Colonoscopic Removal Research Articles

Colonoscopic removal of an intrauterine device with rectal perforation: A case report.

The intrauterine device is one of the effective, safe, convenient, economical, and reversible contraceptive methods. Although its contraceptive effect is definite, some female patients may experience complications such as expulsion, bleeding, and pregnancy with the device in place. Rectal perforation is one of the rare and serious complications, which can lead to complications such as abdominal infection and intestinal adhesions, severely affecting the quality of life of patients. A 34-year-old female was sent to the Department of Gastroenterology with noticeable left lower quadrant abdominal pain. She had presented with abdominal discomfort and anal tenesmus 1 year earlier. Two months ago, her abdominal pain had gradually worsened and she was presented to our hospital. Investigations, including colonoscopy and computed tomography scan, had revealed an intrauterine device migrated and perforated into the rectum. The patient underwent successful colonoscopic removal of the intrauterine device. She recovered well after the treatment. This case proves that endoscopic therapy can be considered the preferred method for removing intrauterine devices displaced into the digestive tract lumen.

S2475 Colonoscopic Removal of IUD From the Rectosigmoid Colon

S2475 Colonoscopic Removal of IUD From the Rectosigmoid Colon

A case of giant fatal fecaloma

Fecaloma is an uncommon intense variation of fecal impaction. Chronic constipation is a very common complaint in these patients. Its association has been observed in elderly women, neuropsychiatric patients, bed bound and institutionalized patients. The treatment of fecaloma can be challenging, ranging from conservative measures, colonoscopic removal to surgical intervention. We are reporting a case of giant fatal fecaloma in an elderly woman, who was on long term treatment for neuropsychiatric disorder.

Colonoscopic Removal of Foreign Body: A Case Report

Colonoscopic Removal of Foreign Body: A Case Report

Colonic perforation as a complication of ventriculoperitoneal shunt: two case reports with a literature review

This report presents two cases of colonic perforation by a ventriculoperitoneal (VP) shunt. In both cases, the displacement of the distal catheter in the colon was diagnosed by abdominal computed tomography (CT). The perforation caused a VP shunt-related cerebrospinal fluid infection, and intravenous antibiotic treatment was applied. The distal end of the shunt catheter was removed by colonoscopy and the perforated site was sealed using hemoclips. There were no intra-abdominal complications after endoscopic management. After the removal of the VP shunt, the aggravation of hydrocephalus was confirmed by brain CT. The patients later died due to complications including aggravation of hydrocephalus, ventriculitis, and pneumonia. Treatment must be individualized and depends upon the clinical presentation. Conservative management, endoscopy, and surgery have been performed. Colonoscopic removal of the shunt catheter is a good option for the treatment of colonic perforation due to VP shunt migration.

S1788 A Rare Case of an Adult Ingesting a Disk Battery With Impaction in the Lower Gastrointestinal Tract

INTRODUCTION: Disk battery ingestion is commonly seen in the pediatric population and rarely in adults. There are no guidelines on how to manage these in the lower GI tract. We present a rare case of a disk battery impacted in the lower GI tract in an adult patient. CASE DESCRIPTION/METHODS: A 96 year-old-male with a history of Alzheimer's disease presented for concerns that he had ingested a battery. Physical examination was remarkable for altered mental status. Abdominal x-ray revealed a coin like lesion in the RLQ (Figure 1). CT scan of abdomen and pelvis confirmed a radiopaque object at the ileo-cecal junction (Figure 2), believed to be a disk battery. Colorectal surgery was consulted for colonoscopic removal with possible surgical conversion but the health care proxy refused and instead opted for conservative management/non-invasive measures. Multiple trials of bowel regimens including polyethylene glycol were initiated to induce dislodgement without success as serial abdominal x-rays revealed that the battery remained impacted in the same location (Figure 3). At this point, the health-care proxy opted for discharge to a nursing home with supportive measures. DISCUSSION: Current guidelines recommend removal if the battery is lodged in the esophagus, if the battery is in the stomach and is less than 2 cm in size, conservative management is advised as it will likely pass through the GI tract. Progression should be followed with serial abdominal x-rays every 3 days and if impaction is suspected, the battery should be removed. Currently no guidelines on impacted objects in the lower GI tract exist, but we hypothesize that if the object is less than 2 cm, it will likely be evacuated. The major risk of foreign body ingestion is perforation. This occurs from penetration of the mucosa or via pressure injury from impaction. Lithium-Ion batteries have a high risk of electrical thermal injury leading to liquefaction necrosis and Nickel-Cadmium batteries can cause caustic injuries. Regardless, they both carry an increased risk of perforation, especially with impaction. In our case, the patient was given multiple bowel regimens to induce dislodgement. Although serial imaging did not show progression of the battery, to our knowledge, there are no other cases in which bowel regimens have been used for managing lower GI tract foreign objects and this creates a need for further investigation.Figure 1.: Abdominal X-Ray showing radiopaque object in RLQ (Red Arrow).Figure 2.: CT Abdomen and Pelvis showing radiopaque object at the Ileocecal Valve (Red Arrow).Figure 3.: Abdominal X-Ray showing unchanged location of radiopaque object in RLQ (Red Arrow).

A Case of Colonoscopic Removal of Foreign Body Penetrating the Sigmoid Colon

A Case of Colonoscopic Removal of Foreign Body Penetrating the Sigmoid Colon

Bowel perforation of ventriculoperitoneal shunt catheter: endoscopically treated two cases.

Many techniques were used for the treatment of hydrocephalus, and ventriculoperitoneal shunt surgery is a widely used procedure. Ventriculoperitoneal shunt surgery has been associated with several complications like obstruction of the tube, infection, cerebrospinal fluid loculation, intestinal obstruction, migration of the shunt, and perforation of the intestinal organs. Perforation of the bowel owing to protrusion of ventriculoperitoneal shunt catheter from the anus is an extremely rare complication. Mini or exploratory laparotomy and revision of peritoneal part of shunt and repair of bowel perforation, or pulling out the ventriculoperitoneal shunt catheter and using external ventricular drainage and antibiotics, or colonoscopic removal of ventriculoperitoneal shunt catheter and repair of the bowel can be performed. Retrograde contamination of cerebrospinal fluid and meningitis is a very important part of the treatment in these cases. We aimed to present two cases with bowel perforation who treated with endoscopically. We report the cases of 2 patients with transanal protrusion of VPS catheter and the management via endoscopic therapeutic options. Successful treatment of the patients was achieved by endoscopic removal of the catheter and endoscopic repair of the bowel perforation. If peritonitis, bowel obstruction, or abscess does not occur, endoscopic removal of shunt and bowel repairing with endoclips may be enough.

Transanal minimally invasive surgery short- and mid-term outcomes

Introduction: Transanal minimally invasive surgery (TAMIS) is a very efficient and safe technique for the management of rectal lesions that are large or not amenable to colonoscopic removal. Both benign and malignant lesions can be excised with higher rates of specimen nonfragmentation and margin negativity. Introduced in 2010 by Atallah it has undergone tremendous growth with respect to indications and instrumentation. We present our short- and mid-term experience in this novel technique. Materials and Methods: A retrospective study from September 2016 (when the first TAMIS case was done in our institution) up to February 2020 was carried out. Case records were analyzed and their outpatient follow-up was traced. Results: A total of 20 patients had undergone TAMIS from September 2016 to February 2020. The most common indication for undergoing TAMIS was rectal adenomas in 6 (30%) patients. This was followed by rectal carcinomas in situ or carcinoma suspected in a previously biopsied polyp in 4 (20%) patients. Hyperplastic polyps constituted 4 (20%) of the TAMIS procedures. We also had two patients with juvenile polyposis. There was no specimen fragmentation in any of the specimens. Only one patient had a positive margin and underwent low anterior resection. The final biopsy showed no residual tumor. There were no procedure-related complications. The average hospital stay was 24 h. All procures were done under general anesthesia. Our longest follow-up is 40 months. The mean follow-up was of 16.1 months. There has been no procedure-related complication. None of our patients have recurrence. Conclusion: TAMIS is a safe and effective technique for the management of benign and early rectal cancer lesions of the rectum. Our short- and mid-term outcomes are encouraging to continue using this technique for our patients.

Does Colon Polyp Surveillance Improve Patient Outcomes?

Colon polyp surveillance now accounts for 25% of all colonoscopies performed. The evidence that colonoscopy surveillance reduces colorectal cancer (CRC) incidence or mortality is weak. The biology of the baseline lesions and quality of the baseline exam are two primary factors contributing to post-colonoscopy CRC. Prior recommendations for surveillance were based largely on the likelihood that patients with adenomas would develop advanced adenomas, a surrogate for CRC. There is now evidence that baseline colonoscopy findings are strongly associated with the risk of incidence or death from CRC. This evidence provides a basis for updated evidence-based recommendations for surveillance. In addition, there is also growing evidence that the quality of the baseline exam is an important predictor of the likelihood of developing post-colonoscopy CRC.

Successful Colonoscopic Removal of Missed Copper-T

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Updates on Translational Research on Prevention of Polyps and Colorectal Cancer.

Morbidity and mortality from colorectal cancer (CRC) can be effectively reduced through early detection and prevention. To date, strategies for managing CRC risk have focused primarily on secondary prevention, through screening asymptomatic individuals for colorectal neoplasia. In the United States, implementation of screening among individuals age ≥50 has led to not only decreased CRC-related mortality but also reduced CRC incidence through colonoscopic removal of precancerous polyps. In contrast to screening's endpoint of early detection, the goal of primary prevention of CRC is to arrest and/or reverse colorectal carcinogenesis. Observational studies and randomized clinical trials continue to examine effects of specific pharmacologic agents (chemoprevention) and dietary interventions on development of advanced colorectal neoplasia. This review will present an overview of strategies for primary and secondary prevention of CRC, including endoscopic, pharmacologic, and dietary interventions.

Colonoscopic Removal of an Intrauterine Device That Had Perforated the Rectosigmoid Colon.

The intrauterine device (IUD) is a widely used contraceptive method. One of the most serious and rare complications of using an IUD is colon perforation. We report a case of colonoscopic removal of an IUD that had perforated into the rectosigmoid colon in a 42-year-old woman who presented with no symptoms. Colonoscopy showed that the IUD had penetrated into rectosigmoid colon wall and that an arm of the IUD was embedded in the colon wall. We were able to remove the IUD easily by using colonoscopy. The endoscopic approach may be considered the first choice therapy for selected patients.

Risk Factors for Postoperative Bleeding in Endoscopic Submucosal Dissection of Colorectal Tumors

Background: Colonoscopic removal of adenomatous polyps or early cancer prevents death from colorectal cancer. Endoscopic submucosal dissection (ESD), which enables endoscopists to perform en bloc resection of flat or depressed colorectal tumors >20 mm, has recently been introduced and become a standard procedure in Japan. Although postoperative bleeding (POB) is a major complication associated with ESD, risk factors for POB have not been fully identified. Methods: A total of 451 patients (509 lesions) who underwent colorectal ESD were retrospectively analyzed to identify clinical parameters associated with POB. Results: POB occurred in 14 patients, and 7 of them had received antithrombotic therapy before ESD. Uni- and multivariate analyses revealed that antithrombotic therapy and rectal tumor location were strongly associated with POB following colorectal ESD. The incidence of POB was higher in patients on heparin bridge therapy (HBT) for the replacement of antithrombotic therapy than in patients with no HBT. Four of 7 patients (57.1%) on antithrombotic therapy experienced POB from the rectal lesions. Conclusion: Antithrombotic therapy and rectal lesions result in a higher POB incidence after colorectal ESD.

Colonoscopic removal of a denture migrated in the appendix

A 76-year-old woman presented because of possible accidental ingestion of a denture. Two days before her admission, she noticed that she had lost a denture from the right lower gingiva implanted 20 years previously. On admission, she was in otherwise fair condition, and she had no contributing abdominal symptoms. A radiograph of the abdomen showed a foreign body in the right lower abdomen (A). We determined that the foreign body had already passed the ileocecal valve, and thus we decided to follow up with the use of laxatives. However, a radiograph 2 days after admission showed that the foreign body still remained in the same position, although she had regular bowel movements.

1119 Using Two Endoloops to Secure the Appendiceal Stump During Colonoscopic Removal of an Inverted Appendix: A Case Report With Video

1119 Using Two Endoloops to Secure the Appendiceal Stump During Colonoscopic Removal of an Inverted Appendix: A Case Report With Video

The role of narrow band imaging in colorectal polyp detection.

Colonoscopic detection and removal of polyps represent the most important prevention method for colorectal cancer. We aimed to investigate the diagnostic yield of narrow band imaging (NBI) colonoscopy for polyp detection compared with standard colonoscopy. In this prospective study, 505 patients that underwent total colonoscopy were randomized into two groups: 226 patients in NBI group and 279 in non-NBI group (standard colonoscopy). The primary endpoints were polyp detection rate (PDR) and adenoma detection rate (ADR) in both groups. Polyps detected with NBI technique were characterized according to the NBI International Colorectal Endoscopic (NICE) classification. The total number of polyps detected in NBI group was significantly higher compared with non-NBI group (325 polyps in 226 patients versus 189 polyps in 279 patients, respectively). PDR in NBI group was 55.3%, versus 43.3% in non-NBI group. ADR in NBI group was significantly higher compared with non-NBI group (35.3% versus 20%, respectively). The proportion of detected adenomas in the left-sided colon was significantly higher in NBI group (72.8% versus 61.06% in non-NBI group), which was related to an increased number of small adenomas detected in NBI group. Also, in NBI group, a significant number of flat adenomas were detected (28 versus 9 in non-NBI group). A total of 147 (45.2%) polyps were classified according to the NICE classification, and showed a good correlation with histological analysis. In conclusion, this study demonstrated increased PDR and ADR for NBI colonoscopy. A good correlation between the NICE classification and histological analysis was also observed.

Two Cases of Colonoscopic Retrieval of a Foreign Body in Children: A Button Battery and an Open Safety Pin

Ingestion of foreign body in children is a relatively common problem among paediatric population. The foreign bodies mostly pass spontaneously through the gastrointestinal tract. However, complications can occur according to its anatomical location, the characteristics of the foreign body, and delays in management. Although the cases of ingested button batteries or sharp objects impacted at the gastrointestinal tract can be very serious, there have been very only a few cases have reported colonoscopic removal of these dangerous foreign bodies in adults, and there have been no case reports in children. We report one case of a button battery and one case of an open safety pin, both impacted in the terminal ileum that had moved from the stomach within a few hours of ingestion and were eventually managed by colonoscopy without any complications.

Analysis of Predictive Factors for Complications and Complete Histological Eradication of Cold Snare Polypectomy in Colonoscopy

Introduction: Colorectal cancer (CRC) is a major cause of morbidity and mortality in Western countries and also in Japan. Colonoscopy is associated with a reduced incidence of CRC, and colonoscopic removal of adenomatous polyps results in the prevention of death from CRC. Endoscopic polypectomy carries a definite risk for complications, such as bleeding or perforation. Recently, the high safety and efficacy of cold snare polypectomy (CSP) has been reported, however, the evaluation of factors associated with safety and efficacy of CSP is deficit. The aim of this study is to elucidate the predictive factors of complications and complete histological eradication of polyp. Methods: We retrospectively reviewed the colonoscopic database of patients who underwent CSP between December 2013 to November 2014 in terms of patient's characteristics, location, size, macroscopic appearance of each colorectal polyp, narrow band imaging with magnification (NBI-M), and endoscopist's experience. CSP were performed by 21 endoscopists consisted of 8 experts and 13 trainee. CSP were indicated for polyps presenting at colonoscopy with at least < 10-mm polyp. Univariate and multivariate analysis were performed to reveal the predictive factors associated with complications and complete histological eradication. Results: A total of 399 polyps in 216 patients without antithrombotics were removed. Of these, 355 polyps (89%) were ≤ 5 mm and 175 polyps (44%) were protruding lesions. Failure of tissue retrieval was noted in 3% of resected polyps. There was no intramucosal carcinoma. Colonoscopy with NBI-M was performed for 75 polyps (19%). Although immediate bleeding or hematochezia after procedure occurred in 30 polyps (7.5%) of 21 patients (9.7%), no delayed bleeding or perforation was observed. At multivariate analysis, protruded lesion was an independent risk factor associated with post-polypectomy bleeding (odds ratio [OR] 2.5; 95%CI 1.12-5.56). The overall rate of complete histological polyp eradication was obtained in 139 polyps (35%). Multivariate analysis elucidated that the observation of the polyp with NBI-M was an independent predictor associated with complete histological eradication (OR 2.27; 95%CI 1.36-3.78). Conclusion: CSP is a safe and effective technique for small and diminutive polyps. Macroscopic protruding appearance of polyp is a risk factor for post-polypectomy bleeding. A higher rate of complete histological eradication with CSP can be achieved by colonoscopy with NBI-M than with white-light imaging.

Colonoscopic removal of a large safety pin opened inside the gut and hooked to the ileocolic valve: a unique case

Colonoscopic removal of a large safety pin opened inside the gut and hooked to the ileocolic valve: a unique case