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Comparing the efficiency of 2 cold snare polypectomy techniques during colonoscopy

ABSTRACT: Interventional Procedure (Arm 1): Snare-WithIn-The-scope-CHannel (SWITCH) Cold Snare Polypectomy In this arm, all polyps encountered during colonoscopy will be removed by SWITCH cold polypectomy technique. This involved advancement of the snare which is already in the scope channel, transecting the polyp (i.e. polypectomy), then partially withdrawing the snare into the channel (without removing the snare from the scope channel) prior to suctioning the polyp for retrieval. All further polyps encountered in the same patient will be removed by the same technique. All procedures will be performed by 2 consultant gastroenterologists with expertise in therapeutic colonoscopy. The procedure duration is similar to any standard colonoscopy and is allocated half an hour slot in the weekday elective endoscopy list. Duration can vary depending on number of polyps encountered. Primary outcome(s): - Mean total polypectomy time per patient The total polypectomy time is defined as the total time from a polyp has been detected detected by the endoscopist until the polyp has been transected, then has been suctioned and has reached the trap (i.e. from polyp detection until polyp reaching the trap) , as measured by the research assistant with a stop watch. [Assessed from polyp detection until polyp retrieval into the trap. ] Study Design: Purpose: Treatment; Allocation: Randomised controlled trial; Masking: Blinded (masking used);Assignment: Parallel;Type of endpoint: Efficacy

DISEASE(S): Oral And Gastrointestinal-other Diseases Of The Mouth, Teeth, Oesophagus, Digestive System Including Liver And Colon,Colonic Polyps,Cancer-bowel-back Passage (rectum) Or Large Bowel (colon)

PROVIDER: 2463888 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:Background: Chronic rhinosinusitis with nasal polyposis (CRSwNP) in western countries is characterized by eosinophilia, IgE production and Th2 cytokine expression. Type 2 innate lymphoid cells (ILC2) from polyps produce IL-5 and IL-13 in response to IL-25 and IL-33 although the relevance of this axis to local mucosal T cell responses is unknown. Objective: To investigate the role of the IL-25/IL-33 axis in local mucosal T cell responses in CRSwNP. Methods: Polyp tissue and blood were obtained from patients undergoing nasal polypectomy. Control nasal biopsies and blood were obtained from healthy volunteers. Tissue was cultured in a short-term explant model. T cell surface phenotype/intracellular cytokines were assessed by flow cytometry. TCR VÎ² analysis was performed with the immunoSEQ assay. Microarrays were performed for gene expression analysis. Results: Using nasal polyp tissue, numerous IL-25 receptor (IL-17RB) positive polarized Th2 cells were identified which were absent in the healthy nasal mucosa and periphery. IL-17RB+CD4+ polyp Th2 cells co-expressed ST2 (IL-33 receptor) and responded to IL-25 and IL-33 with enhanced IL-5 and IL-13 production. Within IL-17RB+CD4+ T cells several identical TCR VÎ² CDR3 sequences were identified in different subjects suggesting clonal expansion driven by a common antigen. Abundant IL-17 producing T cells were observed in healthy nasal mucosal and polyp populations with Th17-related genes the most overexpressed compared to peripheral blood T cells. Conclusion: IL-25 and IL-33 may interact locally with IL-17RB+ST2+ polyp T cells to augment Th2 responses in CRSwNP. A local Th17 response may be the default signature in healthy nasal mucosal immune homeostasis. Three biological replicates. T-helper cells were isolated nasal polyps by explant culture from patients with chronic rhinosinusitis. Cells were then sorted based upon expression of IL17RB by flow cytometric sorting. Resting and activated IL-17RB+ve cells were compared with resting and activated IL-17RB-ve cells.

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Comparing the efficiency of 2 cold snare polypectomy techniques during colonoscopy

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