Humans ; Intestinal Polyps ; Colonic Polyps/surgery* ; Intestinal Polyposis ; Colorectal Neoplasms

OBJECTIVES: To study the clinical features of children with colorectal polyps and the efficacy of endoscopic treatment. METHODS: A retrospective analysis was performed on the medical data of 1 351 children with colorectal polyps who were admitted and received colonoscopy and treatment in the past 8 years, including clinical features and the pattern and outcomes of endoscopic treatment. RESULTS: Among the 1 351 children, 893 (66.10%) were boys and 981 (72.61%) had an age of 2-<7 years, and hematochezia (1 307, 96.74%) was the most common clinical manifestation. Of all the children, 89.27% (1 206/1 351) had solitary polyps, and 95.77% (1 290/1 347) had juvenile polyps. The polyps were removed by electric cauterization with hot biopsy forceps (6 cases) or high-frequency electrotomy and electrocoagulation after snare ligation (1 345 cases). A total of 1 758 polyps were resected, among which 1 593 (90.61%) were pedunculated and 1 349 (76.73%) had a diameter of <2 cm. Postoperative complications included bleeding in 51 children (3.77%), vomiting in 87 children (6.44%), abdominal pain in 14 children (1.04%), and fever in 39 children (2.89%), while no perforation was observed. The children aged <3 years had the highest incidence rates of postoperative bleeding and fever (P<0.0125), and the children with a polyp diameter of ≥2 cm had significantly higher incidence rates of postoperative bleeding, vomiting, and fever (P<0.05). CONCLUSIONS Solitary polyps, pedunculated polyps, and juvenile polyps are common types of pediatric colorectal polyps. Electric cauterization with hot biopsy forceps or high-frequency electrotomy and electrocoagulation after snare ligation can effectively remove colorectal polyps in children, with good efficacy and few complications. Younger age and larger polyp diameter are associated with a higher risk of postoperative bleeding.
Child ; Colonic Polyps/surgery* ; Colonoscopy ; Female ; Humans ; Intestinal Polyps/surgery* ; Male ; Retrospective Studies ; Vomiting

To analyze the clinical and endoscopic characteristics of colorectal polyps in children, and to explore the detection rate, age and gender distribution characteristics, endoscopic treatment effect and follow-up monitoring of colorectal polyps in children, so as to provide reference for disease management of colorectal polyps in children. The clinical and endoscopic characteristics of children with colorectal polyps in Xi 'an Children's Hospital from January 2019 to December 2019 were retrospectively analyzed. The patients were divided into 5 groups according to age (y): 0t test, Pearson Chi-square test (χ²) were used to compare groups' differences. The results showed that a total of 724 colonoscopies were completed in 2019, and 160 colorectal polyps were diagnosed, with a detection rate of 22.10%. Among the children with colorectal polyps, 105 were males, accounting for 65.62%, and 55 were females, accounting for 34.38%. The detection rate of male colorectal polyps was 22.68%, and the detection rate of female colorectal polyps was 21.08%. There was no significant difference in the detection rate of colorectal polyps between males and females (χ² = 0.25, P =0.617). Children with colorectal polyps were most common in the age group of 1≤ y<4 years, 72 cases, accounting for 41.14%(72/175). The detection rate of colorectal polyps in different age groups was statistically significant (χ²=73.929, P<0.05). The main symptom of children with colorectal polyps was hematochezia, accounting for 87.5% (140/160). Colorectal polyps were mainly single polyps in 140 patients, accounting for 87.50%, 15 patients had 2-4 polyps, accounting for 9.38%, and 5 patients had 5 or more polyps, accounting for 3.12%. A total of 210 polyps were removed, and the most common site of polyps was rectum, 123 polyps, accounting for 58.57% (123/210). 111 (52.86%, 111/210) of them were 1 cm to 2 cm in diameter. The Yamada classification was mainly type Ⅲ, 114 pieces, accounting for 54.29% (114/210). Among the 210 polyps with diameter ≥0.5 cm, 165 were removed by endoscopic mucosal resection, accounting for 78.57% (165/210). There were 23 patients with postoperative complications, including hematochezia, abdominal pain, fever, vomiting, diarrhea, dizziness, and no gastrointestinal perforation. Juvenile polyps were the main pathological type, accounting for 88.13% (141/160). The children with juvenile polyps were followed up for 3-30 months, and recurrence was considered in 2 of them. In conclusion, the detection rate of colorectal polyps in children aged 1≤ y<4 years is high, and hematochezia is the main clinical manifestation. Standardized endoscopic treatment and follow-up monitoring are very important for children with colorectal polyps.
Child ; Child, Preschool ; Colonic Polyps ; Colonoscopy ; Female ; Gastrointestinal Hemorrhage/complications* ; Humans ; Intestinal Polyps/surgery* ; Male ; Retrospective Studies

Colonic Polyps/surgery* ; Colonoscopy ; Colorectal Neoplasms/surgery* ; Humans ; Intestinal Polyposis ; Microsurgery ; Treatment Outcome

BackgroundThe diagnosis and treatment of small-bowel diseases is clinically difficult. The purpose of this study was to evaluate the diagnostic and therapeutic value of double-balloon enteroscopy in small-bowel diseases.

MethodsThe history and outcomes of 2806 patients who underwent double-balloon enteroscopy from July 2004 to April 2017 were reviewed, which included 562 patients with obscure digestive tract bleeding, 457 patients with obscure diarrhea, 930 patients with obscure abdominal pain, 795 patients with obscure weight loss, and 62 patients with obscure intestinal obstruction. Examinations were performed through the mouth and/or anus according to the clinical symptoms and abdominal images. If a lesion was not detected through one direction, examination through the other direction was performed as necessary. Eighty-four patients with small-bowel polyps, 26 with intestinal obstruction caused by enterolith, and 18 with bleeding from Dieulafoy's lesions in the small intestine were treated endoscopically.

ResultsA total of 2806 patients underwent double-balloon enteroscopy, and no serious complications occurred. An endoscopic approach through both the mouth and anus was used in 212 patients. Lesions were detected in 1696 patients, with a detection rate of 60.4%; the rates for obscure digestive tract bleeding, diarrhea, abdominal pain, weight loss, and intestinal obstruction were 85.9% (483/562), 73.5% (336/457), 48.2% (448/930), 49.1% (390/795), and 62.9% (39/62), respectively. For patients with small-bowel polyps who underwent endoscopic therapy, no complications such as digestive tract bleeding and perforation occurred. Intestinal obstruction with enteroliths was relieved with endoscopic lithotripsy. Among the 18 patients with bleeding from small-bowel Dieulafoy's lesions, 14 patients were controlled with endoscopic hemostasis.

ConclusionDouble-balloon enteroscopy is useful for diagnosing and treating some small-bowel disease.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Double-Balloon Enteroscopy ; methods ; Female ; Gastrointestinal Hemorrhage ; diagnosis ; surgery ; Humans ; Intestinal Diseases ; diagnosis ; surgery ; Intestinal Obstruction ; Intestine, Small ; diagnostic imaging ; Leiomyosarcoma ; diagnosis ; surgery ; Lymphoma ; diagnosis ; surgery ; Male ; Middle Aged ; Polyps ; diagnosis ; surgery ; Young Adult

The objective of this study was to conduct a meta-analysis to determine risk factors that may facilitate patient selection for radical resections or additional resections after a polypectomy. Eligible articles were identified by searches of PUBMED, Cochrane Library and Korean Medical Database using the terms (early colorectal carcinoma [ECC], lymph node metastasis [LNM], colectomy, endoscopic resection). Thirteen cohort studies of 7,066 ECC patients who only underwent radical surgery have been analysed. There was a significant risk of LNM when they had submucosal invasion (> or = SM2 or > or = 1,000 microm) (odds Ratio [OR], 3.00; 95% confidence interval [CI], 1.36-6.62, P = 0.007). Moreover, it has been found that vascular invasion (OR, 2.70; 95% CI, 1.95-3.74; P < 0.001), lymphatic invasion (OR, 6.91; 95% CI, 5.40-8.85; P < 0.001), poorly differentiated carcinomas (OR, 8.27; 95% CI, 4.67-14.66; P < 0.001) and tumor budding (OR, 4.59; 95% CI, 3.44-6.13; P < 0.001) were significantly associated with LNM. Furthermore, another analysis was carried out on eight cohort studies of 310 patients who underwent additional surgeries after an endoscopic resection. The major factors identified in these studies include lymphovascular invasion on polypectomy specimens (OR, 5.47; 95% CI, 2.46-12.17; P < 0.001) and poorly or moderately differentiated carcinomas (OR, 4.07; 95% CI, 1.08-15.33; P = 0.04). For ECC patients with > or = SM2 or > or = 1,000 microm submucosal invasion, vascular invasion, lymphatic invasion, poorly differentiated carcinomas or tumor budding, it is deemed that a more extensive resection accompanied by a lymph node dissection is necessary. Even if the lesion is completely removed by an endoscopic resection, an additional surgical resection should be considered in patients with poorly or moderately differentiated carcinomas or lymphovascular invasion.
Colectomy ; Colorectal Neoplasms/*pathology/surgery ; Endoscopy ; Female ; Humans ; Intestinal Polyps/surgery ; Lymphatic Metastasis ; Male ; Neoplasm Invasiveness

Hyperplastic or serrated polyps were once believed to have little to no clinical significance. A subset of these polyps are now considered to be precursors to colorectal cancers (CRC) in the serrated pathway that may account for at least 15% of all tumors. The serrated pathway is distinct from the two other CRC pathways and involves an epigenetic hypermethylation mechanism of CpG islands within promoter regions of tumor suppressor genes. This process results in the formation of CpG island methylator phenotype tumors. Serrated polyps are divided into hyperplastic polyps, sessile serrated adenomas/polyps (SSA/Ps), and traditional serrated adenomas (TSAs). The SSA/P and the TSA have the potential for dysplasia and subsequent malignant transformation. The SSA/Ps are more common and are more likely to be flat than TSAs. Their flat morphology may make them difficult to detect and thus explain the variation in detection rates among endoscopists. Challenges for endoscopists also include the difficulty in pathological interpretation as well surveillance of these lesions. Furthermore, serrated polyps may be inadequately resected by endoscopists. Thus, it is not surprising that the serrated pathway has been linked with interval cancers. This review will provide the physician or clinician with the knowledge to manage patients with serrated polyps.
Adaptor Proteins, Signal Transducing/genetics/metabolism ; Adenomatous Polyps/genetics/metabolism/*surgery ; Colonoscopy ; Colorectal Neoplasms/genetics/metabolism/*surgery ; DNA Methylation ; Humans ; Intestinal Polyposis/genetics/metabolism/*surgery ; Intestinal Polyps/genetics/metabolism/*surgery ; Nuclear Proteins/genetics/metabolism ; Proto-Oncogene Proteins/genetics/metabolism ; Proto-Oncogene Proteins B-raf/genetics/metabolism ; ras Proteins/genetics/metabolism

Peutz-Jeghers syndrome is an autosomal dominant inherited disorder characterized by multiple gastrointestinal hamartomatous polyps and mucocutaneous pigmentation. Peutz-Jeghers syndrome has an incidence of approximately 1 in 25,000 to 300,000 births. Crohn's disease is a chronic inflammatory bowel disease that typically manifests as regional enteritis with its incidence ranging from 3.1 to 14.6 cases per 100,000 person-years in North America. Herein, we report a case of a 30-year-old male patient who had both Peutz-Jeghers syndrome and Crohn's disease. We believe that this is the first case in Korea and the second report in the English literatures on Peutz-Jeghers syndrome coincidentally accompanied by Crohn's disease.
Adult ; Crohn Disease/complications/*diagnosis/pathology ; Endoscopy, Gastrointestinal ; Humans ; Intestinal Obstruction/etiology ; Intestinal Perforation/etiology ; Intestinal Polyps/pathology/surgery ; Male ; Peutz-Jeghers Syndrome/complications/*diagnosis/genetics ; Protein-Serine-Threonine Kinases/genetics

BACKGROUND/AIMS: Early colon cancer can be effectively diagnosed and treated by colonoscopy, and surveillance colonoscopy is necessary to detect precursor lesions or new early colon cancer. We analyzed the surveillance results of patients with endoscopically resected early colon cancer to evaluate the detection rate of advanced neoplasia and its associated factors. METHODS: We conducted a retrospective study at Soonchunhyang University Seoul Hospital, from May 2003 to December 2011. Patients who underwent endoscopic resection for early colon cancer, showed mucosal and submucosal invasion on histopathologic examination, and received surveillance colonoscopy at least once were enrolled in the current study. Patients who underwent operation and those who were lost during surveillance period were excluded. RESULTS: Among a total of 305 patients diagnosed with early colon cancer, 211 patients met our inclusion criteria. Of these patients, 15 (7.1%) advanced neoplasias were detected at first colonoscopy. One hundred ninety-eight patients (93.8%) underwent surveillance colonoscopy within one year and 14 (7.0%) advanced neoplasias were detected in this group of patients. When patients with and without advanced neoplasia at first surveillance colonoscopy performed within one year were compared, inadequate bowel preparation (OR, 18.237; 95% CI, 3.741-88.895; p<0.001) and three or more colon polyps (OR, 9.479; 95% CI, 1.103-81.452; p=0.040) were significant risk factors for detecting advanced neoplasia. CONCLUSIONS: Considering the high detection rate of advanced neoplasia at first surveillance colonoscopy in patients with endoscopically resected early colon cancer, surveillance interval should be within one year, especially when the bowel preparation has been inadequate and three or more colon polyps have been detected.
Aged ; Colonic Polyps/pathology/surgery ; Colonoscopy ; Colorectal Neoplasms/*diagnosis/surgery ; Female ; Follow-Up Studies ; Humans ; Intestinal Mucosa/pathology ; Male ; Middle Aged ; Neoplasm Staging ; Odds Ratio ; Recurrence ; Retrospective Studies ; Risk Factors

No abstract available.
Diagnosis, Differential ; Endosonography ; Female ; Humans ; Incidental Findings ; *Intestinal Mucosa/pathology/radiography/surgery ; Intestinal Polyps/*diagnosis/pathology/radiography/surgery ; Middle Aged ; Neoplasms, Fibroepithelial/*diagnosis/pathology/radiography/surgery ; Predictive Value of Tests ; Rectal Neoplasms/*diagnosis/pathology/radiography/surgery ; Tomography, X-Ray Computed