Utilization and determinants of follow-up colonoscopies within 6 years after screening colonoscopy: Prospective cohort study

Previous studies have reported that repeat colonoscopies were often not conducted in the recommended time interval after screening colonoscopy. We prospectively followed participants of screening colonoscopy from Germany for 6 years to investigate utilization and determinants of repeat colonoscopies. In a longitudinal study on the effectiveness of screening colonoscopy in the state of Saarland (Germany), participants who had a screening colonoscopy between 2005 and 2007 were contacted by mail 6 years after screening and requested to fill in a standardized questionnaire on utilization of repeat colonoscopies. For all colonoscopies reported, colonoscopy and histology reports were requested from the physician(s). Of 6,407 screening participants, 2,212 (35%) have utilized another colonoscopy. Among participants with negative findings at screening (no adenomas), 962 (22%) had a subsequent colonoscopy within 6 years from screening, accounting for 43% of all patients with a repeat colonoscopy. Family history of CRC and detection of hyperplastic polyps were found to be determinants of higher repeat colonoscopy use. As many as 44% of the participants with low-risk adenomas (N = 509) and 39% with high-risk adenomas (N = 290) at screening did not utilize surveillance colonoscopy within 6 years. Utilization was better with higher school education, prior cancer screening participation and if high-risk adenomas were detected, lower among current smokers and lowest among participants ≥70 years. New strategies will be required considering determinants of adherence to avoid unnecessary colonoscopies and to improve utilization of surveillance according to recommended time intervals among patients at higher risk of CRC in the future.     

Prophylactic clips to reduce delayed polypectomy bleeding after resection of large colorectal polyps: a systematic review and meta-analysis of randomized trials

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Efficacy and safety of cold snare polypectomy for sessile serrated polyps ≥ 10 mm: A systematic review and meta-analysis

BackgroundCold snare polypectomy (CSP) is a promising technique for the removal of sessile serrated polyps (SSPs) ≥ 10 mm. However, the efficacy and safety of this technique remain undetermined.AimsWe aimed to comprehensively evaluate the efficacy and safety of CSP for SSPs ≥ 10 mm.MethodsPubMed, EMBASE, Web of Science and Cochrane Library were searched up to January 2021.ResultsA total of 10 studies consisting of 1727 SSPs (range, 10–40 mm) from 1021 patients were included. The overall rates of technical success, adverse events (AEs) and residual SSPs were 100%, 0.7% and 2.9%, respectively. Subgroup analysis showed that the rates of technical success and AEs were comparable between CSP and cold endoscopic mucosal resection (EMR) (99.9% vs. 100% and 1.3% vs. 0.5%, respectively), between the proximal and distal colon (100% vs. 99.9% and 0.3% vs. 0, respectively), and between polyps of 10–19 mm and ≥20 mm (99.8% vs. 100% and 0.9% vs. 0, respectively). However, subgroup analysis showed that the rate of residual SSPs was slightly lower in CSP compared with cold EMR (1.3% vs. 3.9%), as well as in polyps of 10–19 mm compared with those ≥20 mm (3.1% vs. 4.7%).ConclusionCSP was an effective and safe technique for removing SSPs ≥ 10 mm.     

子宫内膜息肉宫腔镜电切或诊刮术后联合药物治疗的疗效分析

目的探讨子宫内膜息肉行宫腔镜电切术或行宫腔镜下诊刮术后进行联合用药或未用药的疗效,为临床有效治疗子宫内膜息肉提供依据。方法回顾性分析2018年7月至2019年6月我院的子宫内膜息肉患者的临床资料。将符合要求的患者分为4组。1组:单纯的宫腔镜下诊刮术;2组:宫腔镜下诊刮术术后地屈孕酮治疗3个月;3组:单纯的宫腔镜下子宫内膜息肉电切术;4组:宫腔镜下子宫内膜息肉电切术术后地屈孕酮治疗3个月。比较各组的月经情况、异常子宫出血改善情况、子宫内膜息肉复发情况、术后有生育要求的术后6个月内妊娠情况及子宫内膜厚度情况。结果各组的月经情况比较:4组月经情况改善率(95.42%)最高;异常子宫出血改善情况比较:4组异常子宫出血改善率(89.31%)最高;子宫内膜息肉的复发率情况比较:4组子宫内膜息肉的复发率9.92%最低;子宫内膜的厚度情况比较:4组子宫内膜厚度最薄;术后有生育要求的术后6个月内妊娠情况的比较:4组术后6个月内妊娠率10.69%最高;各组比较差异均有统计学意义(P0.05)。结论单纯的宫腔镜下子宫内膜息肉电切术比单纯宫腔镜下诊刮术疗效好,术后地屈孕酮治疗3个月组较无药物治疗组疗效好,治疗方案以宫腔镜下子宫内膜息肉电切术术后地屈孕酮治疗3个月为最佳。     

气囊辅助内镜治疗小肠息肉的临床价值研究

目的：探讨应用气囊辅助内镜（ BAE）治疗小肠息肉的可行性、安全性及临床价值。方法回顾性总结2006年8月至2014年7月对199例小肠息肉患者行BAE检查及内镜下息肉切除治疗情况,评价其可行性、安全性及小肠息肉内镜治疗的临床价值。结果199例小肠息肉患者共接受558例次BAE诊治术,摘除小肠息肉共3391枚,其中直径5～10 mm 801枚（23．62％）,11～30 mm 1887枚（55．65％）,31～50 mm 563枚（16．60％）,＞50 mm 140枚（4．13％）,最大者约为7 cm ×10 cm。发生21例次（3．76％）手术相关并发症,包括15例息肉残根出血和6例肠穿孔。结论 BAE是一种安全有效的小肠息肉治疗方法,对大多数小肠息肉患者,可替代外科手术而作为首选治疗方法,具有较好的临床应用价值及发展前景。     

Cold snare polypectomy: Indications,devices, techniques,outcomes and future

Colonoscopy has been shown to reduce the risk of colon cancer by enabling the removal of precancerous lesions. Although cold snare and hot snare polypectomy have similar retrieval rates and complete resection rates, rates of delayed bleeding tend to be lower with cold snare polypectomy than with hot snare polypectomy, especially for patients taking antithrombotic agents. However, among cold snares there may be differences in terms of the completeness of polyp excision, as complete removal appears more likely with thin‐wire dedicated cold snares compared to the traditional, thick‐wire cold snares. Cold snare polypectomy may be especially well suited for use in patients taking antithrombotic agents, due to its minimal risk of delayed bleeding. Histological analyses suggest that cold snare polypectomy causes less damage to blood vessels in the submucosal layers, which results in a reduced incidence of hemorrhage compared to hot snare polypectomy. However, cold snare removal of small polyps may result in fragmentation of small specimens during collection and concerns as to whether the resection is complete. An endoscopy biomarker of effective cold snare polypectomy technique is needed to ensure complete removal of non‐pedunculated colorectal polyps ≤10 mm. Future uses of cold snare polypectomy may include piecemeal removal of sessile serrated adenoma/polyp lesions >10 mm. Currently, cold snare polypectomy should be considered a primary method for colorectal polyps of less than 10 mm, especially those in the 4‐ to 10‐mm range.