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Background Methods Results Conclusion Sessile serrated lesions (SSL) account for up to 30% of colorectal carcinoma pathogenesis. With multiple classification changes and improvements in colonoscopy equipment and technique, historical reporting may have underestimated the true incidence of SSLs. This study aimed to determine the incidence of SSLs in patients undergoing colonoscopic investigation in Canterbury, New Zealand over a 1‐year period and describe their clinical and pathological characteristics.Electronic records were searched to identify all lower endoscopy procedures with polypectomy performed from 1 January 2022 to 1 December 2022 (inclusive). Patients' electronic records were used to collect histological classification, location and size of each polyp removed during their procedure. The primary outcome was the number of procedures that had one or more SSL, adenoma or hyperplastic polyp identified. Secondary outcomes included histological classification, location and size of each polyp removed.There were 4346 procedures completed during the study period. Of these, 64.1% (2786) had a polypectomy and 18.6% (808) had at least one SSL excised. Individual polyp analysis was completed on 9166 polyps and found that 24.0% of polyps removed were SSLs and they were found predominately in the right colon (65.1% right colon, 32.6% left colon, 2.3% rectum). SSLs were typically <10 mm (84.8%).This study found a higher incidence of SSLs compared to previous research. These results raise questions regarding whether SLL rates have been historically underestimated, whether SSL detection rate should be included as a key performance indicator and raises further concerns regarding the use of computed tomography colonography as a screening tool. [ABSTRACT FROM AUTHOR]

Objective: To analyze the efficacy of levonorgestrelintrauterine system, Drospirenone & ethinylestradiol tablets (II), and dydrogesterone in preventing the recurrence of endometrial polyps after hysteroscopic endometrial polypectomy. Methods: One hundred seventy patients who underwent hysteroscopic endometrial polypectomy in the Gynecology Department of Tianmen First People's Hospital in Hubei Province from January 2022 to June 2023 were randomly divided into the levonorgestrelintrauterine system group, Drospirenone & ethinylestradiol tablets (II) group, dydrogesterone group, and a control group. The recurrence rates, endometrial thickness, and menstrual volume changes at 6 and 12 months post-operation were compared among these four groups. Results: The recurrence rates in the levonorgestrelintrauterine system group, Drospirenone & ethinylestradiol tablets (II) group, and dydrogesterone group were lower than the control group, with statistical significance (P < 0.01), with the levonorgestrelintrauterine system group having the lowest recurrence rate. The endometrial thickness at 6 and 12 months post-operation in the levonorgestrelintrauterine system group, Drospirenone & ethinylestradiol tablets (II) group, and dydrogesterone group was thinner than that of the control group and thinner than pre-operation, with statistical significance (P < 0.01). The menstrual volume at 3 months post-operation in the levonorgestrelintrauterine system group, Drospirenone & ethinylestradiol tablets (II) group, and dydrogesterone group was significantly less than the control group, and less than the pre-operation volume. Conclusion: Dydrogesterone, drospirenone & ethinylestradiol tablets (II), and levonorgestrelintrauterine system all play a role in preventing the recurrence of endometrial polyps, but levonorgestrelintrauterine system is significantly better than dydrogesterone and Drospirenone & ethinylestradiol tablets (II) in terms of postoperative recurrence rate, endometrial thickness, menstrual changes, and compliance, and is worth promoting in clinical application. [ABSTRACT FROM AUTHOR]

Cold snare polypectomy (CSP) has the disadvantage of a lower histopathological complete resection rate (HCRR) because blunt resection using CSP‐dedicated snares (DSs) causes mucosal retraction into the sheath during capture/resection. In this study, attachments are designed to narrow the sheath tip's inner diameter from 1.8 to 1.3‒1.1 mm to prevent mucosal retraction. Eight prototype snares with different component characteristics are combined with these attachments. Additionally, product version DS with attachment (Smart Snare Cold) and existing DSs, such as Exacto Cold Snare, are prepared. For snare performance evaluation, the force required to resect (FRR) human colonic mucosa, mucosal retraction amount (MRA), and clinical data are obtained. The attachments that narrowed the inner diameter to 1.3 or 1.1 mm reduce the FRR to 74.9%−93.8% and 68.0%−84.9%, respectively, and reduce the MRA to 21.0%−35.3% and 15.1%−26.8%, respectively. Thus, the reduced inner diameter improves resection ability and prevents mucosal retraction. The clinical findings show that Smart Snare Cold has significantly higher muscularis mucosa resection rates and HCRRs than Exacto Cold Snare (P < 0.001 and P = 0.003, respectively). Thus, the novel DS with tip attachment improves the HCRR and overcomes the current CSP disadvantage by simultaneously improving resection ability and preventing mucosal retraction. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of hysteroscopic polypectomy on the in vitro fertilization (IVF) results in infertile women with at least one prior negative IVF outcome. Methods: This retrospective cohort study included women who had attended the "2nd Department of Obstetrics and Gynecology of the National and Kapodistrian University of Athens" and "Iaso" Maternity Hospital from October 2019 to January 2023 for infertility treatment. The medical records of 345 women aged 18–45 years old without abnormal findings in hysterosalpingography (HSG) and with at least one previous failed IVF procedure were analyzed. The male factor was excluded, as well as a prior hysteroscopic removal of polyps. In 67 women, polyps were suspected during initial two-dimensional ultrasound (2D-US) examination. The final sample of the study comprised 40 patients, in which endometrial polyps were removed by hysteroscopy with the use of resectoscope. All patients underwent ovarian stimulation and IVF in the consecutive cycle using a short GnRh antagonist protocol. Main Results: After hysteroscopic polypectomy, 29 (72.5%) out of 40 patients had a positive pregnancy result: 26 (65%) clinical and 3 (7.5%) biochemical pregnancies were documented. There was a statistically significant difference between the number of clinical pregnancies before and after polypectomy (p < 0.001), as well as between the total number of pregnancies (p < 0.001). Secondary Results: Women with positive outcome were significantly younger and had significantly lower FSH levels (p < 0.007). They also had significantly higher AMH (p < 0.009) and peak estradiol levels (p < 0.013) and yielded more M II oocytes (p < 0.009) and embryos (p < 0.002). Conclusions: Hysteroscopic polypectomy in women with a suspected endometrial polyp using 2D ultrasound and a history of prior failed IVF attempt improves IVF outcomes in terms of the clinical and total number of pregnancies. [ABSTRACT FROM AUTHOR]

In this work, for the first time, the specific impedances of various injection solutions as well as the surface and tissue impedance after injection of these solutions were analyzed and compared regarding the radio-frequency surgical cutting process. The impedances of 0.9% NaCl, 4% gelatine, 6% hydroxyethyl starch, 10% glycerol/5% fructose, 10% glucose, 5% and 20% albumin, blood, and blood plasma as well as aqua destillata have been tested in vitro. Even if EMR and ESD are routinely used in clinical practice, there is so far no easy, fast, and safe method to remove larger lesions en bloc. We show that the impedance of the injected solution shows to be a crucial factor for safe removal, especially of larger lesions (Ø > 20 mm) and more importantly in accordance with the requirements of oncology and pathology. Key messages: Impedance is playing a crucial factor in the radio-frequency (RF)-surgery. With a higher Impedance there will be less current necessary to reach the aimed voltage. Injection solution Aqua destillata and 10% Glucose, show significantly higher Impedances. Higher impedances lead to less surgical related complications. Minor changes in existing method to improve patent safety. [ABSTRACT FROM AUTHOR]

• 80 women were randomized to random start nomegestrol acetate/estradiol (n=40) or control (n=40) before undergoing hysteroscopic polypectomy. • Endometrial thickness both pre- and post- hysteroscopic polypectomy was significantly thinner for the intervention group (p < 0.001). • Endometrial preparation, visualization quality, and procedural satisfaction were higher in the intervention group (p < 0.001). • Random start nomegestrol acetate/estradiol provides rapid, satisfactory, low-cost endometrial preparation before polypectomy. To evaluate the use of oral nomegestrol acetate/estradiol in random start rapid preparation of endometrium before office hysteroscopic polypectomy. Multicenter, prospective, randomized controlled trial. University hospitals. 80 adult women undergoing office hysteroscopic polypectomy between January 2023 and March 2024 were randomized to intervention (n = 40) or control (n = 40). Exclusion criteria included the presence of endouterine pathology other than endometrial polyps solely. Subjects in the intervention group were treated with oral nomegestrol acetate/estradiol 1.5 mg/2.5 mg/day started taking the drug from an indefinite time in the menstrual cycle (random start) for 14 days. Subjects in the control group did not receive any pharmaceutical treatment and underwent polypectomy between days 8 and 11 of the menstrual cycle. On the day of the procedure, the difference in pre- and post-office hysteroscopic polypectomy endometrial ultrasound thickness was statistically significant between the two groups, with endometrial thickness in both measurements being thinner for the intervention group (p < 0.001). In the nomegestrol acetate/estradiol-treated group, compared with the control, there was also a statistically significant difference in the physician's assessment of the quality of endometrial preparation (p < 0.001), the quality of visualization of the uterine cavity (p < 0.001), and satisfaction with the performance of the procedure (p < 0.001). Finally, all surgical outcomes analyzed were better in the treatment group. Treatment with nomegestrol acetate/estradiol could provide rapid, satisfactory and low-cost preparation of the endometrium before office polypectomy, thus improving surgical performance and woman's compliance. ClinicalTrials.gov NCT06316219. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To determine a risk scoring system for predicting advanced colorectal neoplasia (ACN) within subcentimetric polyps in a large Asian population.A retrospective study was conducted in Hong Kong SAR, China involving participants who underwent colonoscopy between 2008 and 2015. A random sample of 20 072 subjects were included as the derivation cohort to assess ACN‐associated independent factors using logistic regression modeling. Another 8603 subjects formed a validation cohort. A risk scoring system was developed and its performance was assessed using the area under the receiver operating characteristic curve (AUROC).The risk scores were assigned based on the following criteria: (a) patients who were admitted from inpatient colonoscopy (2.2) or not (1); (b) with three or more chronic diseases (hypertension, diabetes mellitus, hyperlipidemia, heart disease, or cancer) (1.7) or not (1); (c) anemia (1.3) or without anemia (1); (d) receiving aspirin (0.5) or not (1); (e) receiving other nonsteroidal anti‐inflammatory drugs (0.3) or not (1); (f) male (1.2) or female gender (1); (g) age <55 (1), 55–64 (1.4), 65–69 (2), 70 years or above (2.2). ACN was more common in those with scores of 2.192 or higher, and they were classified as high risk (HR). The prevalence of ACN in the validation cohort was 13.28% and 3.56% in the HR and low‐risk groups, respectively. In both the derivation and validation cohorts, AUROC of the risk‐scoring model was 0.7138.Physicians are recommended to utilize this validated score for risk‐stratification of patients having subcentimetric polyps. [ABSTRACT FROM AUTHOR]

Purpose: The fragmentation of polyps affects complete resection confirmation. The primary aim of this study was to assess the feasibility of a novel polyp retrieval bag for reducing the fragmentation rate of colon polyps. Methods: Patients with a 5–15 mm colon polyp were recruited and randomized into two groups at a 1:1 ratio. After polyp resection, polyps obtained from patients in the treatment group were extracted via a novel polyp retrieval bag without traversing the instrument channel, whereas polyps obtained from patients in the control group were collected through the instrument channel, attaching the polyp trap to the instrument channel port, and applying suction. Results: From January to July 2022, 225 patients were assessed for eligibility. The study participants included 204 patients, and seven patients whose samples were not retrieved were excluded. Polyp fragmentation was significantly lower in the treatment group than in the control group (3.0% [3/100] vs. 17.5% [17/97], P = 0.001). The retrieval failure rates in the treatment group and control group were not significantly different (2.0% [2/102] vs. 4.9% [5/102], P = 0.442). There were fewer colonoscope insertions in the treatment group than in the control group (102 vs. 110), but a significant difference was not present (P = 0.065). No significant adverse events were observed during the follow-up. Conclusions: This study demonstrated that the polyp retrieval bag was safe and feasible for reducing the fragmentation rate of retrieved polyps. Trial registration: The study was registered at ClinicalTrials.gov (NCT05189912, 1/12/2021). [ABSTRACT FROM AUTHOR]

Background: Delayed bleeding (DB) is a serious complication after cold snare polypectomy (CSP) for polyps in the colon. The present study aimed to investigate the incidence and risk factors of DB after CSP and to develop a risk-scoring model for predicting DB. Methods: A retrospective study was conducted in four Chinese medical institutions. 10650 patients underwent CSP from June 2019 to May 2023. The study analyzed the rate of DB and extracted the general clinical information and polyp-related information of patients with postoperative DB. As a control, non-DB patients who received CSP at the same 4 hospitals were analyzed. A multivariate Cox regression analysis was performed to develop the prediction model. The model was further validated using a Kaplan–Meier log-rank analysis, receiver operating characteristic curve (ROC) plot and risk plot. Results: In our study, we found a 0.24% rate of DB and the risk factors were history of hypertension, hyperlipidemia, antithrombotics use, antiplatelet use, anticoagulant use, abdominal operation, sigmoid colon lesion, hematoma, cold snare defect protrusion, polyp size, wound size, the grade of wound bleeding, and morphology of Ip. These factors were incorporated into the prediction model for DB after CSP. For 1, 3, and 5 days of bleeding, the AUC of the ROC curve was 0.912, 0.939, and 0.923, respectively. The Kaplan–Meier analysis indicated that the high-risk group had a significantly higher risk of DB than the low-risk group. Conclusions: This study screened the risk factors and established a prediction model of DB after CSP. The results may help preventing and reducing the DB rate after CSP of colorectal polyps. [ABSTRACT FROM AUTHOR]

Background and aim: Guidelines suggest endoscopic resection for rectal neuroendocrine tumors (rNETs) < 10 mm, but the most appropriate resection technique is unclear. In real-life clinical practice, the endoscopic removal of unrecognized rNETs can take place with "simple" techniques and without preliminary staging. The aim of the current study is to report our own experience at a referral center for both neuroendocrine neoplasms and endoscopy. Methods: Retrospective analyses of polypectomies were performed at the Humanitas Research Hospital for rNETs (already diagnosed or previously unrecognized). Results: A total of 19 patients were included, with a median lesion size of 5 mm (range 3–10 mm). Only five lesions were suspected as NETs before removal and underwent endoscopic ultrasound (EUS) before resection, being removed with advanced endoscopic techniques. Unsuspected rNETs were removed by cold polypectomy in eleven cases, EMR in two, and biopsy forceps in one. When described, the margins were negative in four cases, positive in four (R1), and indeterminate in one. The median follow-up was 40 months. A 10 mm polypoid lesion removed with cold snare polypectomy (G2 R1) needed subsequent surgery. Eighteen patients underwent EUS after a median time of 6.5 months from resection. The EUS identified local recurrence after 14 months in a 7 mm polypoid lesion removed with cold snare polypectomy (G1 R1); the lesion was treated with cap-assisted EMR. For all the other lesions, the follow-up was negative. Conclusions: When rNETs are improperly removed without prior staging, caution must be exercised. The data from our cohort suggest that even if inappropriate resection had happened, patients may be safely managed with early EUS evaluation. [ABSTRACT FROM AUTHOR]

Background/Aims: Polyps greater than 30 mm are classified as "giants". Their endoscopic removal represents a technical challenge. The choice of the endoscopic removal technique is important because it provides a resection sample for precise histopathological staging. This is pivotal for diagnostic, prognostic, and management purposes. Methods: From a retrospective analysis, we obtained a sample of 38 giant polyps. Eighteen polypectomies were performed using the epinephrine volume reduction (EVR) method, nine polypectomies utilized endo-looping or clipping methods, and 11 patients underwent surgery. Results: We obtained en bloc resection with the EVR method in all cases; histology confirmed the correct indication for endoscopic resection in all cases. Moreover, no early or delayed complications were observed, and no patient required hospitalization. Using endo- looping or clipping methods, we observed advanced histology in 1/9 (11.1%) cases, while another patient (1/9, 11.1%) had delayed bleeding. Among patients who underwent surgery, 5/11 (45.5%) were deemed overtreated and three had post-surgical complications. Conclusions: We propose EVR as an alternative technique for giant polyp resection due to its safety, effectiveness, cost-efficiency, and the advantage of avoiding the need to postpone polypectomy to a later time. Further prospective studies might help improve this experience and enhance the technique. [ABSTRACT FROM AUTHOR]

Background The wide range of R0 resection rates (R0RR) and incomplete resection rates (IRR) observed with conventional cold snare polypectomy (CCSP) emphasizes the necessity for technique enhancement. The COLDWATER study aimed to compare underwater cold snare polypectomy (UCSP) to CCSP for 5-10-mm colorectal polyps, focusing on comprehensive histopathological evaluation, efficacy, and safety. Methods This was a randomized, single-blind, controlled trial comparing UCSP to CCSP for nonpedunculated colorectal polyps of size 5-10 mm. The primary outcome was to report differences in the muscularis mucosa resection ratio. The secondary outcomes focused on differences in depth of excision, R0-RR, IRR, en bloc resection rate, adverse events, and recurrence rate. Results The COLDWATER study found higher muscularis mucosa resection in UCSP (81.72±62.81% vs. CCSP: 72.33±22.33%, P=0.003) with comparable submucosa presence (UCSP: 16.6%, CCSP: 12.5%, P=0.25). UCSP showed better outcomes regarding IRR (3.5% vs. 8.5%, P=0.05) and en bloc resection (98% vs. 93.5%, P=0.04). In CCSP, expert endoscopists achieved higher R0RR than nonexperts, while UCSP showed no significant difference in R0RR across endoscopist's experience levels. Conclusions UCSP achieves a more extensive excision of the muscularis mucosa compared to CCSP, even though it does not attain a deeper excision. Additionally, UCSP shows a higher en bloc resection rate, with lower rates of IRR, and emerges as a promising technique for training inexperienced endoscopists in polypectomy, given its experience-independent success in achieving R0 resection. [ABSTRACT FROM AUTHOR]

Combined endoscopic mucosal resection (EMR) with endoscopic Full thickness resection (EFTR) is an emerging technique that has been developed to target colorectal polyps larger than 2 cm. We performed a systematic review and meta-analysis to evaluate this technique for the resection of large colorectal lesions. We conducted a comprehensive search of multiple electronic databases from inception through August 2023, to identify studies that reported on hybrid FTR. A random-effects model was employed to calculate the overall pooled technical success, macroscopic complete resection, free vertical margins resection rate, adverse events, and recurrence on follow up. A total of 8 Study arms with 244 patients (30% women) were included in the analysis. The pooled technical success rate was 97% (95% CI 88%-100%, I2 = 79.93%). The pooled rate of macroscopic complete resection was achieved in 95% (95% CI 90%-99%, I2 = 49.98) with a free vertical margins resection rate 88% (95% CI, 78%-96%, I2 = 63.32). The overall adverse events rate was 2% (95% CI 0%-5%, I2 = 11.64) and recurrence rate of 6% (95% CI 2%-12%, I2=20.32). Combined EMR with EFTR is effective and safe for resecting large, and complex colorectal adenomas, offering a good alternative for high surgical risk patients. Regional heterogeneity was observed, indicating that outcomes may be impacted by differences in operator expertise and industry training certification across regions. Comparative studies that directly compare combined EMR with EFTR against alternative methods such as ESD and surgical resection are needed. [ABSTRACT FROM AUTHOR]

Introduction Aural polyps are a misnomer. Any lesion can present as a mass in the external auditory canal. Aural polyps are proliferation of the granulation tissue due to long standing inflammatory process with associated otalgia and otorrhea. Objectives To document the clinicoradiological presentations, intraoperative findings, and histopathological diagnosis of aural polyp, correlating them. Methods In our study 81 patients underwent treatment for aural polyps in the department of Ear, Nose, and Throat (ENT) from April 1997 to April 2022. Results were tabulated, a simple descriptive analysis was done using the Statistical Package Social Sciences software, and the results obtained were represented as percentages and presented in tables. Results The majority (38) of the patients presenting with aural polyps were diagnosed with mucosal and squamous type of CSOM, and 22 with simple granulation polyps. There were also 5 patients with malignant otitis externa, 3 patients had glomus tumors, 2 patients with retained foreign bodies, and 3 patients with brain herniation. We also identified aberrant internal carotid artery, high jugular bulb, one patient had facial nerve neuroma, one patient had polyp from the tragus diagnosed with tuberculosis, one patient with keratosis obturans, and one with exostosis. Conclusion A thorough detailed examination and mastoid exploration with radiological and histopathological evaluation is mandatory for better defining the definitive treatment. Utmost care and meticulousness are advised for the surgeons while dealing with aural polyps to avoid any complications. [ABSTRACT FROM AUTHOR]

The modified Graham patch repair is a well-established technique for management of perforating foregut injuries, often learned by surgeons during general surgery training. There is, however, little to no data regarding the utilization of this technique for perforation of the distal midgut or in the re-operative field. We present two cases of midgut anastomotic complications successfully managed with modified graham patch repair at our institution. The first case is a 79-year-old female who underwent an emergent right hemicolectomy at an outside institution for management of an iatrogenic perforation during endoscopic polypectomy. Over the course of two years she underwent numerous abdominal operations, due to various complications, ultimately resulting in multiple resections and end ileostomy creation. She then had her ileostomy reversed by laparoscopic single incision (SILS) technique at our institution. This was also complicated by anastomotic leak. Intraoperatively, adequate mobilization of the anastomosis for resection was deemed not safe due to dense fibrosis and adhesions in the re-operative field; therefore, she underwent a SILS modified Graham patch repair of an ileocolic anastomotic defect with diverting loop ileostomy. Post-operatively, she had no radiographic evidence of leak from the repaired anastomosis, which facilitated successful loop ileostomy reversal five months later. Our second case is a 64-year-old male referred to our institution for management of his stage IV colon cancer. He underwent an open right hemicolectomy and hepatic metastectomy, which was complicated by anastomotic leak. The small defect was repaired via a SILS modified Graham patch technique. Five months postoperatively, he had neither radiographic nor endoscopic evidence of a leak; therefore, he successfully underwent ileostomy reversal without complication. We encourage further investigation and reporting of the role of the modified graham patch repair in management of midgut anastomotic complications, particularly when resection and re-anastomosis is unsafe due to a hostile re-operative field. [ABSTRACT FROM AUTHOR]

Background: Few studies have evaluated the post-endoscopic adverse events in patients with neutropenia and thrombocytopenia. Current guidelines do not provide clear direction on this topic. Aim: We explore the pooled rates of safety and adverse effects of endoscopic interventions in thrombocytopenia and neutropenia patients via a systematic review & meta-analysis. Methods: Databases, including Medline, Scopus, and Embase, were searched (in May 2023) using specific terms for studies evaluating the clinical outcomes of endoscopy in patients with thrombocytopenia and neutropenia. Standard meta-analysis methods were employed using the random-effects model. I2% heterogeneity was used to assess the heterogeneity. Results: Six studies and four studies evaluated endoscopic outcomes in patients with thrombocytopenia and neutropenia respectively with mean age was 56 years. The pooled rate of total post-biopsy bleeding and total post-polypectomy bleeding among patients with thrombocytopenia was 4% (95% CI 1–11), I2 = 84%, and 12% (95% CI 3–36) I2 = 43%. The total rate of post procedure-related bleeding in thrombocytopenia was 5% (95% CI 1–14) I2 = 95%. The pooled rate of post-endoscopic infection (fever from any cause, bacteremia) in neutropenia was 10% (95% CI 3–28%) I2 = 96%. On sub analysis, the pooled rate of bacteremia and 30 days all-cause mortality in neutropenia was 4% (95% CI 3–5%) I2 = 0% and 13% (95% CI 4–34%) I2 = 95% respectively. Conclusion: Our data supports the notion that endoscopic procedures are safe for neutropenic, thrombocytopenic patients with suitable indications and reasonable functional status and have an acceptable risk/benefit ratio. [ABSTRACT FROM AUTHOR]

Background: Patients with end-stage renal disease (ESRD) who undergo polypectomy may experience postpolypectomy bleeding. To reduce the risk of delayed postpolypectomy bleeding among the general population, cold snare polypectomy (CSP) is recommended for removing colon polyps smaller than 1 cm. Nevertheless, only few studies have examined the effect of CSP on patients with ESRD. Methods: We retrospectively analyzed the data of patients with ESRD who underwent colonoscopic polypectomy for polyps larger than 5 mm at a Taiwanese university hospital from January 2014 to January 2023. The main outcome was delayed postpolypectomy bleeding within 30 days. Multivariate analysis was conducted to adjust for major confounders. Results: A total of 557 patients with ESRD underwent colonoscopic polypectomy during the study period: 201 underwent CSP and 356 underwent hot snare polypectomy (HSP). Delayed postpolypectomy bleeding occurred in 27 patients (4.8%). The rate of delayed postpolypectomy bleeding was lower in patients with ESRD who underwent CSP than in those who underwent HSP (1.9% vs. 6.4%, P = 0.022). The percentage of patients who did not experience postpolypectomy bleeding within 30 days after CSP remained lower than that observed after HSP (P = 0.019, log-rank test). Multivariate analysis demonstrated immediate postpolypectomy bleeding and HSP to be independent risk factors for delayed postpolypectomy bleeding. A nomogram prognostic model was used to predict the potential of delayed postpolypectomy bleeding within 30 days in patients with ESRD. Conclusions: Compared with HSP, CSP is more effective in mitigating the risk of delayed postpolypectomy bleeding in patients with ESRD. [ABSTRACT FROM AUTHOR]

Background: Australia's National Bowel Cancer Screening Program consists of an immunohistochemical faecal occult blood test, targeting adults aged 50–74. Existing literature supports the principle of early detection of colorectal cancer (CRC) via national screening, but little is known about the association between colonoscopy or polypectomy rates and CRC stage over time. The aim of this study is to identify the longitudinal change to colonoscopy and polypectomy rates, and any stage shift associated with this screening program. Methods: A retrospective data‐linkage study was performed using the Australian national health database (Medicare) to obtain colonoscopy and polypectomy rates between 1998 and 2017. A second prospective database of CRC resection specimens was analysed for this period. The cohort was divided based on time intervals related to the National Bowel Cancer Screening Program: pre‐commencement 1998–2006 (Period A), immediately post‐commencement 2007–2011 (Period B), and subsequent years 2012–2017 (Period C). Linear regression was used to test relation between annualized predictor and response variables. Results: Annual colonoscopy rates doubled, and polypectomy rates tripled during the study (P < 0.001). Annual colonoscopy rate correlated to a lower T‐stage (P = 0.038) and lower N‐stage (P = 0.026), and there was a 7% increase in early CRC (stage I–II) in Period C (P < 0.001). Across the study period there was also a significant increase in right‐sided tumours, and concurrent MMR deficiency and BRAF mutation. Conclusion: Polypectomy and colonoscopy rates increased after the introduction of the National Bowel Cancer screening program. There was a clinically significant shift to earlier CRC stage which manifested 5 years after its implementation. [ABSTRACT FROM AUTHOR]

INTRODUCTION: This study aimed to compare the accuracy of polyp size measurements using a virtual scale endoscope (VSE) with an integrated laser-based adaptive scale function and visual assessment (VA) during colonoscopies. METHODS: We conducted a single-blinded, prospective randomized controlled trial. Eligible patients (aged 45-80 years) undergoing screening, surveillance, or diagnostic colonoscopies were randomly assigned (1:1) into 2 groups. In the intervention group, all detected polyps were measured for size using VSE; in the control group, all polyps were measured using VA. Size measurements were compared with a reference standard of digital caliper measurement immediately post polypectomy. The primary outcome was the relative accuracy of real-time VSE measurement compared with VA. Secondary outcomes included the mean differences and the correlations between VSE or VA sizes and the reference standard of measurement. RESULTS: Overall, 230 patients were enrolled and randomized. The relative size measurement accuracy of VSE was84%in 118 polyps, which was significantly higher than that of VA (105 polyps; 68.4%, P < 0.001). VSE resulted in a significantly higher percentage of size measurements within 25% of true size compared with VA (81.4% vs 41%, P < 0.001). VSE had a significantly lower percentage for >5-mm polyps incorrectly sized as 1-5mmcompared with VA (13.5% vs 57.1%; P < 0.001) and a significantly lower percentage for >3-mm polyps incorrectly sized as 1-3 mm compared with VA (11.3% vs 56.5%; P < 0.001). DISCUSSION: VSE significantly improves the size measurement accuracy of colorectal polyps during colonoscopies compared with VA and results in fewer misclassifications at relevant decision-making size thresholds. [ABSTRACT FROM AUTHOR]

Real-time prediction of histologic features of small colorectal polyps may prevent resection or pathologic evaluation and therefore decrease colonoscopy costs. This prospective, single-group study at 6 U.S. sites assessed the diagnostic performance of histologic predictions by general endoscopists before and after assistance from computer-aided diagnosis in a real-life setting. Visual Abstract. Artificial Intelligence for Real-Time Prediction of the Histology of Colorectal Polyps by General Endoscopists: Real-time prediction of histologic features of small colorectal polyps may prevent resection or pathologic evaluation and therefore decrease colonoscopy costs. This prospective, single-group study at 6 U.S. sites assessed the diagnostic performance of histologic predictions by general endoscopists before and after assistance from computer-aided diagnosis in a real-life setting. Background: Real-time prediction of histologic features of small colorectal polyps may prevent resection and/or pathologic evaluation and therefore decrease colonoscopy costs. Previous studies showed that computer-aided diagnosis (CADx) was highly accurate, though it did not outperform expert endoscopists. Objective: To assess the diagnostic performance of histologic predictions by general endoscopists before and after assistance from CADx in a real-life setting. Design: Prospective, multicenter, single-group study. (ClinicalTrials.gov: NCT04437615) Setting: 6 centers across the United States. Participants: 1252 consecutive patients undergoing colonoscopy and 49 general endoscopists with variable experience in real-time prediction of polyp histologic features. Intervention: Real-time use of CADx during routine colonoscopy. Measurements: The primary end points were the sensitivity and specificity of CADx-unassisted and CADx-assisted histologic predictions for adenomas measuring 5 mm or less. For clinical purposes, additional estimates according to location and confidence level were provided. Results: The CADx device made a diagnosis for 2695 polyps measuring 5 mm or less (96%) in 1252 patients. There was no difference in sensitivity between the unassisted and assisted groups (90.7% vs. 90.8%; P = 0.52). Specificity was higher in the CADx-assisted group (59.5% vs. 64.7%; P < 0.001). Among all 2695 polyps measuring 5 mm or less, 88.2% and 86.1% (P < 0.001) in the CADx-assisted and unassisted groups, respectively, could be resected and discarded without pathologic evaluation. Among 743 rectosigmoid polyps measuring 5 mm or less, 49.5% and 47.9% (P < 0.001) in the CADx-assisted and unassisted groups, respectively, could be left in situ without resection. Limitation: Decision making based on CADx might differ outside a clinical trial. Conclusion: CADx assistance did not result in increased sensitivity of optical diagnosis. Despite a slight increase, the specificity of CADx-assisted diagnosis remained suboptimal. Primary Funding Source: Olympus America Corporation served as the clinical study sponsor. [ABSTRACT FROM AUTHOR]

BACKGROUND. Antrochoanal polyps (ACP) were originally reported by Gustav Killian in 1906. Antrochoanal polyps (ACPs) are benign polypoid lesions that begin in the maxillary antrum and extend into the choana. Although there have been recorded occurrences of bilateral ACPs in the literature, ACPs are mostly unilateral. They typically have an impact on youth and youngsters. MATERIAL AND METHODS. In a trial of 15 cases treated and admitted to our ENT Pediatric Department at the Emergency County Hospital Timisoara over the previous four years, the pathology, differential diagnosis, treatment, complications, etiopathogenesis, clinical features, positive and differential diagnosis, preoperative evaluation, pathology, and treatment of ACPs were reviewed in this study. RESULTS. The patients age group comprised five females (33.33%) and ten boys (66.67%), ranging in age from 7 to 16 years. The most common presenting symptoms were unilateral nasal obstruction (100%), purulent rhinorrhea (66.67%), olfactory impairment (53.33%), and mouth breathing (46.67%). A nasal endoscopy and a craniofacial CT scan were the gold standards for diagnosing ACP. The chosen course of treatment for all pediatric patients included in the study was surgery: 12 patients (80%) underwent transnasal endoscopic polypectomy, and 3 patients (20%) underwent both transnasal polypectomy and transcanine fossa approach. The success rate of the combined endoscopic and transcanine fossa approach was 100%, whereas the transnasal endoscopic surgery (polypectomy) had an 80% success rate. CONCLUSION. Polypectomy combined with a transcanine fossa approach technique and transnasal polypectomy is the optimal course of treatment. [ABSTRACT FROM AUTHOR]

Introduction: Endoscopic submucosal dissection (ESD) has been popular worldwide to treat laterally spreading tumors and large polyps. Post-ESD coagulation syndrome (PECS) is more common than the two major ESD-related complications, perforation, and bleeding. The aim of this study was to assess the prevalence of PECS, identify the risk factors for PECS, and create a risk prediction model for PECS. Methods: Retrospective cross-sectional study analyzed a total of 986 patients who underwent colorectal ESD. Logistic regression models were used to assess risk factors with PECS. Each risk factor was scored, and the 3-step risk stratification index of prediction model was assessed. Results: The prevalence of PECS was 21.4% (95% confidence interval [CI] = 18.9–24.1%). The risk factors of PECS in the multivariate logistic regression were tumor size (+1 cm: odds ratio [OR], 1.29; 95% CI, 1.16–7.09), cecal lesion (OR, 1.96; 95% CI, 1.09–1.53), procedure time (+30 min: OR, 1.19; 95% CI, 1.02–1.39), and ESD with snaring (OR, 0.64; 95% CI, 0.43–0.95). Applying a simplified weighted scoring system based on adjusted OR increments of 1, the risk of PECS was 12.3% (95% CI, 0.3–16.0%) for the low-risk group (score ≤4) and was 36.0% (95% CI = 29.4–43.2%) for the high-risk group (score ≥8). Overall discrimination (C-statistic = 0.629; 95% CI = 0.585–0.672) and calibration (p = 0.993) of the model were moderate to good. Conclusion: PECS occurs frequently, and the prediction model can be helpful for effective treatment and prevention of PECS. [ABSTRACT FROM AUTHOR]

Background/Aims Polyps greater than 30 mm are classified as “giants”. Their endoscopic removal represents a technical challenge. The choice of the endoscopic removal technique is important because it provides a resection sample for precise histopathological staging. This is pivotal for diagnostic, prognostic, and management purposes. Methods From a retrospective analysis, we obtained a sample of 38 giant polyps. Eighteen polypectomies were performed using the epinephrine volume reduction (EVR) method, nine polypectomies utilized endo-looping or clipping methods, and 11 patients underwent surgery. Results We obtained en bloc resection with the EVR method in all cases; histology confirmed the correct indication for endoscopic resection in all cases. Moreover, no early or delayed complications were observed, and no patient required hospitalization. Using endo-looping or clipping methods, we observed advanced histology in 1/9 (11.1%) cases, while another patient (1/9, 11.1%) had delayed bleeding. Among patients who underwent surgery, 5/11 (45.5%) were deemed overtreated and three had post-surgical complications. Conclusions We propose EVR as an alternative technique for giant polyp resection due to its safety, effectiveness, cost-efficiency, and the advantage of avoiding the need to postpone polypectomy to a later time. Further prospective studies might help improve this experience and enhance the technique.

The primary objective of this pilot study was to identify which aspects of in-office rhinologic procedures (IORPs) warrant further attention and investigation in the future. The secondary objectives were to survey which IORPs are most common and to identify needs for education and training. A cross-sectional study was carried out following the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). The survey collected demographic, organizational, quality, and safety aspects of IORPs and was electronically distributed to YO-IFOS members across five continents. A total of 194 surgeons completed the survey, and 172 respondents (88%) performed IORPs. Ninety-nine responders (51.5%) worked in an academic setting. Common procedures included powered polypectomy (48, 28.4%) and turbinate reduction (93, 54.1%). The main concerns were about patients’ tolerance (116, 76.3%) and about the safety of the procedure (102, 67.1%). The most important barriers to the diffusion of IORPs are concerns about the tolerance and safety of these procedures. It would be convenient to establish protocols for this type of procedure to ensure the greatest patient comfort based on evidence.

Electrosurgical generator units (ESUs) are instrumental in modern therapeutic gastrointestinal (GI) endoscopy, converting household alternating current into high-frequency current to generate thermal energy within tissues. This review elucidates the essentials of electrosurgery, exploring the thermal effects on tissue, current resistance, voltage, current density, duty cycle, crest factor, and the distinctions between monopolar and bipolar circuitry. The concept of duty cycle, the proportion of time electrical current is delivered, and crest factor, the ratio of peak to root mean square voltage, are essential while comparing differently named modes across various commercially available ESUs. This article discusses the practical applications of electrosurgery in therapeutic GI endoscopy procedures, including endoscopic sphincterotomy, polypectomy, endoscopic mucosal resection, endoscopic submucosal dissection, and peroral endoscopic myotomy. It outlines recommended modes and settings for ESUs across various procedures, emphasizing the balance between cutting and coagulation to achieve optimal outcomes while minimizing adverse effects. The review further addresses special considerations for the use of grounding pads and the management of patients with implanted cardiac devices during electrosurgical procedures. This article concludes with a call for a deeper understanding of electrosurgical principles and their application in GI endoscopy to ensure patient safety and procedural success, backed by references to relevant literature and detailed tables summarizing electrosurgical modes and settings for various therapeutic interventions.

Background: To investigate the impact of chronic endometritis (CE) on the recurrence of endometrial polyps (EPs) in premenopausal women after transcervical resection of endometrial polyps (TCRP). Methods: This prospective study enrolled 507 women who underwent TCRP between January 1, 2022 and December 31, 2022. The patients were divided into a CE group (n = 133) and non-CE group (n = 374) based on the expression of CD138 in the endometrium. The EP recurrence rate at 1 year after TCRP was compared between the CE and non-CE groups and between groups with mild CE and severe CE. The impact of CD138 expression by resected EPs on EP recurrence also was investigated. Results: The EP recurrence rate at 1 year post-TCRP was higher in the CE group than in the non-CE group (25.6% vs. 10.4%) and also higher in the severe CE group than in the mild CE group (34.5% vs. 18.7%). Additionally, the EP recurrence rate was higher among patients with CD138-expressing EPs than among those with EPs lacking CD138 expression (30.5% vs. 6.5%). The odds ratio (OR) for EP recurrence in the CE cohort compared with the non-CE cohort was 3.10 (95% confidence interval [CI] 1.84–5.23) after adjustment for EP number and precautions against EP recurrence. The ORs for EP recurrence in patients with mild CE and severe CE were 2.21 (95%CI 1.11–4.40) and 4.32 (95%CI 2.26–8.26), respectively. Similarly, the OR for EP recurrence in cases with CD138-expressing EPs relative to cases with EPs lacking CD138 expression was 6.22 (95%CI 3.59–10.80) after adjustment for EP number and precautions against EP recurrence. Conclusions: CE multiplied the recurrence rate of EPs in premenopausal women after TCRP, and this effect positively correlated with CE severity. CD138 expression by EPs also was associated with a higher risk for EP recurrence. [ABSTRACT FROM AUTHOR]

Objective: Colorectal cancers are in third place in terms of incidence and second in terms of mortality. This study aims to type the polyps detected during colonoscopy according to the Paris classification, perform polypectomy with the appropriate technique, classify them as histopathological, determine the presence of dysplasia, and review the risk status of colorectal cancer. Material and Method: Our study is a retrospective study presented as a one-year review of 124 patients who were found to have colonic polyps due to colonoscopy, who underwent polypectomy with the appropriate technique, and whose histopathological determination was completed. Results: The study was conducted between 2021 and 2022 with a total of 124 cases, 37.9% female and 62.1% male. The mean age of the cases was 58.58 ± 14.40 years. The way the polyps were removed was determined according to the polyp size and the Paris classification. Polypectomy was performed with biopsy forceps for <5 mm polyps. For =5 mm polyps, polypectomy was performed with a hotsnare after mucosal separation with saline-methylene blue-adrenaline. A piecemeal polypectomy was performed for two very large polyps. The most important factor in determining CRC surveillance and the presence of dysplasia was polyp diameter. The dysplasia rate in polyps removed with biopsy forceps was lower than in the polypectomy group with a hot snare. Conclusion: Colorectal cancers are multifactorial, the initial architecture is polyps. The increase in the diameter of these polyps rather than the removal techniques was significant in terms of colorectal cancer risk. [ABSTRACT FROM AUTHOR]

Aim: A treatment strategy for patients with a significant polyp or early colon cancer (SPECC) of the rectum presents a challenge due to the significant rate of covert malignancy and lack of standardized assessment. For this reason, NICE recommends multidisciplinary meetings to improve outcomes. The primary aim of the present study was to report the performance of our specialist early rectal cancer (SERC) multidisciplinary team (MDT) in correctly substratifying the risk of cancer and to discuss the limitations of staging investigations in those patients with "poor outcomes". Method: This was a retrospective review of patients referred to our SERC MDT from 2014 to 2019. Lesions were assigned by the MDT to three pre‐resection categories (low, intermediate, high) according to the risk of covert malignancy. Resection method and final histology were compared to the pre‐resection categories. Results: Of 350 SPECC lesions, 174 were assessed as low‐risk, 108 intermediate‐risk and 68 high‐risk. The cancer incidence was 4.8%, 8.3% and 53%, respectively (15.5% overall). Eight lesions were categorized as low‐risk but following piecemeal resection were found to be malignant. Five lesions, three of which were categorized as high‐risk, were ultimately benign following conventional surgery. One pT1sm1 cancer, removed by anterior resection, may have been treated by local excision. Conclusion: A total of 83% of malignant polyps were triaged to an en bloc resection technique and surgical resection avoided for nearly all benign lesions. However, 12 patients from this cohort were deemed to have a poor outcome because of miscategorization. Further comparative research is needed to establish the optimum strategy for rectal SPECC lesion assessment. Originality statement: There is currently no consensus for staging significant polyps of the rectum. This paper reports the effectiveness of a specialist early rectal cancer MDT to correctly risk‐stratify significant rectal polyps. It underscores the importance of accurate categorization for treatment decision‐making, while acknowledging the limitations of current staging modalities. [ABSTRACT FROM AUTHOR]

The primary objective of this pilot study was to identify which aspects of in-office rhinologic procedures (IORPs) warrant further attention and investigation in the future. The secondary objectives were to survey which IORPs are most common and to identify needs for education and training. A cross-sectional study was carried out following the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). The survey collected demographic, organizational, quality, and safety aspects of IORPs and was electronically distributed to YO-IFOS members across five continents. A total of 194 surgeons completed the survey, and 172 respondents (88%) performed IORPs. Ninety-nine responders (51.5%) worked in an academic setting. Common procedures included powered polypectomy (48, 28.4%) and turbinate reduction (93, 54.1%). The main concerns were about patients' tolerance (116, 76.3%) and about the safety of the procedure (102, 67.1%). The most important barriers to the diffusion of IORPs are concerns about the tolerance and safety of these procedures. It would be convenient to establish protocols for this type of procedure to ensure the greatest patient comfort based on evidence. [ABSTRACT FROM AUTHOR]

Electrosurgical generator units (ESUs) are instrumental in modern therapeutic gastrointestinal (GI) endoscopy, converting household alternating current into high-frequency current to generate thermal energy within tissues. This review elucidates the essentials of electrosurgery, exploring the thermal effects on tissue, current resistance, voltage, current density, duty cycle, crest factor, and the distinctions between monopolar and bipolar circuitry. The concept of duty cycle, the proportion of time electrical current is delivered, and crest factor, the ratio of peak to root mean square voltage, are essential while comparing differently named modes across various commercially available ESUs. This article discusses the practical applications of electrosurgery in therapeutic GI endoscopy procedures, including endoscopic sphincterotomy, polypectomy, endoscopic mucosal resection, endoscopic submucosal dissection, and peroral endoscopic myotomy. It outlines recommended modes and settings for ESUs across various procedures, emphasizing the balance between cutting and coagulation to achieve optimal outcomes while minimizing adverse effects. The review further addresses special considerations for the use of grounding pads and the management of patients with implanted cardiac devices during electrosurgical procedures. This article concludes with a call for a deeper understanding of electrosurgical principles and their application in GI endoscopy to ensure patient safety and procedural success, backed by references to relevant literature and detailed tables summarizing electrosurgical modes and settings for various therapeutic interventions. [ABSTRACT FROM AUTHOR]

Objective: Neoplastic gallbladder polyps (GPs), including adenomas and adenocarcinomas, are considered absolute indications for surgery; however, the distinction of neoplastic from non-neoplastic GPs on imaging is often challenging. This study thereby aimed to develop a CEUS radiomics nomogram, and evaluate the role of a combined grey-scale ultrasound and CEUS model for the prediction and diagnosis of neoplastic GPs. Methods: Patients with GPs of = 1 cm who underwent CEUS between January 2017 and May 2022 were retrospectively enrolled. Grey-scale ultrasound and arterial phase CEUS images of the largest section of the GPs were used for radiomics feature extraction. Features with good reproducibility in terms of intraclass correlation coefficient were selected. Grey-scale ultrasound and CEUS Rad-score models were first constructed using the Mann-Whitney U and LASSO regression test, and were subsequently included in the multivariable logistic regression analysis as independent factors for construction of the combined model. Results: A total of 229 patients were included in our study. Among them, 118 cholesterol polyps, 68 adenomas, 33 adenocarcinomas, 6 adenomyomatoses, and 4 inflammatory polyps were recorded. A total of 851 features were extracted from each patient. Following screening, 21 and 15 features were retained in the grey-scale and CEUS models, respectively. The combined model demonstrated AUCs of 0.88 (95% CI: 0.83 - 0.93) and 0.84 (95% CI: 0.74 - 0.93) in the training and testing set, respectively. When applied to the whole dataset, the combined model detected 111 of the 128 non-neoplastic GPs, decreasing the resection rate of non-neoplastic GPs to 13.3%. Conclusion: Our proposed combined model based on grey-scale ultrasound and CEUS radiomics features carries the potential as a non-invasive, radiationfree, and reproducible tool for the prediction and identification of neoplastic GPs. Our model may not only guide the treatment selection for GPs, but may also reduce the surgical burden of such patients. [ABSTRACT FROM AUTHOR]

Introduction: The safety and efficacy of cold snare polypectomy (CSP) compared to those of cold endoscopic mucosal resection (CEMR) have been reported. This meta-analysis compared the efficacy and safety of CEMR and CSP. Methods: PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched to identify randomized controlled trials comparing the efficacy and safety of CEMR and CSP in removing 3–10 mm polyps. The outcomes assessed included complete resection rate, intraoperative bleeding rate, delayed bleeding rate, perforation, and polyp removal time. The results are reported as risk ratios (RR) and 95% confidence intervals (CIs) derived from a Mantel-Haenszel random-effects model. Results: Seven studies comprising 1,911 polyps were included in the analysis. The complete resection rate of CEMR was comparable to that of CSP (RR: 1.01, 95% CI: 0.99–1.04, p = 0.32). Comparable results were also demonstrated for intraoperative bleeding rate (polyp-based analysis: RR: 1.22, 95% CI: 0.33–4.43, p = 0.77), delayed bleeding rate (polyp-based analysis: RR: 1.34, 95% CI: 0.44–4.15, p = 0.61), and polyp removal time (mean difference: 28.31 s, 95% CI: −21.40–78.02, p = 0.26). No studies reported cases of perforation. Conclusion: CEMR has comparable efficacy and safety to CSP in removing 3–10 mm polyps. Further randomized controlled trials with long-term follow-up are warranted to compare and validate efficacy. [ABSTRACT FROM AUTHOR]

The objective of polypectomy, a frequent endoscopic procedure, is to prevent colorectal cancer. Consequences of postpolypectomy care include minimizing complications, ensuring patient recovery, and preventing polyp recurrence. Besides monitoring polyp recurrence rates, this study assessed the effectiveness of post-polypectomy care protocols in managing patient comfort, adherence to dietary guidelines, and satisfaction with care. A cross-sectional analysis of 135 patients who underwent polypectomy at a tertiary care center was utilized in this study. Patient satisfaction, dietary adherence, postoperative comfort, and demographics were evaluated at one, three, and six months following the procedure. Recurrence of the polyp was monitored for one year. The research identified noteworthy enhancements in patient-reported comfort (P < 0.05), dietary adherence (P < 0.05), and overall satisfaction with care (P < 0.05). Additionally, complications such as infection (3.7%), bleeding (7.41%), and adherence to a prescribed diet decreased equivalently. Despite this, a trend toward increased polyp recurrence was observed that was not statistically significant, with rates increasing from 4.44% after three months to 12.59% after one year. Amid a gradual decline in dietary recommendation adherence, patient satisfaction with care remained consistently elevated. The results indicated that although prompt post-polypectomy care effectively improves patient comfort and satisfaction, long-term dietary adherence presents obstacles. Despite lacking statistical significance, the rising incidence of polyp recurrence emphasizes the criticality of diligent long-term surveillance. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Underwater endoscopic mucosal resection (UEMR) and cold snare polypectomy (CSP) are novel endoscopic procedures for superficial nonampullary duodenal epithelial tumors (SNADET). However, consensus on how to use both procedures appropriately has not been established. In this study, we evaluated treatment outcomes of both procedures, including resectability. METHODS: In this single-center randomized controlled study conducted between January 2020 and June 2022, patients with SNADET £12 mm were randomly allocated to UEMR and CSP groups. The primary end point was sufficient vertical R0 resection (SVR0), which was defined as R0 resection including a sufficient submucosal layer. We compared treatment outcomes including SVR0 rate between groups. RESULTS: The SVR0 rate was significantly higher in theUEMRgroup than in the CSP group (65.6% vs 41.5%, P5 0.01). By contrast, theR0resection rate was not significantly different between study groups (70.3% vs 61.5%, P50.29). The submucosal layer thickness was significantly greater in theUEMR group than in the CSP group (median 546 [range, 309--833] mm vs 69 [0--295] mm, P < 0.01). CSP had a shorter total procedure time (median 12 [range, 8--16] min vs 1 [1--3] min, P < 0.01) and fewer total bleeding events (9.4% vs 1.5%, P 5 0.06). DISCUSSION: UEMR has superior vertical resectability compared with CSP, but CSP has a shorter procedure time and fewer bleeding events. Although CSP is preferable for most small SNADET, UEMR should be selected for lesions that cannot be definitively diagnosed as mucosal low-grade neoplasias. [ABSTRACT FROM AUTHOR]

Objectives: Cold snare polypectomy (CSP)‐dedicated snares (DSs) may have a higher resection ability than conventional snares. However, a model that can accurately and objectively evaluate and compare the resection ability of each snare has yet to be determined, and characteristics of snare parts that increase resection ability remain unknown. Therefore, we elucidated DSs' resection ability and all characteristics of the parts required for acquiring high resection ability. Methods: An ex vivo model for evaluating resection ability was generated using human colons obtained from forensic autopsy specimens. The force required to resect a 15 mm wide human colonic mucosa (FRR) was measured using this model; if the FRR is small, the resection ability is high. Next, after measuring the stiffness of each snare part, the correlation between the stiffness and resection ability was analyzed. Results: The force required to resect using SnareMaster Plus, Micro‐Tech Cold Snare, Captivator Cold, Exacto Cold Snare, or Captivator II was 13.6 ± 1.0, 12.5 ± 1.2, 7.4 ± 1.2, 6.5 ± 1.0, and 28.7 ± 3.7 N, respectively. All DSs had significantly lower FRR than the conventional snare (Captivator II) and had higher resection ability (P < 0.001). A negative correlation was found between FRR and sheath or wire spindle stiffness, with correlation coefficients of 0.72 (P = 0.042) or 0.94 (P < 0.001), respectively. Moreover, 1 × 7 type wire rings had significantly higher friction coefficients than 1 × 3 type wire rings (P < 0.002). Conclusion: Sheath and wire spindle stiffness should be increased to increase resection ability; 1 × 7 type wire rings may be suitable for CSP‐snare parts. [ABSTRACT FROM AUTHOR]

• Long-term follow-up study after polypectomy comparing hysteroscopic tissue removal systems. • Recurrence and/or persistence of abnormal uterine bleeding was not significantly different. • Polyp recurrence or hysterectomy was not reported in the manually driven group. The aim of this follow-up study is to compare a manually driven hysteroscopic tissue removal system (ResectrTM 9 Fr) with a motor driven system (TruclearTM) in terms of long-term clinical outcomes such as abnormal uterine bleeding and polyp recurrence. This is a follow-up of a multicenter randomized controlled trial comparing a manually and motor driven hysteroscopic tissue removal system for polypectomy. This prospective cohort study was performed at Ghent University Hospital (Ghent, Belgium) and Catharina Hospital Eindhoven (Eindhoven, the Netherlands). The trial was registered at Clinicaltrials.gov (Trial ID = NCT05337605, April 2022). Seventy-five women with abnormal uterine bleeding who participated in the randomized controlled trial and had pathological confirmation of the diagnosis of an endometrial polyp, were contacted. Fifty-five women (70.67 %) were willing to participate in this follow-up study. The primary outcome was the recurrence and/or persistence of abnormal uterine bleeding and the time to the recurrence of abnormal uterine bleeding. Secondary outcomes were polyp recurrence and time to polyp recurrence, symptom relief, satisfaction score regarding symptom relief and general satisfaction score regarding the surgical procedure. In the manually driven group, the mean time to the recurrence or persistence of abnormal uterine bleeding was 26 months (95 % CI 20 – 32). In the motor driven group, the mean time to the recurrence or persistence of abnormal uterine bleeding was 29 months (95 % CI 23– 34). A log-rank test showed a non-significant difference between both groups (P =.77). There was no significant difference in polyp recurrence (P =.22) or symptom relief between the two groups (P =.67). Additionally, the groups did not differ in satisfaction scores regarding symptoms or polypectomy (P =.16 and P =.61, respectively). This long-term follow-up study showed no statistically significant difference in the recurrence and persistence of abnormal uterine bleeding between a manually and motor driven hysteroscopic tissue removal system for polypectomy. [ABSTRACT FROM AUTHOR]

Aim: Giant colorectal polyps (≥3 cm) can be managed by endoscopic excision or surgical resection. There has been a shift to endoscopic submucosal dissection (ESD) for the treatment of such lesions as the expertise in advanced therapeutic endoscopy develops. This study aims to compare the outcome and safety profile of ESD against surgical resection for patients with giant colorectal polyps. Methods: We performed a retrospective review on patients with giant colorectal polyps removed by either ESD or surgery over a 10‐year period (from May 2010 to September 2020) in a regional hospital in Hong Kong. Propensity score matching was performed based on patient demographics and polyp characteristics. Outcomes including polyp histology, complication rates, length of hospital stay, and re‐admission rates were analysed. Results: Fifty‐one patients (ESD group: 34, surgery group: 17) were included in the analysis. The mean polyp diameter was 3.35 cm (ESD group) and 3.53 cm (surgery group). The median procedure time was comparable (160 vs 167 min; P =.251) and the most common polyp histological type was tubulovillous adenoma (44.1% vs 47.1%; P =.130) for both groups. A shorter median length of stay (1 day vs 6 days; P =.028) and lower re‐admission rate (0% vs 5.9%; P <.001) were observed in the ESD group, whereas a higher major complication rate (Clavien–Dindo classification grade IIIa or above; 2.9% vs 11.7%; P =.013) was observed in the surgery group. Conclusions: ESD is a safe and effective treatment for giant colonic polyps with ESD size ≥3 cm. It has the advantage of lower complication rates, shorter length of hospital stays, and lower re‐admission rates compared with surgical resection. [ABSTRACT FROM AUTHOR]

Background and Aim: Small rectosigmoid colorectal polyps (<10 mm) are prevalent, with a low prevalence of advanced neoplastic lesions. The "diagnose‐and‐leave" strategy, employing narrow band imaging (NBI), is gaining popularity for its safety and cost‐effectiveness by reducing polypectomy complications and minimizing histopathology expenses. This study assessed the diagnostic efficacy of NBI with dual focus (DF) magnification for real‐time neoplastic prediction of rectosigmoid polyps and explored the feasibility of implementing this strategy in Vietnam. Methods: In a prospective single‐center study, 307 rectosigmoid polyps from 245 patients were analyzed using three consecutive endoscopic modes: white light endoscopy (WLE), NBI, and NBI‐DF. Endoscopists assessed polyps for size, location, macroscopic shape, optical diagnosis, and confidence levels before histopathological evaluation. High confidence was assigned when the polyp exhibited all features of a single histology type. Predictions were compared with final histopathology results. Results: Of the total, 237 (77.2%) were diminutive (≤5 mm) polyps, and 18 (5.8%) were advanced neoplastic lesions. WLE + NBI and WLE + NBI + NBI‐DF exhibited significantly higher accuracy compared to WLE (88.6% and 90.2% vs 74.2%, P < 0.01). For diminutive polyps, the DF mode significantly increased the rate of high‐confidence optical diagnoses (89.1% vs 94.9%, P < 0.001). WLE + NBI + NBI‐DF demonstrated high sensitivity (90.1%), specificity (95.5%), and negative predictive value (93.4%) in high‐confidence predictions, enabling the implementation of the "diagnose‐and‐leave" strategy. This approach would have reduced 58.2% of unnecessary polypectomies without missing any advanced neoplastic lesions. Conclusion: NBI and DF modes provide accurate neoplastic predictions for rectosigmoid polyps. For diminutive polyps, DF magnification improves the confidence level of the optical diagnosis, allowing the safe implementation of the "diagnose‐and‐leave" strategy. [ABSTRACT FROM AUTHOR]

Background: Mechanical hysteroscopic tissue removal (mHTR) systems are widely used for removing intrauterine pathology. Given the startup and procedural costs for electrically powered mechanical units, disposable manual mHTR systems have been developed. Methods: With little published, we describe its effectiveness for hysteroscopic intrauterine polypectomy. Results: One-hundred fifty-seven infertile women underwent hysteroscopic polypectomy with the manual mHTR device. Complete removal was accomplished in all but three cases, with blood loss being <10 mL and all specimens deemed sufficient for histopathologic diagnosis. Conclusions: These results suggest that the disposable manual mHTR system is effective in removing endometrial polyps. Head-to-head comparisons with other alternative technologies are needed. [ABSTRACT FROM AUTHOR]

Background/Aims: We investigated the clinical practice patterns of post-polypectomy colonoscopic surveillance among Korean endoscopists. Methods: In a web-based survey conducted between September and November 2021, participants were asked about their preferred surveillance intervals and the patient age at which surveillance was discontinued. Adherence to the recent guidelines of the U.S. Multi-Society Task Force on Colorectal Cancer (USMSTF) was also analyzed. Results: In total, 196 endoscopists completed the survey. The most preferred first surveillance intervals were: a 5-year interval after the removal of 1-2 tubular adenomas < 10 mm; a 3-year interval after the removal of 3-10 tubular adenomas < 10 mm, adenomas = 10 mm, tubulovillous or villous adenomas, = 20 hyperplastic polyps < 10 mm, 1-4 sessile serrated lesions (SSLs) < 10 mm, hyperplastic polyps or SSLs = 10 mm, and traditional serrated adenomas; and a 1-year interval after the removal of adenomas with highgrade dysplasia, >10 adenomas, 5-10 SSLs, and SSLs with dysplasia. In piecemeal resections of large polyps (> 20 mm), surveillance colonoscopy was mostly preferred after 1 year for adenomas and 6 months for SSLs. The mean USMSTF guideline adherence rate was 30.7%. The largest proportion of respondents (40.8%-55.1%) discontinued the surveillance at the patient age of 80-84 years. Conclusions: A significant discrepancy was observed between the preferred post-polypectomy surveillance intervals and recent international guidelines. Individualized measures are required to increase adherence to the guidelines. [ABSTRACT FROM AUTHOR]

Background and Aims: The impact of submucosal injection during cold snare polypectomy (CSP) remains uncertain. We conducted an evidence-based comparison of conventional CSP (C-CSP) and CSP with submucosal injection (SI-CSP) for colorectal polyp resection. Methods: PubMed, Embase, and the Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing C-CSP with SI-CSP. Major outcomes included the rates of complete resection, en bloc resection, polyp retrieval, and adverse events, as well as the duration of polypectomy. Data were analyzed by using a random-effects model. Results: A total of seven RCTs were included. Complete resection rates for all polyps (RR 0.98; 95% CI 0.93–1.03), polyps ≤ 10 mm (RR 0.99; 95% CI 0.96–1.02) and polyps > 10 mm (RR 0.92; 95% CI 0.69–1.12) were not substantially different between C-CSP and SI-CSP groups. En bloc resection rate (RR 0.93; 95% CI 0.79–1.09) and polyp retrieval rate (RR 1.00; 95% CI 0.99–1.01) were also not significantly different between the two groups. The SI-CSP group required a prolonged polypectomy time than the C-CSP group (SMD − 0.89; 95% CI -1.29 to -0.49). Adverse events were rare in both groups. Conclusions: SI-CSP is not an optimal substitute for CSP in the resection of colorectal polyps, particularly diminutive and small polyps. [ABSTRACT FROM AUTHOR]

Background and Aim: Hot snare polypectomy using blend or coagulation current is widely used; however, it causes deeper tissue heat injury, leading to adverse events. We hypothesized that hot polypectomy using low‐power pure cut current (PureCut, effect 1 10 W) could reduce deeper tissue heat injury. We conducted animal experiments to evaluate the deeper tissue heat injury and conducted a prospective clinical study to examine its cutting ability. Methods: In a porcine rectum, hot polypectomy using Blend current (EndoCut, effect 3 40 W) and low‐power pure cut current was performed. The deepest part of heat destruction and thickness of the non‐burned submucosal layer were evaluated histologically. Based on the results, we performed low‐power pure cut current hot polypectomy for 10–14 mm adenoma. The primary endpoint was complete resection defined as one‐piece resection with negative for adenoma in quadrant biopsies from the defect margin. Results: In experiments, all low‐power pure‐cut resections were limited within the submucosal layer whereas blend current resections coagulated the muscular layer in 13% (3/23). The remaining submucosal layer was thicker in low‐power pure cut current than in blend current resections. In the clinical study, low‐power pure‐cut hot polypectomy removed all 100 enrolled polyps. For 98 pathologically neoplastic polyps, complete resection was achieved in 84 (85.7%, 95% confidence interval, 77–92%). The lower limit of the 95% confidence interval was not more than 15% below the pre‐defined threshold of 86.6%. No severe adverse events occurred. Conclusions: A novel low‐power pure‐cut hot polypectomy may be feasible for adenoma measuring 10–14 mm. (UMIN000037678). [ABSTRACT FROM AUTHOR]

Background: Incidence of detection of colorectal polyp is increasing in recent years. But factors associated with malignant potentiality of colorectal polyp is largely unknown. Aims of the study: The aim of this study was to correlate patient age and colonic polyp size with malignant potentiality. Materials and methods: This was an observational cross sectional study, carried out in Gastroenterology department of Combined Military Hospital (CMH) Dhaka cantonment in between January to December 2019. Total 240 patients were included in the study, whose underwent colonoscopy, had colonic polyps and polyp biopsy was done. Data was collected and analyzed by using SPSS 20 and obtained in tables and diagrams. Results: Out of 240 patients male 165(68.7%), female 75(31.3%) with male to female ratio 2.5:1; mean age±SD 53.3±15.4 years; below 40 years 43 (17.9%), 40-60 years 102 (42.5%) and above 60 years 95(39.6%); 92 (38.3%) patients had different co-morbidity including 39 (16.3%) had multiple co-morbidity; colonic polyps found in caecum 32(13.3%), ascending colon 14 (5.8%), transverse colon 8(3.3%), descending colon 20(8.3%), sigmoid colon 32(13.3%), rectum 104 (43.3%), and multiple sites 30(12.5%);180(75.0%) polyps were sessile and 60(25.0%) pedunculated with minimum size 3mm and maximum 21mm in diameter; polyps were of neoplastic 91(37.9%), hyperplastic 18 (7.5%), and inflammatory 131(54.6%); among neoplastic polyps 83(34.6%) benign and 8(3.3%) malignant; among neoplastic polyps mild dysplasia 66(72.5%), moderate dysplasia 17(18.7%) and severe dysplasia 8(8.8%); polyps larger than 10mm size were associated with increasing degree of dysplasia, odds ratio (OR) 9.2; 95% CI (2.9 to 29.1), p value < .001; patients of more than 60 years of age were also more associated with increasing degree of polyp dysplasia, odds ratio 3.5; 95% CI (1.3 to 9.2), p value .01. Conclusion: Increasing age of patients and increasing size of colorectal polyps were associated with increasing degree of dysplasia in colonic polyp histopathology. [ABSTRACT FROM AUTHOR]

Background The choice of polypectomy device and surveillance intervals for colorectal polyps are primarily decided by polyp size. We developed a deep learning-based system (ENDOANGEL-CPS) to estimate colorectal polyp size in real time. Methods ENDOANGEL-CPS calculates polyp size by estimating the distance from the endoscope lens to the polyp using the parameters of the lens. The depth estimator network was developed on 7297 images from five virtually produced colon videos and tested on 730 images from seven virtual colon videos. The performance of the system was first evaluated in nine videos of a simulated colon with polyps attached, then tested in 157 real-world prospective videos from three hospitals, with the outcomes compared with that of nine endoscopists over 69 videos. Inappropriate surveillance recommendations caused by incorrect estimation of polyp size were also analyzed. Results The relative error of depth estimation was 11.3% (SD 6.0%) in successive virtual colon images. The concordance correlation coefficients (CCCs) between system estimation and ground truth were 0.89 and 0.93 in images of a simulated colon and multicenter videos of 157 polyps. The mean CCC of ENDOANGEL-CPS surpassed all endoscopists (0.89 vs. 0.41 [SD 0.29]; P <0.001). The relative accuracy of ENDOANGEL-CPS was significantly higher than that of endoscopists (89.9% vs. 54.7%; P <0.001). Regarding inappropriate surveillance recommendations, the system's error rate is also lower than that of endoscopists (1.5% vs. 16.6%; P <0.001). Conclusions ENDOANGEL-CPS could potentially improve the accuracy of colorectal polyp size measurements and size-based surveillance intervals. [ABSTRACT FROM AUTHOR]

Objective: Gastrointestinal polyps form as a result of epithelial or submucosal tissues growing and protruding towards the intestinal lumen. These are seen at a rate of 2% in childhood. The aim of this study was to evaluate the demographic and clinical findings of pediatric cases determined to have colon polyps. Methods: The study included a total of 78 pediatric cases, comprising 37 (47.4%) females and 41 (52.6%) males, who underwent colonoscopic polypectomy in the Paediatric Gastroenterology Clinic between 2010 and 2021. Results: The mean age of the patients was 8.0 ± 4.3 years (range: 1-17 years). The complaints on presentation were mostly bloody feces, chronic abdominal pain, diarrhea, constipation, and polyp prolapse. The mean duration of complaints was 6.5 ± 2.0 months (range: 1-18 months). A familial history of polyps was present in 9 cases. The presence of a single polyp was determined in 67 and a pedunculated polyp in 63. The most frequent localization of the polyps was the rectum. Polypectomy was performed in all the cases. Surgical repair was performed in 3 cases that developed perforation after the procedure. Histopathologically, juvenile polyps were determined to be seen most often. Of the 9 children diagnosed with familial polyposis coli, 4 were diagnosed with Peutz-Jeghers syndrome, 4 with familial adenomatous polyposis syndrome, and 1 with Cowden syndrome. Conclusion: As a result of the more frequent use of endoscopic interventions in childhood, the diagnosis and treatment of colon polyps have become easier. In cases with Peutz-Jeghers syndrome, the risk of perforation during polypectomy must be taken into consideration. [ABSTRACT FROM AUTHOR]