P. Dell'Abate

Endoscopic treatment of colorectal benign-appearing lesions 3 cm or larger: Techniques and outcome

PURPOSE: Colonoscopic polypectomy is the preferred technique to remove the majority of polyps. The authors evaluate feasibility, safety, and the effectiveness of endoscopic treatment of colorectal benign-appearing polyps equal to or larger than 3 cm. METHODS: Ninety-seven patients with 104 giant polyps underwent polypectomy within a nine-year period. The majority of these procedures were performed on an outpatient basis, all on unsedated patients. Gross appearance, size, location, histologic characteristics, synchronous lesions, modality, and adequacy of removal of giant polyps were analyzed. The follow-up was achieved in 89 percent of patients during a period ranging from 6 to 96 months (median, 38). RESULTS: Of the 104 removed polyps, 75 (72 percent) were adenomatous, 2 (2 percent) were hyperplastic, and 27 (26 percent) were malignant polyps. Six patients had more than one giant polyp. Several additional smaller polyps were found in 52 patients and a synchronous cancer in 4. Twenty-one (20 percent) giant polyps were equal to or larger than 4 cm. Forty-nine were pedunculated, 20 were short-stalked, and 35 were sessile. Sixty-one polyps were excised in one piece, and forty-three were excised using a piecemeal technique. Only four complications (3.8 percent) were recorded; all cases were treated endoscopically. Fifty-eight (75 percent) adenomas and eighteen (67 percent) malignant polyps were completely excised. Surgery was performed in 7 of 27 patients (27 percent) with malignant polyps, where there was a doubtful, infiltrated margin or poorly differentiated cancer. Post-polypectomy surveillance permitted the detection and treatment of 25 metachronous or recurrent polyps and a metachronous cancer. CONCLUSIONS: This study shows that polypectomy of giant colorectal polyps, performed by an expert endoscopist, is feasible, effective, and safe, even on an outpatient basis. The authors confirm that malignant polyps with incomplete excision, lymphovascular invasion, and poor differentiation require bowel resection. Post-polypectomy surveillance is useful for all patients who have undergone colonoscopic resection of giant adenomatous or malignant polyps.

Pulmonary endothelial cell modifications after storage in solid-organ preservation solutions.

During lung preservation, the vascular endothelium is probably the first site of damage and these lesions are considered the main limiting factor in solid-organ preservation. In the present study, the ultrastructural changes in the endothelial cells of human pulmonary artery hypothermically stored (at 4 °C) for 6 and 12 h in Euro-Collins, University of Wisconsin and Ringer-lactate solutions were compared. The arteries obtained from three patients who underwent pneumonectomy were divided into 20 segments and preserved in the three solutions mentioned. The specimens, which were fixed in osmic acid, were examined using transmission electron microscopy. Transmission electron microscopy indicated that the cells stored in the University of Wisconsin solution either for 6 or 12 h were the best preserved, while the most severely damaged cells were those stored in Euro-Collins solution, even after just 6 h. The cells stored in Ringer-lactate showed an intermediate level of damage. The data from an ultrastructural grading scale, which quantified the damage to the cytoplasm, mitochondria and nucleus, were in broad agreement with the general transmission electron microscopy observations. Analysis of variance of the grading scale data showed that there were statistically significant differences between the groups after both 6 and 12 h storage (P < 0.05).

Choledocholithiasis caused by migration of a surgical clip after video laparoscopic cholecystectomy.

We present a case of a 67-year-old woman, in which a clip in the common bile duct (CBD) was the nidus of stone formation. The ultrasonographic examination reported a CBD with an abnormally large diameter and an endoscopic retrograde sphincterotomy showed a stone in the ampulla. The stone was extracted through the Vaters Papilla and the patient was discharged after 24 hours.

Syndrome du «bumper» enfoui A propos de deux cas Recommandations et traitement. Expérience personnelle

RésuméLes auteurs rapportent leur expérience concernant la survenue et le traitement d’une complication rare de la gastrostomie percutanée: le syndrome du «bumper enfoui».La solution endoscopique retenue a consisté à libérer le «bumper» interne en pratiquant deux incisions muqueuses radiales à l’aide d’une aiguille diathermique.Après avoir examiné différents facteurs déclenchants possibles, les auteurs tirent la conclusion que le système avec «bouton» est un substitut fiable et efficace pour tous les patients non cancéreux qui nécessitent une nutrition entérale sur une longue période (supérieure à 2 à 3 mois).SummaryThe Authors report their experience in the occurrence and management of an uncommon PEG complication «The Buried Bumper Syndrome».The endoscopic solution adopted in both patients was to free the internal bumper through radial incisions using a diathermic needle.Having examined the possible causative factors they conclude that the «button» device system is to be considered a more efficient and safe substitute for non-neoplastic patients needing long-term (more than 2–3 months) enteral feeding.

Self-Expanding Metal Stents in the Treatment of Colonic Obstruction

Background: The use of self-expanding metal stents in the treatment of obstruction of esophageal tract, biliary tract, major vessel diseases and colonic obstruction has found favor in the last years. Patients and Methods: 13 patients (7 women and 6 men) with a mean age of 74.7 years were treated for an obstruction located at the descending colon-sigmoid tract in 9 cases, at the rectosigmoid tract in 2 cases, and at the transverse colon in 2 cases. Two cases had an obstruction post ischemic colitis. Results: The stents were conducted successfully in all patients. The mean hospital stay was 3.7 days versus 7.8 days for a colostomy (p < 0.001). Conclusions: The self-expanding stent for the treatment of colonic obstruction is a procedure that can be used not only in neoplastic and inoperable stenoses but also in all colonic stenoses where the surgical risk is bigger than that of the endoscopic procedure.