The NICE classification is an international endoscopic classification of colorectal neoplasia through a narrowband spectrum that on the basis of lesion colors, vascular pattern, and structure of the ...surface of the mucous membrane classifies colorectal neoplasms in three categories: type 1 as hyperplastic lesions, type 2 as adenomas, and type 3 as invasive tumors. The aim of this study was to verify diagnostic accuracy of the NICE classification system compared to the reference standard: histopathological analysis. This retrospective study was conducted by ten physicians on a sequential sample of 418 patients and 735 polyps. The total diagnostic accuracy of the NICE classification system is found to be 76.7%. Optical recognition is significantly better with larger polyps, high-risk lesions (HGIEN), and neoplastic lesions. This research has shown that the NICE classification system is at the moment inferior to histopathological analysis. However, it is noticed that some physicians achieve significantly better results, with the accuracy of diagnosis ranging from 59.5% to 84.2%. These results show that with proper training of physicians and the use of endoscope enhancements to improve image quality, the NICE classification system could in the future potentially replace the histopathological diagnosis process.
The aims of this study were to evaluate diagnostic value of endoscopic ultrasound strain ratio elastography in patients with focal pancreatic masses and to determine the cutoff value between the ...pancreatic malignancies and inflammatory pancreatic masses using reference areas different than those used by other investigators.
In a prospective single-center study, strain ratio was measured in patients with pancreatic masses. After the diagnosis was established, statistical analysis was used to compare the group with pancreatic malignancies to the one with inflammatory masses.
Strain ratio cutoff of 7.59 provided 100% sensitivity, 95% specificity, and 97% overall accuracy for differentiation of patients with pancreatic malignancies from those with inflammatory masses.
Our data show high sensitivity and specificity for the calculated strain ratio. Adjacent normal pancreatic tissue is adequate as a reference area based on the inclusion criteria. Diverse cutoff values and standardization of methods in the studies published so far require further investigations, before the implementation of the method in a routine clinical practice becomes possible.
Colorectal cancer is a malignant neoplasm which has an increasing incidence and represents a global public health problem. The majority of patients are diagnosed after the age of 50, and the risk of ...developing it over lifetime is 5%. Development of preventive, diagnostic and treatment methods has resulted in a significant reduction in mortality and other negative clinical outcomes. Precisely because of the efficient method of prevention and early detection of this disease, numerous countries, including Croatia, have organized national colorectal cancer screening and monitoring programs. However, these programs are primarily organized for the population with the usual, i.e. average risk of developing colorectal cancer. High-risk groups include persons with endoscopically detected and removed colon polyps, persons surgically treated for colon cancer, persons with a positive family history of colorectal cancer, persons with inflammatory bowel diseases, individuals and families with hereditary disorders or genetic mutations that increase the risk of this disease several fold, persons with acromegaly, and patients who have undergone ureterosigmoidostomy. Recommendations for the detection and monitoring of high-risk groups are often not defined clearly, and some of the existing ones are based mostly on scarce scientific evidence. It is commonly accepted that screening in high-risk groups should start at an earlier age, with shorter intervals between follow-ups. The basic diagnostic method for screening and monitoring in these patient groups is endoscopic monitoring, or colonoscopy. The aim of this review paper is to present the characteristics of the abovementioned risk groups and provide clear screening recommendations.
The European Society of Gastrointestinal Endoscopy (ESGE) together with the United European Gastroenterology (UEG) recently developed a short list of performance measures for small-bowel endoscopy ...(i.e. small-bowel capsule endoscopy and device-assisted enteroscopy) with the final goal of providing endoscopy services across Europe with a tool for quality improvement. Six key performance measures both for small-bowel capsule endoscopy and for device-assisted enteroscopy were selected for inclusion, with the intention being that practice at both a service and endoscopist level should be evaluated against them. Other performance measures were considered to be less relevant, based on an assessment of their overall importance, scientific acceptability, and feasibility. Unlike lower and upper gastrointestinal endoscopy, for which performance measures had already been identified, this is the first time small-bowel endoscopy quality measures have been proposed.
Colonic lipomas (CL) are rare benign adipose tumours usually found incidentally during colonoscopy. Endoscopic resection of symptomatic large CL remains controversial, since significant rates of ...perforation have been reported. In recent years, a novel technique for removal of large CL has been described, consisting of looping and ligating the lipoma with a nylon snare. The aim of our study was to evaluate the safety and efficacy of the "loop and let go" technique for large colon lipomas in a large case series.
Consecutive patients referred to our institution for colonoscopy were eligible for the study. The diagnosis of CL was confirmed endoscopically by "pillow" and "naked fat" signs. Following diagnosis, lipomas were looped and ligated by endoloop. Follow-up colonoscopies were scheduled at 1- and 3-months interval.
A total of 11 patients with large CL were enrolled in study. The indications for the colonoscopy included altered bowel habits (7 patients, 64%), screening for colorectal neoplasm (3 pts, 27%) and lower gastrointestinal bleeding (1 pts, 9%). The median lesion size was 3 cm (range 2,5-6 cm). Lesions were located at the hepatic flexure in 4 patients (36%), cecum and ascending colon (4 pts, 36%), rectosigmoid (2 pts, 18%) and transverse colon (1 pts, 9%). There were no immediate and late complications. On follow-up (median follow-up time 11.9 months, range 8-24), there was one small residual lipoma (<1 cm).
The results of this study confirm that "loop-and-let-go" technique is safe and efficacious treatment of large colonic lipomas.
Područje gastrointestinalne endoskopije kod bolesnika na antiagregacijskoj terapiji karakteriziraju dva klinička scenarija. Zbog ulceriformnog potencijala acetilsalicilne kiseline postoji povećan ...rizik od nastanka gastrointestinalnog krvarenja, osobito u bolesnika starije životne dobi. U ovom kontekstu uloga liječnika obiteljske medicine očituje se u prepoznavanju populacije s čimbenicima rizika od nastupa krvarenja te poduzimanju prikladnih mjera prevencije. Drugi scenarij uključuje pripremu bolesnika na antiagregacijskoj terapiji za intervencijske gastrointestinalne zahvate. Odluka o prekidu antiagregacijske terapije ovisi o ravnoteži rizika od nastanka tromboembolijskog incidenta s jedne strane te rizika od nastanka postproceduralnog krvarenja s druge strane. Liječnik obiteljske medicine treba biti upoznat s navedenim čimbenicima rizika radi adekvatne pripreme bolesnika za endoskopsku proceduru. Ipak, bolesnici s visokim rizikom od nastanka tromboembolijskog incidenta u kojih se planira zahvat s visokim rizikom od nastanka postproceduralnog krvarenja zaslužuju zajedničku odluku gastroenterologa i kardiologa, i to za svakog bolesnika individualno.
Kolorektalni karcinom zlocudna je novotvorina incidencija kojega je u stalnom porastu i koja predstavlja globalni javnozdravstveni problem. U vecine bolesnika ova se bolest dijagnosticira nakon 50. ...godine zivota, a rizik od njenog razvoja tijekom zivotnog vijeka iznosi oko 5%. Razvoj preventivnih, dijagnostickih i terapijskih metoda rezultirao je znacajnim smanjenjem smrtnosti i drugih negativnih klinickih ishoda. Upravo zbog ucinkovite metode prevencije i ranog otkrivanja ove bolesti u brojnim drzavama pa tako i u Republici Hrvatskoj organizirani su nacionalni programi probira i pracenja kolorektalnog karcinoma. Medutim, navedeni su programi prvenstveno organizirani za populaciju s uobicajenim, odnosno prosjecnim rizikom obolijevanja od kolorektalnog karcinoma. Visokorizicne skupine obuhvacaju osobe u kojih su endoskopski otkriveni, odnosno uklonjeni polipi debelog crijeva, osobe kirurski lijecene zbog karcinoma debelog crijeva, osobe s pozitivnom obiteljskom anamnezom za kolorektalni karcinom, osobe oboljele od upalnih bolesti crijeva, pojedinci i obitelji s nasljednim poremecajima, odnosno genetskim mutacijama koje visestruko povecavaju rizik za razvoj ove bolesti, osobe oboljele od akromegalije te bolesnici u kojih je ucinjen zahvat ureterosigmoidostomije. Preporuke za otkrivanje i pracenje visokorizicnih skupina cesto nisu jasno definirane, a neke od postojecih se temelje na uglavnom oskudnim znanstvenim dokazima. Opee je prihvaceno misljenje da bi probir u visokorizicnih skupina trebao zapoceti u ranijoj zivotnoj dobi uz krace vremenske intervale izmedu pojedinih pregleda. Osnovna dijagnosticka metoda probira i pracenja u ovih skupina bolesnika je endoskopsko pracenje, odnosno kolonoskopija. Cilj ovoga preglednog rada je prikazati znacajke navedenih rizicnih skupina i dati jasne preporuke za probir. Kljucne rijeci: Oportunisticki probir; Rak debelog i zavrsnog crijeva; Obiteljska medicina
Abstract
Background and study aims
The choice of endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) in non-ampullary superficial duodenal tumors (NASDTs) is challenging and ...the benefits of ESD remain unclear. The aim was to comparatively analyze the feasibility, outcomes and safety of these techniques in these lesions.
Patients and methods
This is an observational and retrospective study. All consecutive patients presenting with NASDTs who underwent EMR or ESD between 2005 and 2017 were included. The following main outcomes were comparatively evaluated: en-bloc and complete (R0) resection rates, and local recurrence. Secondary outcomes were perforation and delayed bleeding.
Results
One hundred sixty-six tumors in 150 patients (age: 66 years, range: 31 – 83, 42.7 % males) were resected by ESD (n = 37) or EMR (n = 129) and included. The median procedure time (81 vs. 50 min,
P
= 0.007) and tumor size (25 vs. 20 mm,
P
= 0.01) were higher in the ESD group. The global malignancy rate was 50.3 %. There were no differences in en-bloc resection (29.7 % vs. 44.2 %,
P
= 0.115), complete resection (19.4 % vs. 35.5 %,
P
= 0.069), and local recurrence (14.7 % vs. 16.7 %,
P
= 0.788) rates. Tumor size was associated with recurrence (28 vs. 20 mm,
P
= 0.008), with a median follow-up of 6.5 months. Focal recurrence (n = 22, 13.3 %) was treated endoscopically in 86.4 %. En-bloc resection in the ESD group was comparable in large ( ≥ 20 mm) and small lesions (27.6 % vs. 37.5 %,
P
= 0.587), while this outcome decreased significantly in large lesions resected by EMR (17.4 % vs. 75 %,
P
< 0.001). Nine perforations were confirmed in 6 lesions (16.2 %) resected by ESD and 3 (2.3 %) by EMR (
P
= 0.001). Endoscopic therapy was successful in all but 1 patient (88.9 %) presenting with a delayed perforation.
Conclusions
ESD may be an alternative to EMR and surgery in selected NASDTs, such as large duodenal tumors where EMR achieves low en-bloc resection rates and the local recurrence may be higher. However, this technique may have a higher risk of perforations.
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