Snare Tip Soft Coagulation vs Argon Plasma Coagulation vs No Margin Treatment After Large Nonpedunculated Colorectal Polyp Resection: a Randomized Trial.

Background & Aims: Thermal treatment of the defect margin after endoscopic mucosal resection (EMR) of large nonpedunculated colorectal lesions reduces the recurrence rate. Both snare tip soft coagulation (STSC) and argon plasma coagulation (APC) have been used for thermal margin treatment, but there are few data directly comparing STSC with APC for this indication.

Methods: We performed a randomized 3-arm trial in 9 US centers comparing STSC with APC with no margin treatment (control) of defects after EMR of colorectal nonpedunculated lesions ≥15 mm.

One-device colonoscopy: feasibility, cost savings, and plastic waste reduction by procedure indication, when performed by a high detecting colonoscopist.

Background: Cold forceps and snares are each effective for removing polyps of 1-3 mm, while snares are more effective for polyps of 4-10 mm in size. If, in the same patient, polyps of 1-3 mm are removed with forceps and those of 4-10 mm with snares, two devices are used. If cold snares are used to resect all lesions of 1-10 mm (one-device colonoscopy), there is a potential for lower costs and less plastic waste.

Frequency of serrated polyposis syndrome recognition by community endoscopists.

Some data indicate serrated polyposis syndrome (SPS) is underdiagnosed. We determined the frequency of SPS diagnosis by community endoscopists prior to referral to a tertiary center. We performed a retrospective analysis of a prospectively collected database of SPS patients at a tertiary academic hospital.

Characterization of endoscopic features and histology of a distinct mucosal transition zone on the ileocecal valve (with video).

Background And Aims: We have endoscopically encountered a zone of transitional mucosa between the colonic and ileal mucosa located in a 3- to 10-mm-wide ring around the ileocecal valve (ICV) orifice. We aimed to describe the features of the ICV transitional zone mucosa.

Methods: We used videos and photographs from normal ICVs and biopsy samples from normal colonic mucosa, transitional zone mucosa, and normal ileal mucosa to characterize the endoscopic and histologic features of the ICV transitional zone mucosa.

Impact of changing diagnostic criteria on the diagnosis of serrated polyposis syndrome.

The World Health Organization criteria for serrated polyposis syndrome (SPS) were established in 2010 and modified in 2019. Neither set of criteria have been validated against genetic markers or proven to be the optimal criteria for defining colorectal cancer risk in patients with serrated colorectal lesions. In this study, we sought to gain insight into how frequently the change in SPS criteria in 2019 impacted the diagnosis of SPS.

Frequency and nature of endoscopic and pathologic errors leading to referral for endoscopic resection to a tertiary center.

We anecdotally encounter cases where referring endoscopists made errors in endoscopic interpretation of a colorectal lesion, sometimes combined with pathology errors at the referring centers, resulting in referral to our center for endoscopic resection. In this paper, we describe the frequency and nature of endoscopic and pathology errors leading to consultation for endoscopic resection. Review of 760 consecutive referrals to our center over a 26-month interval.

Prevalence of synchronous neoplasia in patients with large pedunculated colorectal polyps.

Background: Large (≥ 20 mm) nonpedunculated colorectal lesions have high rates of synchronous neoplasia and advanced neoplasia. Synchronous neoplasia prevalence in patients with large pedunculated lesions is uncertain. We describe synchronous neoplasia in patients with large pedunculated colorectal polyps, using a cohort of patients with large nonpedunculated lesions as controls.

Impact of margin thermal treatment after EMR of giant (≥40 mm) colorectal lateral spreading lesions.

Background And Aims: Increasing lesion size is a risk factor for recurrence after piecemeal EMR (pEMR). Snare-tip soft coagulation (STSC) treatment of the normal-appearing margin after pEMR of lesions ≥ 20 mm has been shown to reduce recurrence rates by 75% to 80%. We sought to evaluate the impact of STSC on giant (≥ 40 mm) lateral spreading lesions treated by pEMR.

Most large colorectal polyps missed by gastroenterology fellows at colonoscopy are sessile serrated lesions.

Data on adenoma and sessile serrated lesion (SSL) miss rates for gastroenterology fellows during colonoscopy are limited. We aimed to describe the miss rate of fellows based on a second examination by a colonoscopist with a high rate of detection. Second- and third-year gastroenterology fellows at a single, tertiary center performed initial examinations.

Assessment of submucosal distortion and mass effect seen at follow-up after colorectal EMR with ORISE (with video).

Background And Aims: ORISE (Boston Scientific, Marlborough, Mass, USA) is a viscous gel used for submucosal injection. We noted anecdotally that ORISE is associated with submucosal distortion of EMR scars at follow-up.

Methods: We blindly reviewed photographs of 30 consecutive EMR scars at follow-up after resections using ORISE and 30 resections using other agents.

2021 Patient Perceptions Regarding Colonoscopy Experience.

Goal: We sought to document patient perceptions in 2021 regarding colonoscopy experience and potential deterrents to repeat colonoscopy.

Background And Aim: Bowel preparation has been previously considered by patients to be the worst part of a colonoscopy.

Materials And Methods: We conducted a prospective survey of consecutive patients age 18 years and older who had just completed colonoscopy at 2 outpatient endoscopy centers at a tertiary academic hospital.

Cold versus hot snare resection with or without submucosal injection of 6- to 15-mm colorectal polyps: a randomized controlled trial.

Background And Aims: Cold snare resection of colorectal lesions has been found to be safe and effective for an expanding set of colorectal lesions. In this study, we sought to understand the efficacy of simple cold snare resection and cold EMR versus hot snare resection and hot EMR for colorectal lesions 6 to 15 mm in size.

Methods: At 3 U.

Implications of stable or increasing adenoma detection rate on the need for continuous measurement.

Background And Aims: Measurement of the adenoma detection rate (ADR) is resource intensive, and the benefit of continuous measurement for colonoscopists with high ADR is unclear. We examined the ADR trends at our center to determine whether continuous measurement for consistently high ADR is warranted.

Methods: Among colonoscopies performed between January 1999 and November 2019 at a tertiary center, we analyzed data from colonoscopists performing at least 50 screening colonoscopies annually for 5 consecutive years.

Impact of Expanding Screening Colonoscopy Interval on Providers Choice of Prescribing Colonoscopy for Colorectal Cancer Screening.

Goals: We investigated if increasing the colonoscopy screening interval from 10 to 15 years would increase provider preferences for colonoscopy as a screening test. We further examined whether having colonoscopy performed at a 15-year interval by an endoscopist with a high adenoma detection rate would influence preferences.

Background: Colonoscopy is recommended every 10 years in average risk individuals without polyps for colorectal cancer (CRC) screening.

Yield of a second right colon examination during colonoscopy after a first examination using a mucosal exposure device.

Background And Aims: Double right colon examination during colonoscopy has been advocated to reduce the risk of interval cancer in the right colon. Whether 2 examinations are necessary when the first examination is performed with a mucosal exposure device is uncertain. We documented the rates of missed adenomas, sessile serrated lesions, and hyperplastic polyps after an initial right colon examination by a high-level detector using a mucosal exposure device.

Room temperature water infusion during colonoscopy insertion induces rectosigmoid colon mucus production.

Background: Water filling during colonoscopy improves several colonoscopy outcomes. We evaluated an anecdotal observation that room temperature water filling during colonoscope insertion results in mucus production in the left colon, which may impair mucosal visualization during withdrawal.

Methods: We performed 55 colonoscopies with either water or saline filling during insertion, and video recorded the examinations.

Impact of water filling on terminal ileum intubation with a distal-tip mucosal exposure device.

Background And Aims: Endocuff improves detection at colonoscopy but seems to impede terminal ileal (TI) intubation. We assessed the impact of Endocuff Vision (EV) on TI intubation using adult or pediatric colonoscopes and evaluated whether filling the cecum with gas versus water affected the impact of EV on TI intubation.

Methods: Using a prospectively recorded quality control database, we explored the impact of EV on TI intubation in ≤1 minute.