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      Rate of adverse events of gastroduodenal snare polypectomy for non-flat polyp is low: A prospective and multicenter study

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          Abstract

          AIM

          To evaluate the rate of adverse events (AEs) during consecutive gastric and duodenal polypectomies in several Spanish centers.

          METHODS

          Polypectomies of protruded gastric or duodenal polyps ≥ 5 mm using hot snare were prospectively included. Prophylactic measures of hemorrhage were allowed in predefined cases. AEs were defined and graded according to the lexicon recommended by the American Society for Gastrointestinal Endoscopy. Patients were followed for 48 h, one week and 1 mo after the procedure.

          RESULTS

          308 patients were included and a single polypectomy was performed in 205. Only 36 (11.7%) were on prior anticoagulant therapy. Mean polyp size was 15 ± 8.9 mm (5-60) and in 294 cases (95.4%) were located in the stomach. Hemorrhage prophylaxis was performed in 219 (71.1%) patients. Nine patients presented AEs (2.9%), and 6 of them were bleeding ( n = 6, 1.9%) (in 5 out of 6 AE, different types of endoscopic treatment were performed). Other 24 hemorrhagic episodes could be managed without any change in the outcome of the endoscopy and, consequently, were considered incidents. We did not find any independent risk factor of bleeding.

          CONCLUSION

          Gastroduodenal polypectomy using prophylactic measures has a rate of AEs small enough to consider this procedure a safe and effective method for polyp resection independently of the polyp size and location.

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          Most cited references 31

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          A lexicon for endoscopic adverse events: report of an ASGE workshop.

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            Complications of colonoscopy in an integrated health care delivery system.

            Information about colonoscopy complications, particularly postpolypectomy bleeding, is limited. To quantify the magnitude and severity of colonoscopy complications. Retrospective cohort. Kaiser Permanente of Northern California. 16, 318 members 40 years of age or older undergoing colonoscopy between January 1994 and July 2002. Electronic records reviewed for serious complications, including hospital admission within 30 days of colonoscopy for colonic perforation, colonic bleeding, diverticulitis, the postpolypectomy syndrome, or other serious illnesses directly related to colonoscopy. 82 serious complications occurred (5.0 per 1000 colonoscopies [95% CI, 4.0 to 6.2 per 1000 colonoscopies]). Serious complications occurred in 0.8 per 1000 colonoscopies without biopsy or polypectomy and in 7.0 per 1000 colonoscopies with biopsy or polypectomy. Perforations occurred in 0.9 per 1000 colonoscopies (CI, 0.5 to 1.5 per 1000 colonoscopies) (0.6 per 1000 without biopsy or polypectomy and 1.1 per 1000 with biopsy or polypectomy). Postbiopsy or postpolypectomy bleeding occurred in 4.8 per 1000 colonoscopies with biopsy (CI, 3.6 to 6.2 per 1000 colonoscopies). Biopsy or polypectomy was associated with an increased risk for any serious complication (rate ratio, 9.2 [CI, 2.9 to 29.0] vs. colonoscopy without biopsy). Ten deaths (1 attributable to colonoscopy) occurred within 30 days of the colonoscopy. 99.3% (16 204) of colonoscopies were nonscreening examinations. The rate of complications may be lower in a primary screening sample. The small number of observed adverse events limited power to detect risk factors for complications. Colonoscopy with biopsy or polypectomy is associated with increased risk for complications. Perforation may also occur during colonoscopies without biopsies.
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              ASGE guideline: the role of endoscopy in the surveillance of premalignant conditions of the upper GI tract.

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                Author and article information

                Contributors
                Journal
                World J Gastroenterol
                World J. Gastroenterol
                WJG
                World Journal of Gastroenterology
                Baishideng Publishing Group Inc
                1007-9327
                2219-2840
                21 December 2017
                21 December 2017
                : 23
                : 47
                : 8405-8414
                Affiliations
                Endoscopy Unit. Institut de Malalties Digestives, Hospital Clínic, IDIBAPS, CIBERehd, Universitat de Barcelona, Barcelona 08036, Spain
                Digestive Endoscopy Unit, Digestive Diseases Department, Gastrointestinal Endoscopy Research Group, IIS, La Fe Polytechnic University Hospital, Valencia 46026, Spain
                Hospital Universitari Mútua de Terrassa, CIBERehd, Terrassa 08221, Spain
                Hospital Reina Sofía, Córdoba 14004, Spain
                Hospital Del Mar, Barcelona 08003, Spain
                Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Hospitalet de Llobregat, Barcelona 08907, Spain
                Hospital Universitario de Canarias, Santa Cruz de Tenerife 38320, Spain
                Hospital Universitari Mútua de Terrassa, CIBERehd, Terrassa 08221, Spain
                Hospital Santos Reyes, Aranda de Duero, Burgos 09400, Spain
                Hospital San Jorge, Huesca 22004, Spain
                Consorci Hospitalari de Vic, Universitat de Vic, Vic 08500, Spain
                Hospital de Viladecans, Viladecans, Barcelona 08840, Spain
                Hospital Morales Meseguer, Murcia 30008, Spain.
                Hospital Moisès Broggi, Sant Joan Despí, Barcelona 08970, Spain
                Hospital Joan XXIII, Tarragona 43005, Spain
                Complejo Hospitalario de Pontevedra, Pontevedra 36164, Spain
                Endoscopy Unit. Institut de Malalties Digestives, Hospital Clínic, IDIBAPS, CIBERehd, Universitat de Barcelona, Barcelona 08036, Spain
                Endoscopy Unit. Institut de Malalties Digestives, Hospital Clínic, IDIBAPS, CIBERehd, Universitat de Barcelona, Barcelona 08036, Spain. mgfernan@ 123456clinic.ub.es
                Author notes

                Author contributions: Córdova H and Fernández-Esparrach G designed research and wrote the paper; Córdova H, Argüello L, Loras C, Naranjo Rodríguez A, Riu Pons F, Gornals JB, Nicolás-Pérez D, Andújar Murcia X, Hernández L, Santolaria S, Leal C, Pons C, Pérez-Cuadrado-Robles E, García-Bosch O, Papo Berger M, Ulla Rocha JL and Fernández-Esparrach G performed research; Córdova H, Sánchez-Montes C and Fernández-Esparrach G contributed new reagents or analytic tools; Córdova H, Sánchez-Montes C and Fernández-Esparrach G analyzed data.

                Correspondence to: Gloria Fernández-Esparrach, MD, PhD, Endoscopy Unit. Institut de Malalties Digestives, Hospital Clínic, Villarroel 170, Barcelona 08036, Spain. mgfernan@ 123456clinic.ub.es

                Telephone: +34-93-2275400 Fax: +34-93-2279387

                Article
                jWJG.v23.i47.pg8405
                10.3748/wjg.v23.i47.8405
                5743511
                ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.

                This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                Categories
                Observational Study

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