Removal Of Polyps Research Articles

Healthy Food Choices, Physical Activity, and Screening Reduce the Risk of Colorectal Cancer.

Cancer is the second leading cause of death in the United States with an estimated 1,806,590 new cases and 606,520 deaths in 2020. Cancer is a public health concern due to the numbers of cases, financial costs, and morbidity and mortality rates. An estimated 42% of all diagnosed cancers and 45% of cancer deaths in the United States in 2014 could be attributed to modifiable risk factors. Colorectal cancer screening is effective because small polyps take years to grow and turn to cancers allowing for early detection and removal of precancerous polyps. Primary prevention of colorectal cancer by risk factor reduction is also effective as these factors cause over half of colorectal cancer cases and deaths. Physical activity, weight control, healthy dietary choices, and abstinence from alcohol and tobacco are protective. The gastroenterology nurse can assess physical activity and food choices as vital signs and recommend a gradual addition of physical activity and a more plant-based diet with reduced processed food. All nurses need to advocate for policy improvements per our pledge to the Code of Ethics for Nurses. Policy changes improve the health of large numbers of people and make healthy behaviors a normalized way of life.

Endoscopic band ligation for the removal of colonic polyp invading the diverticulum.

Endoscopic mucosal resection (EMR) is one of the primary treatment approaches for colonic polyps [1] [2]. However, polyps invading the colonic diverticulum are difficult to identify on whole endoscopic images, making EMR or endoscopic submucosal dissection (ESD) difficult. Moreover, perforation may occur during EMR or ESD for this type of polyp. Endoscopic full-thickness resection can be an alternative approach, albeit costly. Endoscopic band ligation (EBL) is a simple and effective modality to prevent colonic diverticular hemorrhage [3] [4] [5]. Here, we present the utility of EBL for the removal of colonic polyps invading the diverticulum.

The American College of Gastroenterology's 2021 Colorectal Cancer Screening Guidelines: A Summary for Gastroenterology Nurses & Associates.

Colorectal cancer ranks third for both men and women as the most common cause of cancer death in the United States. Screening allows for removal of polyps before they turn to cancer or by identifying early-stage colorectal cancers, which are most treatable. The American College of Gastroenterology recently released an update of their 2009 recommendations, which includes average risk individuals between ages 45 and 49 years due to the increased incidence of early-onset colorectal cancers. They consider screening two types of screening options: (1) one-step colonoscopy, which is both diagnostic and therapeutic and (2) two-step options, all of which require a follow-up colonoscopy when the first step is positive. They added the recommendation of daily aspirin for some people aged 50 to 69 years. However, the recommendations for screening remain the same when people do take aspirin. They recommend endoscopists measure cecal intubation rates, adenoma detection rates, and withdrawal times to reduce postcolonoscopy cancers due to missed lesions. They also propose strategies to promote screening adherence and suggest health systems adopt them. These are important updates of which the gastroenterology nurse should be aware and assist with their implementation.

Polyps seen but not removed during index colonoscopy: an underestimated inefficiency in endoscopy practice

In the United Kingdom endoscopists are certified for independent practice once competent in the removal of polyps up to 20mm in size. Where polyps are detected but not removed during the index colonoscopy, a repeat procedure is required. The aim of this study was to identify the proportion of polyps<20mm that were not removed at the time of diagnosis. Polyps identified at colonoscopy during a 12-month period in a single institution were included in this study. All polyps were categorized according to the reported size and complexity per the size, morphology, site, access (SMSA) classification. In cases where polyps≤20mm were not removed, patient records and endoscopy reports were interrogated to ascertain the reasons for this. Across 1444 patients, 2442 polyps<20mm in size were diagnosed. Removal at the time of the index procedure occurred in 1158 patients (80.2%). Nonremoval for a predefined acceptable reason, such as concomitant anticoagulation therapy, accounted for 174 cases (12.0%). Nonremoval without contraindication was noted in 112 cases (7.8%). The mean polypectomy complexity as determined by the SMSA score of these polyps was lower than level 2, denoting low complexity. The requirement for unnecessary repeat procedures equated to 9.3 days of endoscopy capacity per year. This study demonstrates that a small but significant proportion of small colorectal polyps are not removed at the time of diagnosis. This practice has implications for both patients and service provision.

A30 RECURRENCE RATES AFTER ENDOSCOPIC RESECTION OF LARGE COLORECTAL POLYPS: A SYSTEMATIC REVIEW AND META-ANALYSIS

BackgroundComplete polyp resection is the main goal of endoscopic removal of large colonic polyps. Resection techniques used for their removal have evolved in recent years and endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR) with margin ablation, cold snare polypectomy (CSP), cold snare EMR and underwater EMR have been introduced. Yet, efficacy of these techniques with regard to local recurrence rates (LRR) compared to traditional hot snare polypectomy (HSP) and standard EMR remains unclear.AimsWe aimed to analyze LRR of large colonic polyps in a systematic review and meta-analysis.MethodsMEDLINE, EMBASE, EBM Reviews, and CINAHL databases were searched to identify prospective studies reporting LRR or incomplete resection rate (IRR) after colonic polypectomy of polyps >10 mm, published between January 2011 and July 2021. Primary outcome was LRR for polyps >10 mm.Results6928 publications were identified, of which 34 prospective studies were included into the analysis. LRR for polyps >10 mm at follow-up (FU) up to 12 months was 11.0% (95% CI 7.1–14.8; 15 studies; 6259 polyps). ESD (1.7%; 95% CI 0–3.4; 3 studies, 221 polyps) and EMR with margin ablation (3.3%; 95% CI 2.2–4.5; 2 studies, 947 polyps) significantly reduced LRR compared to standard EMR without (15.2%; 95% CI 12.5–18.0%; 4 studies, 650 polyps) or with unsystematic margin ablation (16.5%; 95% CI 15.2–17.8; 6 studies, 3183 polyps).ConclusionsLocal polyp recurrence after standard EMR of large colonic polyps is high. LRR is significantly lower after ESD or EMR with routine margin ablation, so that these techniques should be considered standard for endoscopic removal of large colorectal polyps. CSP, cold snare EMR and underwater EMR should only be used within clinical trials until more high-quality data regarding LRR becomes available. Funding AgenciesNone

A108 A RETROSPECTIVE REVIEW OF COMPLEX POLYP MANAGEMENT IN THE CHAMPLAIN REGION, ONTARIO

BackgroundAdvanced endoscopic techniques have enabled the removal of polyps which, due to their size, location, or morphology, would otherwise have been removed surgically. Patients with such complex polyps should be referred promptly to expert centres for adjudication and management.AimsTo review patterns of referral and initial management of complex polyps at The Ottawa Hospital (TOH), to identify gaps in care and to identify strategies to address those gaps.MethodsWe performed a retrospective chart review of cases where large (>3cm) colonic polyps were evaluated at TOH, from March 2019-March 2021. Cases were identified using Canadian Institute of Health Information codes. Descriptive statistics were analyzed, and were compared using Mann-Whitney U tests where appropriate.Results94 consecutive patients with large polyps (mean age 68; 56.4% male) were included. The average polyp size was 4.7(4.4–5.1)cm. 45 patients were referred for a known complex polyp while the rest were referred for FIT/FOBT+ (n=20), symptoms or anemia (n=17), surveillance (n=9), or abnormal imaging (n=3). 32 patients were referred from >50km from Ottawa (travelling), and 62 were referred from <50km from Ottawa (local). Of the 45 referrals for known polyp, 20 (44.4%) included photodocumentation of the lesion; 33 (73.3%) had a prior biopsy, and 8 (17.8%) were partially removed. Key statistics are summarized in Table 1. All 8 patients referred with a partially removed polyp eventually had a successful endoscopic polypectomy. 10/94 (10.6%) patients required surgical resection: 7 for malignant pathology, and 3 for endoscopic failure. Overall, 3 patients had post-polypectomy bleeding, and 1 patient sustained a full-thickness perforation. As of October 2021, 26/78 (33.3%) patients eligible for a 4–6 month recheck and 36/48 (75%) patients eligible for a 12-month follow-up colonoscopy were overdue.ConclusionsThis retrospective review highlights significant differences in the management of complex polyps based on patient geography and the need to develop strategies to improve access for patients referred from outside of Ottawa. As expected, COVID had a significant impact on the time to complete removal of polyps, and affected the timely endoscopic follow up of these high-risk patients. Strategies to ensure timely endoscopic follow up of patients after complex polyp removal are needed.Table 1. Number of procedures and time to complete polyp removal based on patient geography, prior polyp management and COVID lockdownMean # Procedures to Complete Removalp=Mean # Removal Attemptsp=Time from Detection to Complete Removal (days)p=All Cases (n=94)2.071.1998Travelling Pts (n=32)2.48<0.011.440.0361270.022Local Pts (n=62)1.981.0794Travelling Pts Known Polyp w/ (n=22)2.64<0.011.50<0.01138NSLocal Pts w/ Known Polyp (n=23)2.351.2298Partially Removed Polyp (n=8)2.75NSKnown Polyp, Not Partially Removed (n=37)2.41Pre-COVID Lockdown (n=29)860.013During COVID Lockdown (n=58)115Funding AgenciesNone

A106 THE EPIDEMIOLOGY OF COMPLEX COLONIC POLYPS: A POPULATION BASED STUDY OF THE SOUTHWEST ONTARIO COLONOSCOPY COHORT

BackgroundComplex polyps are well recognized amongst endoscopists, but its definition varies in the literature and from one endoscopist to another. Despite its clinical importance, the epidemiology of complex polyps is poorly understood.AimsTo assess the epidemiology of complex polyps on a population level, and in FIT positive individuals.MethodsThe Southwest Ontario Colonoscopy cohort is a prospective database consisting of all adult patients undergoing colonoscopy at 21 hospitals in Southwest Ontario. Data is collected through a mandatory quality assurance form completed by the endoscopist after each procedure. All outpatient adult colonoscopies for any indication were included. Incomplete colonoscopies, repeat procedures, and poor preparation colonoscopies were excluded. A manual review of the colonoscopy report was completed in cases where the description of the complex polyps was missing. The primary outcomes were the prevalence of complex polyps in the cohort, and in FIT positive patients. Secondary outcomes include endoscopic description of the complex polyp, rates of attempted and complete resection, and identification of possible associations between patient and endoscopist factors with complex polyp detection and removal. A multivariate logistic regression model was generated to assess for factors associated with complex polyp detection.ResultsFrom February 2019 to December 2020, 43389 colonoscopies were included, of which 1459 were for FIT positive patients. 2294 patients had a complex polyp, with a prevalence of 5.3% [95% CI 0.051–0.055], while the prevalence was 17.1% [95% CI 0.152–0.191] in the FIT positive cohort. Compared to average-risk patients undergoing colonoscopy for colon cancer screening, the odds ratio (OR) of detecting a complex polyp in individuals with positive FIT was 4.12 [95% CI 3.42–4.98, p<0.0001]. Among complex polyps,1324 (57.7%) were described as large (>2cm) and 1290 (56%) described as sessile. Of 2294 patients with complex polyps,1992 (86.8%) [95% CI 0.855–0.882] underwent a removal attempt, with successful complete removal as determined by the endoscopist achieved in 1905 patients (95.6%) [95% CI 0.947–0.965]. Compared to gastroenterologists, general surgeons and internists were less likely to detect a complex polyp, OR 0.67 [95% CI 0.61–0.73, p <0.0001] and 0.36 [95% CI 0.20–0.67, p=0.0011] respectively. Trainee involvement was associated with higher rate of complex polyp detection, OR 1.20 [95% CI 1.07–1.35, p=0.0022]. Females were less likely to have a complex polyp compared to males, OR 0.71 [95% CI 0.65–0.77, p<0.0001].ConclusionsComplex polyps are more prevalent than previously reported in the literature, with a high prevalence among the FIT positive population compared to other indications of colonoscopy.Funding AgenciesNone

Complete Endoscopic Removal of a Sessile Polyp Located on the Bottom of the Appendiceal Orifice.

Complete Endoscopic Removal of a Sessile Polyp Located on the Bottom of the Appendiceal Orifice.

Are we overtreating patients with malignant colorectal polyps? A 5-year review of the ACPGBI position statement.

In 2013, The Association of Coloproctology of Great Britain and Ireland (ACPGBI) issued a position statement regarding management of malignant polyps. We reviewed the management of endoscopically resected malignant colorectal polyps in a district general hospital to evaluate whether patients were being overtreated as per these guidelines. All patients who underwent a complete, non-piecemeal endoscopic removal of a malignant polyp between October 2013 and September 2018 were studied. Polyps were risk stratified for residual disease and followed up as per the ACPGBI. Patients were divided into two groups based on management after polypectomy. Primary outcome measured was the presence of residual tumour or involved lymph nodes in the resection specimen. Secondary outcomes included complications and recurrence. Thirty-three patients were included: 21 in the non-operative group (NOG) and 12 in the operative group (OG). The ACPGBI risk score in the NOG varied between 1 and over 4 compared with the OG who all scored over 4. Two patients in the OG (16%) demonstrated residual disease. Five patients suffered a postoperative complication. No recurrences were noted in the OG and one in the NOG. Our findings against a backdrop of the available literature suggest that the risk of residual disease after malignant polypectomy may not be as high as stated by the ACPGBI. As a result, there is a risk of overtreating patients and exposing them to the significant complications of surgery if careful consideration is not exercised.

Comment on "Artificial intelligence in gastroenterology: A state-of-the-art review".

Colon capsule endoscopy (CCE) was introduced nearly two decades ago. Initially, it was limited by poor image quality and short battery time, but due to technical improvements, it has become an equal diagnostic alternative to optical colonoscopy (OC). Hastened by the coronavirus disease 2019 pandemic, CCE has been introduced in clinical practice to relieve overburdened endoscopy units and move investigations to out-patient clinics. A wider adoption of CCE would be bolstered by positive patient experience, as it offers a diagnostic investigation that is not inferior to other modalities. The shortcomings of CCE include its inability to differentiate adenomatous polyps from hyperplastic polyps. Solving this issue would improve the stratification of patients for polyp removal. Artificial intelligence (AI) has shown promising results in polyp detection and characterization to minimize incomplete CCEs and avoid needless examinations. Onboard AI appears to be a needed application to enable near-real-time decision-making in order to diminish patient waiting times and avoid superfluous subsequent OCs. With this letter, we discuss the potential and role of AI in CCE as a diagnostic tool for the large bowel.

Juvenile polyposis diagnosed with an integrated histological, immunohistochemical and molecular approach identifying new SMAD4 pathogenic variants

Juvenile polyposis (JP) is a rare familial syndrome characterized by the development of numerous hamartomatous polyps of the gastrointestinal tract and by an increased risk of developing gastrointestinal cancers. It follows a pattern of autosomal dominant inheritance and is associated with germline variants of SMAD4 or BMPR1A genes. Differential diagnosis may be difficult based on histology alone, due to morphological similarities to other familial syndromes. Here we report a case of familial JP diagnosed in a 50-years woman with a familial history positive for gastrointestinal cancers and other tumor types. The patient presented with severe iron deficiency anemia and showed numerous polyps in the stomach and jejunum according to endoscopy and imaging. She underwent an intra-gastric laparoscopic removal of the major gastric polyp, followed by jejunal exploration and resection of a segment with multiple neoformations. Histological examination revealed the presence of hamartomatous polyposis. Gastric and intestinal samples were analyzed with next-generation sequencing. Molecular analysis showed that the patient harbored a germline splicing site variant of SMAD4, c.1139 + 3A > G, which was complemented by different somatic variants of the same gene in the different polyps. Immunohistochemistry for SMAD4 confirmed loss of protein expression in the polyps, with regular expression in normal cells. cDNA sequencing further confirmed the findings. We thus definitively diagnosed the woman as having JP thanks to an integrated approach based on histology, immunohistochemistry and molecular analysis. The identified variants, all previously reported as variants of unknown significance, were classified as pathogenic as they complemented each other leading to SMAD4 loss.

P470 Real-world characteristics and complications of patients with Ulcerative Colitis receiving conventional therapy in the public healthcare system in Brazil

Abstract Background Ulcerative colitis (UC) therapy management is complex and typically begins with conventional therapy (CVT) followed by biologic drugs. For many years, CVTs were the only available option for the treatment of UC in the public healthcare system in Brazil (SUS). Biologic therapy was only available at the end of 2020. This study aimed to observe the real-world intestinal complications (IC) experienced in patients with UC receiving CVT in SUS. Methods This study was a secondary analysis of patients (&amp;gt;18 years) with UC (ICD-10 code: K51) who received at least two claims of CVT (index data defined as first CVT), between January 2011 and February 2020, in the DATASUS database. UC IC was defined as at least one claim (after index date) for either: UC-related hospitalisation, pre-defined procedure codes for rectum or intestinal surgeries, pre-defined ICD-10 codes were validated by independent clinical experts (malignant neoplasia of colon, stenosis, haemorrhage, ulcer and other rectum and anus disease, megacolon, functional diarrhea volvulus, intussusception and erythema nodosum). Patients with an anal or rectal fissure or fistula, with &amp;lt;6 months of follow-up from index date, with a CVT claim 12 months before index date or patients treated outside of the public healthcare system, were excluded. Descriptive statistics, annual incidence and incidence rate (IR; per 100 patient-years [PY]) over the available follow-up period were calculated. Results In total, 41,229 patients with UC were included (median age, 48 years; 65% women) and the median (interquartile range [IQR]) follow-up period was 3.3 (1.8 - 5.3) years. CVT utilized during follow-up was: mesalazine (87%), sulfasalazine (15%), azathioprine (16%) or methotrexate (1%); the median (IQR) CVT duration was 1.9 (0.8 – 4.0) years. The overall IR of IC was 2.5 per 100 PY during the follow-up period. Of the IC, 54% were related to ICD-10, 20% were related to a procedure and 26% to a UC-related hospitalisation (Table 1). The overall annual incidence of IC was 2.9%, 2.6% and 2.5% in the first, second and third year after index, respectively (Table 2). Over the first 3 years, the annual IR of UC-related hospitalisations ranged from 0.8% to 1.1%, for ICD-10 related events 0.9%-1.2% (anus and rectum disease, and malignant neoplasia of colon most frequently reported) and for procedure-related events 0.6%-0.7% (intestinal resection and polyp removal were the most frequent procedures). Conclusion The IR of IC was constant along the use of CVT. This study suggests the need to consider additional strategies for intestinal complications associated with the management of UC in Brazil, including but not limited to biologics.

Comparison of cold biopsy forceps vs cold snare for diminutive colorectal polyp removal: A multicenter non-inferiority randomized controlled trial

European guidelines recommends the use of cold snare polypectomy (CSP) for removal of diminutive colorectal polyps (DCP). However, for DCP < 4 mm cold biopsy forceps (CBF) may be optional. We aimed to compare the efficacy of CSP with CBF for removal of DCP in routine colonoscopy. We conducted a multicenter non-inferiority randomized controlled trial. After screening, 123 patients were prospectively included and 180 DCPs were removed by either CBF or CSP after randomization (1:1). The primary end-point was the histological complete resection rate defined by negative additional biopsies taken from the edge of the polypectomy ulcer site. Among DCPs, 121 (67.2%) adenomas or sessile serrated lesions were considered for the analysis. Polyps were 4 [1-5] mm in size, mostly flat (55.4%) and located in the proximal colon (44.6%). The en bloc resection rate was higher in the CSP group than the CBF group (91.7% vs. 42.6%, p<0.001). The histological complete resection rate was comparable in the two groups (93.33% vs 90.16%; p=0.527), even for polyps < 4 mm (91.30% vs 91.30%; p=1). All specimens were retrieved and there was no difference in terms of procedure times and adverse events. Finally, univariate analysis did not identify any potential factor associated with complete resection rate. In this study, CSP was comparable to CBF for the removal of DCP. Therefore, CBF may be considered as an alternative technique for resection of DCP, together with CSP, ClinicalTrials.gov registry (NCT04727918).

Underwater versus conventional cold snare polypectomy of colorectal polyps 4-9mm in diameter: a prospective randomized controlled trial.

Cold snare polypectomy (CSP) has been reported as safe and effective method for the removal of small colorectal polyps. However, some studies showed low R0 resection rate. Underwater endoscopic mucosal resection is an effective technique to increase the proportions of complete resection. Therefore, the aim was to compare the rate of R0 resection of colorectal polyps 4-9mm in diameter between conventional CSP (C-CSP) and underwater CSP (U-CSP). This study was a prospective randomized controlled trial. A total of 198 polyps (4-9mm) in 110 patients were enrolled between December 2019 and June 2020. The polyps were randomized to be treated with either C-CSP (100 polyps) or U-CSP (98 polyps). The R0 resection rate was significantly higher in U-CSP group than in C-CSP groups (84.7% vs. 59.0%; p < 0.001). The polyp retrieval rate of C-CSP and U-CSP was 94.5% and 100% (p = 0.030). The rate of polyp fragmentation of C-CSP and U-CSP group was 5.3% and 0% (p = 0.027). The resection time and retrieval time were longer in C-CSP than U-CSP (45.0 ± 37.7s vs. 34.1 ± 21.2s, p = 0.032 and 51.9 ± 67.7s vs. 12.7 ± 12.4s, p < 0.001). No clinically significant bleeding or perforation occurred in either group. The results of this study were excellent with U-CSP of 4-9mm colorectal polyps in terms of R0 resection, polyp retrieval and fragmentation rate, and procedure/retrieval time. Therefore, U-CSP is a safe and effective technique for removing colorectal polyps 4-9mm in diameter. KCT (0004530).

A Rare Clinical Presentation of an Isolated Spheno-Choanal Polyp

Antrochoanal polyps (ACP) are more common benign polypoidal lesions arising from the maxillary sinus which grow into the maxillary sinus and extend into the choana. They occur more commonly in children and young adults; and are almost always unilateral. Polyps originating from the sphenoid sinus are rarely seen and are known as sphenochoanal polyp (SCP). Nasal obstruction and often headache are their main presenting symptoms. Computed tomography (CT), Cone beam computed tomography (CBCT), magnetic resonance imaging (MRI) and naso-endoscopic examination evaluates the presence of sphenochoanal polyp. Endoscopic removal of the spheno-choanal polyp together with the pedicle and the portion inside the sphenoid sinus is the treatment of choice. Finally, histopathology confirms the diagnosis.

Surgical removal of asymptomatic polyps detected on the day of egg collection increases fertility outcome

Surgical removal of asymptomatic polyps detected on the day of egg collection increases fertility outcome

Successful colonoscopic decompression of colocolic intussusception with polypectomy in a five-year-old

The incidence of colocolic intussusception is rare in the pediatric population. When it is encountered, there should be a high index of suspicion for colonic neoplasm acting as the lead point. Our case involves a 5-year-old male who presented with left-sided colocolic intussusception secondary to multiple colonic polyps. He underwent colonoscopy with successful reduction of the intussusception in addition to endoscopic removal of multiple colonic polyps. The use of endoscopy to resolve the intussusception proved to be a valuable tool for our patient as it avoided subjecting the patient to an operation and allowed for surveillance of the remainder of the colon. IV. • Colocolic intussusception is rare in children. • Management frequently includes air enema, but open or laparoscopic surgical resection has also often been reported. • We introduce the use of colonoscopy for reduction of colocolonic intussusception, which has not previously been described.

Colonoscopy Screening and Polyp Detection in the Southeastern United States.

Screening colonoscopy is recommended for polyp detection and colorectal cancer prevention for those aged 50-75 years. The aim of this study was to determine colon polyp incidence rates detected through screening colonoscopies in the Southeast United States. A retrospective chart review was conducted to determine polyp rates. Charts with a diagnostic code of "screening" colonoscopy were reviewed for age, gender, number of polyps, and type of polyps. The number of charts reviewed was 534, with a total of 239 found to have polyps. Polyp type was defined as hyperplastic and adenomatous, with all adenomatous types grouped together. Descriptive statistics were used for data analysis. The median age of participants was 62 years with 58% being male. The combined rate of colon polyp detection was 44.6%. Seventy percent of the overall sample was found to have at least one polyp. From 16% to 20% of the study population had mixed (adenomatous and hyperplastic) polyps. This study supports the need for continued screening colonoscopies for polyp detection and removal. Education is key and nurses are often the ones who have the greatest educational opportunity. This study indicates the need for further research that may support colorectal cancer screening beginning at an earlier age.

The Correlation of Peripheral Blood Eosinophils with Allergic Nasal Polyps

Aim: To observe the association of peripheral blood eosinophil percentage in patients with allergic nasal polyps. Design: Descriptive cross-sectional study Place and duration: Pathology Department of Bakhtawar Amin Medical &amp; Dental Hospital, Multan from September 2020 to August 2021. Methodology: Blood samples of all the cases operated for nasal polyps in Bakhtawar Amin Trust Institute are drawn before surgery to look for eosinophils. Family and past history of allergy is recorded. Histopathology of all the operated specimen of nasal polyps is done and sample for eosinophil count is collected again in cases that proved to be allergic nasal polyps on microscopic examination to look for any alteration in eosinophil percentage in blood on excision of polyps. Results: Twenty nine out of forty (72.5) percent of patients with allergic nasal polyps reveal increase in peripheral blood eosinophil percentage that returned to normal in 26(65%) patient on excision of nasal polyps. Conclusion: The study disclosed a notable link between allergic nasal polyps and peripheral blood eosinophil percentage and this association is further enhanced by the fact that the blood eosinophil count returned to normal on removal of nasal polyps. Keywords: Allergic nasal polyps, peripheral blood eosinophilia, eosinophil count, atopy

Prevalence of Forceps Polypectomy of Nondiminutive Polyps Is Substantial But Modifiable

The use of forceps for removal of nondiminutive polyps is associated with incomplete resection compared with snare polypectomy. However, few studies have characterized the frequency of forceps polypectomy for nondiminutive polyps or identified strategies to improve this practice. To address this gap, we estimated the prevalence and predictors of forceps polypectomy in clinical practice and examined the effectiveness of a multicomponent intervention to reduce inappropriate forceps polypectomy. We retrospectively reviewed all colonoscopies with polypectomies performed at 2 U.S. health systems between October 1, 2017, and September 30, 2019. We used a mixed-effects logistic regression model to examine the effect of a multicomponent intervention, including provider education and a financial incentive, to reduce inappropriate forceps polypectomy, defined as use of forceps polypectomy for polyps ≥5 mm. A total of 9968 colonoscopies with 25,534 polypectomies were performed by 42 gastroenterologists during the study period. Overall, 8.5% (n= 2176) of polyps were removed with inappropriate forceps polypectomy. Inappropriate forceps polypectomy significantly decreased after the intervention (odds ratio [OR], 0.34, 95% confidence interval [CI], 0.30-0.39), from 11.4% (n= 1539) to 5.3% (n= 637). Predictors of inappropriate forceps polypectomy included inadequate bowel prep (OR, 1.25; 95% CI, 1.06-1.47), polyps in the right colon (vs left: OR, 1.29; 95% CI, 1.09-1.51), and number of polyps removed (OR, 0.96; 95% CI, 0.94-0.97). Inappropriate forceps polypectomy also varied by gastroenterologist (median OR, 3.43). In a post hoc analysis, the proportion of polyps >2 mm removed with forceps decreased from 50.0% before the intervention to 43.0% after it (OR, 0.62; 95% CI, 0.58-0.68). Inappropriate forceps polypectomy is common but modifiable. The proportion of nondiminutive polyps removed with forceps polypectomy should be considered as a quality measure.