Guidelines versus real life practice: the case of colonoscopy in acromegaly

Purpose

The aim of this study is to investigate guideline application and colonoscopy findings in real-life practice in acromegaly.

Methods

We conducted a retrospective observational non-interventional and cross-sectional analysis on 146 patients with acromegaly (ACRO) referred to our clinic. We evaluated colonoscopy data, focusing on the correlation between colonoscopy findings and hormonal/metabolic values.

Results

The total number of colonoscopies performed in ACRO patients increased from 6 in the period 1990–1994 to 57 in the period 2010–2014. Colonoscopy procedures were performed according to guidelines in 25% of ACRO patients at diagnosis, 51% at follow-up and 11% globally (both at diagnosis and follow-up). Among the 146 ACRO patients, 68% were subjected to at least one colonoscopy and in 32% of the cases a polyp was detected during the procedure. The presence of polyps was significantly associated with mean levels of growth hormone (GH), insulin-like growth factor 1 (IGF-1), fasting glucose and insulin levels (p?<?0.05). Polyps were detected in 48% of untreated patients and in 26% of patients under treatment for acromegaly (p?=?0.04). The general risk of polyps and adenomatous polyps in ACRO patients was higher compared to the control population of Veneto Region, Italy (odds ratio 1.33 and 1.16, respectively). No cancerous polyps were detected in our analysis.

Conclusion

In real-life practice, adherence to ACRO colonoscopy clinical guidelines was lower than expected. Among patients who underwent colonoscopy, the prevalence of colon polyps was higher for ACRO patients, suggesting the need for new strategies to ensure adherence to colonoscopy guidelines.

     

Capsule endoscopy vs. colonoscopy vs. histopathology in colorectal cancer screening: matched analyses of polyp size,morphology, and location estimates

Purpose

Colon capsule endoscopy (CCE) is considered a potential alternative to optical colonoscopy (OC) for colorectal cancer screening. However, the accuracy of CCE in polyp size and morphology estimation is unknown.

Methods

A fully paired study was performed (2015–2016), where 255 participants from the Danish national screening program had CCE, OC, and histopathology (HP) of all detected polyps. We developed a new algorithm to match CCE and OC polyps, based on objective measures of similarity between polyps. We performed paired comparisons of size, morphology and location of CCE, and OC- and HP-matched polyps. We used cross-validation to develop a model able to predict HP polyp size, based on CCE.

Results

CCE overestimated size assessed by HP (by 4.3 mm; 95%CI 3.3–5.2 mm) and OC (by 2.7 mm; 95%CI 1.4–3.9 mm). Polyps were more likely to being assessed as “pedunculated” and less likely to being assessed as “flat” in CCE, compared to OC (p?<?0.0001). Our model could predict HP polyp size ≥?6 mm, solely using CCE-assessed size, location, and morphology as model inputs, with a sensitivity?=?0.93 (95%CI 0.66–1.00) and specificity?=?0.50 (95%CI 0.32–0.68).

Conclusions

If CCE is to be used as a screening test, it is essential: (1) to translate CCE polyp estimations into histopathologic polyp sizes and (2) to consider that, compared to OC, CCE has a higher tendency to assess polyps as pedunculated and a lower tendency to assess them as flat.

Trial registration

Clinicaltrials.gov No. NCT02303756

     

Detection rate and proximal shift tendency of adenomas and serrated polyps: a retrospective study of 62,560 colonoscopies

Purpose

The purpose of this study is to estimate the detection rates of adenomas and serrated polyps and to identify proximalization and associate risk factors in patients from Southern China.

Methods

Consecutive patients undergoing colonoscopy from 2004 to 2013 in Guangzhou were included. The proportions of proximal adenomas to advanced adenomas and serrated polyps were compared and potential predictors were evaluated.

Results

Colonoscopies (n?=?62,560) were performed, and 11,427 patients were diagnosed with polyps. Detection rates for adenomas, hyperplastic polyps, and serrated adenomas were 12.0, 2.5, and 0.2 patients per 100 colonoscopies. When comparing the 1st (2004–2008) to the 2nd period (2009–2013), adenoma and serrated polyp detection in proximal and distal colon both increased significantly (proximal colon [adenoma 3.9 vs. 6.1 patients/100 colonoscopies, P?<?0.001; serrated polyp 0.4 vs. 1.1 patients/100 colonoscopies, P?<?0.001]; distal colon [adenoma 6.6 vs. 7.2 patients/100 colonoscopies, P?=?0.003; serrated polyp 1.2 vs. 2.4 patients/100 colonoscopies, P?<?0.001]). Advanced adenoma detection increased over these two periods only in proximal colon (1st vs. 2nd period: 1.5 vs. 2.4 patients/100 colonoscopies, P?<?0.001), not the distal colon (P?=?0.114). Multivariate analyses showed that diagnostic period was an independent predictor for adenoma proximalization (OR?=?1.36, 95% CI 1.25–1.48, P?<?0.001), but not for advanced adenomas (P?=?0.117) or serrated polyps (P?=?0.928).

Conclusions

Adenomas and serrated polyps were increasingly detected throughout the colon, whereas advanced adenomas were only in proximal colon. A proximal shift tendency detected by colonoscopy was observed for adenomas, but not advanced adenomas or serrated polyps, in Southern China. The screening for proximal polyps should be emphasized and colonoscopy might be a preferred initial screening tool.

     

A randomized controlled trial comparing water exchange and air insufflation during colonoscopy without sedation

Objectives

Previous studies have shown that water exchange is superior to air insufflation in attenuating insertion pain during colonoscopy. We conducted a randomized controlled trial with head-to-head comparison of these methods to assess their effectiveness in colonoscopy without sedation.

Methods

A total of 447 outpatients were randomized to either water exchange (WE) or the standard air (CO₂) insufflation (AI). The primary outcome was the improvement of patient intraprocedural pain (pain score), evaluated using a questionnaire (scores 1 to 5).

Results

After exclusion of 44 patients from further analysis, 403 patients were analyzed. There was no difference in clinical background between the WE and AI groups. Patients in the WE group reported less intraprocedural pain than those in the AI group (2.17?±?1.06 vs. 2.42?±?1.03; unpaired t test, p?=?0.021). We divided the cases into two groups, more or less painful colonoscopy, based on age, body mass index, use of anti-peristaltic drugs or not, and physician’s experience. In less painful colonoscopy, the WE method could reduce pain effectively but its effect was limited in the more painful group.

Conclusion

WE is superior to AI for attenuating insertion pain during colonoscopy without sedation, but its efficacy is limited in more painful endoscopy.

     

Management of complex polyps of the colon and rectum

Puprpose

Benign polyps that are technically challenging and unsafe to remove via polypectomy are known as complex polyps. Concerns regarding safety and completeness of resection dictate they undergo advanced endoscopic techniques, such as endoscopic mucosal resection or surgery. We provide a comprehensive overview of complex polyps and current treatment options.

Methods

A review of the English literature was conducted to identifyarticles describing the management of complex polyps of the colon and rectum.

Results

Endoscopic mucosal resection is the standard of care for the majority of complex polyps. Only polyps that fail endoscopic mucosal resection or are highly suspicious of invasive cancer but which cannot be removed endoscopically warrant surgery.

Conclusion

Several factors influence the treatment of a complex polyp; therefore, there cannot be a “one-size-fitsall” approach. Treatment should be tailored to the lesion’s characteristics, the risk of adverse events, and the resources available to the treating physician.

     

The Prophylactic Placement of Hemoclips to Prevent Delayed Post-polypectomy Bleeding: An Unnecessary Practice? A Case Control Study

Background

With the recent, widespread availability of endoscopic hemoclips, it has become common clinical practice to apply hemoclips to some non-bleeding polypectomy sites “prophylactically” to prevent delayed post-polypectomy bleeding (PPB). Few published data support this practice, however.

Aim

The aim of this study was to compare rates of delayed PPB in matched patients who had polypectomies performed with and without the prophylactic placement of hemoclips.

Methods

We reviewed medical records of patients who had elective colonoscopy at our VA Medical Center between July 2008 and December 2009. We identified patients who had hemoclips applied prophylactically (cases) and compared their rate of delayed PPB within 30 days to that of patients who had polypectomy without hemoclipping (controls). Controls were matched 1:1 to cases based on age and on factors known to contribute to the risk of PPB including polyp size, morphology, technique of polyp removal, number of polyps removed, and use of anticoagulants.

Results

We identified 184 patients (cases) who underwent prophylactic hemoclipping and 184 well-matched controls. An average of 3.8 polyps per patient were removed in the case group compared to 3.3 polyps per patient in controls (p = 0.6). Delayed PPB occurred in three patients in the prophylactic hemoclip group and in one patient in the control group (1.6 vs. 0.5 %, p = 0.62).

Conclusions

We found no significant difference in the rate of delayed PPB between patients who had prophylactic hemoclipping of polypectomy sites and a well-matched control group of patients who had polypectomy without prophylactic hemoclipping. These data call into question the expensive practice of prophylactic hemoclipping.

     

Colonoscopy overuse in colorectal cancer screening and associated factors in Argentina: a retrospective cohort study

Background

In recent years, there has been growing concern about the overuse of colonoscopy (CC). Our objective was to evaluate the incidence rate and cumulative probability of having a potentially inadequate CC (PI-CC, e.g. a CC that was performed earlier that recommended) and the association between the report of a hyperplastic polyp in the baseline CC report and the probability of having a PI-CC.

Methods

A retrospective cohort of adults 50y/o or older with a complete baseline CC between January 1st and December 31st 2005, without reported lesions or with hyperplastic polyps, based on secondary data extracted from the electronic medical record of the Hospital Italiano of Buenos Aires. The outcome consisted of time until a PI-CC, defined as the time measured between basal colonoscopy and a colonoscopy performed earlier than the inter-screening interval recommended by the USPSTF and the USMSTF.

Results

389 patients were included. The cumulative probability of receiving a PI-CC over 10 years was 0.29 (95% CI 0.241, 0.342). The incidence rate resulted in 30.91 PI-CC per 1000 person-years (95% CI 25.14, 38). The crude analysis of the association between the outcome and the presence of hyperplastic polyps in the baseline CC, showed a statistically significant difference between both groups (log rank, p 0.036). The multivariate analysis yielded a hazard ratio of 1.67 (95% CI 1.02–2.73).

Conclusion

We observed that 3 in every 10 patients treated in our health system received a PI-CC during the first ten consecutive years after a normal complete CC. Furthermore, this could be in part attributed to the presence of a hyperplastic polyp in the baseline CC.

     

No increased risk of perforation during colonoscopy in patients undergoing propofol versus traditional sedation: A meta-analysis

Background and Aims

The safety of propofol sedation during colonoscopy remains unclear, and we performed a meta-analysis to assess the risk of perforation in patients undergoing propofol vs. traditional sedation.

Methods

MEDLINE, CBM, VIP, CNKI, and Wanfang databases were searched up to December 2016. Two reviewers independently assessed abstract of those searched articles. Data about perforation condition in propofol and traditional sedation groups were extracted and combined using the random effects model.

Results

A total of 19 studies were included in the current meta-analysis. Compared to traditional sedation, propofol sedation did not increase the risk of perforation (RD?=???0.00, 95% CI ??0.00~0.00, p?=?0.98; subgroup analysis: OR?=?1.30, 95% CI 0.83~2.05, p?=?0.25).

Conclusion

This meta-analysis suggested that propofol sedation did not increase the risk of perforation compared to traditional sedation during colonoscopy.

     

Improved survival of patients with colon cancer detected by screening colonoscopy

Background

Screening for colon cancer (CC) may not only reduce its occurrence but has also the potential to reduce the overall mortality. So far, there has been little evidence that detection of colon cancer by screening colonoscopy results in different survival rates compared to symptomatic patients.

Patients and methods

Clinical, histological, diagnostic, and survival data of 1016 consecutive patients with CC from a prospectively expanded single-institutional database were analyzed for diagnostic, treatment, and prognostic factors. Findings were then stratified according to detection by screening colonoscopy vs. patients who became symptomatic prior to further diagnostic work-up.

Results

7.1 % of all patients were identified by screening colonoscopy for colon cancer. Screened patients were younger (68.2 vs. 64.8 years), had smaller T stage (p?=?0.032), lower tumor stage (p?=?0.009), and a tendency to less lymph node metastasis. Overall survival was superior in screened patients, and stage-specific survival showed a tendency to improved survival, which was not statistically significant. Furthermore, a higher percentage of screened patients underwent adjuvant chemotherapy (84.6 vs. 55.0 %, p?=?0.032).

Conclusion

Survival outcome and enrollment in a multimodal treatment was higher in screening-detected patients compared to patients diagnosed after the onset of clinical symptoms. Besides a potential occurrence of lead time bias, these findings strongly support the need for continued improvement of screening programs and the recruitment of more patients for colorectal cancer screening.

     

Clinical validation of a novel urine-based metabolomic test for the detection of colonic polyps on Chinese population

Purpose

Colorectal cancer is the fifth leading cause of cancer-related deaths in China. When detected early, with the removal of adenomatous polyps, precursors of colorectal cancer, it is preventable. The aim of this study was to evaluate a novel urine-based metabolomic diagnostic test for the detection of adenomatous polyps, PolypDx?, that was originally developed and validated using 1000 samples from Canadian Cohort, on Chinese population.

Methods

Prospective urine samples were collected from 1000 participants undergoing colonoscopy examination, from March 2013 to July 2014 at Minhang District, Shanghai Centre for Disease Control and Prevention. One-dimensional nuclear magnetic resonance spectra of urine metabolites were analyzed to determine the concentrations of three key metabolites used in PolypDx?. The predicted results were then compared to the gold standard for colorectal cancer diagnostic, colonoscopy. Area under curve (AUC) was calculated specifically for the Chinese population and compared with the Canadian dataset. Sensitivity and specificity of this urine-based metabolomic diagnostic test were also compared with three commercially available fecal-based tests.

Results

An AUC of 0.717 for PolypDx? was calculated on Chinese dataset which is slightly lower than the AUC on the Canadian dataset. A sensitivity of 82.6% and a specificity of 42.4% were achieved on Chinese dataset.

Conclusions

Here, we validated a novel urine-based metabolomic diagnostic test for the detection of adenomatous polyps, PolypDx?, on Chinese population through a sample size of 1000 participants with a greater level of sensitivity than fecal-based tests.

     

Diagnosis and management of splenic injury following colonoscopy: algorithm and case series

Background

Splenic injury following colonoscopy is a rare yet life-threatening complication. These injuries are often associated with delayed diagnosis and may require invasive intervention. We sought to study the emergent presentation associated with splenic injury post-colonoscopy and to suggest a new treatment algorithm.

Methods

Six cases of splenic injury following colonoscopy were collected from three medical centers. Data regarding patient medical history, clinical presentation, laboratory and imaging findings and clinical management were recorded. A systematic PubMed/MEDLINE search was performed. Non-English-language publications and publications dating earlier than 2010 were excluded. An emergency department trauma-based management algorithm was designed according to the identified publications and review of the available trauma literature.

Results

The mean age was 65.3 years and the male-to-female ratio was 1:5. Five of the cases presented within 24 h of the colonoscopy complaining of severe abdominal pain. Hemodynamic instability was noted in four patients who presented with tachycardia (105–130), hypotension and/or a rapid drop in hemoglobin levels. All of the patients underwent initial resuscitation and a computerized abdominal tomography scan. Four of them required emergent splenectomy. No mortality or major morbidity was reported following the hospitalization.

Conclusions

Although very rare, splenic injury during colonoscopy is an acute, severe and possible fatal complication. Patients may present with a rapid clinical deterioration and hemodynamic instability. Physicians should be familiar with the practical management of this surgical emergency and the treatment options available.

     

Objective Differences in Colonoscopy Technique Between Trainee and Expert Endoscopists Using the Colonoscopy Force Monitor

Background

Learning to perform colonoscopy safely and effectively is central to gastroenterology fellowship programs. The application of force to the colonoscope is an important part of colonoscopy technique.

Aims

We compared force application during colonoscopy between novice and expert endoscopists using a novel device to determine differences in colonoscopy technique.

Methods

This is an observational cohort study designed to compare force application during colonoscopy between novice and experienced trainees, made up of gastroenterology fellows from two training programs, and expert endoscopists from both academic and private practice settings.

Results

Force recordings were obtained for 257 colonoscopies by 37 endoscopists, 21 of whom were trainees. Experts used higher average forward forces during insertion compared to all trainees and significantly less clockwise torque compared to novice trainees.

Conclusions

We present significant, objective differences in colonoscopy technique between novice trainees, experienced trainees, and expert endoscopists. These findings suggest that the colonoscopy force monitor is an objective tool for measuring proficiency in colonoscopy. Furthermore, the device may be used as a teaching tool in training and continued medical education programs.

     

Antral hyperplastic polyp causing intermittent gastric outlet obstruction: Case report

Background

Hyperplastic polyps are the most common polypoid lesions of the stomach. Rarely, they cause gastric outlet obstruction by prolapsing through the pyloric channel, when they arise in the prepyloric antrum.

Case presentation

A 62-year-old woman presented with intermittent nausea and vomiting of 4 months duration. Upper gastrointestinal endoscopy revealed a 30 mm prepyloric sessile polyp causing intermittent gastric outlet obstruction. Following submucosal injection of diluted adrenaline solution, the polyp was removed with a snare. Multiple biopsies were taken from the greater curvature of the antrum and the corpus. Rapid urease test for Helicobacter pylori yielded a negative result. Histopathologic examination showed a hyperplastic polyp without any evidence of malignancy. Biopsies of the antrum and the corpus revealed gastritis with neither atrophic changes nor Helicobacter pylori infection. Follow-up endoscopy after a 12-week course of proton pomp inhibitor therapy showed a complete healing without any remnant tissue at the polypectomy site. The patient has been symptom-free during 8 months of follow-up.

Conclusions

Symptomatic gastric polyps should be removed preferentially when they are detected at the initial diagnostic endoscopy. Polypectomy not only provides tissue to determine the exact histopathologic type of the polyp, but also achieves radical treatment.

     

The incidence of post-colonoscopy colorectal cancer: a retrospective long-term cohort study using a colonoscopy database

Purpose

The cumulative incidence of post-colonoscopy colorectal cancer remains unclear. Our aims were to estimate the incidence of and identify risk factors associated with post-colonoscopy colorectal cancer.

Methods

We conducted a retrospective cohort study using the colonoscopy database of the Department of Gastroenterology, the University of Tokyo Hospital Records from1995–2012. A cohort of 2544 patients, who received multiple colonoscopies without colorectal cancer findings at first colonoscopy, was selected. The primary outcome was post-colonoscopy colorectal cancer; data were censored at the date of final colonoscopy. We assessed patients’ background characteristics, colonoscopy findings, and cancer characteristics, including location and size. The cumulative incidence of colorectal cancer was evaluated, and a Cox proportional hazards model was used to estimate hazard ratios (HRs).

Results

Colorectal cancer was identified in seven (0.77/1000 person-years) patients during the mean follow-up period of 3.6 years (maximum, 17 years). The cumulative incidence of colorectal cancer was 0, 0.47, 0.62, and 0.62% at 1, 5, 10, and 15 years, respectively. Cancer was identified in the rectum in five of seven patients. Polyp size >10 mm (HR 5.7, p = 0.023) and intubation time >30 min (HR 11.6, p = 0.003) at first colonoscopy were associated significantly with an increased incidence of post-colonoscopy colorectal cancer.

Conclusions

Although several factors were associated with an increased risk of post-colonoscopy colorectal cancer, the incidence of this disease might be low in patients who received at least twice colonoscopy. High proportion of rectal cancer in post-colonoscopy colorectal cancer should be noted.

     

Low frequency of polyps in colonic regions with diverticulosis

Purpose

Conflicting evidence exists regarding any association between diverticulosis and adenomatous polyps. We evaluated the prevalence of polyps and cancer in colonic regions containing diverticula.

Methods

Six hundred consecutive colonoscopy reports from a single endoscopist were reviewed to determine prevalence and location of diverticulosis and polyps. Additionally, pathology reports of 88 colon cancer resection specimens were reviewed for the presence of diverticulosis, and compared with expected prevalence of diverticulosis in that colonic region based on the collected colonoscopy data.

Results

Overall, rates of detected polyps were comparable between patients with and without diverticulosis. However, analyzing the data by colonic segment containing diverticulosis, the prevalence of adenomatous polyps was reduced in regions of diverticulosis compared to the same colonic segment unaffected by diverticulosis (7 vs. 17% for rectosigmoid (p = 0.005); 5 vs. 18% for descending (p < 0.0001); and 17 vs. 27% for ascending colon (p = 0.0495)). Among colon cancer resection specimens, the prevalence of diverticulosis was significantly reduced in the rectosigmoid and ascending colon, compared with expected rates of diverticulosis in those regions. (13 vs. 42% in rectosigmoid (p = 0.0006); 3 vs. 17% in ascending colon (p = 0.043)).

Conclusion

Despite similar overall frequency of polyps in patients with and without diverticulosis, polyps were significantly less likely in the colonic segment affected by diverticulosis. Additionally, the frequency of diverticulosis in areas of cancer in the rectosigmoid and ascending colon was significantly lower than expected compared with the expected frequency of diverticulosis for those colonic regions. These observations suggest a true negative association between colonic neoplasia and diverticulosis.

     

Reduced Effectiveness of Interruptive Drug-Drug Interaction Alerts after Conversion to a Commercial Electronic Health Record

Background

Drug-drug interaction (DDI) alerts in electronic health records (EHRs) can help prevent adverse drug events, but such alerts are frequently overridden, raising concerns about their clinical usefulness and contribution to alert fatigue.

Objective

To study the effect of conversion to a commercial EHR on DDI alert and acceptance rates.

Design

Two before-and-after studies.

Participants

3277 clinicians who received a DDI alert in the outpatient setting.

Intervention

Introduction of a new, commercial EHR and subsequent adjustment of DDI alerting criteria.

Main Measures

Alert burden and proportion of alerts accepted.

Key Results

Overall interruptive DDI alert burden increased by a factor of 6 from the legacy EHR to the commercial EHR. The acceptance rate for the most severe alerts fell from 100 to 8.4%, and from 29.3 to 7.5% for medium severity alerts (P?<?0.001). After disabling the least severe alerts, total DDI alert burden fell by 50.5%, and acceptance of Tier 1 alerts rose from 9.1 to 12.7% (P?<?0.01).

Conclusions

Changing from a highly tailored DDI alerting system to a more general one as part of an EHR conversion decreased acceptance of DDI alerts and increased alert burden on users. The decrease in acceptance rates cannot be fully explained by differences in the clinical knowledge base, nor can it be fully explained by alert fatigue associated with increased alert burden. Instead, workflow factors probably predominate, including timing of alerts in the prescribing process, lack of differentiation of more and less severe alerts, and features of how users interact with alerts.

     

Interobserver variability amongst gastrointestinal pathologists in assessing prognostic parameters of malignant colorectal polyps: a cause for concern

Background

Malignant colorectal polyps (MCRP) have become a major challenge in the field of coloproctology from diagnosis to full treatment. One important facet of the challenge is the histopathological staging of the lesion and identifying various prognostic parameters. The primary aim of this study was to find the interobserver variation amongst 4 experienced gastrointestinal pathologists when assessing important parameters and staging systems (Haggitt, Kikuchi and Ueno) in MCRPs.

Methods

Four experienced gastrointestinal pathologists independently assessed 56 cases of MCRP, and each pathologist completed a pro forma for each case. The results were collated and statistically analysed.

Results

There was a significant variation in the assessments using the various published staging systems agreed upon on important prognostic parameters.

Conclusions

None of the staging systems used is suitable for all polyp types or has good reproducibility. There is an urgent need to make pathologists’ assessment of MCRPs easier and more reproducible.

     

Insulated-tip knife endoscopic polypectomy for difficult pedunculated colorectal polyps: a prospective pilot study

Background

Endoscopic polypectomy is widely used for colorectal polyps. However, for giant pedunculated colorectal polyps (≥3 cm), conventional techniques are so difficult with en bloc resection that patients had to be transferred to surgery. We had firstly reported our first experience with an insulated-tip knife to successfully remove a giant pedunculated polyp in the sigmoid colon. In this study, our aim was to explore safety and feasible of insulated-tip knife endoscopic polypectomy (IT-EP) for difficult pedunculated colorectal polyps.

Methods

A total of seven consecutive patients with giant pedunculated colorectal polyps (≥3 cm) were prospectively enrolled. IT-EP was conducted with the help of clips for all the seven patients, and data of them was recorded and analyzed.

Results

Of seven patients, five were men and two were women with a mean age 61 years (49–72 years). The mean diameter of polyp head and stalk was 36.4 ± 4.9 mm (30–42 mm) and 14.6 ± 3.6 mm (10–20 mm), respectively. All the polyps were successfully removed with IT-EP, with a mean operation time of 14.9 ± 3.5 min (11–20 min). No serious bleeding or perforation was experienced, and no surgery was needed. There was no recurrence or residual of polyps at a mean 8.1-month follow-up.

Conclusions

Insulated-tip knife endoscopic polypectomy is a safe and feasible alternative for difficult pedunculated colorectal polyps.

     

Radiologische Diagnostik der Sigmadivertikulitis und Stadieneinteilung

Background and objectives

Radiological imaging is of central importance for diagnosing acute and chronic diverticular disease. The indications for the various radiological imaging modalities and their most important findings are discussed in this review article.

Methods

The current literature on this topic was reviewed and summarized.

Results

Contrast-enhanced computed tomography of the abdomen is the method choice in cases of suspected acute diverticulitis and should enable a differentiation between complicated and uncomplicated forms. In suspected chronic diverticular disease virtual colonoscopy represents an equivalent alternative to classical colonoscopy.

Conclusion

Based on imaging findings therapeutic decisions can be made and the radiological findings can have some prognostic value in the follow-up of patients.