This information could also potentially influence the radiologist's use of CAD results., (Copyright © 2018 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2018
- Full Text
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43. Management of a circumferential duodenal polyp.
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Storm AC and Topazian MD
- Subjects
- Adenoma diagnostic imaging, Aged, Constriction, Pathologic etiology, Constriction, Pathologic therapy, Duodenal Neoplasms diagnostic imaging, Female, Humans, Intestinal Polyps diagnostic imaging, Stents, Adenoma surgery, Duodenal Neoplasms surgery, Duodenum pathology, Endoscopic Mucosal Resection adverse effects, Intestinal Polyps surgery
- Published
- 2018
- Full Text
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44. Adjunctive use of chromoendoscopy may improve the diagnostic performance of narrow-band imaging for small sessile serrated adenoma/polyp.
- Author
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Chang LC, Tu CH, Lin BR, Shun CT, Hsu WF, Liang JT, Wang HP, Wu MS, and Chiu HM
- Subjects
- Adenoma pathology, Adult, Aged, Cohort Studies, Colorectal Neoplasms pathology, Female, Humans, Intestinal Polyps pathology, Male, Middle Aged, Prospective Studies, Sensitivity and Specificity, Adenoma diagnostic imaging, Colonoscopy methods, Colorectal Neoplasms diagnostic imaging, Image Enhancement methods, Intestinal Polyps diagnostic imaging, Narrow Band Imaging methods
- Abstract
Background and Aim: Endoscopic diagnosis of sessile serrated adenoma/polyp (SSA/P) is challenging because of their subtle appearance. Narrow-band imaging (NBI) is useful for diagnosis, but its utility with concurrent chromoendoscopy (CE), especially to detect small SSA/P, is unproven., Methods: This prospective study enrolled 367 consecutive patients who underwent screening colonoscopy with the finding of serrated polyps. Patients were divided into derivation and validation cohorts: Diagnostic criteria using different endoscopic modalities were generated by regression analysis in the derivation cohort and were validated in the validation cohort for sensitivity, specificity, and accuracy., Results: There were 180 patients with 119 SSA/P and 147 hyperplastic polyps (HP) in the derivation cohort and 187 patients with 177 SSA/P and 125 HP in the validation cohort. With white-light endoscopy plus NBI, mucus cap, surface grooves, and expanded crypt were most associated with SSA/P. With white-light endoscopy plus CE, II-O pit pattern, mucus cap, and superficial telangiectasia were most associated with SSA/P. With the combined use of these three modalities, II-O pit pattern, mucus cap, and surface grooves were most associated with SSA/P. For large serrated polyp, NBI in combination with CE had a better accuracy than NBI alone (91% vs 86%, P = 0.025) to distinguish SSA/P from HP. CE alone had a better accuracy than NBI alone for distinguishing small SSA/P from small HP (85% vs 72%, P < 0.0001)., Conclusion: Compared with NBI alone, adjunctive use of CE can improve the diagnostic accuracy for distinguishing SSA/P from HP, especially for small SSA/P., (© 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)
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- 2018
- Full Text
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45. The Serrated Polyp Pathway: Is It Time to Alter Surveillance Guidelines?
- Author
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O'Connell B, Hafiz N, and Crockett S
- Subjects
- Adenoma etiology, Colorectal Neoplasms etiology, Humans, Hyperplasia diagnostic imaging, Hyperplasia pathology, Intestinal Polyps pathology, Population Surveillance, Intestinal Polyps diagnostic imaging, Practice Guidelines as Topic
- Abstract
Purpose of Review: In this manuscript, we review current surveillance guidelines for serrated polyps (SPs) and discuss how recent studies inform the selection of appropriate surveillance intervals for patients with SPs., Recent Findings: Large and/or proximal SPs, particularly sessile serrated polyps (SSPs), are associated with increased risk of both synchronous and metachronous neoplasia, including advanced adenomas and colorectal cancer (CRC). Persons harboring multiple SSPs or dysplastic SSPs are at the highest risk. Moreover, a high percentage of large and/or proximal SPs are reclassified as SSPs when read by trained gastrointestinal pathologists, even if they were originally reported as hyperplastic polyps. These findings support the adoption of surveillance guidelines that prescribe closer surveillance of large and/or proximal SPs, regardless of subtype. SSPs remain a challenge to reliably identify, resect, and diagnose via histology. The increased risk of future neoplasia in patients with SSPs is likely driven by a combination of underdetection, inadequate removal, misclassification, and biology. Until further evidence emerges, we support guidelines that recommend close surveillance of patients with a history of large and/or proximal SPs and SSPs specifically in order to mitigate the threat of interval CRC.
- Published
- 2017
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46. Computer-Aided Detection of Colorectal Polyps at CT Colonography: Prospective Clinical Performance and Third-Party Reimbursement.
- Author
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Ziemlewicz TJ, Kim DH, Hinshaw JL, Lubner MG, Robbins JB, and Pickhardt PJ
- Subjects
- Colonography, Computed Tomographic statistics & numerical data, Female, Humans, Insurance, Health, Reimbursement statistics & numerical data, Machine Learning economics, Machine Learning statistics & numerical data, Male, Radiographic Image Interpretation, Computer-Assisted statistics & numerical data, Reproducibility of Results, Sensitivity and Specificity, United States epidemiology, Colonography, Computed Tomographic economics, Colorectal Neoplasms diagnostic imaging, Colorectal Neoplasms economics, Insurance, Health, Reimbursement economics, Intestinal Polyps diagnostic imaging, Intestinal Polyps economics
- Abstract
Objective: We assessed the initial clinical performance and third-party reimbursement rates of supplementary computer-aided detection (CAD) at CT colonography (CTC) for detecting colorectal polyps 6 mm or larger in routine clinical practice., Materials and Methods: We retrospectively assessed the prospective clinical performance of a U.S. Food and Drug Administration-approved CAD system in second-reader mode in 347 consecutive adults (mean age, 57.6 years; 205 women, 142 men) undergoing CTC evaluation over a 5-month period. The reference standard consisted of the prospective interpretation by experienced CTC radiologists combined with subsequent optical colonoscopy (OC), if performed. We also assessed third-party reimbursement for CAD for studies performed over an 18-month period., Results: In all, 69 patients (mean [± SD] age, 59.0 ± 7.7 years; 32 men, 37 women) had 129 polyps ≥ 6 mm. Per-patient CAD sensitivity was 91.3% (63 of 69). Per-polyp CAD-alone sensitivity was 88.4% (114 of 129), including 88.3% (83 of 94) for 6- to 9-mm polyps and 88.6% (31 of 35) for polyps 10 mm or larger. On retrospective review, three additional polyps 6 mm or larger were seen at OC and marked by CAD but dismissed as CAD false-positives at CTC. The mean number of false-positive CAD marks was 4.4 ± 3.1 per series. Of 1225 CTC cases reviewed for reimbursement, 31.0% of the total charges for CAD interpretation had been recovered from a variety of third-party payers., Conclusion: In our routine clinical practice, CAD showed good sensitivity for detecting colorectal polyps 6 mm or larger, with an acceptable number of false-positive marks. Importantly, CAD is already being reimbursed by some third-party payers in our clinical CTC practice.
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- 2017
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47. Assessment of colorectal polyp recognition skill: development and validation of an objective test.
- Author
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Hill A, Horswill MS, Plooy AM, Watson MO, Rowlands LN, Wallis GM, Riek S, Burgess-Limerick R, and Hewett DG
- Subjects
- Colonic Polyps diagnostic imaging, Female, Humans, Learning Curve, Male, Middle Aged, Observer Variation, Reproducibility of Results, Clinical Competence, Colon diagnostic imaging, Colonoscopy, Intestinal Mucosa diagnostic imaging, Intestinal Polyps diagnostic imaging, Rectum diagnostic imaging
- Abstract
Background: The quality of colonoscopy is known to vary. The extent to which colonoscopists can recognize the presence of subtle colorectal lesions by visually distinguishing them from the surrounding mucosa (i.e., polyp recognition skill) may be one of several attributes that influence polyp detection rates. The aim of the present study was to develop and validate the first objective test of polyp recognition skill., Methods: Validation study. Twenty-eight experienced colonoscopists and eighty novices took a preliminary 280-item computer-based polyp recognition test. Items were genuine endoscopic images which participants assessed for the presence of "likely polyps." Half included clinically identified polyps. Participants clicked on a suspected lesion or a button marked "no likely polyp", and the main outcome measures were accuracy and response latency. The best items were selected for the final 50-item test., Results: In the preliminary test, experienced colonoscopists correctly identified more polyps than novices (P < .0001) and better discriminated between clinically identified polyps and non-polyp features (as measured by d', P < .0001). For polyp items, the experienced group also responded faster (P < .01). Effect sizes were large for accuracy (Cohen's d = 3.22) and d' (Cohen's d = 3.22). The 50 final test items produced comparable results for accuracy, d', and response latency. For both versions of the test, score scale reliability was high for both polyp and non-polyp items (α = .82 to .97)., Conclusions: The observed experienced-novice differences support the construct validity of the performance measures derived from the tests, indicating that polyp recognition skill can be quantified objectively. The final test may potentially be used to assess trainees, but test sensitivity may be insufficient to make fine-grained distinctions between different skill levels among experienced colonoscopists. More sensitive future tests may provide a valuable supplement to clinical detection rates, allowing objective comparisons between skilled colonoscopists.
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- 2017
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48. The vanishing duodenal polyp: mesenteric invagination presenting as duodenal pseudopolyp.
- Author
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de Bakker BS, Phoa SSKS, Kara M, Al-Eryani S, Gielen ME, Ponsioen CIJ, de Bakker HM, and van Gulik TM
- Subjects
- Adult, Diagnosis, Differential, Endoscopy methods, Female, Humans, Intestinal Polyps surgery, Intussusception surgery, Tomography, X-Ray Computed methods, Treatment Outcome, Ultrasonography methods, Duodenum pathology, Intestinal Polyps diagnostic imaging, Intussusception complications
- Abstract
Duodenal polypoid masses are an uncommon finding mainly diagnosed incidentally at endoscopy or surgery. We report a 39-year-old female patient with symptoms of intermittent stabbing pain in the upper right abdominal quadrant and an iron deficiency anaemia, without complaints of weight loss, haematemesis or melaena. A duodenal polyp and acute duodenitis have been described during endoscopic examinations and CT and ultrasound. Surgical excision of the polyp was advised. Intraoperatively, an elongated duodenum was remarkable; however, at duodenotomy, no polyp was found, nor during intraoperative endoscopy. Looking back at the endoscopy and imaging results, it was noted that the polyp varied in size and location. It was therefore concluded that we dealt with the pseudopolyp phenomenon, caused by invagination of the duodenal wall and its mesentery into the duodenum, presenting as a lipomatous pseudopolyp. Telescopic invagination of the duodenal wall was facilitated by the elongated hypermobile duodenum., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
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- 2017
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49. Narrow-band imaging endoscopy is advantageous over conventional white light endoscopy for the diagnosis and treatment of children with Peutz-Jeghers syndrome.
- Author
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Cheng W, Liu H, Gu Z, Hu Z, Wang L, and Wang X
- Subjects
- Adenomatous Polyps diagnostic imaging, Adenomatous Polyps surgery, Adolescent, Child, Child, Preschool, Colon diagnostic imaging, Colon surgery, Female, Hamartoma diagnostic imaging, Hamartoma surgery, Humans, Male, Retrospective Studies, Sensitivity and Specificity, Stomach diagnostic imaging, Stomach surgery, Endoscopy, Gastrointestinal, Intestinal Polyps diagnostic imaging, Intestinal Polyps surgery, Narrow Band Imaging, Peutz-Jeghers Syndrome diagnostic imaging, Peutz-Jeghers Syndrome surgery
- Abstract
Using narrow-band imaging (NBI), the micro morphology of polyp surfaces was visualized at high resolution when the contrast between the lesions and the surrounding tissue areas was intensified. The objective of the study was to compare NBI and conventional white light endoscopy (C-WLI) for diagnostic efficacy and treatment of children with Peutz-Jeghers syndrome (PJS), a rare autosomal dominant-genetic disease.We retrospectively analyzed the clinical data of 18 patients diagnosed with PJS and 72 diagnosed with juvenile polyps during the same time period. Endoscopy was used to observe the morphology of polyps, which were classified according to the Kudo pit pattern. Eighty-two and 76 polyps were resected using endoscopy from PJS and juvenile polyp patients, respectively, and pathologically examined for comparison with NBI or C-WLI endoscopic observations.With NBI, 57 (69.5%) type I, 10 (12.2%) type II, and 13 (15.9%) type III polyps were identified in 82 (100%) polyps excised from 18 PJS patients, whereas 69 (88.5%) type I, 5 (6.4%) type II and 4 (5.1%) type III were identified in 78 (100%) of polyps removed from 72 juvenile polyp patients. The combined ratios of types II and III were higher in PJS (28.1%) than in juvenile polyp patients (11.5%). Pathological diagnosis identified 69 of 82 PJS polyps as hamartoma and 13 as adenoma, whereas NBI detected 10 adenomas and C-WLI only 4. The sensitivity, specificity, and accuracy of NBI in the diagnosis of adenoma were 76.9%, 97.1%, and 93.9%, respectively, whereas those of C-WLI were 30.8%, 94.2%, and 84.1%.NBI endoscopy had higher sensitivity and specificity than C-WLI for the diagnosis of adenomatous polyps and is recommended for the diagnosis, characterization, and resection of polyps in children with PJS.
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- 2017
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50. Small-bowel Surveillance in Patients With Peutz-Jeghers Syndrome: Comparing Magnetic Resonance Enteroclysis and Double Balloon Enteroscopy.
- Author
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Goverde A, Korsse SE, Wagner A, van Leerdam ME, Krak NC, Stoker J, van Buuren HR, Hofstra RM, Bruno MJ, Dewint P, Dekker E, and Spaander MC
- Subjects
- Double-Balloon Enteroscopy, Endoscopes, Gastrointestinal, Female, Humans, Ileal Neoplasms pathology, Intestinal Polyps pathology, Jejunal Neoplasms pathology, Magnetic Resonance Imaging, Male, Middle Aged, Netherlands, Sensitivity and Specificity, Ileal Neoplasms diagnostic imaging, Intestinal Polyps diagnostic imaging, Jejunal Neoplasms diagnostic imaging, Peutz-Jeghers Syndrome complications
- Abstract
Background and Study Aims: Small-bowel surveillance with polypectomy of polyps ≥15 mm prevents complications in patients with Peutz-Jeghers syndrome (PJS). We aimed to compare magnetic resonance enteroclysis (MRE) and double balloon enteroscopy (DBE) for diagnostic yield of these polyps and for patient preference., Materials and Methods: PJS patients prospectively underwent MRE followed by proximal DBE within 20 weeks. Endoscopists were blinded to the MRE results. We compared number of polyps ≥15 mm detected by MRE and DBE. Patients' perceptions of both procedures were assessed using questionnaires., Results: Fifteen PJS patients (67% males, median age 47 y) underwent both MRE and DBE. Polyps ≥15 mm were identified by MRE and/or DBE in 12/15 (80%) patients. There was no significant difference in the detection of polyps ≥15 mm (38 by MRE vs. 50 by DBE, P=0.37). Sensitivity for these polyps was 62% (38/61) for MRE and 82% (50/61) for DBE. Patients' perceived shame and burden did not differ significantly between MRE and DBE. Patients reported significantly more pain during preparation for MRE than for DBE (moderate vs. no pain, P=0.02), although perceived pain during the procedures was comparable (both mild, P=0.89). For future small-bowel surveillance 10/13 (77%) patients preferred DBE over MRE (P=0.09)., Conclusions: Our results suggest that MRE and DBE have a comparable diagnostic yield of polyps ≥15 mm. However, DBE allows for direct intervention and was preferred over MRE by most patients in this series. Larger cohorts of PJS patients are needed to fully evaluate the diagnostic yield of DBE compared with other modalities.
- Published
- 2017
- Full Text
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