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  1. Artikel: Managing difficult polyps: techniques and pitfalls.

    Tholoor, Shareef / Tsagkournis, Orestis / Basford, Peter / Bhandari, Pradeep

    Annals of gastroenterology

    2014  Band 26, Heft 2, Seite(n) 114–121

    Abstract: There is no standardized definition of difficult polyps. However, polyps become difficult and challenging to remove endoscopically when they are large in size, flat in nature, situated in a high-risk location and when access to them is very awkward. ... ...

    Abstract There is no standardized definition of difficult polyps. However, polyps become difficult and challenging to remove endoscopically when they are large in size, flat in nature, situated in a high-risk location and when access to them is very awkward. Recently, an SMSA (Size, Morphology, Site, Access) classification has been proposed that helps to qualify the degree of difficulty by scoring on the above parameters. This article reviews the features that make polyps difficult to remove and provides some practical tips in managing these difficult polyps. We believe that 'difficult polyp' is a relative term and each endoscopist should define their own level of difficulty and what they would be able to handle safely. However, in expert trained hands, most difficult polyps can be safely removed by an endoscopic approach.
    Sprache Englisch
    Erscheinungsdatum 2014-01-01
    Erscheinungsland Greece
    Dokumenttyp Review
    ZDB-ID 2032850-3
    ISSN 1108-7471
    ISSN 1108-7471
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  2. Artikel ; Online: Acetic acid chromoendoscopy in Barrett's esophagus surveillance is superior to the standardized random biopsy protocol: results from a large cohort study (with video).

    Tholoor, Shareef / Bhattacharyya, Rupam / Tsagkournis, Orestis / Longcroft-Wheaton, Gaius / Bhandari, Pradeep

    Gastrointestinal endoscopy

    2014  Band 80, Heft 3, Seite(n) 417–424

    Abstract: Background: Currently, various advanced endoscopic techniques are available with varying success rates. These technologies are manufacturer dependent, which has financial implications in the current era of austerity. Acetic acid is a commonly available ... ...

    Abstract Background: Currently, various advanced endoscopic techniques are available with varying success rates. These technologies are manufacturer dependent, which has financial implications in the current era of austerity. Acetic acid is a commonly available dye that has been used in the detection of neoplasia within Barrett's esophagus. It has been shown to be effective in detecting neoplasia in high-risk subgroups, but its efficacy in a low-prevalence surveillance population remains unproven.
    Objective: This study aimed to investigate the effectiveness of acetic acid chromoendoscopy in a Barrett's esophagus surveillance population. We aimed to compare the neoplasia yield of acetic acid chromoendoscopy (AAC) with the neoplasia yield from standardized random biopsy (SBP) protocol-guided biopsies in the routine surveillance of patients with Barrett's esophagus.
    Design: Retrospective cohort study.
    Setting: Tertiary referral hospital in the United Kingdom.
    Patients: Patients 18 years of age and older with a diagnosis of Barrett's esophagus undergoing surveillance gastroscopy.
    Interventions: AAC versus standardized random biopsy protocol (SBP) for Barrett's esophagus surveillance.
    Main outcome measurements: Neoplasia detection in 2 groups.
    Results: The overall neoplasia detection rates for all grades of neoplasia were 13 of 655 (2%) in the SBP-guided biopsy cohort and 41 of 327 (12.5%) in the AAC cohort (P = .0001). On per-patient analysis, a 6.5-fold gain in neoplasia detection was seen in the AAC cohort compared with the SBP cohort (0.13 vs 0.02, P = .000). In the SBP cohort, a total of 13 of 655 (2%) neoplasias were detected, of which 3 of 655 patients (0.5%) had low-grade dysplasia, 7 of 655 (1%) had high-grade dysplasia, and 3 of 655 (0.5%) were found to have superficial cancer (T1a/T1b). In the AAC cohort, a total of 41 of 327 neoplasias (12.5%) were found, of which 9 of 327 patients (2.7%) had low-grade dysplasia, 18 of 327 (5.5%) had high-grade dysplasia, and 14 of 327 (4.2%) were found to have superficial cancer. The number of biopsies required to detect 1 neoplasia was 15 times lower in the AAC cohort (40 biopsies) than in the SBP cohort (604 biopsies). On per-biopsy analysis, a 14.7-fold increase in neoplasia detection was seen in the AAC cohort per biopsy compared with the SBP cohort (0.025 vs 0.0017; P = .000).
    Limitations: Not a randomized, controlled study.
    Conclusions: Our study demonstrates that acetic acid detects more neoplasias than conventional protocol-guided mapping biopsies and requires 15 times fewer biopsies per neoplasia detected.
    Mesh-Begriff(e) Acetic Acid ; Adenocarcinoma/pathology ; Adult ; Aged ; Aged, 80 and over ; Barrett Esophagus/pathology ; Biopsy/methods ; Cohort Studies ; Endoscopy, Digestive System/methods ; Esophageal Neoplasms/pathology ; Female ; Humans ; Indicators and Reagents ; Male ; Middle Aged ; Retrospective Studies ; Young Adult
    Chemische Substanzen Indicators and Reagents ; Acetic Acid (Q40Q9N063P)
    Sprache Englisch
    Erscheinungsdatum 2014-09
    Erscheinungsland United States
    Dokumenttyp Comparative Study ; Journal Article ; Video-Audio Media
    ZDB-ID 391583-9
    ISSN 1097-6779 ; 0016-5107
    ISSN (online) 1097-6779
    ISSN 0016-5107
    DOI 10.1016/j.gie.2014.01.041
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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