Use of disposable graduated biopsy forceps improves accuracy of polyp size measurements during endoscopy

AIM: To determine the accuracy of endoscopic polyp size measurements using disposable graduated biopsy forceps(DGBF). METHODS: Gradations accurate to 1 mm were assessed with the wire of disposable graduated biopsy forceps. When a polyp was noted, endoscopists determined the width of the polyp; then, the graduated biopsy forceps was inserted and the largest diameter of the tumor was measured. After excision, during surgery or endoscopy, the polyp was measured using the vernier caliper.RESULTS: One hundred and thirty-three colorectal polyps from 119 patients were studied. The mean diameter, by post-polypectomy measurement, was 0.92 ± 0.69 cm; 83 were < 1 cm, 36 were between 1 and 2 cm, and 14 were > 2 cm. The mean diameter, by visual estimation, was 1.15 ± 0.88 cm; compared to the actual size measured using vernier calipers, the difference was statistically significant. The mean diameter measured using the DGBF was 0.93 ± 0.68 cm; compared to the actual size measured using vernier calipers, this difference was not statistically significant. The ratio between the mean size estimated by visual estimation and the actual size was significantly different from that between the mean size estimated using the DGBF and the actual size(1.26 ± 0.30 vs 1.02 ± 0.11).CONCLUSION: The accuracy of polyp size estimation was low by visual assessment; however, it improved when the DGBF was used.

Measurement system that improves the accuracy of polyp size determined at colonoscopy

AIM:To assess the accuracy of polyp size using an endoscopic lesion measurement system(ELMS).METHODS:The accuracy of polyp size assessment was compared among measurements acquired by visual estimation,disposable graduated biopsy forceps(DGBF;used as a"scale-plate")and the ELMS.RESULTS:There were 192 polyps from 166 cases included in this study.The mean diameter of the post polypectomy measurement was 0.85±0.53 cm(range:0.2-3.0 cm).The mean diameter by visual estimation was 1.10±0.53 cm,which was significantly different compared to the actual size of the polyp(P<0.001).The mean diameters obtained using DGBF(0.87±0.54cm)and ELMS(0.85±0.53 cm)did not significantly differ from the actual size of the polyp.The difference between the measurements from the ELMS and DGBF was not significant.CONCLUSION:Unlike visual estimations at colonoscopy,endoscopic graduated biopsy forceps and the endoscopic lesion measurement system are accurate methods to estimate polyp size.

在复杂 fistula-in-ano: 的肛门管塞子对 mucosa 前进拍动元分析

AIM:To investigate the efficacy of the anal fistula plug(AFP) compared to the mucosa advancement flap(MAF),considered the best procedure for patients with a complex anal fistula.METHODS:The literature search included PubMed,EMBASE,Cochrane Library and OVID original studies on the topic of AFP compared to MAF for complex fistula-in-ano that had a deadline for publication by April 2011.Randomized controlled trials,controlled clinical trials and prospective cohort studies were included in the review.After information collection,a meta-analysis was performed using data on overall success rates as well as incidence of incontinence and morbidity.The quality of postoperative life was also included with the clinical results.RESULTS:Six studies involving 408 patients(AFP = 167,MAF = 241) were included in the meta-analysis.The differences in the overall success rates and incidence of fistula recurrence were not statistically significant between the AFP and MAF [risk difference(RD) =-0.12,95%CI:-0.39-0.14;RD = 0.13;95%CI:-0.18-0.43,respectively].However,for the AFP,the risk of postoperative impaired continence was lower(RD =-0.08,95%CI:-0.15--0.02) as was the incidence of other complications(RD =-0.06,95%CI:-0.11-0.00).The postoperative quality of life,for patients treated using the AFP was superior to that of the MAF patients.Patients treated with the AFP had less persistent pain of a shorter duration and the healing time of the fistula and hospital stay were also reduced.CONCLUSION:The AFP is an effective procedure for patients with a complex anal fistula;it has the same success rate but a lower risk of complications than the MAF and may also be associated with an improved postoperative quality of life.Additional evidence is needed to confirm these findings.

A study of laparoscopic extraperitoneal sigmoid colostomy after abdomino-perineal resection for rectal cancer

Objective:To established a procedure for laparoscopic extraperitoneal ostomy after abdomino-perineal resection(APR)and study safety aspects and complications.Method:From July 2011 to July 2012,36 patients with low rectal cancer undergoing APR were included in the study and divided into extraperitoneal ostomy group(n=18)and intraperitoneal ostomy group(n=18).Short-and long-term complications were compared between the two groups.All patients were followed up and the median duration was 17 months(range:12-24).Results:The rates of short-term complication related to colostomies were comparable between the two groups,except the rate for stoma edema was higher in the extraperitoneal group(33.3%vs 0%;P=0.008).In the intraperitoneal ostomy group,two patients developed stoma prolapse,one had stoma stenosis,and two had parastomal hernia.In contrast,no long-term complications related to colostomies occurred in the extraperitoneal ostomy group.The rate of long-term complication was lower in the extraperitoneal ostomy group(0%vs 22.2%;P=0.036).Conclusion:The laparoscopic extraperitoneal ostomy is a relatively simple and safe procedure,with fewer long-term complications related to colostomy.However the follow-up period was not too long and needs to be extended.