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Combined Endoscopic-Laparoscopic Surgery (CELS) for Colorectal Polypectomy
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Miguel E Gomez, Parul J Shukla
Combined endoscopic-laparoscopic surgery (CELS) is a type of procedure that uses laparoscopy and colonoscopy techniques in conjunction. In the context of polypectomy, it is used to remove complex polyps that cannot be removed through colonoscopic methods [1]. Complex polyps can be large, broad-based, lodged within intestinal folds, and/or situated in areas with increased risk of bowel perforation [2]. In these cases, endoscopic removal is difficult, as ensnaring the polyp becomes tricky. CELS facilitates the removal of these polyps through gentle prodding of the external wall of the colon using laparoscopic tools, allowing the polyp to stick out and providing more surface area for the endoscope to snare [3]. CELS has been lauded as a safe and effective way of approaching polypectomy for these complex polyps. In general, this procedure is considered minimally invasive, and is seen as a promising alternative to bowel resection surgeries.
General Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rebecca Fish, Aisling Hogan, Aoife Lowery, Frank McDermott, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Yew-Wei Tan, Thomas Tsang
Colonoscopy is a safe procedure but the most common risks are bleeding and perforation. These risks are higher in patients undergoing a polypectomy. The risk of bleeding post- polypectomy is roughly 1%–6% and perforation in <1:1000. I would also consent patients for the risks of sedation if used.
Lynch Syndrome
Published in Dongyou Liu, Handbook of Tumor Syndromes, 2020
Andreas V. Hadjinicolaou, Mashiko Setshedi
Patients with LS who are part of a screening program have a better outcome than those not screened. In a study following up patients with LS for 15 years, the risk of developing CRC was 62% less for those undergoing screening compared to those who were not screened. This was broadly ascribed to the removal of polyps by polypectomy during screening colonoscopy. Furthermore, there were no cancer-related deaths in the screened cohort [21,95]. The best evidence that colonoscopic screening is beneficial for preventing colon cancer in patients with LS has come from observational studies of 22 LS families that were followed for 15 years [8,9]. During the study period, 133 family members were voluntarily screened every 3 years, whereas 119 declined colonoscopic surveillance. A significant reduction in the incidence of CRC was observed in those screened compared those who were not, an effect attributed to the impact of polypectomies performed in the intervention group. In addition to this, the same study reported no CRC-related deaths occurring in the group that underwent regular colonoscopic screening compared with a 36% CRC-related mortality rate in the unscreened group [96].
Definition of severity and treatment response in chronic rhinosinusitis with nasal polyps: a Delphi study among French experts
Published in Expert Review of Clinical Immunology, 2023
Florent Carsuzaa, Léa Fath, Maxime Fieux, Sophie Bartier, Guillaume de Bonnecaze, Cécile Rumeau, Justin Michel, Jean-François Papon, Mihaela Alexandru, Valentin Favier
Regarding the treatment response, olfactory disorders, nasal blockage, QOL impairment (using SNOT-22 score), the response to background therapy, resistance and/or dependence to oral corticosteroids, the cumulative annual dose of systemic corticosteroids, the response to surgery and to biologics must be considered to define the treatment response (strong agreement). Persistence or recurrence of symptoms after a simple polypectomy should not be considered as a failure of the surgical strategy (strong agreement). No improvement or less than 2 years of improvement in main symptoms and QoL following surgical treatment represents a poor treatment response (strong agreement). All appropriate proposals for treatment response are summarized in Table 4. A proposal of management strategy according to the panelists is provided in Figure 3.
Long-term bowel dysfunction after right-sided hemicolectomy for cancer
Published in Acta Oncologica, 2020
Helene Mathilde Larsen, Hossam Elfeki, Katrine Jøssing Emmertsen, Søren Laurberg
All Danish colon cancer patients diagnosed between May 2001 and December 2014 and treated with right-sided hemicolectomy, extended right-sided hemicolectomy, ileocecal resection, or polypectomy were invited. In the following, the term ‘right-sided hemicolectomy’ (RHC) includes all the right-sided resections. Resections were performed either with the laparoscopic, robot-assisted, or open approach. Polypectomies were performed with colonoscopy either by simple polypectomy, endoscopic mucosa resection or endoscopic submucosal dissection. Exclusion criteria were metastasis, recurrent disease, permanent stoma, radiation therapy and dementia. The DCCG data were compared to the Danish Civil Registration System to exclude patients who were dead or emigrated, and patients with research protection. The study was approved by the Danish Data Protection Agency and the Danish Health Authority.
Efficacy and safety of Tramadol as an analgesic in women undergoing vaginoscopic hysteroscopy: a randomized placebo-controlled trial
Published in Journal of Obstetrics and Gynaecology, 2020
Shree Bharathi, Dilip Kumar Maurya, Anish Keepanasseril, N. S. Kubera
Strengths of the study include its design where the investigator, the patient, and the statistician were unaware of the allocation till the analysis of the study and the use of placebo group which helped to assess the need of an analgesic. Performance of the procedure by a single operator helped to eliminate the inter-operator variations in performing the procedure which might contribute to pain and discomfort. Cervical preparation for softening/priming, which may confound the effect of analgesia, was not used in both the groups. Oral Tramadol was shown to be an effective analgesic in the study, where the majority of women were multiparous in whom cervical negotiation might have been easier compared to nulliparous women, resulting in lesser discomfort and pain. However, the distribution of women according to parity and the indication were similar in both the groups. Restricting to women undergoing diagnostic/minor procedures might have led to an underestimation of the results. It is difficult to comment on the confounding effects of minor procedures such as polypectomy, which may have increased the pain and the total procedural time, as it was equally distributed in both the groups.