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Morphometric study of the blood supply of pedunculated colon polyps: What is the optimal position on the stalk for snare resection?

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      Abstract

      Background and study aims: Bleeding after colonoscopic resection of pedunculated polyps cannot be easily predicted. The aims of this study were to evaluate the blood supply in pedunculated polyps and to clarify the optimal position on the polyp stalk for snare placement to prevent post-polypectomy hemorrhage. ]Patients and methods: In one institution, 11 pedunculated polyps from 11 patients were studied prospectively. All polyps were resected at the base of the stalk using a snare wire with electrocautery. Histologic axial sections from the apex and base of the stalk were examined with hematoxylin eosin and elastica stains. Elastica stains were used to identify blood vessels. The cross-sectional area of the stalk, total vessel area, maximum diameter of artery/arteriole lumen, number of thick (≥ 0.1 mm) vessels, and number of arteries/arterioles were measured in each section with image processing software. Wilcoxon signed-ranks test was used for comparison.

      Results: The median polyp diameter was 16 mm (range 7 to 24 mm) and median length of the stalk was 11 mm (range 7 to 23 mm). Two invasive cancers (T1) were included. The maximum diameter of the arterial/arteriolar lumen was greater at the base ( P = 0.0044), whereas the ratio of the vessel area to the cross-section area was greater at the apex ( P = 0.016). The number of thick vessels and arteries/arterioles were equivalent between apex and base.

      Conclusions: Morphometric study of the blood supply of pedunculated polyps confirmed that the optimal site for the excision of pedunculated polyps is in the middle of the stalk.

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      Most cited references 13

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      NIH Image to ImageJ: 25 years of image analysis.

      For the past 25 years NIH Image and ImageJ software have been pioneers as open tools for the analysis of scientific images. We discuss the origins, challenges and solutions of these two programs, and how their history can serve to advise and inform other software projects.
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        Risk of colonoscopic polypectomy bleeding with anticoagulants and antiplatelet agents: analysis of 1657 cases.

        Anticoagulants and antiplatelet agents commonly are used to treat patients with cardiovascular and cerebrovascular diseases. Data on the safety of the use of these drugs before colonoscopic polypectomy are scanty. An audit was conducted for a 2-year period of consecutive patients undergoing colonoscopy and polypectomy. Patient demographics, site and size of polyps, and the use of anticoagulants and antiplatelet agents were documented from a hospital on-line database. Bleeding episodes were classified as immediate or delayed and were graded as mild, moderate, or severe. Risk factors associated with postendoscopy bleeding were analyzed by multivariate logistic regression analysis. A total of 5593 cases were reviewed. Polypectomy was performed in 1657 patients. There were 37 cases of polypectomy-associated bleeding (2.2%); bleeding was immediate in 32 and delayed in 5. Multivariate analysis showed that warfarin use, after adjustment for the effects of each of the other factors, was an independent risk factor for bleeding, with an odds ratio 13.37: 95% CI[4.10, 43.65]. Age; the location and size of polyp; and the use of aspirin, non-steroidal anti-inflammatory drugs, and other antiplatelet agents were not associated with a higher risk of polypectomy-associated bleeding. The use of antiplatelet agents during polypectomy was not associated with an increase in post-polypectomy bleeding. In contrast, treatment with warfarin should be discontinued, because this was associated with a significant increase in post-polypectomy bleeding.
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          Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies.

          The diagnostic and therapeutic benefits of colonoscopy are well known but most large-scale surveys, especially those involving multiple centres, may underestimate the range and incidence of complications. The detailed records of 5000 colonoscopies in a specialist unit have been analysed and conclusions drawn which may help to make the procedure safer. The incidence of haemorrhage was 1% and bowel perforation 0.1%. All the major haemorrhages occurred during polypectomies over 2 cm in size. Secondary haemorrhage was an unpredictable occurrence, one to 14 days later. Three deaths followed colonoscopy: one cardiorespiratory death was related to oversedation; a second was due to mismanaged ischaemic colitis developing two days after traumatic instrumentation, and the third was due to peritonitis. Minor complications included thrombophlebitis, abdominal distension, and vasovagal episodes. Because of experience during the first half of the series and also due to improvements in instrumentation, the complication rate of the later part of the series was halved. Recommendations include the avoidance of oversedation, review of previous barium enema films so as to be aware of large polyps which are more likely to bleed, and the recognition of situations where perforation or septicaemia is likely to occur.
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            Author and article information

            Affiliations
            [1 ]Department of Coloproctology, Aizu Medical Center Fukushima Medical University, Japan
            [2 ]Department of Pathology, Aizu Medical Center, Fukushima Medical University, Japan
            [3 ]University of Queensland School of Medicine, Brisbane, Australia
            [4 ]Department of Gastroenterology, Queen Elizabeth II Jubilee Hospital, Brisbane, Australia
            Author notes
            Corresponding author Kazutomo Togashi, MD, PhD 21-2 Maeda, TanisawaKawahigashi, Aizuwakamatsu CityFukushima, 969-3492Japan+81-242-75-2100+81-242-75-2568 togashik@ 123456fmu.ac.jp
            Journal
            Endosc Int Open
            Endosc Int Open
            10.1055/s-0034-1377934
            Endoscopy International Open
            © Georg Thieme Verlag KG (Stuttgart · New York )
            2364-3722
            2196-9736
            December 2015
            06 October 2015
            : 3
            : 6
            : E655-E658
            4683148 10.1055/s-0034-1393082
            © Thieme Medical Publishers
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