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Monza, Italy

Murino A.,University of Milan | Hassan C.,Endoscopy Unit | Repici A.,University of Milan
Current Opinion in Gastroenterology | Year: 2016

Diminutive polyps, measuring between 1 and 5mm, represent the vast majority of colorectal polyps encountered during screening colonoscopy. Although the chance of harboring advanced adenoma or neoplastic cells is low, ensuring a complete polyp resection with clear margins is crucial to reduce the risk of interval colorectal cancer. The purpose of this review was to evaluate the different methods applied for polypectomy of diminutive polyps and clarify whether a diminutive polyp should be retrieved or left in place. Recent findings Cold biopsy polypectomy is indicated for resection of polyps measuring 1-3 mm and removal of 4-5 mm polyps should be ensured by cold snare polypectomy. Over the last decade, hot biopsy polypectomy has been gradually abandoned because of an increased risk of diathermic injury. The resect and discard strategy and the diagnose and disregard strategy should be performed only by expert endoscopists, who should use validated scales and document the polyp features by storing several endoscopic images. Summary Nowadays, complete resection of diminutive polyps, following the most appropriate technique, is recommended in clinical practice. The resect and discard strategy and the diagnose and disregard strategy should be reserved to expert endoscopists. © 2015 Wolters Kluwer Health, Inc.


Chong V.H.,Endoscopy Unit
World Journal of Gastroenterology | Year: 2013

Heterotopic gastric mucosa of the proximal esophagus (HGMPE), also referred to as "inlet patch" or "cervical inlet patch", is a salmon colored patch that is usually located just distal to the upper esophageal sphincter. HGMPE is uncommon with endoscopic studies reporting a prevalence ranging from less than one percent to 18%. Most HGMPE are asymptomatic and are detected incidentally during endoscopy for evaluations of other gastrointestinal complaints. Most consider HGMPE as clinically irrelevant entity. The clinical significance of HGMPE is mainly acid related or neoplastic transformation. The reported prevalence of laryngopharyngeal reflux symptoms varies from less than 20% to as high as 73.1%. However, most of these symptoms are mild. Clinically significant acid related complications such as bleeding, ulcerations, structure and fistulization have been reported. Although rare, dysplastic changes and malignancies in association with HGMPE have also been reported. Associations with Barrett's esophagus have also been reported but the findings so far have been conflicting. There are still many areas that are unknown or not well understood and these include the natural history of HGMPE, risk factors for complications, role of Helicobacter pylori infection and factors associated with malignant transformations. Follow-up may need to be considered for patients with complications of HGMPE and surveillance if biopsies show intestinal metaplasia or dysplastic changes. Despite the overall low incidence of clinically relevant manifestations reported in the literature, HGMPE is a clinically significant entity but further researches are required to better understand its clinical significance. © 2013 Baishideng. All rights reserved.


Goodhand J.R.,Blizard Institute of Cell and Molecular Science | Wahed M.,Blizard Institute of Cell and Molecular Science | Mawdsley J.E.,Blizard Institute of Cell and Molecular Science | Farmer A.D.,Blizard Institute of Cell and Molecular Science | And 3 more authors.
Inflammatory Bowel Diseases | Year: 2012

Background: Anxiety and depression are common in patients with inflammatory bowel disease (IBD); however, the factors associated with mood disorders in patients with ulcerative colitis (UC) and Crohn's disease (CD) are poorly defined. Methods: In all, 103 patients with UC, 101 with CD, and 124 healthy controls completed the Hospital Anxiety and Depression Scale (HADS). Disease activity was defined both from symptom scores and in UC endoscopically, and in CD by fecal calprotectin and/or serum C-reactive protein. Multivariate regression analyses were used to identify factors associated with anxiety and depression. Results: In both UC and CD, anxiety (HADS-A) and depression (HADS-D) scores were higher than in controls (HADS-A: 8.5 ± 4.1 [mean ± SD], 8.6 ± 3.9, 3.2 ± 1.8, P < 0.001; and HADS-D: 4.1 ± 3.3, 4.7 ± 3.3, 1.7 ± 1.4, P < 0.001, respectively). There were no differences in the prevalence of mild, moderate, and severe anxiety and depression in UC and CD. In UC, anxiety scores were associated with perceived stress and a new diagnosis of IBD; depression was associated with stress, inpatient status, and active disease. In CD, anxiety was associated with perceived stress, abdominal pain, and lower socioeconomic status, and depression with perceived stress and increasing age. Conclusions: Anxiety and depression are common in IBD. Perceived stress is associated with mood disturbances in both UC and CD, but the other associated factors differ in the two diseases. Gastroenterologists should look for mood disorders in IBD and consider stress management and psychotherapy in affected patients. © 2012 Crohn's & Colitis Foundation of America, Inc.


Gralnek I.M.,Rambam Health Care Campus | Suissa A.,Rambam Health Care Campus | Domanov S.,Endoscopy Unit
Endoscopy | Year: 2014

BACKGROUND AND STUDY AIMS: Although colonoscopy is the gold standard for detecting colorectal cancer (CRC), adenomas and cancers are missed. We aimed to establish the safety and feasibility of use of a novel balloon-colonoscope.PATIENTS AND METHODS: Patients (40 - 75 years) referred for CRC screening, polyp surveillance, or diagnostic evaluation were enrolled in a prospective pilot cohort study whose primary endpoint was device safety. Additional endpoints included success of and time to cecal intubation, withdrawal and total procedure times, polyp detection rate (PDR), adenoma detection rate (ADR), and success of polypectomies.RESULTS: Among 50 patients (mean age 59.0 years, 27 women [54 %]), three were excluded (inadequate colon preparation, technical problem, abdominal hernia) and 47 were analyzed. Two patients experienced minor adverse events (diarrhea, abdominal pain). Cecal intubation rate was 47 /47 (100 %). Mean times, to reach cecum, withdrawal, and total procedure, were 4.3, 7.4, and 16.5 minutes, respectively. We identified 44 polyps (all successfully removed) in 25 /47 patients (PDR 53.2 %), 35 polyps (79.5 %) were 1 - 5 mm, 4 (9.1 %) 6 - 9 mm, and 5 (11.4 %) ≥ 10 mm. Of 44 polyps, 36 (81.8 %) were "adenomas"; 21/47 patients had ≥ 1 adenoma (ADR 44.7 %).CONCLUSIONS: The NaviAid G-EYE balloon-colonoscope appears safe and feasible to use. Comparative human studies are underway.Clinicaltrials.gov identifier: NCT01749722. © Georg Thieme Verlag KG Stuttgart · New York.


Chong V.H.,Endoscopy Unit | Chong C.F.,Raja Isteri Pengiran Anak Saleha RIPAS Hospital
Journal of Gastrointestinal Surgery | Year: 2010

Introduction: Post-cholecystectomy clip migration (PCCM) is rare and can lead to complications which include clip-related biliary stones. Most have been reported as case reports. This study reviews cases of clip migration reported in the literatures. Method: Searches and reviews of the literatures from "PubMed," "EMBASE," and "Google Scholar" search engines using the keywords "clip migration" and "bile duct stones" were carried out. Eighty cases from 69 publications were identified but details for only 69 cases were available for the study. Results: The median age at presentations of PCCM was 60 years old (range, 31 to 88 years; female, 61. 8%) and the median time from the initial cholecystectomy to clinical presentations was 26 months (range, 11 days to 20 years). Of primary surgeries, 23. 2% was for complicated gallstones disease. The median number of clips placed during surgery was six (range, two to more than ten clips). Common diagnoses at presentations of PCCM were obstructive jaundice (37. 7%), cholangitis (27. 5%), biliary colic (18. 8%), and acute pancreatitis (8. 7%). The median number of migrated clip was one (range, one to six). Biliary dilatation and strictures were encountered in 74. 1% and 28. 6%, respectively. Of the 69 cases of PCCM-associated complications, 53 (77%) were successfully treated with endoscopic retrograde cholangiopancreatography (ERCP), 14 (20. 2%) with surgery, and one (1. 4%) with successful percutaneous transhepatic cholangiography treatment. One patient had spontaneous clearance of PCCM. There was no reported mortality related to PCCM. Conclusion: PCCM can occur at any time but typically occur at a median of 2 years after cholecystectomy. Clinical presentations are similar to those with primary or secondary choledocholithiasis. Most can be managed successfully with ERCP. © 2009 The Society for Surgery of the Alimentary Tract.

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