Recurrence Rate Of Polyps Research Articles

The Recurrence Rate of Colorectal Polyps among Patients with Average Risk of Colorectal Cancer.

CRC is going to be an important issue in Middle East countries. Also, the main parts of this cancer develop from benign adenomas. To understand the recurrence rate of colorectal polyps among average-risk subjects. In a prospective study, the average-risk patients with colorectal adenoma were enrolled in this study based on inclusion criteria. The patients were consulted annually by an expert gastroenterologist. A control colonoscopy was programmed after three years of follow-up. It was not an obligation to follow our program, and each patient could exit the study at any time. The patient who developed one of the exclusion criteria was also withdrawn from the study by the gastroenterologist of this study. 237 patients were enrolled in this study. Of them, 102 patients completed their 3-year follow-up. Among these participants, 62 (60.8%) were male and 40 (39.2%) were female, with a mean age of 57.05 ± 12.87 years. Additionally, 20 (19.6%) subjects had adenomatous polyps at the end of the study. Patients with recurrent colorectal polyps tend to be raised in large ones with a tubulovillous morphology. The polyps were more commonly located in the sigmoid colon, rectum. Furthermore, high-grade dysplasia was recorded in 5 patients. Tubulovillous polyp had higher chance of recurrence than patients with tubular polyp. We believe the colonoscopy screening needs to be set up in regions previously considered low-risk for CRC. Also, it may be valuable to control colonoscopy for less than three years in patients with dysplasia.

Combined Endo-Laparoscopic Surgery (CELS) for the management of complex colorectal lesions

Detection of colon polyps is common and is expected in 20–30 % of screening colonoscopies. As the number of colonoscopies performed increases, the detection of advanced and difficult to resect polyps will also rise. These polyps tend to be larger, greater than 2 cm, have flat morphology, and are in difficult anatomic locations behind haustral folds or at sharp flexures of the colon. Advanced endoscopic techniques such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are useful to remove these polyps. However, many polyps remain unresectable with these techniques. Combined endoscopic laparoscopic surgery (CELS) has shown to be an effective technique to facilitate safe removal of complex polyps. CELS encompasses a variety of techniques including laparoscopic assisted ESD/EMR and laparo-endoscopic full thickness excisions (FLEX). Success rate of CELS ranges from 70 to 100 %, with less than 5 % conversion to colectomy. Perioperative outcomes boast shorter hospital length of stay, with low rates of serious post-op complications when compared to colectomy. Malignancy rate after CELS in appropriately selected patients is low, ranging from 1.6 %-10 % of cases. Polyp recurrence rate after CELS is also low, usually less than 10 %. Use of CELS for early-stage cancers remains controversial but maybe adequate in appropriately selected patients. Further evaluation and long-term studies are needed to study its efficacy in cases of known cancer. The purpose of this review is to provide recommendations for use of CELS techniques, appropriate indications, describe technical tips, and review potential future applications.

The Effect of Hysteroscopy Combined with Diane-35 on Endometrial Polyps and Its Impact on the Recurrence Rate

Objective: To analyze the effect of hysteroscopy combined with Diane-35 on endometrial polyps and observe its value in reducing the recurrence rate. Methods: Between June 2022 and January 2023, 90 patients with uterine polyps who met the research criteria were included in the study. A controlled experimental design was employed, and the digital table random grouping method was utilized to divide the patients into the observation and control groups, with 45 cases in each. Patients in the control group underwent hysteroscopic polypectomy, diagnostic curettage during the operation, and routine anti-inflammatory treatment post-surgery. The observation group received Diane-35 treatment after hysteroscopy. The analysis included patient treatment effects, recurrence rate post-surgery, and endometrial thickness. Results: The effective rate among patients treated with combined Diane-35 was 95.56%, which was significantly higher than that among patients treated with hysteroscopy alone (82.22%; χ2 = 4.050, P < 0.05). Both groups were followed up for one year. The recurrence rate in the observation group was 2.22%, significantly lower than that in the control group (13.33%; χ2 = 3.873, P < 0.05). Preoperative endometrial thickness was compared between the two groups, showing no significant difference in the data (P > 0.05). However, at the 6-month and 12-month follow-up post-surgery, the endometrial thickness in the observation group was significantly lower than that in the control group (P < 0.05). After surgery, no adverse reactions such as uterine adhesion, infection, or massive bleeding occurred in either group (P > 0.05). Conclusion: Hysteroscopic surgery combined with Diane-35 yields higher efficacy in patients with endometrial polyps. This approach not only improves surgical outcomes but also reduces the recurrence rate of postoperative polyps and enhances the patient’s endometrial thickness, thus safeguarding the health of female patients.

Efficacy and Safety of Thermal Ablation after Endoscopic Mucosal Resection: A Systematic Review and Network Meta-Analysis.

(1) Background: Large colonic polyps during colonoscopy can be managed by Endoscopic mucosal resection (EMR). To decrease the polyp recurrence rate, thermal ablation methods like argon plasma coagulation (APC) and snare tip soft coagulation (STSC) have been introduced. We performed this network meta-analysis to assess the efficacy and safety of these modalities. (2) Methods: We performed a comprehensive literature review, through 5 January 2024, of databases including Embase, PubMed, SciELO, KCI, Cochrane Central, and Web of Science. Using a random effects model, we conducted a frequentist approach network meta-analysis. The risk ratio (RR) with 95% confidence interval (CI) was calculated. Safety and efficacy endpoints including rates of recurrence, bleeding, perforation, and post polypectomy syndrome were compared. (3) Results: Our search yielded a total of 13 studies with 2686 patients. Compared to placebo, both APC (RR: 0.33 CI: 0.20-0.54, p < 0.01) and STSC (RR: 0.27, CI: 0.21-0.34, p < 0.01) showed decreased recurrence rates. On ranking, STSC showed the lowest recurrence rate, followed by APC and placebo. Regarding individual adverse events, there was no statistically significant difference between either of the thermal ablation methods and placebo. (4) Conclusions: We demonstrated the efficacy and safety of thermal ablation after EMR for decreasing recurrence of adenoma.

Post-Polypectomy Care: Balancing Comfort and Nutritional Needs

The objective of polypectomy, a frequent endoscopic procedure, is to prevent colorectal cancer. Consequences of post-polypectomy care include minimizing complications, ensuring patient recovery, and preventing polyp recurrence. Besides monitoring polyp recurrence rates, this study assessed the effectiveness of post-polypectomy care protocols in managing patient comfort, adherence to dietary guidelines, and satisfaction with care. A cross-sectional analysis of 135 patients who underwent polypectomy at a tertiary care center was utilized in this study. Patient satisfaction, dietary adherence, post-operative comfort, and demographics were evaluated at one, three, and six months following the procedure. Recurrence of the polyp was monitored for one year. The research identified noteworthy enhancements in patient-reported comfort (P &lt; 0.05), dietary adherence (P &lt; 0.05), and overall satisfaction with care (P &lt; 0.05). Additionally, complications such as infection (3.7%), bleeding (7.41%), and adherence to a prescribed diet decreased equivalently. Despite this, a trend toward increased polyp recurrence was observed that was not statistically significant, with rates increasing from 4.44% after three months to 12.59% after one year. Amid a gradual decline in dietary recommendation adherence, patient satisfaction with care remained consistently elevated. The results indicated that although prompt post-polypectomy care effectively improves patient comfort and satisfaction, long-term dietary adherence presents obstacles. Despite lacking statistical significance, the rising incidence of polyp recurrence emphasizes the criticality of diligent long-term surveillance.

Recurrences of advanced sessile and lateral spreading colorectal adenoma after endoscopic mucosal resection (EMR) thermal ablation versus no adjuvant therapy (RESPECT): a protocol of an international randomized controlled trial

BackgroundNowadays, large benign lateral spreading lesions (LSLs) and sessile polyps in the colorectum are mostly resected by endoscopic mucosal resection (EMR). A major drawback of EMR is the polyp recurrence rate of up to 20%. Snare tip soft coagulation (STSC) is considered an effective technique to reduce recurrence rates. However, clinical trials on STSC have mainly been conducted in expert referral centers. In these studies, polyp recurrence was assessed optically, and additional adjunctive techniques were excluded. In the current trial, we will evaluate the efficacy and safety of STSC in daily practice, by allowing adjunctive techniques during EMR and the use of both optical and histological polyp recurrence to assess recurrences during follow-up.MethodsThe RESPECT study is a multicenter, parallel-group, international single blinded randomized controlled superiority trial performed in the Netherlands and Germany. A total of 306 patients undergoing piecemeal EMR for LSLs or sessile colorectal polyps sized 20–60 mm will be randomized during the procedure after endoscopic complete polyp resection to the intervention or control group. Post-EMR defects allocated to the intervention group will be treated with thermal ablation with STSC of the entire resection margin. Primary outcome will be polyp recurrence by optical and histological confirmation at the first surveillance colonoscopy after 6 months. Secondary outcomes include technical success and complication rates.DiscussionThe RESPECT study will evaluate if STSC is effective in reducing recurrence rates after piecemeal EMR of large colorectal lesions in daily clinical practice performed by expert and non-expert endoscopists. Moreover, endoscopists will be allowed to use adjunctive techniques to remove remaining adenomatous tissue during the procedure. Finally, adenomatous polyp recurrence during follow-up will be defined by histologic identification.Trial registrationClinicalTrials.gov NCT05121805. Registered on 16 November 2021. Start recruitment: 17 March 2022. Planned completion of recruitment: 31 April 2025.

Recurrence and Carcinogenetic Rates of Colorectal Polyps.

to determin the recurrence rate of benign recto-colonic polyps in a 5-year interval, and compare the development rate of intrapolypoid carcinomatous lesions in polypectomized versus nonpolypectomized subjects. a group of 77 patients diagnosed with recto-colonic polypoid lesions during the period 2014-2019 underwent colonoscopy at the time of study initiation and then annually during a five-year interval. Results: The recurrence rate of polyps increased annually from 5 to 12.5%; the highest rate was noted in the last two years. The five-year cumulative risk of neoplastic lesions was 73% in patients without polypectomy and 20% among those with endoscopic resection (p 0.05). Comparing the recurrence rate of benign lesions (60%) in patients without neoplastic findings with the recurrence rate of adenomas in patients with benign lesions (40%), a higher risk of recurrence was found in the first category, and seemed to be influenced by the personal history of pre-existing adenomatous lesions. an increased risk of colorectal polyps recurrence was reported during five year follow up; moreover, during the first three years an increased risk of malignant transformation was observed among cases in which endoscopic resection was not feasible when compared to those in which complete excision was feasible.

Adverse Events of Dupilumab Injection in Patients With Chronic Rhinosinusitis With Nasal Polyposis

Background and Objectives Chronic rhinosinusitis with nasal polyposis (CRSwNP) is one phenotype of the diffuse type. In spite of surgical and medical treatment, the polyp recurrence rate is high. Recently biologics are concerned as a therapeutic option of it. To figure out adverse events associated with the dupilumab injection in adult patients with CRSwNP.Subjects and Method Retrospective chart review of patients that were treated with dupilumab from January 2022 to December 2022 for CRSwNP was performed.Results Of 40 patients (23 of male and 17 of female), 8 patients (20.0%) experienced 9 patients (22.5%) adverse events. The most common adverse event was skin reaction (3 patients, 7.5%), followed by 2 of pruritis, 2 of epistaxis. Three patients quit dupilumab after the adverse events, 4 patients continued, and 1 patient hold the next injection.Conclusion Dupilumab is reported to be relatively safe medication. However, physician should notice that adverse events including skin rash can occur after dupilumab injection.

Clinical feature-based diagnosis criteria of eosinophil and non-eosinophil chronic rhinosinusitis in Taiwan.

The prevalence of eosinophilic chronic rhinosinusitis (ECRS) has increased in Taiwan with a higher recurrence rate of nasal polyps after surgery. Therefore, we aimed to formulate the pre-operative diagnostic criteria for patients with ECRS in Taiwan. This case-control study included patients diagnosed with CRS with nasal polyps (CRSwNP) who underwent functional endoscopic sinus surgery (FESS) at a tertiary hospital in Taiwan. The patients were classified into ECRS and non-eosinophilic CRS (NECRS) groups based on their histopathology. Demographic data, symptom severity scores, and computed tomography findings of the two groups were analyzed. We utilized receiver operating characteristic curve (ROC) analysis to evaluate parameters that could predict the diagnosis of ECRS. Total 408 CRSwNP patients were enrolled (ECRS group: 163; NECRS group: 245). ECRS group was strongly associated with asthma (6.1% vs. 2.0%, p = .03), higher blood eosinophil counts (4.3% vs. 2.7%, p < .01), higher serum IgE (285.3 vs. 50.2 IU/mL, p = .02), and higher 22-item Sino-Nasal Outcome Test (SNOT-22) score (40.5 vs. 36.7, p = .03). The ECRS criteria based on ROC curve included the SNOT-22 (>45, 2 points), serum eosinophil count percentage (>4%, 4 points), asthma (4 points), total serum IgE (>140 IU/mL, 4 points), Lund-Mackay score (>9.5, 4 points), and ethmoid-to-maxillary opacification ratio on CT (>1.5, 5 points). The cutoff score was 14 points (sensitivity, 70.2%; specificity, 93.3%). Clinical-feature-based criteria may predict the diagnosis of ECRS before FESS in Taiwan. Level 3.

A Comparative Analysis of the Efficacy and Safety of Hot Snare Polypectomy and Cold Snare Polypectomy for Removing Small Colorectal Polyps: A Systematic Review and Meta-Analysis.

Both cold snare polypectomy (CSP) and hot snare polypectomy (HSP) have been shown to be effective methods for removing small colorectal polyps, but the optimal method for achieving complete resection remains unclear. To address this issue, we conducted a systematic search of relevant articles using databases such as PubMed, ProQuest, and EBSCOhost. The search criteria included randomized controlled trials that compared CSP and HSP for small colorectal polyps ≤10 mm and the articles were screened based on specific inclusion and exclusion criteria. The data were analyzed using RevMan software (version 5.4; Cochrane Collaboration, London, United Kingdom), and meta-analysis was performed with outcomes measured using pooled odds ratios (OR) and 95% confidence intervals (CI). The Mantel-Haenszel random effect model was used to calculate the OR. We selected a total of 14 randomized controlled trials involving 11601 polyps for analysis. Pooled analysis showed no statistically significant difference in the incomplete resection rate between CSP and HSP (OR: 1.22; 95% CI: 0.88-1.73, p-value: 0.27; I2: 51%), en bloc resection rate (OR: 0.66; 95%CI: 0.38-1.13; p: 0.13; I2: 60%), and polyp retrieval rate (OR:0.97; 95%CI: 0.59-1.57; p: 0.89; I2: 17%). For safety endpoints, there is no statistically significant difference in intraprocedural bleeding rate between CSP and HSP per patient analysis (OR: 2.37, 95% CI: 0.74-7.54; p: 0.95; I2: 74%) and per polyp basis (OR: 1.84, 95% CI: 0.72-4.72; p: 0.20; I2: 85%). CSP had lower OR for the delayed bleeding outcome when compared with the HSP group per patient basis (OR: 0.42; 95% CI: 0.2-0.86; p: 0.02; I2: 25%), but not in the per polyp analysis (OR: 0.59; 95% CI: 0.12-3; p: 0.53; I2: 0%). Total polypectomy time was significantly shorter in the CSP group (mean difference: -0.81 minutes; 95% CI: -0.96, -0.66; p:<0.00001; I2: 0%). Thus, CSP is both an efficacious and safe method for removing small colorectal polyps. Therefore, it can be recommended as a suitable alternative to HSP for the removal of small colorectal polyps. However, more studies are necessary to evaluate any long-term differences between the two methodssuch as polyp recurrence rates.

Evaluation of the efficacy of endoscopic posterior nasal neurectomy with pharyngeal neurectomy of allergic rhinitis combined with chronic rhinosinusitis with nasal polyps

Objective:To investigate the effect of posterior nasal neurectomy（PNN） with pharyngeal neurectomy （PN） on chronic sinusitis with nasal polyps （CRSwNP）complicated with perennial allergic rhinitis （PAR）. Methods:83 patients with perennial allergic rhinitis combined with chronic group-wide sinusitis with nasal polyps who attended our hospital from July 2020 to July 2021 were selected. All patients underwent conventional functional endoscopic sinusitis surgery（FESS）+ nasal polypectomy. Patients were divided according to whether they underwent PNN+PN. 38 cases in the experimental group underwent FESS combined with PNN+PN; 44 cases in the control group underwent conventional FESS alone. All patients underwent the VAS, RQLQ, and MLK before treatment, and at 6 months and 1 year after surgery. Meanwhile, other relevant data were collected and the preoperative and postoperative follow-up data were collected and analyzed to assess the differences between the two groups. Results:The total postoperative follow-up period was 1 year. The recurrence rate of nasal polyps at 1 year postoperatively and the nasal congestion VAS score at 6 months postoperatively were not statistically significant in the two groups（P>0.05）. However, the patients in the experimental group had statistically significantly lower effusion and sneezing VAS scores, MLK endoscopy scores and RQLQ scores at 6 months and 1 year postoperatively, and nasal congestion VAS scores at 1 year postoperatively compared to the control group（P<0.05）. Conclusion:For patients with perennial AR complicated with CRSwNP, the combination of the PNN+PN in FESS can significantly improve the short-term curative effect, and PNN+PN is a safe and effective surgical treatment.

Therapeutic Strategies to Prevent the Recurrence of Nasal Polyps after Surgical Treatment: An Update and In Vitro Study on Growth Inhibition of Fibroblasts.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is the most bothersome phenotype of chronic rhinosinusitis, which is typically characterized by a Type 2 inflammatory reaction, comorbidities and high rates of nasal polyp recurrence, causing severe impact on quality of life. Nasal polyp recurrence rates, defined as the number of patients undergoing revision endoscopic sinus surgery, are 20% within a 5 year period after surgery. The cornerstone of CRSwNP management consists of anti-inflammatory treatment with local corticosteroids. We performed a literature review regarding the therapeutic strategies used to prevent nasal polyp recurrence after surgical treatment. Finally, we report an in vitro study evaluating the efficacy of lysine-acetylsalicylic acid and other non-steroidal anti-inflammatory drugs (ketoprofen and diclofenac) on the proliferation of fibroblasts, obtained from nasal polyp tissue samples. Our study demonstrates that diclofenac, even more so than lysine-acetylsalicylic acid, significantly inhibits fibroblast proliferation and could be considered a valid therapeutic strategy in preventing CRSwNP recurrence.

The Learning Curve for Advanced Endoscopy for Colorectal Lesions: A Surgeon's Experience at a High-Volume Center.

Advanced endoscopy can be utilized for complete removal of large colorectal polyps. To date, few surgeons perform advanced endoscopy, and it is unknown how many procedures are needed to reach proficiency. To determine the learning curve for colorectal advanced endoscopy. Retrospective. Tertiary referral center. We queried a prospectively maintained institutional database of advanced endoscopy performed by a high-volume colorectal surgeon between 2011 and 2018. Advanced endoscopy characteristics were compared for 6 chronological intervals. Primary endpoints were the rates of complications and polyp recurrence. Secondary endpoint was the change in polyp removal rate (mm/hour) over time. Proficiency was defined as achieving low complication and polyp recurrence rates, high en-bloc resection rate, and an efficient removal rate, equivalent to the median polyp size per hour. Total of 207 patients underwent advanced endoscopy for a single colorectal polyp. Median polyp size was 30 (4-70) mm, 61.5% were located in right colon, and 8.8% were malignant. Mean procedure time was 77 (range, 16-320) minutes. Immediate colon resection occurred in 25 patients due to suspicion of cancer or concern for perforation and were excluded from learning curve analysis. The remaining 182 advanced endoscopy procedures were divided into intervals of 30 procedures. Median removal rate was highest in the last interval and in the endoscopy suite. A removal rate of 30 mm/hour was achieved after performing 100 cases. Complication rate (bleeding or return to OR) was 12.1% and was similar across intervals. Readmission rate was 11.5%, and 6.6% of 6-month follow-up colonoscopies showed polyp recurrence at the resection site. Retrospective design, single surgeon. The learning curve for achieving proficiency with advanced endoscopy in the colon and rectum requires a minimum of 100 cases with a low complication rate, low polyp recurrence rate, high en-bloc resection rate, and a polyp removal rate of 30mm/hr.

Helicobacter pylori eradication reduces risk for recurrence of gastric hyperplastic polyp after endoscopic resection.

Little is known about the effect of Helicobacter pylori eradication on the recurrence of gastric hyperplastic polyps after endoscopic resection. Thus, we evaluated the recurrence rate of gastric hyperplastic polyps based on H. pylori eradication following endoscopic resection. We retrospectively reviewed the medical records of 201 patients with H. pylori infection who underwent endoscopic resection for gastric hyperplastic polyps at six medical centers. H. pylori status was assessed by histological analysis and a rapid urease test. A total of 149 patients underwent successful H. pylori eradication (eradication group), whereas 52 patients had persistent H. pylori infections (non-eradication group). The recurrence rate of gastric hyperplastic polyps and the risk factors according to H. pylori status were analyzed. During the mean follow-up period of 18.3 months, recurrent gastric polyps developed after endoscopic resection in 10 patients (19.2% [10/52]) in the non-eradication group and 12 patients (8.1% [12/149]) in the eradication group. The cumulative incidence of recurrent gastric hyperplastic polyps was significantly higher in the non-eradication group than in the eradication group (p = 0.041, log-rank test). In the adjusted analysis, H. pylori eradication reduced the recurrence of gastric hyperplastic polyps (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.18 to 0.99), whereas anticoagulation therapy increased the risk of recurrence of gastric hyperplastic polyps (HR, 4.91; 95% CI, 1.39 to 17.28). Successful eradication of H. pylori may reduce the recurrence of gastric hyperplastic polyps in patients after endoscopic mucosal resection.

Chronic endometritis increases the recurrence of endometrial polyps in premenopausal women after hysteroscopic polypectomy

BackgroundThe reported recurrence rate of endometrial polyps (EPs) after hysteroscopic polypectomy varied widely, and the factors influencing the recurrence of EPs are still controversial. Furthermore, the known definite independent risk factors are almost unchangeable, such as the number of EPs and previous polypectomy history. The aim of this study was to evaluate the impact of chronic endometritis (CE) on the recurrence of EPs in premenopausal women who underwent hysteroscopic polypectomy.MethodsA retrospective study was conducted at a university-affiliated hospital. Premenopausal women who underwent hysteroscopic polypectomy were enrolled, and those with definite confounding factors for polyp recurrence were excluded, including endometriosis and previous polypectomy history. A total of 233 women were enrolled in this study, including 64 (27.5%) cases with CE and 169 (72.5%) cases without CE. CE was diagnosed via immunohistochemical detection of CD138 on the endometrial specimen. Comparison of the recurrence rate of EPs was performed in women with or without CE at each monitoring stage (i.e., at 3, 6, 9 and 12 months) after hysteroscopic polypectomy.ResultsThe recurrence rates of EPs at one year in patients with and without CE were 26.6% (95% confidence interval [CI] 15.8–37.4%) and 9.5% (95% CI 5.0–14.0%), respectively, with an overall recurrence rate of 14.2% (95% CI 9.7–18.7%). The hazard ratio (HR) for EPs recurrence in the EPs with CE cohort versus the EPs without CE cohort was 3.08 (95% CI 1.56–6.09) (P = 0.001). Similarly, the recurrence rate of EPs was significantly higher in women with CE than in those without CE at each monitoring stage (i.e., 3, 6 and 9 months). CE and multiple EPs were risk factors for EPs recurrence. The HR for EPs recurrence in the EPs with CE cohort compared with the EPs without CE cohort was 3.06, after adjustment for the number of EPs.ConclusionsCE was a harmful factor for the recurrence of EPs in premenopausal women after hysteroscopic polypectomy. Thus, routine screening for CE during hysteroscopic polypectomy was needed. Frequent monitoring was needed for multiple EPs as the number of EPs also contributed to polyp recurrence.

Combined Endoscopic–Laparoscopic Surgery (CELS) in the Management of Early Colorectal Lesions

AbstractOver 14 million colonoscopies are performed annually in the United States. With the growing number of colonoscopies comes corresponding increases in the rates of colectomies performed for benign polyps. These advanced adenomas have the potential, if removed early, to promote decreased rates of colon cancer and improve patient survival. Difficult to resect polyps may be located at colonic flexures, tortuous turns in the colon, the ileocecal valve, or the appendiceal orifice presenting a unique challenge to endoscopic resection. Various advanced endoscopic techniques are now available for the resection of these polyps such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection, but these techniques have a steep learning curve and are technically challenging. For the community colorectal surgeon, relatively simpler options include combined endoscopic and laparoscopic surgery (CELS) and full-thickness laparo-endoscopic colonic excision (FLEX) for either the endoscopic or laparoscopic removal of challenging polyps. The FLEX procedure resembled a nonanatomic wedge resection of the colon with polyp, while CELS resembles a laparoscopically augmented EMR. With the technical success rate for CELS reportedly between 74 and 97%, the postoperative complication rate of less than 5%, and polyp recurrence rates bordering less than 2%, these procedures have the capacity to safely facilitate the complete removal of difficult-to-resect endoscopic polyps. The purpose of this review is to both provide recommendations for CELS and FLEX utilization for the resection of polyps and describe our operative techniques and tips and tools for increasing the efficacy of these procedures.

Predictive factors of revision endoscopic sinus surgery.

Despite endoscopic sinus surgery (ESS) being the standard best treatment for chronic rhinosinusitis with nasal polyps (CRSwNP), there still remains a high recurrence rate of nasal polyps after ESS. The aim of this study was to analyze the impact of ESS in the treatment of CRSwNP and identify possible predictors for revision surgery. We conducted a cross-sectional retrospective study of patients with CRSwNP submitted to ESS between the years 2013 and 2021. We analyzed 517 cases, of which 15.1% were submitted to revision ESS. The presence of hyposmia/anosmia, asthma, intolerance/allergy to non-steroid inflammatory drugs, non-steroidal anti-inflammatory drug exacerbated respiratory disease, and bilateral polyposis were more frequent in patients who needed revision surgery. Initial values of peripheral eosinophilia and Lund-Mackay scores were significantly higher in this sub-group of patients. Lund-Mackay score was the only independent risk factor for revision surgery. Factors like peripheral eosinophilia and Lund-Mackay score were associated with a higher probability of revision ESS. Applying these concepts to the clinical practice could help predict the evolution of patient's pathology in the post-operative period and identify in advance those cases that may need a multidisciplinary approach.

Management Strategy for Gallbladder Polypoid Lesions: Results of a 5-Year Single-Center Cohort Study

Introduction: Controversy remains about the classification, differential diagnosis, and treatment strategy for gallbladder polypoid lesions (GPLs). This study sought to explore the individualized treatment strategy for GPLs. Methods: We retrospectively studied 642 consecutive patients with GPLs from January 2015 to May 2020. Univariate and multivariable analyses were performed to explore the potential risk factors for neoplastic polyps. The outcome of laparoscopic gallbladder-preserving polypectomy (GPP) was evaluated and compared with that of laparoscopic cholecystectomy (LC). Results: Of 642 enrolled patients, 572 underwent LC, and 70 underwent GPP. Pathologically, the majority of GPLs were cholesterol polyps (68.4%), followed by adenomyomatosis (19.9%), benign adenoma (7.3%), adenocarcinoma (3.6%), and rare pathological types (0.8%). Additionally, 66.3% (379/572) of the LC cases were classified as non-neoplastic, and 33.7% (193/572) neoplastic polyps. Multivariate analysis demonstrated that single polyps (OR 1.956, 95% CI: 1.121–3.412; p = 0.018), polyps located at the gallbladder fundus (OR 4.326, 95% CI: 2.179–8.591; p < 0.001), polyps not less than 14 mm (OR 2.833, 95% CI: 1.614–4.973; p < 0.001), and polyps with a broad base (OR 4.173, 95% CI: 1.743–9.990; p = 0.001) were independent risk factors for neoplastic polyps. The 5-year prospective results after GPP showed that the 1-year and 3-year polyp recurrence rates were 13.2% and 23.4%, respectively. Conclusion: The majority of GPLs are cholesterol or other benign lesions without malignant potential. LC is the main treatment procedure for GPLs with a high neoplastic risk. GPP is potentially feasible and could be an alternative management strategy for a group of GPLs patients who meet the selection criteria.

JudgeNet: Inverse Attention and Multiscale Fusion Networks With Boundary Determination in Polyp Segmentation

Colonoscopy is one of the most effective means of detecting intestinal polyps and colon cancer. With the development of machine vision, doctors often use automation to help diagnose intestinal polyps when using colonoscopy. The high rate of missed polyps during traditional intestinal polyp detection can lead to an increased recurrence rate and cancer of polyps. Therefore, we propose a multi-scale fusion network with boundary judgment function. The network can accurately segment smaller polyps and improve the blurred boundaries of segmented images. The network achieves the purpose of deepening the boundary information by using the attention mechanism by judging the global information generated by the encoder at different levels and the prediction mask map obtained by multi-scale fusion. Experimental results show that the network can accurately identify the boundaries of diminutive polyps and improve the overall accuracy of polyp segmentation. Compared with the latest network models, we achieved first place in several metrics in the mainstream datasets(e.t., Kvasir, CVC-ClinicDB, CVC-300, and ETIS LaribPolypDB). Codes available: <uri xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">https://github.com/Wdy1997/J–Net.git</uri>

Retracted: Effect of Hysteroscopic Polypectomy Combined with Mirena Placement on Postoperative Adverse Reactions and Recurrence Rate of Endometrial Polyps: Based on a Large-Sample, Single-Center, Retrospective Cohort Study.

[This retracts the article DOI: 10.1155/2022/1232495.].