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Ferlitsch M, Hassan C, Bisschops R, Bhandari P, Dinis-Ribeiro M, Risio M, Paspatis GA, Moss A, Libânio D, Lorenzo-Zúñiga V, Voiosu AM, Rutter MD, Pellisé M, Moons LMG, Probst A, Awadie H, Amato A, Takeuchi Y, Repici A, Rahmi G, Koecklin HU, Albéniz E, Rockenbauer LM, Waldmann E, Messmann H, Triantafyllou K, Jover R, Gralnek IM, Dekker E, Bourke MJ. Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2024. Endoscopy 2024. [PMID: 38670139 DOI: 10.1055/a-2304-3219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
1: ESGE recommends cold snare polypectomy (CSP), to include a clear margin of normal tissue (1-2 mm) surrounding the polyp, for the removal of diminutive polyps (≤ 5 mm).Strong recommendation, high quality of evidence. 2: ESGE recommends against the use of cold biopsy forceps excision because of its high rate of incomplete resection.Strong recommendation, moderate quality of evidence. 3: ESGE recommends CSP, to include a clear margin of normal tissue (1-2 mm) surrounding the polyp, for the removal of small polyps (6-9 mm).Strong recommendation, high quality of evidence. 4: ESGE recommends hot snare polypectomy for the removal of nonpedunculated adenomatous polyps of 10-19 mm in size.Strong recommendation, high quality of evidence. 5: ESGE recommends conventional (diathermy-based) endoscopic mucosal resection (EMR) for large (≥ 20 mm) nonpedunculated adenomatous polyps (LNPCPs).Strong recommendation, high quality of evidence. 6: ESGE suggests that underwater EMR can be considered an alternative to conventional hot EMR for the treatment of adenomatous LNPCPs.Weak recommendation, moderate quality of evidence. 7: Endoscopic submucosal dissection (ESD) may also be suggested as an alternative for removal of LNPCPs of ≥ 20 mm in selected cases and in high-volume centers.Weak recommendation, low quality evidence. 8: ESGE recommends that, after piecemeal EMR of LNPCPs by hot snare, the resection margins should be treated by thermal ablation using snare-tip soft coagulation to prevent adenoma recurrence.Strong recommendation, high quality of evidence. 9: ESGE recommends (piecemeal) cold snare polypectomy or cold EMR for SSLs of all sizes without suspected dysplasia.Strong recommendation, moderate quality of evidence. 10: ESGE recommends prophylactic endoscopic clip closure of the mucosal defect after EMR of LNPCPs in the right colon to reduce to reduce the risk of delayed bleeding.Strong recommendation, high quality of evidence. 11: ESGE recommends that en bloc resection techniques, such as en bloc EMR, ESD, endoscopic intermuscular dissection, endoscopic full-thickness resection, or surgery should be the techniques of choice in cases with suspected superficial invasive carcinoma, which otherwise cannot be removed en bloc by standard polypectomy or EMR.Strong recommendation, moderate quality of evidence.
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Affiliation(s)
- Monika Ferlitsch
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
- Department of Gastroenterology, Evangelical Hospital, Vienna, Austria
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, KU Leuven, Leuven, Belgium
| | - Pradeep Bhandari
- Endoscopy Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Mário Dinis-Ribeiro
- Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
- MEDCIDS/Faculty of Medicine, University of Porto, Porto, Portugal
- Porto Comprehensive Cancer Center (Porto.CCC) and RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Mauro Risio
- Department of Pathology, Institute for Cancer Research and Treatment, Candiolo, Turin, Italy
| | - Gregorios A Paspatis
- Gastroenterology Department, Venizeleio General Hospital, Heraklion, Crete, Greece
| | - Alan Moss
- Department of Gastroenterology, Western Health, Melbourne, Australia
- Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Diogo Libânio
- Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
- MEDCIDS/Faculty of Medicine, University of Porto, Porto, Portugal
- Porto Comprehensive Cancer Center (Porto.CCC) and RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Vincente Lorenzo-Zúñiga
- Endoscopy Unit, La Fe University and Polytechnic Hospital / IISLaFe, Valencia, Spain
- Department of Medicine, Catholic University of Valencia, Valencia, Spain
| | - Andrei M Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
- Internal Medicine and Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Matthew D Rutter
- Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
- Department of Gastroenterology, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Leon M G Moons
- III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Halim Awadie
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
| | - Arnaldo Amato
- Digestive Endoscopy and Gastroenterology Department, Ospedale A. Manzoni, Lecco, Italy
| | - Yoji Takeuchi
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Gabriel Rahmi
- Hepatogastroenterology and Endoscopy Department, Hôpital européen Georges Pompidou, Paris, France
- Laboratoire de Recherches Biochirurgicales, APHP-Centre Université de Paris, Paris, France
| | - Hugo U Koecklin
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Teknon Medical Center, Barcelona, Spain
| | - Eduardo Albéniz
- Gastroenterology Department, Hospital Universitario de Navarra (HUN); Navarrabiomed, Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Lisa-Maria Rockenbauer
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Waldmann
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Helmut Messmann
- III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Propaedeutic Internal Medicine, Medical School, National and Kapodastrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria ISABIAL, Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
| | - Ian M Gralnek
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
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Okamoto T, Nakamura K, Yamamoto K, Yoshimoto T, Takasu A, Shiratori Y, Ikeya T, Okuyama S, Takagi K, Fukuda K. Safety and Effectiveness of Endoscopic Band Ligation for Colonic Diverticular Bleeding in Elderly Patients. Digestion 2021; 102:760-766. [PMID: 33556954 DOI: 10.1159/000513310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/24/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Colonic diverticulosis increases with age, leading to a higher risk of colonic diverticular bleeding (CDB) in the elderly. As life expectancy continues to increase, the need for endoscopic hemostasis for CDB in the elderly can also be expected to increase. However, there have been no reports to date on the feasibility of endoscopic hemostasis for elderly CDB patients. Several recent studies have addressed the effectiveness of endoscopic band ligation (EBL) for CDB. In this study, we evaluate the safety and effectiveness of EBL in elderly CDB patients compared to younger CDB patients. METHODS We retrospectively analyzed the medical records of consecutive patients treated with EBL for the first time at a tertiary referral center between March 2011 and November 2017. Patients were grouped according to age into those at least 75 years old (the Elderly) and those <75 years old (the Nonelderly). Patient characteristics, technical success, and complications were compared between the two groups. RESULTS EBL was performed in 153 patients during the study period (49 Elderly patients and 104 Nonelderly patients). Elderly patients were less likely to be male (p < 0.001) and had lower hemoglobin levels on admission (p < 0.001). Bleeding on the right side of the splenic flexure was observed more frequently in the Nonelderly (p = 0.002). Charlson Comorbidity Index (CCI) and use of antithrombotic agents were significantly higher in the Elderly (p < 0.001 and p < 0.001, respectively). Active bleeding tended to be observed more frequently in the Elderly (p = 0.054), while the difference was not significant. There were no significant differences in the shock index, procedure time, or units of packed red blood cells transfused between the 2 groups. No significant differences in the technical success rate (97.1 vs. 98%, p = 0.76), early rebleeding rate (10.2 vs. 14.4%, p = 0.47), or other complications (2 vs. 1%, p = 0.58) were observed. Perforation and abscess formation were not observed in either group. Female gender, left-sidedness, higher CCI, and lower hemoglobin level were all significantly more frequently observed in the Elderly on multiple logistic regression analysis. DISCUSSION/CONCLUSION EBL may be similarly safe and effective for the treatment of CDB in the elderly as in the nonelderly.
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Affiliation(s)
- Takeshi Okamoto
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Kenji Nakamura
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan, .,Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan,
| | - Kazuki Yamamoto
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Takaaki Yoshimoto
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Ayaka Takasu
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Yasutoshi Shiratori
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Takashi Ikeya
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Shuhei Okuyama
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Koichi Takagi
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Katsuyuki Fukuda
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
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Goldis A, Goldis R, Chirila TV. Biomaterials in Gastroenterology: A Critical Overview. ACTA ACUST UNITED AC 2019; 55:medicina55110734. [PMID: 31726779 PMCID: PMC6915447 DOI: 10.3390/medicina55110734] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/30/2019] [Accepted: 11/08/2019] [Indexed: 02/07/2023]
Abstract
In spite of the large diversity of diagnostic and interventional devices associated with gastrointestinal endoscopic procedures, there is little information on the impact of the biomaterials (metals, polymers) contained in these devices upon body tissues and, indirectly, upon the treatment outcomes. Other biomaterials for gastroenterology, such as adhesives and certain hemostatic agents, have been investigated to a greater extent, but the information is fragmentary. Much of this situation is due to the paucity of details disclosed by the manufacturers of the devices. Moreover, for most of the applications in the gastrointestinal (GI) tract, there are no studies available on the biocompatibility of the device materials when in intimate contact with mucosae and other components of the GI tract. We have summarized the current situation with a focus on aspects of biomaterials and biocompatibility related to the device materials and other agents, with an emphasis on the GI endoscopic procedures. Procedures and devices used for the control of bleeding, for polypectomy, in bariatrics, and for stenting are discussed, particularly dwelling upon the biomaterial-related features of each application. There are indications that research is progressing steadily in this field, and the establishment of the subdiscipline of "gastroenterologic biomaterials" is not merely a remote projection. Upon the completion of this article, the gastroenterologist should be able to understand the nature of biomaterials and to achieve a suitable and beneficial perception of their significance in gastroenterology. Likewise, the biomaterialist should become aware of the specific tasks that the biomaterials must fulfil when placed within the GI tract, and regard such applications as both a challenge and an incentive for progressing the research in this field.
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Affiliation(s)
- Adrian Goldis
- Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence:
| | | | - Traian V. Chirila
- Queensland Eye Institute, South Brisbane, QL 4101, Australia;
- Science & Engineering Faculty, Queensland University of Technology, Brisbane, QL 4000, Australia
- Faculty of Medicine, University of Queensland, Herston, QL 4029, Australia
- Australian Institute for Bioengineering and Nanotechnology, University of Queensland, St Lucia, 4072 QL, Australia
- Faculty of Science, University of Western Australia, Crawley, WA 6009, Australia
- University of Medicine, Pharmacy, Sciences and Technology, 540139 Targu Mures, Romania
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Ma MX, Bourke MJ. Complications of endoscopic polypectomy, endoscopic mucosal resection and endoscopic submucosal dissection in the colon. Best Pract Res Clin Gastroenterol 2016; 30:749-767. [PMID: 27931634 DOI: 10.1016/j.bpg.2016.09.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/25/2016] [Accepted: 09/06/2016] [Indexed: 02/07/2023]
Abstract
Endoscopic resection (ER), including endoscopic polypectomy (EP), endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are used to remove superficial neoplasms from the colon. Snare resection is used for EP and EMR, whereas endoscopic knives are used to perform dissection in the submucosal space in ESD. 80-90% colonic polyps are <10 millimetres (mm) and are effectively managed by conventional EP. Increasingly cold snare polypectomy is preferred. Large laterally spreading lesions (LSLs) and sessile polyps ≥20 mm are primarily removed by EMR. ESD may be used when superficial invasive disease is suspected and for some LSLs, particularly non-granular subtypes. Resection of colonic lesions by ER is associated with a small but definite incidence of significant complications, most commonly bleeding and perforation. This review discusses complications of ER with a particular focus on their prevention, early recognition and management. In many cases, complications from all three procedures share similar mechanisms and management principles and these are described at the start of each section, followed by a description of specific aspects for individual procedures.
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Affiliation(s)
- Michael X Ma
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia.
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Han JH, Kim M, Lee TH, Kim H, Jung Y, Park SM, Chae H, Youn S, Shin JY, Lee IK, Lee TS, Choi SH. Endoluminal Closure of Colon Perforation with Endoscopic Band Ligation: Technical Feasibility and Safety in an In Vivo Canine Model. Clin Endosc 2015; 48:534-41. [PMID: 26668801 PMCID: PMC4676667 DOI: 10.5946/ce.2015.48.6.534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/26/2015] [Accepted: 04/03/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/AIMS Endoscopic band ligation (EBL) is an accepted method in the management of variceal bleeding; however, there is little evidence on the safety and feasibility of EBL for the closure of bowel perforation. In this study, we aimed to evaluate the technical feasibility and efficacy of EBL in iatrogenic colon perforation by using a canine model. METHODS We established an iatrogenic colon perforation model by using seven beagle dogs. Longitudinal 1.5- to 1.7-cm colon perforations were created with a needle knife and an insulated-tip knife, and the perforation was subsequently closed with EBL. During a 2-week follow-up period, the animals were carefully monitored and then euthanized for pathologic examination. RESULTS The EBL of iatrogenic colon perforations was successful in all dogs. The mean procedure time for EBL closure with one to three bands was 191.7 seconds, and there were no immediate complications. One animal was euthanized after 3 days because of peritonitis. There were no clinical and laboratory features of sepsis or peritonitis in the remaining six animals. On necropsy, we did not find any fecal peritonitis, pericolonic abscess formation, or transmural dehiscence at the perforation site. Histopathology demonstrated inflamed granulation tissue and scar lesions replaced by fibrosis. CONCLUSIONS EBL might be a feasible and safe method for the management of iatrogenic colon perforations in an in vivo model.
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Affiliation(s)
- Joung-Ho Han
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Myounghwan Kim
- Department of Veterinary Surgery, Chungbuk National University College of Veterinary Medicine, Cheongju, Korea
| | - Tae Hoon Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hyun Kim
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Yunho Jung
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Seon Mee Park
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Heebok Chae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seijin Youn
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ji Yun Shin
- Department of Biomedical Engineering, Chungbuk National University College of Medicine, Cheongju, Korea
| | - In-Kwang Lee
- Department of Biomedical Engineering, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Tae Soo Lee
- Department of Biomedical Engineering, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seok Hwa Choi
- Department of Veterinary Surgery, Chungbuk National University College of Veterinary Medicine, Cheongju, Korea
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Brock AS, Rockey DC. Mechanical Hemostasis Techniques in Nonvariceal Upper Gastrointestinal Bleeding. Gastrointest Endosc Clin N Am 2015; 25:523-33. [PMID: 26142036 DOI: 10.1016/j.giec.2015.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
One of the most important advances in gastroenterology has been the use of endoscopic hemostasis techniques to control nonvariceal upper gastrointestinal bleeding, particularly when high-risk stigmata are present. Several options are available, including injection therapy, sprays/topical agents, electrocautery, and mechanical methods. The method chosen depends on the nature of the lesion and experience of the endoscopist. This article reviews the available mechanical hemostatic modalities.
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Affiliation(s)
- Andrew S Brock
- Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Don C Rockey
- Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA.
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Abstract
Bleeding is a relatively rare complication occurring mainly after snare polypectomy. The majority of cases can be managed successfully by endoscopic means leaving very few cases which will ultimately need an operation. Colonic perforation, on the other hand is a serious complication that requires intensive and careful management. Prompt recognition of the perforation during the procedure allows, in selected cases, immediate endoscopic closure with an uneventful and full recovery followed by close monitoring and surgical management in case of clinical deterioration. The criteria for the right selection of perforation cases amenable to endoscopic treatment do still need to be confirmed by prospective studies and further experience is required before a standard algorithm on the endoscopic management of perforations is developed.
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Ji JS, Cho YS. Endoscopic band ligation: Beyond prevention and management of gastroesophageal varices. World J Gastroenterol 2013; 19:4271-4276. [PMID: 23885137 PMCID: PMC3718894 DOI: 10.3748/wjg.v19.i27.4271] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 03/19/2013] [Accepted: 04/29/2013] [Indexed: 02/06/2023] Open
Abstract
Endoscopic band ligation (EBL) is the preferred endoscopic technique for the endoscopic treatment of acute esophageal variceal bleeding. EBL has also been used to treat nonvariceal bleeding. Recently, Han et al demonstrated that EBL can be a feasible and safe alternate technique for the management of iatrogenic gastric perforation especially in cases in which closure with endoclips is difficult. EBL is technically simpler to perform than other methods and provides a good view of the lesions under direct pressure and suction from the transparent ligation cap. EBL can be used even if the diameter of the perforation is greater than 10 mm or if there is a severe tangential angle. In this commentary, we discuss the efficacy and safety of EBL for the closure of iatrogenic gastrointestinal perforation. We also discuss the advantages and disadvantages of EBL for the treatment of nonvariceal bleeding.
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Postpolypectomy bleeding: incidence, risk factors, prevention, and management. Surg Laparosc Endosc Percutan Tech 2012; 22:102-7. [PMID: 22487620 DOI: 10.1097/sle.0b013e318247c02e] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Endoscopic polypectomy is at the forefront of colorectal cancer (CRC) prevention. However, endoscopic polypectomy is not completely free of complications, with bleeding being one of the most common complications encountered. In view of the ongoing campaign to introduce colorectal cancer screening to the population, addressing the issue of colonoscopic complications, and postpolypectomy bleeding (PPB) in particular is becoming more important. Despite the fact that the overall incidence of PPB is low, predisposing factors need to be elucidated to further decrease the frequency of this complication. Furthermore, the role of various techniques of PPB prophylaxis remains controversial. We review recent studies on the incidence, risk factors, prophylaxis, and management of PPB.
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Endoscopic band ligation for nonvariceal bleeding: a review. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 22:748-52. [PMID: 18818787 DOI: 10.1155/2008/165264] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Liu J, Petersen BT, Tierney WM, Chuttani R, Disario JA, Coffie JMB, Mishkin DS, Shah RJ, Somogyi L, Song LMWK. Endoscopic banding devices. Gastrointest Endosc 2008; 68:217-21. [PMID: 18656592 DOI: 10.1016/j.gie.2008.03.1121] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 03/31/2008] [Indexed: 01/27/2023]
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Raju GS, Kaltenbach T, Soetikno R. Endoscopic mechanical hemostasis of GI arterial bleeding (with videos). Gastrointest Endosc 2007; 66:774-85. [PMID: 17905022 DOI: 10.1016/j.gie.2007.04.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Accepted: 04/14/2007] [Indexed: 01/09/2023]
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13
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Ringold DA, Jonnalagadda S. Complications of Therapeutic Endoscopy: A Review of the Incidence, Risk Factors, Prevention, and Endoscopic Management. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2007. [DOI: 10.1016/j.tgie.2007.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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14
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Paspatis GA, Paraskeva K, Theodoropoulou A, Mathou N, Vardas E, Oustamanolakis P, Chlouverakis G, Karagiannis I. A prospective, randomized comparison of adrenaline injection in combination with detachable snare versus adrenaline injection alone in the prevention of postpolypectomy bleeding in large colonic polyps. Am J Gastroenterol 2006; 101:2805; quiz 2913. [PMID: 17026560 DOI: 10.1111/j.1572-0241.2006.00855.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Our study sought to compare the efficacy of adrenaline injection in combination with detachable snare versus adrenaline injection alone in the prevention of postpolypectomy bleeding in large colonic polyps. METHODS At the time of colonoscopy, patients with at least one colonic polyp > or =2 cm were randomized to receive treatment either by the injection of a 1:10.000 solution of adrenaline and the position of a detachable snare followed by a conventional snare polypectomy (group A) or injection of adrenaline followed by a conventional snare polypectomy (group B). A total of 159 consecutive patients were randomly assigned to one of the above groups. Out of them, 84 patients (47 men, 37 women, mean age 61 yr) were assigned to group A and 75 (37 men, 38 women, mean age 64 yr) to group B. Early (<24 h) and late (>24 h-30 days) bleeding complications were assessed. RESULTS Overall bleeding complications occurred in 10/159 (6.2%) of the patients. There were two cases of bleeding in group A (2.3%), and eight in group B (10.6%) (P= 0.04). The number of early bleeding episodes was significantly reduced in group A patients (1 case) compared to that of group B (7 cases) (P= 0.02). In contrast, there was no significant difference between group A and B as far as late bleeding is concerned. CONCLUSIONS Our data suggest that the use of adrenaline injection in combination with detachable snare may significantly decrease the number of early postpolypectomy bleeding episodes in patients with large colonic polyps.
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Affiliation(s)
- Gregorios A Paspatis
- Department of Gastroenterology, Benizelion General Hospital, Heraklion-Crete, Greece
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Higuchi N, Akahoshi K, Sumida Y, Kubokawa M, Motomura Y, Kimura M, Matsumoto M, Nakamura K, Nawata H. Endoscopic band ligation therapy for upper gastrointestinal bleeding related to Mallory-Weiss syndrome. Surg Endosc 2006; 20:1431-4. [PMID: 16703428 DOI: 10.1007/s00464-005-0608-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Accepted: 01/05/2006] [Indexed: 01/12/2023]
Abstract
BACKGROUND No consensus exists as to the best endoscopic treatment for Mallory-Weiss syndrome. Endoscopic band ligation is a readily available and easily learned technique. This prospective study evaluated the efficacy and safety of endoscopic band ligation therapy for Mallory-Weiss syndrome. METHODS From August 1998 to June 2005, a clinical trial assessed 37 patients with a diagnosis of Mallory-Weiss syndrome who had active bleeding, exposed vessels, or both. Their lesions were treated using endoscopic band ligation. RESULTS Endoscopic band ligation was successful in 36 of 37 cases, with a follow-up period ranging from 1 to 24 months. The remaining patient had severe liver failure and disseminated intravascular coagulation. The patient bled again at 12 h and subsequently died. Except for this case, no recurrent bleeding, perforation, or other complications occurred. CONCLUSIONS The study results suggest that endoscopic band ligation is an effective, safe, and easily learned procedure for treating upper gastrointestinal bleeding related to Mallory-Weiss syndrome.
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Affiliation(s)
- N Higuchi
- Department of Gastroenterology, Aso Iizuka Hospital, 3-83 Yoshio, Iizuka, Fukuoka, 820-8505, Japan
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Akahoshi K, Yoshinaga S, Fujimaru T, Kondoh A, Higuchi N, Furuno T, Oya M. Endoscopic resection with hypertonic saline-solution-epinephrine injection plus band ligation for large pedunculated or semipedunculated gastric polyp. Gastrointest Endosc 2006; 63:312-6. [PMID: 16427941 DOI: 10.1016/j.gie.2005.06.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2005] [Accepted: 06/09/2005] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endoscopic resection of pedunculated polyps with heads 1 cm or greater in diameter presents a risk of bleeding. To minimize this complication, we performed endoscopic resection with hypertonic saline-solution-epinephrine injection plus band ligation and evaluated its safety and effectiveness. METHODS Seventeen patients with 20 pedunculated or semipedunculated polyps with heads 1 cm or greater in diameter were treated with this technique. Conventional upper-GI endoscope, hypertonic saline-solution and epinephrine, sclerotherapy needle, and endoscopic band ligator device are needed for the procedure. OBSERVATIONS All lesions were easily and safely resected. During this procedure, a band ligation chamber proved to be satisfactory for accurate recognition of a postpolypectomy ulcer under good visual control. No hemorrhage, perforation, or other complication occurred as a result of the use of this technique. The histologic resection margin was affected by nonneoplastic components in 6 of 20 lesions. Follow-up endoscopy 1 week later revealed a small, shallow ulcer without residual polyp in all lesions. CONCLUSIONS This preliminary study suggests that endoscopic resection with hypertonic saline-solution-epinephrine injection plus band ligation is a simple and effective method for the prevention of polypectomy-associated bleeding. Prospective trials, including randomized controlled studies, are required to evaluate the suitability of this modality for wide clinical use.
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Affiliation(s)
- Kazuya Akahoshi
- Department of Gastroenterology and Pathology, Aso Iizuka Hospital, Iizuka, Japan
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18
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Lee YJ, Myung SJ, Byeon JS, Yang SK, Kim KJ, Hong SS, Jung HY, Lee YS, Hong WS, Kim JH, Min YI. ENDOSCOPIC LIGATION BY DETACHABLE SNARE FOR THE HEMOSTASIS OF COLONIC BLEEDING FOLLOWED BY SUCCESSFUL LIVER TRANSPLANTATION. Dig Endosc 2004. [DOI: 10.1111/j.1443-1661.2004.00409.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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19
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Abstract
Colonoscopy continues to be the primary tool for diagnostic evaluation and management of lower gastrointestinal bleeding (LGIB). With the advent of newer endoscopy delivery therapeutic modalities, the treatment of LGIB has changed dramatically over the decades. The most dramatic change has been the role of surgery, which has been substantially reduced due to the therapeutic colonoscopy. This article reviews recent advances in the endoscopic treatment options in LGIB of the colon and rectum.
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Affiliation(s)
- Naveen Arya
- The Centre for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, 16-062 Cardinal Carter Wing, 30 Bond Street, Toronto, ON M5B 1W8, Canada.
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Nishiyama H, Mizuta Y, Isomoto H, Kadokawa Y, Kanazawa Y, Takeshima F, Omagari K, Fukuda Y, Murata I, Kohno S. Pseudoxanthoma elasticum with recurrent gastric hemorrhage managed by endoscopic mechanical hemostasis. Dig Endosc 2004. [DOI: 10.1111/j.1443-1661.2003.00328.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Junquera F, Brullet E, Campo R, Calvet X, Puig-Diví V, Vergara M. Usefulness of endoscopic band ligation for bleeding small bowel vascular lesions. Gastrointest Endosc 2003; 58:274-9. [PMID: 12872104 DOI: 10.1067/mge.2003.357] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal therapy for bleeding small bowel vascular lesions is controversial. This study investigated the efficacy and safety of endoscopic band ligation in this clinical condition. METHODS Fourteen patients bleeding from angiodysplasia and 4 bleeding from Dieulafoy's lesions located in the small bowel were included in this pilot study. Endoscopic band ligation was performed by using less than 200 mBar negative pressure in suctioning the target lesion into the ligation cap just before band release. Mean follow-up was 18 months (range 6-31 months). OBSERVATIONS Endoscopic band ligation achieved hemostasis in a single session in all patients. No adverse events occurred except for mild abdominal pain in two patients. Mortality was null, and no patient required further blood transfusion during the 40 days after endoscopic band ligation. No patient with Dieulafoy's lesion had further bleeding, whereas bleeding recurred in 6 of 14 (43%) patients with angiodysplasia during long-term follow-up. CONCLUSIONS Endoscopic band ligation is safe and effective for treatment of acutely bleeding small bowel vascular lesions. Although endoscopic band ligation is definitive therapy for Dieulafoy's lesion, long-term efficacy in the treatment of GI bleeding from angiodysplasia is limited.
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Affiliation(s)
- Félix Junquera
- Endoscopy Unit, UDIAT-CD, Corporació Parc Taulí, Sabadell, Spain
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22
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Dominitz JA, Eisen GM, Baron TH, Goldstein JL, Hirota WK, Jacobson BC, Johanson JF, Leighton JA, Mallery JS, Raddawi HM, Vargo JJ, Waring JP, Fanelli RD, Wheeler-Harbough J, Faigel DO. Complications of colonoscopy. Gastrointest Endosc 2003; 57:441-5. [PMID: 12665750 DOI: 10.1016/s0016-5107(03)80005-6] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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FUJISHIRO HIROFUMI, ADACHI KYOICHI, IMAOKA TOMONORI, KOHGE NARUAKI, KAWAMURA AKIRA, KOMAZAWA YOSHINORI, ONO MASAHIRO, YUKI MIKA, SATO HIROSHI, AMANO YUJI, ISHIHARA SHUNJI, KINOSHITA YOSHIKAZU. Analysis of urgent colonoscopy for acute lower intestinal bleeding. Dig Endosc 2003. [DOI: 10.1046/j.1443-1661.2003.00228.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
| | - KYOICHI ADACHI
- Department of Internal Medicine II, Shimane Medical University, and
| | - TOMONORI IMAOKA
- Department of Digestion, Shimane Prefectural Central Hospital, Izumo, Japan
| | - NARUAKI KOHGE
- Department of Digestion, Shimane Prefectural Central Hospital, Izumo, Japan
| | - AKIRA KAWAMURA
- Department of Internal Medicine II, Shimane Medical University, and
| | | | - MASAHIRO ONO
- Department of Internal Medicine II, Shimane Medical University, and
| | - MIKA YUKI
- Department of Internal Medicine II, Shimane Medical University, and
| | - HIROSHI SATO
- Department of Internal Medicine II, Shimane Medical University, and
| | - YUJI AMANO
- Department of Internal Medicine II, Shimane Medical University, and
| | - SHUNJI ISHIHARA
- Department of Internal Medicine II, Shimane Medical University, and
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TOMIYAMA RYOSAKU, KINJO FUKUNORI, HOKAMA AKIRA, MIYAGI TSUYOSHI, NAKASONE HIROKI, KINJO NAGISA, SAKUGAWA HIROSHI, SAITO ATSUSHI. Endoscopic band ligation for postpolypectomy gastric bleeding. Dig Endosc 2003. [DOI: 10.1046/j.1443-1661.2003.00230.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
| | - FUKUNORI KINJO
- First Department of Internal Medicine and
- Department of Endoscopy, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | | | | | | | - NAGISA KINJO
- First Department of Internal Medicine and
- Department of Endoscopy, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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Affiliation(s)
- Gary C Vitale
- Director of Interventional Endoscopy of the Center for Advanced Surgical Technologies, Norton Hospital Surgical Director, Digestive Disease Center, University of Louisville, Louisville, Kentucky, USA
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26
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Abstract
Urgent colonoscopy has emerged as the initial diagnostic and main therapeutic tool in the evaluation and treatment of colonic lower gastrointestinal bleeding. Endoscopic therapy can effectively treat most cases of colonic bleeding with a demonstrable improvement in clinical outcome parameters. The identification of high-risk stigmata of hemorrhage enables selective targeting of endoscopic therapy to lesions at high risk of rebleeding. Advances in technologies such as novel mechanical methods of hemostasis (eg, metallic clips), injection techniques (eg, cyanoacrylate injection), and the widening application of established endoscopic hemostatic techniques (eg, rubber-band ligation) to colonic lesions offers the possibility of further improvements in the efficacy of endoscopic hemostasis. Clinical trials are needed to compare these novel endoscopic techniques with more conventional approaches to establish the best form of endoscopic therapy for different bleeding lesions and finally to establish more definitively the optimal timing of colonoscopy.
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Affiliation(s)
- Umar Beejay
- Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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27
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Mizuta Y, Yamakawa M, Isomoto H, Takeshima F, Murase K, Irie J, Kawai K, Murata I, Kohno S. Successful Endoscopic Band Ligation for Treatment of Postpolypectomy Hemorrhage. Dig Endosc 2001. [DOI: 10.1046/j.1443-1661.2000.00077.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Yohei Mizuta
- *Department of Medicine, Nagasaki Municipal Hospital, † Second Department of Internal Medicine, Nagasaki University School of Medicine, ‡Department of Pathology, Nagasaki Municipal Hospital and §Department of Pharmacotherapeutics, Nagasaki University Graduate School of Pharmaceutical Science, Nagasaki, Japan
| | - Masaki Yamakawa
- *Department of Medicine, Nagasaki Municipal Hospital, † Second Department of Internal Medicine, Nagasaki University School of Medicine, ‡Department of Pathology, Nagasaki Municipal Hospital and §Department of Pharmacotherapeutics, Nagasaki University Graduate School of Pharmaceutical Science, Nagasaki, Japan
| | - Hajime Isomoto
- *Department of Medicine, Nagasaki Municipal Hospital, † Second Department of Internal Medicine, Nagasaki University School of Medicine, ‡Department of Pathology, Nagasaki Municipal Hospital and §Department of Pharmacotherapeutics, Nagasaki University Graduate School of Pharmaceutical Science, Nagasaki, Japan
| | - Fuminao Takeshima
- *Department of Medicine, Nagasaki Municipal Hospital, † Second Department of Internal Medicine, Nagasaki University School of Medicine, ‡Department of Pathology, Nagasaki Municipal Hospital and §Department of Pharmacotherapeutics, Nagasaki University Graduate School of Pharmaceutical Science, Nagasaki, Japan
| | - Kunihiko Murase
- *Department of Medicine, Nagasaki Municipal Hospital, † Second Department of Internal Medicine, Nagasaki University School of Medicine, ‡Department of Pathology, Nagasaki Municipal Hospital and §Department of Pharmacotherapeutics, Nagasaki University Graduate School of Pharmaceutical Science, Nagasaki, Japan
| | - Jyunji Irie
- *Department of Medicine, Nagasaki Municipal Hospital, † Second Department of Internal Medicine, Nagasaki University School of Medicine, ‡Department of Pathology, Nagasaki Municipal Hospital and §Department of Pharmacotherapeutics, Nagasaki University Graduate School of Pharmaceutical Science, Nagasaki, Japan
| | - Kioko Kawai
- *Department of Medicine, Nagasaki Municipal Hospital, † Second Department of Internal Medicine, Nagasaki University School of Medicine, ‡Department of Pathology, Nagasaki Municipal Hospital and §Department of Pharmacotherapeutics, Nagasaki University Graduate School of Pharmaceutical Science, Nagasaki, Japan
| | - Ikuo Murata
- *Department of Medicine, Nagasaki Municipal Hospital, † Second Department of Internal Medicine, Nagasaki University School of Medicine, ‡Department of Pathology, Nagasaki Municipal Hospital and §Department of Pharmacotherapeutics, Nagasaki University Graduate School of Pharmaceutical Science, Nagasaki, Japan
| | - Shigeru Kohno
- *Department of Medicine, Nagasaki Municipal Hospital, † Second Department of Internal Medicine, Nagasaki University School of Medicine, ‡Department of Pathology, Nagasaki Municipal Hospital and §Department of Pharmacotherapeutics, Nagasaki University Graduate School of Pharmaceutical Science, Nagasaki, Japan
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Gralnek IM, Jensen DM. An assortment of colonic lesions that present with severe hematochezia. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2001. [DOI: 10.1053/tgie.2001.27863] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Witte JT. Band ligation for colonic bleeding: modification of multiband ligating devices for use with a colonoscope. Gastrointest Endosc 2000; 52:762-5. [PMID: 11115913 DOI: 10.1067/mge.2000.109872] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Current multiband ligating devices can be useful in the treatment of colorectal hemorrhage but are not designed to be used with a colonoscope. This restricts the ability to treat more proximal sites of colonic bleeding with this type of device. This study describes methods of modifying multiband ligating devices for use with a colonoscope, and the application of both single band and modified multiband ligating devices in the treatment of colonic bleeding. METHODS Five consecutive patients with colorectal hemorrhage were treated endoscopically with a single-band ligating device or a modified multiband ligating device. The lesions treated included two postpolypectomy ulcers, one arteriovenous malformation, one post-coagulation ulcer after ablation of an arteriovenous malformation, and one diverticulum. RESULTS Colonoscopic band ligation using either device was successful in all five patients with follow-up ranging from 2 to 5 months. CONCLUSIONS Colonoscopic band ligation appears to be a safe and effective treatment for various types of colorectal hemorrhage. Currently available multiband ligating devices can be easily modified for use with a colonoscope. Endoscopic band ligation of colonic bleeding may be particularly useful in patients with coagulopathies and those cases in which bleeding is uncontrollable with other therapeutic modalities.
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Affiliation(s)
- J T Witte
- Idaho Gastroenterology Associates, Boise, Idaho 83702, USA
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30
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Soetikno RM, Friedland S, Lewit V, Woodford S. Lift and ligate: a new technique to treat a bleeding polypectomy stump. Gastrointest Endosc 2000; 52:681-3. [PMID: 11060200 DOI: 10.1067/mge.2000.106541] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- R M Soetikno
- Endoscopy Unit, Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, Palo Alto, California 94304, USA.
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31
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Abstract
Acute gastrointestinal bleeding is a significant worldwide medical problem. Despite modern measures for diagnosis and treatment, morbidity and mortality rates associated with gastrointestinal bleeding remain largely unchanged. Aggressive medical resuscitation while initiating an evaluation to localize the site of blood loss remains the key to successful management of acute gastrointestinal bleeding. A multidisciplinary approach with early involvement of a gastroenterologist, surgeon, and radiologist can be extremely helpful in the management of these patients. With the logical and direct approach to the evaluation of patients with gastrointestinal bleeding described in this article, most episodes can be managed successfully.
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Affiliation(s)
- M A Fallah
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Sorbi D, Norton I, Conio M, Balm R, Zinsmeister A, Gostout CJ. Postpolypectomy lower GI bleeding: descriptive analysis. Gastrointest Endosc 2000; 51:690-6. [PMID: 10840301 DOI: 10.1067/mge.2000.105773] [Citation(s) in RCA: 192] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Postpolypectomy hemorrhage may warrant intensive care monitoring, transfusions, and surgery. We sought factors predicting significant bleeding requiring blood transfusion and the benefits of critical care monitoring. METHODS Patients with postpolypectomy bleeding between April 1989 and November 1996 were identified from a comprehensive GI bleeding database. Data included age, gender, medical history, medications, polyp characteristics, and polypectomy technique. Outcomes assessed included bleeding cessation, transfusion requirements, recurrent bleeding, length of stay, and death. RESULTS There were 83 patients with a median age of 73 years (range 18 to 88 years; 56 men, 27 women). Comorbid conditions were common (71.1% cardiovascular, 43.4% musculoskeletal, 14.5% hematologic, 6.0% renal). Within 3 days of presentation, 32.5% had taken aspirin, 10.8% nonsteroidal anti-inflammatory drugs, 12.0% warfarin, and 12.0% corticosteroids; and within 1 day, 10.8% intravenous heparin, 7.2% subcutaneous heparin, and 7.2% dipyridamole. Fifty-seven percent of patients were hemodynamically stable. Sessile cecal polyps greater than 2 cm in diameter bled more commonly. The median number of units transfused was equal between critical care and noncritical care patients. Using age in the logistic regression model, no other variable was predictive of transfusion. Eighty patients (96.4%) received endoscopic therapy, 1 required embolization and 2 hemicolectomy. There was no significant difference in outcomes for patients managed in an intensive care unit versus a general medical floor. CONCLUSIONS Postpolypectomy bleeding appears to have a predictable presentation and outcome. Advanced age seems to be predictive of transfusion requirement. Patient monitoring in an intensive care setting is not absolutely necessary.
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Affiliation(s)
- D Sorbi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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35
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Cappell MS, Abdullah M. Management of gastrointestinal bleeding induced by gastrointestinal endoscopy. Gastroenterol Clin North Am 2000; 29:125-67, vi-vii. [PMID: 10752020 DOI: 10.1016/s0889-8553(05)70110-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Therapeutic gastrointestinal endoscopy has a much greater risk of inducing gastrointestinal hemorrhage than diagnostic endoscopy. For example, colonoscopic polypectomy has a risk of approximately 1.6% of inducing bleeding, compared with a risk of approximately 0.02% for diagnostic colonoscopy. Higher-risk procedures include colonoscopic polypectomy, endoscopic biliary sphincterotomy, endoscopic dilatation, endoscopic variceal therapy, percutaneous endoscopic gastrostomy, and endoscopic sharp foreign body retrieval. The risk of inducing hemorrhage is decreased by meticulous endoscopic technique. Hemorrhage from endoscopy may be immediate or delayed. Immediate hemorrhage should be immediately treated by endoscopic hemostatic therapy, including injection therapy, thermocoagulation, or electrocoagulation. Delayed hemorrhage generally requires repeat endoscopy for diagnosis and for therapy, using the same hemostatic techniques.
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Affiliation(s)
- M S Cappell
- Division of Gastroenterology, Maimonides Medical Center, Brooklyn, New York, USA
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37
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Akahoshi K, Kojima H, Fujimaru T, Kondo A, Kubo S, Furuno T, Nakanishi K, Harada N, Nawata H. Grasping forceps assisted endoscopic resection of large pedunculated GI polypoid lesions. Gastrointest Endosc 1999; 50:95-8. [PMID: 10385732 DOI: 10.1016/s0016-5107(99)70354-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Endoscopic resection of pedunculated polyps with heads 1 cm or greater in diameter is technically complex. To facilitate removal of such polyps, we developed grasping forceps assisted endoscopic resection in which we use a detachable snare to prevent polypectomy-related bleeding and evaluated the usefulness and safety of the procedure. METHODS Ten patients with pedunculated polyps with heads 1 cm or greater in diameter were treated with this technique. A two-channel endoscope, grasping forceps, electrosurgical snare, and detachable snare are needed for the procedure. RESULTS All lesions were easily and safely resected. During this procedure, a two-channel endoscope with grasping forceps proved to be satisfactory for handling the detachable snare and the electrosurgical snare and for accurate recognition of the stalk under good visual control. No hemorrhage, perforation, or other complication occurred as a result of use of this new technique. CONCLUSIONS Grasping forceps assisted endoscopic resection of polyps with a detachable snare is an effective method for the prevention of polypectomy-associated bleeding. This technique makes it technically easier to resect large pedunculated polypoid lesions of the GI tract.
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Affiliation(s)
- K Akahoshi
- Department of Gastroenterology, Aso Iizuka Hospital, Yoshio town, Iizuka, Japan
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McGrath K, Mergener K, Branch S. Endoscopic band ligation of Dieulafoy's lesion: report of two cases and review of the literature. Am J Gastroenterol 1999; 94:1087-90. [PMID: 10201488 DOI: 10.1111/j.1572-0241.1999.01019.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Two cases of endoscopic band ligation as lone therapy for Dieulafoy's lesions are presented. Neither patient has experienced further gastrointestinal bleeding; one patient has been followed for 27 months. Endoscopic band ligation is an alternative and attractive treatment modality for Dieulafoy's lesions.
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Affiliation(s)
- K McGrath
- Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA
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39
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Vandervoort J, Montes H, Soetikno RM, Ukomadu C, Carr-Locke DL. Use of endoscopic band ligation in the treatment of ongoing rectal bleeding. Gastrointest Endosc 1999; 49:392-4. [PMID: 10049429 DOI: 10.1016/s0016-5107(99)70022-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- J Vandervoort
- Division of Gastroenterology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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40
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Affiliation(s)
- G R Zuckerman
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
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41
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Uno Y, Satoh K, Tuji K, Wada T, Fukuda S, Saito H, Munakata A. Endoscopic ligation by means of clip and detachable snare for management of colonic postpolypectomy hemorrhage. Gastrointest Endosc 1999; 49:113-5. [PMID: 9869736 DOI: 10.1016/s0016-5107(99)70458-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Y Uno
- First Department of Internal Medicine, Hirosaki University School of Medicine
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42
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Abi-Hanna D, Williams SJ, Gillespie PE, Bourke MJ. Endoscopic band ligation for non-variceal non-ulcer gastrointestinal hemorrhage. Gastrointest Endosc 1998; 48:510-4. [PMID: 9831841 DOI: 10.1016/s0016-5107(98)70094-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is no consensus as to the best treatment for non-variceal, non-ulcer gastrointestinal hemorrhage. Endoscopic band ligation is an inexpensive, readily available, and easily learned technique in contrast to conventional thermal methods of endoscopic hemostasis. We present the preliminary results of an open trial using endoscopic band ligation for non-variceal, non-ulcer bleeding in the gastrointestinal tract. METHODS Eighteen patients were treated by band ligation between June 1996 and November 1997. The lesions treated were: arteriovenous malformations in 10, Dieulafoy's lesions in 4, Mallory-Weiss tear in 2, and post-colonic polypectomy bleeding in 2. RESULTS Endoscopic band ligation was successful in 17 of 18 cases, with a follow-up period ranging from 2 to 18 months. The remaining case, a duodenal Dieulafoy's lesion, bled again at 24 hours but was successfully treated by adrenalin injection. CONCLUSIONS Endoscopic band ligation is effective for non-variceal, non-ulcer bleeding. It has the advantage of ease of use and is relatively inexpensive.
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Affiliation(s)
- D Abi-Hanna
- Department of Gastroenterology and Hepatology, Westmead Hospital, NSW, Australia
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43
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Bak YT, Oh CH, Kim JH, Lee CH. Blue rubber bleb nevus syndrome: endoscopic removal of the gastrointestinal hemangiomas. Gastrointest Endosc 1997; 45:90-2. [PMID: 9013179 DOI: 10.1016/s0016-5107(97)70311-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Y T Bak
- Division of Gastroenterology, Korea University Guro Hospital, Seoul, Korea
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44
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Fowler CL. New application of endoloop for rectal polypectomy. J Pediatr Surg 1996; 31:1685. [PMID: 8986988 DOI: 10.1016/s0022-3468(96)90049-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The primary difficulty in performing rectal procedures such as polypectomy in children is the limited space in which to suture after a biopsy. Use of an available laparoscopic pretied loop ligature has been adapted to simplify these cases.
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Affiliation(s)
- C L Fowler
- Division of Pediatric Surgery, University of Kentucky Medical Center, Lexington 40536-0084, USA
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45
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Chang KJ, Yoshinaka R, Nguyen P. Endoscopic ultrasound-assisted band ligation: a new technique for resection of submucosal tumors. Gastrointest Endosc 1996; 44:720-2. [PMID: 8979064 DOI: 10.1016/s0016-5107(96)70058-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- K J Chang
- Department of Medicine, University of California-Irvine Medical Center, Orange 92668, USA
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46
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Iishi H, Tatsuta M, Narahara H, Iseki K, Sakai N. Endoscopic resection of large pedunculated colorectal polyps using a detachable snare. Gastrointest Endosc 1996; 44:594-7. [PMID: 8934168 DOI: 10.1016/s0016-5107(96)70015-9] [Citation(s) in RCA: 110] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Colonoscopic resection of pedunculated polyps with heads 1 cm or greater in diameter is difficult because of the risk of bleeding. To minimize this complication, we used a detachable snare that allowed endoscopic ligation of the stalk of a large pedunculated polyp and evaluated its safety and effectiveness in comparison with conventional endoscopic snare polypectomy. METHODS Patients with pedunculated polyps with heads 1 cm or greater in diameter were randomly assigned to colonoscopic polypectomy with (N = 47) or without (N = 42) a detachable snare. Arterial pumping bleeding immediately after colonoscopic polypectomy or hematochezia resulting in a 10% or greater drop in hematocrit was defined as "bleeding." RESULTS No bleeding occurred during or after polypectomy with a detachable snare, but bleeding occurred significantly more frequently (five patients, 12%) without a snare. Moreover, the use of a detachable snare reduced the duration of hospitalization after polypectomy. CONCLUSIONS Colonoscopic polypectomy with a detachable snare may be safer than conventional polypectomy without a detachable snare for resection of large, pedunculated polyps.
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Affiliation(s)
- H Iishi
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan
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47
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Murray KF, Jennings RW, Fox VL. Endoscopic band ligation of a Dieulafoy lesion in the small intestine of a child. Gastrointest Endosc 1996; 44:336-9. [PMID: 8885358 DOI: 10.1016/s0016-5107(96)70176-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- K F Murray
- Combined Program in Pediatric Gastroenterology and Nutrition, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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