• colonoscopic polypectomy
• microperforation
• outcome
• predictive factors
• treatment

• effectiveness
• endoscopes
• hemorrhoids
• ligation
• safety

• Humans
• Hemorrhoids/surgery
• Ligation/instrumentation
• Ligation/methods
• Female
• Male
• Pilot Projects
• Middle Aged
• Prospective Studies
• Disposable Equipment
• Treatment Outcome
• Endoscopes
• Adult
• Aged
• Endoscopy/methods

• B2022201 Guangdong Medical Research Foundation
• 2021JD047 Basic Research (Medical and Health) Project of Bao 'an, Shenzhen

Applying a lubricant to the colonic mucosa and reducing the dynamic friction coefficient (DFC) between the endoscopic shaft and colonic mucosa may reduce colonoscopy invasiveness. However, the ideal lubricant viscosity remains unknown. Here, we developed a DFC measurement model integrating samples of colonic mucosa from forensic autopsy specimens into a simulated bowel bend and determined the low-friction lubricant viscosity that minimizes the DFC. Carboxymethyl cellulose, xanthan gum, hydroxyethyl cellulose, sodium alginate, and sodium polyacrylate aqueous solutions of various concentrations were used as lubricants. Low-friction lubricants minimized the load on the colonic mucosa during colonoscope insertion and reduced the total endoscopy insertion time. The highest correlation was between the DFC and the lubricant viscosity at a shear rate of 100 1/s. The lowest DFC was almost constant at approximately 0.09, irrespective of the chemical composition of the lubricant, and the low-friction lubricant viscosity (100 1/s) was 0.031–0.086 (median: 0.059). The viscosities of conventional colonoscopic lubricants were suitable for lubricating the anorectal skin owing to their low DFC, but too high for lubricating the colonic mucosa because of their high DFC. The utilization of the low-friction lubricants with the optimal viscosity can reduce the stress on colonic mucosa during colonoscopy.

Watanabe and colleagues investigate the effects of different lubricants on the friction coefficient during colonoscopy. They also develop a corresponding model to measure the dynamic friction coefficient and determine the optimal viscosity for minimizing colonoscopy invasiveness, enhancing patient comfort, and improving surgical efficiency.

• health care
• gels and hydrogels
• biomedical materials

• This work was supported by TERUMO LIFE SCIENCE FOUNDATION and “The Translational Research program; Strategic PRomotion for practical application of INnovative medical Technology (TR-SPRINT).”

• Colorectal cancer
• Discriminant validity
• EQ-5D-5L
• Health-related quality of life
• QLU-C10D

• Adult
• Humans
• Quality of Life
• Neoplasms
• Surveys and Questionnaires
• Fatigue/diagnosis

• APP1101837 National Health and Medical Research Council
• Cancer Council South Australia
• Flinders University

• Colonoscopy
• End-stage renal disease
• Post-polypectomy bleeding

• Humans
• Aged
• Colonic Polyps/surgery
• Colonic Polyps/complications
• Colonoscopy/methods
• Retrospective Studies
• Postoperative Hemorrhage/epidemiology
• Postoperative Hemorrhage/etiology
• Risk Factors
• Intestinal Polyps
• Kidney Failure, Chronic/complications

• colon cancer
• colon cancer screening
• colonoscopy
• indicator
• quality

• Humans
• Colonoscopy/methods
• Cecum
• Quality Indicators, Health Care
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/prevention & control
• Colorectal Neoplasms/epidemiology
• Adenoma/diagnosis
• Early Detection of Cancer/methods

• Abdominal pain
• Case report
• Gastrointestinal bleeding
• Postpolypectomy syndrome
• Sepsis

• Male
• Humans
• Female
• Aged
• Aged, 80 and over
• Cross-Sectional Studies
• Colonoscopy/adverse effects
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/epidemiology
• Colorectal Neoplasms/prevention & control
• Life Expectancy
• Mass Screening
• Early Detection of Cancer/methods

• adverse events
• endoscopic submucosal dissection
• gastrointestinal tract
• post-endoscopic submucosal dissection electrocoagulation syndrome
• review

Post-polypectomy electrocoagulation syndrome (PPES) can occur after colonoscopic polypectomy and is usually treated conservatively with a positive prognosis. Nevertheless, there can be cases with complications developing.

A 58-year-old woman, who had no previous medical history, visited the Emergency Department of another hospital with symptoms of abdominal pain and fever, 1 d after multiple colonoscopic polypectomies. An abdominopelvic computed tomography (CT) scan demonstrated colo-colonic intussusception, and she was transferred to our hospital to consider an operation. CT showed colo-colonic intussusception with PPES and no evidence of obstruction. The physical examination showed localized mild tenderness on the right sided abdomen. The patient fasted and was admitted for treatment with intravenous antibiotics (piperacillin/tazobactam 4.5 g each 8 h, ornidazole 500 mg each 12 h). After admission, the symptoms got better and a follow-up CT scan demonstrated resolution of the PPES and intussusception. The patient was discharged on hospital day 9.

Colo-colic intussusception can occur with PPES, and it can be properly treated conservatively.

• Intussusception
• Endoscopy
• Colonoscopy
• Colonic polyps
• Intestinal polyps
• Case report

• colonoscopy
• adverse events
• complications
• colon cancer screening

• Colonoscopy/adverse effects
• Colonoscopy/methods
• Colorectal Neoplasms/epidemiology
• Early Detection of Cancer/methods
• Humans
• Mass Screening
• Prospective Studies
• Risk Factors

• TL1 TR002555 NCATS NIH HHS

• Adult
• Child
• Consensus
• Endoscopy, Gastrointestinal/methods
• Gastroenterology
• Humans
• Quality Improvement

• Child
• Consensus
• Endoscopy, Gastrointestinal/methods
• Gastroenterology
• Humans
• Quality Improvement

• Breast Neoplasms/diagnosis
• Colorectal Neoplasms/diagnosis
• Cultural Competency
• Early Detection of Cancer/standards
• Humans
• Lung Neoplasms/diagnosis
• Practice Guidelines as Topic
• Racial Groups

Delayed post-polypectomy bleeding (DPPB) is a potentially severe complication of therapeutic colonoscopy which can result in hospital readmission and re-intervention. Over the last decade, rates of DPPB reported in the literature have fallen from over 2% to 0.3–1.2%, largely due to improvements in resection technique, a shift towards cold snare polypectomy, better training, adherence to guidelines on periprocedural antithrombotic management, and the use of antithrombotics with more favourable bleeding profiles. However, as the complexity of polypectomy undertaken worldwide increases, so does the importance of identifying patients at increased risk of DPPB. Risk factors can be categorised according to patient, polyp and personnel related factors, and their integration together to provide an individualised risk score is an evolving field. Strategies to reduce DPPB include safe practices relevant to all patients undergoing colonoscopy, as well as specific considerations for patients identified to be high risk. This narrative review sets out an evidence-based summary of factors that contribute to the risk of DPPB before discussing pragmatic interventions to mitigate their risk and improve patient safety.

• adverse event
• colonoscopy
• complications
• haemorrhage
• polypectomy

Introduction. Colorectal cancer (CRC) prevention programs using fecal immunochemical testing (FIT) in screening rely on colonoscopy for secondary and surveillance testing. Colonoscopy capacity is an important constraint. Some European programs lack sufficient capacity to provide optimal screening intensity regarding age ranges, intervals, and FIT cutoffs. It is currently unclear how to optimize programs within colonoscopy capacity constraints. Design. Microsimulation modeling, using the MISCAN-Colon model, was used to determine if more effective CRC screening programs can be identified within constrained colonoscopy capacity. A total of 525 strategies were modeled and compared, varying 3 key screening parameters: screening intervals, age ranges, and FIT cutoffs, including previously unevaluated 4- and 5-year screening intervals (using a lifetime horizon and 100% adherence). Results were compared with the policy decisions taken in Ireland to provide CRC screening within available colonoscopy capacity. Outcomes estimated net costs, quality-adjusted life-years (QALYs), and required colonoscopies. The optimal strategies within finite colonoscopy capacity constraints were identified. Results. Combining a reduced FIT cutoff of 10 µg Hb/g, an extended screening interval of 4 y and an age range of 60–72 y requires 6% fewer colonoscopies, reduces net costs by 23% while preventing 15% more CRC deaths and saving 16% more QALYs relative to a strategy (FIT 40 µg Hb/g, 2-yearly, 60–70 year) approximating current policy. Conclusion. Previously overlooked longer screening intervals may optimize cancer prevention with finite colonoscopy capacity constraints. Changes could save lives, reduce costs, and relieve colonoscopy capacity pressures. These findings are relevant to CRC screening programs across Europe that employ FIT-based testing, which face colonoscopy capacity constraints.

• Colonoscopy
• bowel cleansing agents
• outcome

The risk for colonoscopic postpolypectomy bleeding (PPB) in patients with chronic liver disease (CLD) remains unclear. We determined the incidence and risk factors for colonoscopic PPB in patients with CLD, especially those with liver cirrhosis.

We retrospectively reviewed the medical records of patients with CLD who underwent colonoscopic polypectomy at Seoul National University Hospital between 2011 and 2014. The study endpoints were immediate and delayed PPB.

A total of 1,267 consecutive patients with CLD were included in the study. Immediate PPB occurred significantly more often in the Child-Pugh (CP) B or C cirrhosis group (17.5%) than in the CP-A (6.3%) and chronic hepatitis (4.6%) groups (p<0.001). Moreover, the incidence of delayed PPB in the CP-B or C cirrhosis group (4.4%) was significantly higher than that in the CP-A (0.7%) and chronic hepatitis (0.2%) groups (p<0.001). The independent risk factors for immediate PPB were CP-B or C cirrhosis (p=0.011), a platelet count <50,000/μL (p<0.001), 3 or more polyps (p=0.017), endoscopic mucosal resection or submucosal dissection (p<0.001), and polypectomy performed by trainees (p<0.001). The independent risk factors for delayed PPB were CP-B or C cirrhosis (p=0.009), and polyps >10 mm in size (p=0.010).

Patients with CP-B or C cirrhosis had an increased risk for bleeding following colonoscopic polypectomy.

• Chronic liver disease
• Colonoscopy
• Hepatitis
• Liver cirrhosis
• Postpolypectomy bleeding
• chronic

• Age Factors
• Aged
• Aged, 80 and over
• Colonoscopy/methods
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/mortality
• Early Detection of Cancer/adverse effects
• Early Detection of Cancer/methods
• Female
• Humans
• Male
• Middle Aged
• Occult Blood
• Practice Guidelines as Topic
• Risk
• Sigmoidoscopy
• Tomography, X-Ray Computed

• Colon
• Colonoscope
• Jet
• Phantom
• Propulsion
• Water

• Colon Cancer
• Complication
• Detection
• Injury
• Risk of Death

• Colonoscopy
• Colorectal Neoplasms
• Early Detection of Cancer
• Hospitalization
• Humans
• Mass Screening
• Middle Aged
• Poland

Current guidelines recommend temporary cessation of clopidogrel for 7-10 days for patients on clopidogrel undergoing colonoscopy with polypectomy. However, recent prospective randomized controlled trials have advocated for uninterrupted clopidogrel, due to similar post-polypectomy bleeding (PPB) rates with and without continued clopidogrel therapy. Thus, a meta-analysis was conducted to assess the risk of PPB rate in patients on continued clopidogrel therapy. Systemically identified publications were used to compare the rate of PPB in patients on continued clopidogrel therapy with those who had interrupted clopidogrel therapy. The primary outcome was the incidence of PPB. The secondary outcomes were immediate PPB, delayed PPB and serious cardio-thrombotic events. This study has been registered in PROSPERO (no. CRD42018118325). A total of five studies were identified, which included 655 patients in the continued clopidogrel group and 6620 patients in the control group. There was an increased risk of PPB with continued clopidogrel [P=0.0003; risk ratio (RR), 1.96; 95% confidence interval (CI), 1.36-2.83). The rate of immediate PPB was slightly higher in the continued clopidogrel group (5.77% vs. 1.77%, respectively), but was not statistically significant (P=0.06; RR, 1.57; 95%CI, 0.98-2.51). The rate of delayed PPB was increased in the continued clopidogrel group (P=0.0008; RR, 3.10; 95%CI, 1.60-5.98). However, no significant difference in serious cardio-thrombotic events was observed within 30 days (P=0.74; RR, 0.78; 95%CI, 0.18-3.40). Although continued clopidogrel therapy decreased the incidence of serious cardio-thrombotic events, the risk of delayed PPB was increased. Therefore, endoscopists should make all preparations to prevent bleeding in the perioperative period for patients at high thrombotic risk and on continued clopidogrel therapy, if polypectomy cannot be reasonably postponed.

• PPB
• clopidogrel therapy
• review and meta-analysis

• colonoscopy
• national standard
• quality indicator

• colonic polyps
• colonoscopy
• colorectal adenomas
• colorectal cancer
• surveillance

• Colonic Polyps/surgery
• Colonoscopy/standards
• Colorectal Neoplasms/surgery
• Evidence-Based Medicine/methods
• Humans
• Long-Term Care/methods
• Long-Term Care/standards
• Neoplasm Recurrence, Local/diagnosis
• Patient Selection
• Population Surveillance/methods
• Postoperative Period

• 25004 Cancer Research UK
• HTA/15/80/13 Department of Health
• British Society of Gastroenterology
• Public Health England

• Colonoscopy
• Complications
• Intestinal perforation

• Diversion stoma
• Neoadjuvant chemoradiation
• Peritoneal deposits
• Rectal cancer
• Staging laparoscopy

• colonoscopy
• colorectal cancer
• elderly patients

This study evaluates tissue injury, which results from electrosurgical ablation, by correlating lesion depth to tissue impedance, and introduces a newly developed real-time feedback control system that can be applied for preventing excessive tissue injury. Although some previous studies had evaluated such tissue injuries in other ways, a specific mechanism is necessary to actually prevent excessive tissue injury.

Ablation tests were performed by using an impedance bridge circuit and gel block that have been developed in two previous studies. Depth of the ablation site was measured with the use of a laser displacement measurement device. To simplify the programing work, voltage was used, as a substitution of tissue impedance, to evaluate tissue injury.

The depth of the ablation site was found to increase with either increased power setting or ablation duration, and the depth was analyzed to investigate correlation with measured voltage. The real-time feedback control system was developed by achieving communication between LabVIEW and an Arduino microcontroller.

It is concluded that the depth of the ablation site modestly correlates with the measured voltage under specific conditions, and the newly developed system fulfills the goal of the design.

• colonoscopy
• electrosurgical ablation
• impedance
• perforation

• Adverse Events
• Cardiovascular
• Colorectal
• Population-based
• Pulmonary

• Adult
• Aged
• Ambulatory Care/methods
• Cohort Studies
• Colonic Neoplasms/diagnosis
• Colonoscopy/adverse effects
• Colonoscopy/methods
• Early Detection of Cancer/adverse effects
• Early Detection of Cancer/methods
• Female
• Hospitals, University
• Humans
• Logistic Models
• Longitudinal Studies
• Male
• Middle Aged
• Multivariate Analysis
• Outpatients/statistics & numerical data
• Patient Safety/statistics & numerical data
• Prospective Studies
• Quebec
• Risk Assessment

• Colon capsule endoscopy
• Crohn’s disease
• colonoscopy
• endoscopy
• postoperative management
• second-generation colon capsule

Colonoscopy is effective in reducing the morbidity and mortality associated with colorectal cancer (CRC). Interval cancers or post-colonoscopy CRCs, are cancers detected within the surveillance interval, or between 6–36 months after a clearing colonoscopy. The incidence of interval cancers is 3.4%–9.2% of all detected CRCs, as reported in population-based studies. Colonoscopy is a technically difficult procedure that is challenging to learn, and needs time and effort to gain competency. Therefore, trainee competence is a critical component of CRC screening and surveillance. Herein, we review the colonoscopy training methods and quality assessment metrics for colonoscopy competency.

• Colonoscopy
• Education

• Cold snare polypectomy
• Colon polyp
• Stenosis

• Digestive System Diseases/diagnostic imaging
• Endoscopy, Digestive System/standards
• Humans
• Quality Indicators, Health Care

To identify the factors influencing cecal insertion time (CIT) and to evaluate the effect of obesity indices on CIT.

We retrospectively reviewed the data for participants who received both colonoscopy and abdominal computed tomography (CT) from February 2008 to May 2008 as part of a comprehensive health screening program. Age, gender, obesity indices [body mass index (BMI), waist-to-hip circumference ratio (WHR), waist circumference (WC), visceral adipose tissue (VAT) volume and subcutaneous adipose tissue (SAT) volume on abdominal CT], history of prior abdominal surgery, constipation, experience of the colonoscopist, quality of bowel preparation, diverticulosis and time required to reach the cecum were analyzed. CIT was categorized as longer than 10 min (prolonged CIT) and shorter than or equal to 10 min, and then the factors that required a CIT longer than 10 min were examined.

A total of 1678 participants were enrolled. The mean age was 50.42 ± 9.931 years and 60.3% were men. The mean BMI, WHR, WC, VAT volume and SAT volume were 23.92 ± 2.964 kg/m², 0.90 ± 0.076, 86.95 ± 8.030 cm, 905.29 ± 475.220 cm³ and 1707.72 ± 576.550 cm³, respectively. The number of patients who underwent abdominal surgery was 268 (16.0%). Colonoscopy was performed by an attending physician alone in 61.9% of cases and with the involvement of a fellow in 38.1% of cases. The median CIT was 7 min (range 2-56 min, IQR 5-10 min), and mean CIT was 8.58 ± 5.291 min. Being female, BMI, VAT volume and involvement of fellow were significantly associated with a prolonged CIT in univariable analysis. In multivariable analysis, being female (OR = 1.29, P = 0.047), lower BMI (< 23 kg/m²) (OR = 1.62, P = 0.004) or higher BMI (≥ 25 kg/m²) (OR = 1.80, P < 0.001), low VAT volume (< 500 cm³) (OR = 1.50, P = 0.013) and fellow involvement (OR = 1.73, P < 0.001) were significant predictors of prolonged CIT. In subgroup analyses for gender, lower BMI or higher BMI and fellow involvement were predictors for prolonged CIT in both genders. However, low VAT volume was associated with prolonged CIT in only women (OR = 1.54, P = 0.034).

Being female, having a lower or higher BMI than the normal range, a low VAT volume, and fellow involvement were predictors of a longer CIT.

• Visceral obesity
• Difficult colonoscopy
• Cecal insertion time
• Body mass index
• Female

• Adult
• Colonoscopy/statistics & numerical data
• Female
• Humans
• Intra-Abdominal Fat
• Male
• Middle Aged
• Obesity
• Retrospective Studies
• Time Factors

• Colorectal cancer
• Morbidity
• Review
• Screening

• ADENOMA
• COLORECTAL CANCER SCREENING
• COLORECTAL CARCINOMA