OBJECTIVE To assess the results of endoscopic mucosal resection （EMR） of benign mucosal neoplasms located on the duodenal bulb using endoscope retroflexion. METHODS This study involved 14 patients with 16 mucosal ne...OBJECTIVE To assess the results of endoscopic mucosal resection （EMR） of benign mucosal neoplasms located on the duodenal bulb using endoscope retroflexion. METHODS This study involved 14 patients with 16 mucosal neoplasms located on the duodenal bulb. The diameter of each neoplasm was less than 15 mm. After endoscope retroflexion within the duodenum for evaluation of the size, extent and depth of the tumor, EMR was attempted with endoscope retroflexion for removing the lesion in the duodenal bulb. The rate of endoscope retroflexion, the time required for endoscope retroflexion, median operation time, curative resection rate, en bloc resection rate, complication, and median follow-up period were evaluated. RESULTS Sixteen lesions in 14 patents （median age of 56 years, 5 female, 9 male） were removed through EMR. The mean size of the lesions resected was 6.9 mm （median size of 5.5 mm, range of 3-15 mm）. Post-EMR histologic examination revealed Brunner＇s gland hyperplasia in 6, gastric mucosal metaplasia in 5, adenoma in 1, chronic inflammation in 3, and benign lymphocytic hyperplasia in 1. The curative resection rate was 100% （16/16）, and the en bloc resection rate was 94% （15/16）, with EMR. One of the lesions was piecemeal removed through EMR for its large size （15 mm） and for its involving the area from the duodenal bulb to the pyloric ring. The success rate of endoscope retroflexion within the duodenum was 94% （15/16）. The time required for endoscope retroflexion was longer for the first 10 lesions （median time of 2 min, range of 1-2.5 min） than that for the last 5 lesions （median time of 1.5 min, range of 1-2 min）. The median follow-up period was 22 months （range of 4-48 months）. During the follow-up, no residual, no pyloric or duodenal stenosis was found in any of the patients after EMR. There was no severe hemorrhage, or perforations occurring. CONCLUSION EMR of mucosal neoplasm located on the duodenal bulb through endoscope retroflexion, which is a feasible and useful adjunctive procedure, appears to be a safe and effective technique.展开更多
AIM： To investigate the value of retroflexion in detecting neoplasia in the distal rectum. METHODS： This was a prospective observational study performed in an academic endoscopy unit. Consecutive patients undergoing...AIM： To investigate the value of retroflexion in detecting neoplasia in the distal rectum. METHODS： This was a prospective observational study performed in an academic endoscopy unit. Consecutive patients undergoing colonoscopy had careful forward viewing of the distal rectum by retroflexion. Of 1502 procedures, 1076 （72%） procedures were performed with a 140^o angle of view colonoscope and 426 （28%） were performed with a 170^o angle of view colonoscope. The outcome measurement was the yield of neoplasia in the distal rectum detected by forward viewing vs retroflexion. RESULTS： A total of 1502 patients, including 767 （51%） females and 735 （49%） males, with mean age of 58.8 ± 12.5 years were enrolled. Retroflexion was successful in 1411 （93.9%） patients, unsuccessful or not performed because the rectum appeared narrow in 91 （6.1%）. Forty patients had a polyp detected in the distal rectal mucosa. Thirty-three were visible in both the forward and retroflexed view （25 hyperplastic, 8 adenomatous）. Seven polyps were visualized only by retroflexion （6 hyperplastic sessile polyps, one 4 mm sessile tubular adenoma）. There was no significant difference in information added by retroflexion with 140^o vs 170^o angle of view instrument. CONCLUSION： To our knowledge, this is the largest reported evaluation of retroflexion in the rectum. Routine rectal retroflexion did not detect clinically important neoplasia after a careful forward examination of the rectum to the dentate line. Since retroflexion has risks and may cause discomfort, theuse of routine retroflexion should be at the discretion of the endoscopist.展开更多
BACKGROUND Colonoscopy is the accepted gold standard for the detection of colorectal cancer. However, colonoscopy is less effective in preventing colon cancer in the right side compared with the left side.AIM To inves...BACKGROUND Colonoscopy is the accepted gold standard for the detection of colorectal cancer. However, colonoscopy is less effective in preventing colon cancer in the right side compared with the left side.AIM To investigate the feasibility of a novel type of retroflexion colonoscope, EC-3490 Ti colonoscope, for detection of proximal colon lesions.METHODS In this prospective trial, we recruited patients who underwent colonoscopy for screening or surveillance. When the endoscopists could not grasp the whole observation of the right-side colon mucosa in the forward view(FV), insertion and withdrawal were repeatedly performed in the FV group with the EC38-i10 F colonoscope while retroflexion was performed in the retroflexed view(RV) group with the EC-3490 Ti colonoscope. Adenoma detection rate, the total number of adenomas per positive participant, the success rate of retroflexion, and endoscope withdrawal time were recorded and compared.RESULTS The total adenoma detection rate(39.3% vs 37.7%, P = 0.646) did not show any significant difference between the two groups. However, the polyp detection rate(59.6% vs 51.0%, P = 0.002), adenoma detection rate in the right colon(21.6% vs 14.4%, P = 0.012), and the total number of adenomas per positive participant(2.1 vs 1.7, P = 0.011) reached statistical significance. Retroflexion was achieved in 91.7% of our cohort. Compared with the FV group, the withdrawal time was significantly prolonged in the RV group(586.1 ± 124.4 s vs 508.8 ± 129.6 s, P < 0.001). In contrast, the proportion of additional ancillary pressure decreased(27.4% vs 45.7%, P < 0.001), and the visual analog scale pain scores did not increase(2.7 ± 1.4 vs 2.8 ± 1.4, P = 0.377).CONCLUSION Retroflexion in the proximal colon could be performed successfully and safely with the EC-3490 Ti colonoscope. This maneuver could detect more adenomas effectively.展开更多
Complications of cecal retroflexion performed during colonoscopy have not previously been reported to occur. We report a case of contained colonic perforation secondary to using cecal retroflexion technique to examine...Complications of cecal retroflexion performed during colonoscopy have not previously been reported to occur. We report a case of contained colonic perforation secondary to using cecal retroflexion technique to examine the colon, and review available published reports of complications associated with this technique. We conclude that complications may rarely occur with use of cecal retroflexion, and that the clinical benefit of this technique is uncertain.展开更多
Colonoscopy and polypectomy remain the gold standard investigation for the detection and prevention of colorectal cancer.Halting the progression of colonic adenoma through adequate detection of pre-cancerous lesions i...Colonoscopy and polypectomy remain the gold standard investigation for the detection and prevention of colorectal cancer.Halting the progression of colonic adenoma through adequate detection of pre-cancerous lesions interrupts the progression to carcinoma.The adenoma detection rate is a key performance indicator.Increasing adenoma detection rates are associated with reducing rates of interval colorectal cancer.Endoscopists with high baseline adenoma detection rate have a meticulous technique during colonoscopy withdrawal that improves their adenoma detection.This minireview article summarizes the evidence on the following simple operator techniques and their effects on the adenoma detection rate;minimum withdrawal times,dynamic patient position change and proximal colon retroflexion.展开更多
文摘OBJECTIVE To assess the results of endoscopic mucosal resection （EMR） of benign mucosal neoplasms located on the duodenal bulb using endoscope retroflexion. METHODS This study involved 14 patients with 16 mucosal neoplasms located on the duodenal bulb. The diameter of each neoplasm was less than 15 mm. After endoscope retroflexion within the duodenum for evaluation of the size, extent and depth of the tumor, EMR was attempted with endoscope retroflexion for removing the lesion in the duodenal bulb. The rate of endoscope retroflexion, the time required for endoscope retroflexion, median operation time, curative resection rate, en bloc resection rate, complication, and median follow-up period were evaluated. RESULTS Sixteen lesions in 14 patents （median age of 56 years, 5 female, 9 male） were removed through EMR. The mean size of the lesions resected was 6.9 mm （median size of 5.5 mm, range of 3-15 mm）. Post-EMR histologic examination revealed Brunner＇s gland hyperplasia in 6, gastric mucosal metaplasia in 5, adenoma in 1, chronic inflammation in 3, and benign lymphocytic hyperplasia in 1. The curative resection rate was 100% （16/16）, and the en bloc resection rate was 94% （15/16）, with EMR. One of the lesions was piecemeal removed through EMR for its large size （15 mm） and for its involving the area from the duodenal bulb to the pyloric ring. The success rate of endoscope retroflexion within the duodenum was 94% （15/16）. The time required for endoscope retroflexion was longer for the first 10 lesions （median time of 2 min, range of 1-2.5 min） than that for the last 5 lesions （median time of 1.5 min, range of 1-2 min）. The median follow-up period was 22 months （range of 4-48 months）. During the follow-up, no residual, no pyloric or duodenal stenosis was found in any of the patients after EMR. There was no severe hemorrhage, or perforations occurring. CONCLUSION EMR of mucosal neoplasm located on the duodenal bulb through endoscope retroflexion, which is a feasible and useful adjunctive procedure, appears to be a safe and effective technique.
文摘AIM： To investigate the value of retroflexion in detecting neoplasia in the distal rectum. METHODS： This was a prospective observational study performed in an academic endoscopy unit. Consecutive patients undergoing colonoscopy had careful forward viewing of the distal rectum by retroflexion. Of 1502 procedures, 1076 （72%） procedures were performed with a 140^o angle of view colonoscope and 426 （28%） were performed with a 170^o angle of view colonoscope. The outcome measurement was the yield of neoplasia in the distal rectum detected by forward viewing vs retroflexion. RESULTS： A total of 1502 patients, including 767 （51%） females and 735 （49%） males, with mean age of 58.8 ± 12.5 years were enrolled. Retroflexion was successful in 1411 （93.9%） patients, unsuccessful or not performed because the rectum appeared narrow in 91 （6.1%）. Forty patients had a polyp detected in the distal rectal mucosa. Thirty-three were visible in both the forward and retroflexed view （25 hyperplastic, 8 adenomatous）. Seven polyps were visualized only by retroflexion （6 hyperplastic sessile polyps, one 4 mm sessile tubular adenoma）. There was no significant difference in information added by retroflexion with 140^o vs 170^o angle of view instrument. CONCLUSION： To our knowledge, this is the largest reported evaluation of retroflexion in the rectum. Routine rectal retroflexion did not detect clinically important neoplasia after a careful forward examination of the rectum to the dentate line. Since retroflexion has risks and may cause discomfort, theuse of routine retroflexion should be at the discretion of the endoscopist.
基金Digestive Medical Coordinated Development Center of Beijing Hospitals Authority,No. XXZ015Capital Citizens Health Cultivation Project of Beijing Municipal Science&Technology Commission,No. Z161100000116084+1 种基金Medical and Health Public Foundation of Beijing,No. YWJKJJHKYJJ-B17262-067Science and Technology Development Project of China State Railway Group,No. N2019Z004。
文摘BACKGROUND Colonoscopy is the accepted gold standard for the detection of colorectal cancer. However, colonoscopy is less effective in preventing colon cancer in the right side compared with the left side.AIM To investigate the feasibility of a novel type of retroflexion colonoscope, EC-3490 Ti colonoscope, for detection of proximal colon lesions.METHODS In this prospective trial, we recruited patients who underwent colonoscopy for screening or surveillance. When the endoscopists could not grasp the whole observation of the right-side colon mucosa in the forward view(FV), insertion and withdrawal were repeatedly performed in the FV group with the EC38-i10 F colonoscope while retroflexion was performed in the retroflexed view(RV) group with the EC-3490 Ti colonoscope. Adenoma detection rate, the total number of adenomas per positive participant, the success rate of retroflexion, and endoscope withdrawal time were recorded and compared.RESULTS The total adenoma detection rate(39.3% vs 37.7%, P = 0.646) did not show any significant difference between the two groups. However, the polyp detection rate(59.6% vs 51.0%, P = 0.002), adenoma detection rate in the right colon(21.6% vs 14.4%, P = 0.012), and the total number of adenomas per positive participant(2.1 vs 1.7, P = 0.011) reached statistical significance. Retroflexion was achieved in 91.7% of our cohort. Compared with the FV group, the withdrawal time was significantly prolonged in the RV group(586.1 ± 124.4 s vs 508.8 ± 129.6 s, P < 0.001). In contrast, the proportion of additional ancillary pressure decreased(27.4% vs 45.7%, P < 0.001), and the visual analog scale pain scores did not increase(2.7 ± 1.4 vs 2.8 ± 1.4, P = 0.377).CONCLUSION Retroflexion in the proximal colon could be performed successfully and safely with the EC-3490 Ti colonoscope. This maneuver could detect more adenomas effectively.
基金Supported by(in part)Merit Review Award number 1 I01 HX001574-01A1(GuptaPI)from the United States Department of Veterans Affairs Health Services Research and Development Service of the VA Office of Research and Development
文摘Complications of cecal retroflexion performed during colonoscopy have not previously been reported to occur. We report a case of contained colonic perforation secondary to using cecal retroflexion technique to examine the colon, and review available published reports of complications associated with this technique. We conclude that complications may rarely occur with use of cecal retroflexion, and that the clinical benefit of this technique is uncertain.
文摘Colonoscopy and polypectomy remain the gold standard investigation for the detection and prevention of colorectal cancer.Halting the progression of colonic adenoma through adequate detection of pre-cancerous lesions interrupts the progression to carcinoma.The adenoma detection rate is a key performance indicator.Increasing adenoma detection rates are associated with reducing rates of interval colorectal cancer.Endoscopists with high baseline adenoma detection rate have a meticulous technique during colonoscopy withdrawal that improves their adenoma detection.This minireview article summarizes the evidence on the following simple operator techniques and their effects on the adenoma detection rate;minimum withdrawal times,dynamic patient position change and proximal colon retroflexion.
