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Korean guideline for colonoscopic polypectomy.

ABSTRACT: There is indirect evidence to suggest that 80% of colorectal cancers (CRC) develop from adenomatous polyps and that, on average, it takes 10 years for a small polyp to transform into invasive CRC. In multiple cohort studies, colonoscopic polypectomy has been shown to significantly reduce the expected incidence of CRC by 76% to 90%. Colonoscopic polypectomy is performed frequently in primary outpatient clinics and secondary and tertiary medical centers in Korea. However, there are no evidence-based, procedural guidelines for the appropriate performance of this procedure, including the technical aspects. For the guideline presented here, PubMed, Medline, and Cochrane Library literature searches were performed. When little or no data from well-designed prospective trials were available, an emphasis was placed on the results from large series and reports from recognized experts. Thus, these guidelines for colonoscopic polypectomy are based on a critical review of the available data as well as expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data become available. This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline is not a rule and should not be construed as a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions for any particular case involve a complex analysis of the patient's condition and the available courses of action.

SUBMITTER: Lee SH

PROVIDER: S-EPMC3363129 | biostudies-literature | 2012 Mar

REPOSITORIES: biostudies-literature

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Korean guideline for colonoscopic polypectomy.

Lee Suck-Ho SH Shin Sung Jae SJ Park Dong Il DI Kim Seong-Eun SE Jeon Hae Jeong HJ Kim Se Hyung SH Hong Sung Pil SP Hong Sung Noh SN Yang Dong-Hoon DH Lee Bo In BI Kim Young-Ho YH Kim Hyun-Soo HS Kim Hyun Jung HJ Yang Suk-Kyun SK Kim Hyo Jong HJ

Clinical endoscopy 20120331 1

There is indirect evidence to suggest that 80% of colorectal cancers (CRC) develop from adenomatous polyps and that, on average, it takes 10 years for a small polyp to transform into invasive CRC. In multiple cohort studies, colonoscopic polypectomy has been shown to significantly reduce the expected incidence of CRC by 76% to 90%. Colonoscopic polypectomy is performed frequently in primary outpatient clinics and secondary and tertiary medical centers in Korea. However, there are no evidence-bas ...[more]

PMID: 22741130

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Project description:BackgroundRemimazolam is a newer benzodiazepine with properties of rapid onset, short duration of action, and fast recovery. Our study was to evaluate the effects of different doses of remimazolam combined with alfentanil in colonoscopic polypectomy.MethodsOne hundred twenty patients were randomly divided into four groups: alfentanil and propofol (AP) group, alfentanil and remimazolam 0.1 mg/kg (AR1 group), 0.15 mg/kg (AR2 group), or 0.2 mg/kg (AR3 group). Patients in the four groups received alfentanil 10 μg/kg, followed by propofol 2 mg/kg and three dosages of remimazolam. Modified Observer's Assessment of Alertness and Sedation (MOAA/S) scale, heart rate (HR), oxygen saturation (SpO2), respiratory rate (RR), bispectral index (BIS) values and mean arterial pressure (MAP) were collected at intervals of 5 min and analyzed at different time points: before anesthesia (T0), 5 min (T1), 10 min (T2), 15 min after anesthesia (T3) and at the end of surgery (T4). The average MAP was calculated utilizing the average of all MAP values. The primary outcome was the success rate of sedation. Secondary outcomes included time to full alert and adverse events.ResultsThe success rate of sedation was 100% among the four groups. The incidence of hypotension was significantly decreased (all P < 0.05) and the average MAP was higher in AR1-AR3 groups than AP group (all P < 0.001). None of the patients developed bradycardia or hypertension during surgery in all study groups. BIS values were higher (all P < 0.001) and the time to full alert was statistically shorter in AR1-AR3 groups (all P < 0.05) compared with the AP group. The MOAA/S score in AR1 was higher than AR2 (P < 0.05) and the AR3 group (P < 0.05) at T1 and BIS values in the AR1 group were significantly higher than AR3 group (P < 0.05) at T4.ConclusionsRemimazolam combined with alfentanil have a non-inferior sedative effect than propofol during the colonoscopic polypectomy. Moreover, this combination of two short-acting drugs might be a safer alternative.Trial registrationThe clinical trial was registered on (16/05/2021, ChiCTR2100046492).

Project description:Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth most frequent cause of cancer-related death in the world. CRC screening programs have been widely introduced worldwide, allowing for early detection and removal of precancerous lesions and avoiding major surgical intervention. However, not all polyps are suitable for conventional and advanced colonoscopic polypectomy. Thus, laparoscopically assisted colonoscopic polypectomy (LACP) was introduced to clinical practice as a method of choice for these polyps and adenomas.To overlook our experience in laparoscopically assisted colonoscopic polypectomies and evaluate effectiveness and quality of the procedure.A retrospective analysis of a prospectively maintained database was performed. using the Vilnius University Hospital Santariskiu Klinikos patient database for the period from 2010 to 2016, resulting in 21 cases in which LACP was performed. All procedures were performed using combined laparoscopy and videocolonoscopy techniques. Morphology of adenomas was classified according to the Paris classification during the procedure. Creation of the database was approved by the Lithuanian Bioethics committee.Twenty-two adenomas were removed from 21 patients, aged 65.33 ±8.9. There was no difference between male and female age, but occurrence of adenomas in females was 2-fold higher. The majority of removed lesions were localized in the cecum and mean size was 27.2 ±11.1 mm. The morphology of adenomas was distributed equally between 0-Is, 0-Ip, and 0-IIa, except one, which belonged to 0-III. Histological analysis revealed that tubulovillous adenoma occurrence was 1.4 times higher than tubulous adenoma. There was only one postoperative complication - bleeding from the adenoma resection site, which was managed by conservative means. One patient developed G2 adenocarcinoma at the polyp resection site and was referred for radical surgery.The LACP is a safe procedure with minimal risk to the elderly patient. Patient follow-up is essential for detection of recurrence.

Project description:BackgroundAdherence to post-polypectomy surveillance guideline recommendations is suboptimal. Surveillance is frequently over- and under-recommend, resulting in strained colonoscopy capacity, potential risks without expected benefits, and missed opportunities for colorectal cancer risk reduction.AimsTo identify factors associated with adherence to post-polypectomy surveillance guidelines.MethodsWe conducted a three-phase study with a retrospective review of usual care post-polypectomy surveillance recommendations through medical chart abstraction (Phase I), prospective online physician survey (Phase II), and analysis of survey-based and other physician-based predictors of usual care surveillance recommendations (Phase III). Subjects included patients who underwent usual care colonoscopy 2011-2012 (Phases I and III) and gastroenterology (GI) attendings and fellows (Phases II and III). We identified rates of recommendations consistent with guideline adherence, surveillance overuse, and surveillance underuse based on usual care medical chart documentation and physician survey, as well as predictors of physician adherence to guidelines.ResultsWe reviewed 640 patient charts for 28 survey respondents. Rates of usual practice recommendations consistent with guideline adherence, surveillance overutilization, and underutilization were 84, 13, and 3%, respectively. At survey, 82% of physicians were concerned about missed cancer. Eleven percentage believed that guidelines were not aggressive enough. GI trainees were 2.5 times more likely to issue guideline-adherent recommendations [OR 2.5, 95% CI (1.5-4.2)]. Disagreement with guideline aggressiveness was independently associated with 40% lower likelihood of adherence [OR 0.6, 95% CI (0.4-0.8)].ConclusionsBelief in the appropriate aggressiveness of guidelines and trainee position, but not fear of missed cancer or guideline knowledge, was associated with adherence to post-polypectomy surveillance guidelines.

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Korean guideline for colonoscopic polypectomy.

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Korean guideline for colonoscopic polypectomy.

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