Endoscopic Removal Of Large Polyps Research Articles

A rare cause of upper gastrointestinal bleeding; giant lesion in esophagus!

Fibrovascular polyps are one of the benign esophageal tumors and rare gastrointestinal bleeding reasons. They are mostly located in the proximal esophagus. Swallowing and breathing problems, mass feelings, discomfort when swallowing, nausea, weight loss, and a persistent cough are the most common symptoms. Endoscopic resection or esophagectomy are the two main options for treatment. A 60-year-old male patient was admitted for epigastric pain and melena. Endoscopy showed a 15-centimeter-long pedunculated polyp originating from the proximal esophagus and extending to the cardia, narrowing the lumen. The lesion was excised with multiple incisions using surgical ligature and an endoscopic knife after endoscopic ultrasonography and computed tomography examinations. The lesion was too big to be endoscopically removed from the esophageal lumen. Therefore, nearly a 3-4 cm incision was made on the abdomen skin. Under the guidance of the endoscope, the polyp was removed from the incision region using a clamp. Following hemostasis, the stomach was reconstructed and the procedure ended. No problems occurred. The patient is protected from major surgical and operational risks with endoscopic removal of large polyps. Patients who are candidates for endoscopic resection should consider it.

PTU-039 Should Mr Enterography Be The Preferred Surveillance Modality Compared To Small Bowel Capsule Endoscopy In Peutz-jegher’s Syndrome?

IntroductionPeutz-Jeghers syndrome (PJS) causes multiple hamartomatous polyp formation throughout the gastrointestinal tract. Large polyps within the small bowel (SB) may cause complications and morbidity including obstruction, bleeding, an increased risk...

A Cost-efficacy Decision Analysis of Prophylactic Clip Placement After Endoscopic Removal of Large Polyps

Delayed bleeding after lower endoscopy and polypectomy can cause significant morbidity. One strategy to reduce bleeding is to place an endoscopic clip on the polypectomy site. We used decision analysis to investigate the cost-effectiveness of routine clip placement after colon polypectomy. Probabilities and plausible ranges were obtained from the literature, and a decision analysis was conducted by using TreeAge Pro 2011 Software. Our cost-effectiveness threshold was an incremental cost-effectiveness ratio of $100,000 per quality-adjusted life year. The reference case was a 50-year-old patient who had a single 1.0- to 1.5-cm polyp removed during colonoscopy. We estimated postpolypectomy bleeding rates for patients receiving no medications, those with planned resumption of antiplatelet therapy (nonaspirin), or those receiving anticoagulation therapy after polypectomy. We performed several sensitivity analyses, varying the cost of a clip and hospitalization, number of clips placed, clip effectiveness in reducing postpolypectomy bleeding, reduction in patient utility days related to gastrointestinal bleeding, and probability of harm from clip placement. On the basis of the reference case, when patients did not receive anticoagulation therapy, clip placement was not cost-effective. However, for patients who did receive anticoagulation and antiplatelet therapies, prophylactic clip placement was a cost-effective strategy. The cost-effectiveness of a prophylactic clip strategy was sensitive to the costs of clips and hospitalization, number of clips placed, and clip effectiveness. Placement of a prophylactic endoscopic clip after polypectomy appears to be a cost-effective strategy for patients who receive antiplatelet or anticoagulation therapy. This approach should be studied in a controlled trial.