An endoscopic full-thickness resection with FTRD system (Ovesco Endoscopy, Tübingen, Germany) was performed in a 69-year-old man with a granular laterally spreading tumor (G-LST) with non-lifting ...sign in the ascending colon. Histology showed a low-grade dysplasia tubulovillous adenoma, R0 resection. At surveillance colonoscopy after 12 months, the clip was found with a polypoid tissue with regular mucosal surface pattern trapped inside. Since the length of time the clip was left in place ensured proper healing and in order to avoid any recurrence of adenoma in the area, the polypoid lesion and the clip were resected en bloc. The histological study revealed a polypoid formation with muscular tissue surrounded by healthy mucosa, suggesting a leiomyoma. Immunohistochemical actine staining confirmed the presence of muscularis mucosae and the muscularis propria inside the polypoid lesion, due to a full-thickness clip entrapment of the colon wall, with the development a leiomyoma-like clip artifact. The presence of foreign bodies such as clips at the resection site may produce artifacts leading to confusion in the diagnosis as in this case in which it has been able to produce an abnormal growth of the muscularis propria. The detection of a clip artifact leiomyoma has not yet been reported and highlights the importance of transmitting correct information about the case and the technique to the pathologist in order to achieve a correct diagnosis.
Endoscopic ampullectomy is indicated for the resection of non-invasive papillary adenomas in selected patients. Cholangitis is an uncommon complication (0-2%) that may be secondary to contamination ...during the procedure, poor emptying of the bile duct and prosthesis dysfunction or migration. Placement of a prophylactic biliary stent after the resection is not well established. We present a rare case of acute cholangitis after endoscopic ampullectomy secondary to a biliary prosthesis obstruction, due to a pancreatic prosthesis intrusion.
Abstract
Background and study aims Effective bowel cleansing is critical
for detecting lesions during colonoscopy, highlighting the importance of bowel preparations.
1L polyethylene glycol (PEG) + ...ascorbate (Asc) is the only recommended 1L PEG product in
Europe and the United States. Its efficacy was demonstrated in large-scale controlled trials
and confirmed in smaller-scale real-world studies. However, no large-scale real-world data
exist.
Patients and methods This observational, retrospective,
multicenter study, used outpatient follow-up data from medical records from 10 centers in
Spain and two in Portugal. Outpatients aged ≥18 years using 1L PEG + Asc as bowel preparation
were included. The main outcome measures were overall adequate colon cleansing (Boston Bowel
Preparation Scale BBPS score ≥6 with BBPS score ≥2 in each segment) and high-quality
cleansing of the right colon (BBPS score=3).
Results Data from 13169 eligible patients were included. Overall
cleansing success was achieved in 89.3% (95%CI 88.7%-89.8%) and high-quality cleansing in the
right colon in 49.3% (95%CI 48.4%–50.2%) of patients. For the overnight split-dose and
same-day regimens, overall adequate quality cleansing success rate was 94.7% and 86.7% (P<0.0001) and high-quality cleansing of the right colon rate was
65.4% and 41.4% (P<0.0001), respectively. Colonoscopy was
completed in 97.3% of patients, with non-completion due to poor preparation in only 0.8%; 2.3%
of patients experienced at least one adverse event (AE).
Conclusions This large-scale, real-world study demonstrates the
effectiveness of 1L PEG + Asc in the total and right colon, with a low percentage of patients
with AEs in routine clinical practice.
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