Polypectomy

14,000,000 Leading Edge Experts on the ideXlab platform

Scan Science and Technology

Contact Leading Edge Experts & Companies

Scan Science and Technology

Contact Leading Edge Experts & Companies

The Experts below are selected from a list of 327 Experts worldwide ranked by ideXlab platform

Jae Young Jang - One of the best experts on this subject based on the ideXlab platform.

Soo-kyung Park - One of the best experts on this subject based on the ideXlab platform.

  • Prospective analysis of delayed colorectal post-Polypectomy bleeding
    Surgical endoscopy, 2018
    Co-Authors: Soo-kyung Park, Yoon Suk Jung, Jeong Yeon Seo, Min-gu Lee, Hyo-joon Yang, Kyu Yong Choi, Hungdai Kim, Hyung Ook Kim, Kyung Uk Jung, Ho-kyung Chun
    Abstract:

    Although post-Polypectomy bleeding is the most frequent complication after colonoscopic Polypectomy, only few studies have investigated the incidence of bleeding prospectively. The aim of this study was to investigate the incidence of delayed post-Polypectomy bleeding and its associated risk factors prospectively. Patients who underwent colonoscopic Polypectomy at Kangbuk Samsung Hospital from January 2013 to December 2014 were prospectively enrolled in this study. Trained nurses contacted patients via telephone 7 and 30 days after Polypectomy and completed a standardized questionnaire regarding the development of bleeding. Delayed post-Polypectomy bleeding was categorized as minor or major and early or late bleeding. Major delayed bleeding was defined as a > 2-g/dL drop in the hemoglobin level, requiring hospitalization for control of bleeding or blood transfusion; late delayed bleeding was defined as bleeding occurring later than 24 h after Polypectomy. A total of 8175 colonoscopic polypectomies were performed in 3887 patients. Overall, 133 (3.4%) patients developed delayed post-Polypectomy bleeding. Among them, 90 (2.3%) and 43 (1.1%) patients developed minor and major delayed bleeding, respectively, and 39 (1.0%) patients developed late delayed bleeding. In the polyp-based multivariate analysis, young age (  10 mm (OR 2.45; 95% CI 1.38–4.36) were significant risk factors for major delayed bleeding, while young age (

  • Risk of developing metachronous colon neoplasm after Polypectomy: comparison of one-stage versus two-stage Polypectomy
    Surgical Endoscopy, 2014
    Co-Authors: Soo-kyung Park, Jong Wook Kim, Sang Hyoung Park, Dong-hoon Yang, Kee Wook Jung, Kyung-jo Kim, Seung-jae Myung, Suk-kyun Yang, Jin-ho Kim, Jeong-sik Byeon
    Abstract:

    Background The impact of one-stage Polypectomy (removal of all neoplasms during diagnostic colonoscopy) versus two-stage Polypectomy (removal of all neoplasms during therapeutic colonoscopy following the initial diagnostic colonoscopy) on the development of metachronous neoplasms is poorly understood. Our aim was to compare the effects of one- versus two-stage Polypectomy on the development of metachronous neoplasms Methods We retrospectively reviewed the medical records of 249 patients in a tertiary center who underwent one-stage Polypectomy, which was followed by one or more surveillance colonoscopy. The development of metachronous neoplasm in this group was compared with that of an age- and sex-matched two-stage Polypectomy group consisting of 498 patients Results In total, 346 (46.3 %) patients developed any metachronous neoplasm and 29 (3.9 %) patients developed advanced metachronous neoplasm. The 5 years cumulative incidences of any and advanced metachronous neoplasm were 46.2 and 5.0 %, respectively, in the one-stage group, which are not significantly different from the rates of 50.7 and 3.3 % in the two-stage group ( p  = 0.94 and 0.30, respectively). The only significant risk factor for developing any metachronous neoplasm was ≥3 neoplasms at the baseline Polypectomy [hazard ratio (HR) 1.75; 95 % confidence interval (CI) 1.41–2.17; p  

  • Risk of developing metachronous colon neoplasm after Polypectomy: comparison of one-stage versus two-stage Polypectomy
    Surgical endoscopy, 2014
    Co-Authors: Soo-kyung Park, Jong Wook Kim, Sang Hyoung Park, Dong-hoon Yang, Kee Wook Jung, Kyung-jo Kim, Seung-jae Myung, Suk-kyun Yang, Jin-ho Kim
    Abstract:

    Background The impact of one-stage Polypectomy (removal of all neoplasms during diagnostic colonoscopy) versus two-stage Polypectomy (removal of all neoplasms during therapeutic colonoscopy following the initial diagnostic colonoscopy) on the development of metachronous neoplasms is poorly understood. Our aim was to compare the effects of one- versus two-stage Polypectomy on the development of metachronous neoplasms

Rajesh N. Keswani - One of the best experts on this subject based on the ideXlab platform.

  • Adding efficiency to proficiency: a study of trainee Polypectomy efficiency metrics.
    Endoscopy, 2020
    Co-Authors: Larissa Muething, Anna Duloy, Tonya Kaltenbach, Sachin Wani, Matt Hall, Violette C. Simon, Ezenwanyi Ezekwe, Tiffany Nguyen-vu, Carmel Malvar, Rajesh N. Keswani
    Abstract:

    Background Although validated colonoscopy assessment tools exist, they do not measure efficiency. This study aimed to assess content validity of Polypectomy efficiency (PE) and neoplastic Polypectomy efficiency (NPE) as colonoscopy efficiency indices. Methods Data from a randomized controlled trial evaluating Polypectomy among gastroenterology trainees were utilized. PE and NPE were defined as number of polyps (or neoplastic polyps) removed/withdrawal time × 100. Content validity was assessed by determining the association between efficiency indices and Polypectomy times. Results 20 trainees performed 601 colonoscopies. There was a strong association between PE/NPE and actual Polypectomy times: as Polypectomy time increased by 1 minute, the PE decreased by 0.48 (P = 0.001) and NPE decreased by 0.24 (P = 0.03). Conclusions The study proposed and provided content validity for PE and NPE as colonoscopy efficiency indices.

  • Assessing the Quality of Polypectomy and Teaching Polypectomy.
    Gastrointestinal endoscopy clinics of North America, 2019
    Co-Authors: Anna Duloy, Rajesh N. Keswani
    Abstract:

    Ineffective Polypectomy technique may lead to incomplete polyp resection, high complication rates, interval colorectal cancer, and costly referral to surgery. Despite its central importance to endoscopy, training in Polypectomy is not standardized nor has the most effective training approach been defined. Polypectomy competence is rarely reported and quality metrics for this skill are lacking. Use of tools and measurements to assess Polypectomy outcomes is low. There is a need for standardization of training and remediation in Polypectomy; defining standards of competent Polypectomy and how it is feasibly measured; and integration of Polypectomy quality metrics into training programs and the accreditation process.

  • Cold Snare Polypectomy: Techniques and Applications.
    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2019
    Co-Authors: Rajesh N. Keswani
    Abstract:

    The introduction of snare Polypectomy in 1971 resulted in a paradigm shift from endoscopy as a diagnostic to a therapeutic procedure. By resecting neoplastic polyps before they progress to cancer, high-quality colonoscopy and Polypectomy effectively prevent colorectal cancer. Over recent years, there has been a shift to snare Polypectomy without the use of electrocautery, known as cold snare Polypectomy (CSP), which allows for the complete removal of a polyp without the attendant risks of electrocautery. Although CSP is an established, basic, and prevalent endoscopic technique, data suggest that there is still a significant quality gap in the implementation of CSP among trainees and independent practitioners. Thus, there is an urgent need to assess the current state of CSP best practice.

  • Colon Polypectomy report card improves Polypectomy competency: results of a prospective quality improvement study (with video).
    Gastrointestinal endoscopy, 2019
    Co-Authors: Anna Duloy, Tonya Kaltenbach, Mariah Wood, Dyanna L. Gregory, Rajesh N. Keswani
    Abstract:

    Background and Aims Polypectomy competency varies significantly among providers. Poor Polypectomy technique may lead to interval cancer and/or adverse events. Our aim was to determine the effect of a Polypectomy skills report card on subsequent Polypectomy performance. Methods We conducted a 3-phase, prospective, single-blinded study. In phase 1 (“baseline”), we graded 10 polypectomies per endoscopist using the Direct Observation of Polypectomy Skills (DOPyS) tool (scores 1-4); mean overall scores ≥3 are competent. In phase 2 (“pre–report card”), we selected 10 additional polypectomies per endoscopist. We subsequently gave endoscopists a report card with baseline scores and instructional videos demonstrating optimal Polypectomy technique. In phase 3 (“post–report card”), 10 additional polypectomies per endoscopist were selected. Raters, blinded to study phase, graded 10 pre– and 10 post–report card polypectomies per endoscopist. We compared mean DOPyS scores and rate of competent Polypectomy in the pre– and post–report card phases. Results We graded 110 pre– and 110 post–report card polypectomies performed by 11 endoscopists. The mean DOPyS score increased between the pre– and post–report card phases (2.7 ± .9 vs 3.0 ± .8, P = .01); this improvement was seen for diminutive (P  Conclusions Report cards with educational videos effectively improved Polypectomy technique, primarily because of improvements in resecting diminutive polyps. The improved competency and decreased piecemeal resection may reduce the risk of polyp recurrence. Further education is needed to improve larger polyp resection.

  • Assessing colon Polypectomy competency and its association with established quality metrics
    Gastrointestinal endoscopy, 2017
    Co-Authors: Anna Duloy, Tonya Kaltenbach, Rajesh N. Keswani
    Abstract:

    Background and Aims Inadequate Polypectomy leads to incomplete resection, interval colorectal cancer, and adverse events. However, Polypectomy competency is rarely reported, and quality metrics are lacking. The primary aims of this study were to assess Polypectomy competency among a cohort of gastroenterologists and to measure the correlation between Polypectomy competency and established colonoscopy quality metrics (adenoma detection rate and withdrawal time). Methods We conducted a prospective observational study to assess Polypectomy competency among 13 high-volume screening colonoscopists at an academic medical center. Over 6 weeks, we made video recordings of ≥28 colonoscopies per colonoscopist and randomly selected 10 polypectomies per colonoscopist for evaluation. Two raters graded the polypectomies by using the Direct Observation of Polypectomy Skills, a Polypectomy competency assessment tool, which assesses individual Polypectomy skills and overall competency. Results We evaluated 130 polypectomies. A total of 83 polypectomies (64%) were rated as competent, which was more likely for diminutive (70%) than small and/or large polyps (50%, P  = .03). Overall Direct Observation of Polypectomy Skills competency scores varied significantly among colonoscopists ( P  = .001), with overall Polypectomy competency rates ranging between 30% and 90%. Individual skills scores, such as accurately directing the snare over the lesion ( P  = .02) and trapping an appropriate amount of tissue within the snare ( P  = .001) varied significantly between colonoscopists. Polypectomy competency rates did not significantly correlate with the adenoma detection rate (r = 0.4; P  = .2) or withdrawal time (r = 0.2; P  = .5). Conclusions Polypectomy competency varies significantly among colonoscopists and does not sufficiently correlate with established quality metrics. Given the clinical implications of suboptimal Polypectomy, efforts to educate colonoscopists in Polypectomy techniques and develop a metric of Polypectomy quality are needed.

Jaejun Shim - One of the best experts on this subject based on the ideXlab platform.

Akira Horiuchi - One of the best experts on this subject based on the ideXlab platform.

  • cold snare Polypectomy indications devices techniques outcomes and future
    Digestive Endoscopy, 2019
    Co-Authors: Akira Horiuchi, Tamaki Ikuse, Naoki Tanaka
    Abstract:

    : 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.

  • comparison of newly found polyps after removal of small colorectal polyps with cold or hot snare Polypectomy
    Acta Gastro-enterologica Belgica, 2015
    Co-Authors: Akira Horiuchi, Masashi Kajiyama, Toshiyuki Makino, Yasuyuki Ichise, Naoyuki Kato, Naoki Tanaka
    Abstract:

    BACKGROUND AND STUDY AIMS: There are limited data regarding polyp recurrence following cold or hot snare Polypectomy for small colorectal polyps. The aim of this study was to evaluate the prevalence of newly found polyp after cold or hot snare Polypectomy and the predictive factors. PATIENTS AND METHODS: This was a retrospective case-control study at a single municipal hospital. Patients undergoing cold or hot snare Polypectomy for colorectal polyps≤8 mm included in a previous study (Digestion 2011; 84:78) were enrolled. Newly found polyps were defined as polyps detected at follow-up colonoscopy within 3 years. Predictive factors for new polyps were assessed by multivariate analysis using logistic regression. RESULTS: A total of 72 patients (female 22, mean age 68) with 184 polyps were enrolled. Eighty-nine polyps (mean size±SD, 5.3±2 mm) were resected with cold snare while 95 polyps (mean size 5.5±6 mm) were resected with hot snare Polypectomy. Twenty-four new polyps (<5 mm) were found at follow-up. No Polypectomy scars were detected in the vicinity of the new polyps. The prevalence of new polyps was similar (i.e., cold vs. hot snare Polypectomy; 23% vs. 19%, P=0.68). Multivariate analysis revealed that the removal of ≥4 polyps was an independent predictor associated with new polyps (odds ratio:7.8, 95% confidence interval: 2.1-32, P=0.0022). CONCLUSIONS: Diminutive polyps were newly found with similar prevalence after cold or hot snare Polypectomy, but there were no recurrent polyps detected.

  • removal of small colorectal polyps in anticoagulated patients a prospective randomized comparison of cold snare and conventional Polypectomy
    Gastrointestinal Endoscopy, 2014
    Co-Authors: Akira Horiuchi, Yoshiko Nakayama, Masashi Kajiyama, Naoki Tanaka, Kenji Sano, David Y Graham
    Abstract:

    Background The bleeding risk after cold snare Polypectomy in anticoagulated patients is not known. Objective To compare the bleeding risk after cold snare Polypectomy or conventional Polypectomy for small colorectal polyps in anticoagulated patients. Design Prospective randomized controlled study. Setting Municipal hospital in Japan. Interventions Anticoagulated patients with colorectal polyps up to 10 mm in diameter were enrolled. Patients were randomized to Polypectomy with either cold snare technique (Cold group) or conventional Polypectomy (Conventional group) without discontinuation of warfarin. The primary outcome measure was delayed bleeding (ie, requiring endoscopic intervention within 2 weeks after Polypectomy). Secondary outcome measures were immediate bleeding and retrieval rate of colorectal polyps. Results Seventy patients were randomized (159 polyps): Cold group (n = 35, 78 polyps) and Conventional group (n = 35; 81 polyps). The patients' demographic characteristics including international normalized ratio and the number, size, and shape of polyps removed were similar between the 2 techniques. Immediate bleeding during the procedure was more common with conventional Polypectomy (23% [8/35]) compared with cold Polypectomy (5.7% [2/35]) ( P  = .042). No delayed bleeding occurred in the Cold group, whereas 5 patients (14%) required endoscopic hemostasis in the Conventional group ( P  = .027). Complete polyp retrieval rates were identical (94% [73/78] vs 93% [75/81]). The presence of histologically demonstrated injured arteries in the submucosal layer with cold snare was significantly less than with conventional snare (22% vs 39%, P  = .023). Limitation Small sample size, single-center study. Conclusions Delayed bleeding requiring hemostasis occurred significantly less commonly after cold snare Polypectomy than conventional Polypectomy despite continuation of anticoagulants. Cold snare Polypectomy is preferred for removal of small colorectal polyps in anticoagulated patients. (Clinical trial registration number: NCT 01553565.)

Related terms

Polypectomy - 15 days free trial to Access Experts & Abstracts