Endoscopic management of large ileocecal valve lesions over an 18-year interval.

 Ileocecal valve (ICV) lesions are challenging to remove endoscopically.  This was a retrospective cohort study, performed at an academic tertiary US hospital. Sessile polyps or flat ICV lesions ≥ 20 mm in size referred for endoscopic mucosal resection (EMR) were included.

Disagreement between high confidence endoscopic adenoma prediction and histopathological diagnosis in colonic lesions ≤ 3 mm in size.

Background: Diminutive colorectal polyps resected during colonoscopy are sometimes histologically interpreted as normal tissue. The aim of this observational study was to explore whether errors in specimen handling or processing account in part for polyps ≤ 3 mm in size being interpreted as normal tissue by pathology when they were considered high confidence adenomas by an experienced endoscopist at colonoscopy.

Methods: One endoscopist photographed 900 consecutive colorectal lesions that were ≤ 3 mm in size and considered endoscopically to be high confidence conventional adenomas.

Risk of cancer in 10 - 19 mm endoscopically detected colorectal lesions.

Background: Recent data indicate that the risk of cancer in colorectal lesions < 10 mm is lower than previously reported, possibly reflecting improved detection of flat, low-volume lesions with a low risk of cancer. Few studies have examined the prevalence of cancer in colorectal lesions 10 - 19 mm in size.

Methods: We reviewed a prospectively collected database of all colorectal lesions removed at a single endoscopy center in order to identify lesions of 10 - 19 mm in size and review their histology.

Diminutive Polyps With Advanced Histologic Features Do Not Increase Risk for Metachronous Advanced Colon Neoplasia.

Background & Aims: With advances in endoscopic imaging, it is possible to differentiate adenomatous from hyperplastic diminutive (1-5 mm) polyps during endoscopy. With the optical Resect-and-Discard strategy, these polyps are then removed and discarded without histopathology assessment. However, failure to recognize adenomas (vs hyperplastic polyps), or discarding a polyp with advanced histologic features, could result in a patient being considered at low risk for metachronous advanced neoplasia, resulting in an inappropriately long surveillance interval.

Faster colonoscope withdrawal time without impaired detection using EndoRings.

Background And Study Aims:  Mucosal exposure devices on the colonoscope tip have improved detection. We evaluated detection and procedure times in colonoscopies performed with EndoRings.

Patients And Methods:  We had 14 endoscopists in a university practice trial EndoRings.

High-definition colonoscopy versus Endocuff versus EndoRings versus full-spectrum endoscopy for adenoma detection at colonoscopy: a multicenter randomized trial.

Background And Aims: Devices used to improve polyp detection during colonoscopy have seldom been compared with each other.

Methods: We performed a 3-center prospective randomized trial comparing high-definition (HD) forward-viewing colonoscopy alone to HD with Endocuff to HD with EndoRings to the full spectrum endoscopy (FUSE) system. Patients were age ≥50 years and had routine indications and intact colons.

Calculating the adenoma detection rate in screening colonoscopies only: Is it necessary? Can it be gamed?

 Current recommendations are to calculate the adenoma detection rate (ADR) in screening colonoscopies only. The need to confine the measure to screening has not been established.  We retrospectively assessed our quality database for whether calculating ADR from screening, surveillance, and diagnostic colonoscopies (overall ADR) would alter conclusions about the performance of colonoscopists, compared to using an ADR based only on screening colonoscopies.

Neoplasia at 10-year follow-up screening colonoscopy in a private U.S. practice: comparison of yield to first-time examinations.

Background And Aims: Prior studies assessing the yield of a second screening colonoscopy performed 10 years after an initial screening colonoscopy with negative results did not include a control group of persons undergoing a first screening colonoscopy during the same time interval. Our aim was to describe the incidence of neoplasia at a second screening colonoscopy (performed at least 8 years after the first colonoscopy) in average-risk individuals and compare it with the yield of first screening examinations performed during the same time interval.

Methods: Review of a database of outpatient screening colonoscopies performed between January 2010 and December 2015 in an Atlanta private practice.

Prevalence of sessile serrated adenoma/polyp in hyperplastic-appearing diminutive rectosigmoid polyps.

Background And Aims: The American Society for Gastrointestinal Endoscopy recommends that distal colon hyperplastic lesions can be left in place without resection if adenomatous histology can be excluded with >90% negative predictive value. However, some lesions could be sessile serrated adenomas/polyps (SSA/Ps), which is also precancerous. The aim of this study was to describe the prevalence of SSA/Ps in hyperplastic-appearing diminutive rectosigmoid polyps.

The "valley sign" in small and diminutive adenomas: prevalence, interobserver agreement, and validation as an adenoma marker.

Background And Aims: Classification schemes for differentiation of conventional colorectal adenomas from serrated lesions rely on patterns of blood vessels and pits. Morphologic features have not been validated as predictors of histology. The aim of this study was to describe the prevalence of the "valley sign" and validate it as a marker of conventional adenomas.

Clip retention rates and rates of residual polyp at the base of retained clips on colorectal EMR sites.

Background And Aims: Prophylactic endoscopic clipping may be effective in preventing delayed post-polypectomy hemorrhage after EMR of large colorectal lesions. The rate of retention of hemoclips on EMR sites has not been fully described. The aim of this study was to evaluate the adherence rates of hemoclips placed after EMR of large colorectal lesions.

Risk of cancer in small and diminutive colorectal polyps.

The prevalence of cancer in small and diminutive polyps is relevant to "resect and discard" and CT colonography reporting recommendations. We evaluated a prospectively collected colonoscopy polyp database to identify polyps <10mm and those with cancer or advanced histology (high-grade dysplasia or villous elements). Of 32,790 colonoscopies, 15,558 colonoscopies detected 42,630 polyps <10mm in size.

High yield of synchronous lesions in referred patients with large lateral spreading colorectal tumors.

Background And Aims: There are few data on the prevalence of synchronous colorectal lesions in patients who have large lateral spreading tumors (LLSTs). We sought to describe the rate of synchronous lesions found in patients who underwent endoscopic resection of large sessile adenomas and serrated lesions.

Methods: This is a retrospective assessment of a prospectively created database of 728 consecutive patients with resected LLSTs who underwent complete clearing of the colon during 2 colonoscopies by a single expert endoscopist.

Yield of a second screening colonoscopy 10 years after an initial negative examination in average-risk individuals.

Background And Aims: Current guidelines recommend screening colonoscopy at 10-year intervals in average-risk individuals who had baseline screening colonoscopy (no polyps or only hyperplastic polyps ≤5 mm in the recto-sigmoid colon), but the yield of repeat screening at 10 years is unknown. Our aim was to describe the yield of second screening colonoscopy in average-risk individuals performed at least 8 years after a first screening colonoscopy had shown no polyps or only distal hyperplastic polyps ≤5 mm in size.

Methods: This was a review of a database for colonoscopies performed at Indiana University Hospital between January 1999 and November 2015.

Cold snare polypectomy effectively reduces polyp burden in familial adenomatous polyposis.

Background And Study Aims: Familial adenomatous polyposis (FAP) is generally managed by colectomy, but in some cases surgery is delayed and polyp burdens are managed endoscopically. We aimed to describe the use of cold snare polypectomy to control the polyp burden in selected patients with FAP.

Patients And Methods: This was a retrospective cohort study.