Clinical Endoscopy

Factors influencing endoscopic estimation of colon polyp size in a colon model: Koen Robert Beukema, Jaimy A. Simmering, Marjolein Brusse-Keizer, Sneha John, Rutger Quispel, Peter B. Mensink; Clin Endosc 2022;55(4):540-548. Published online July 28, 2022; DOI: https://doi.org/10.5946/ce.2022.017

Background
/Aims: Colorectal polyps are removed to prevent progression to colorectal cancer. Polyp size is an important factor for risk stratification of malignant transformation. Endoscopic size estimation correlates poorly with pathological reports and several factors have been suggested to influence size estimation. We aimed to gain insight into the factors influencing endoscopic polyp size estimation.
Methods
Images of polyps in an artificial model were obtained at 1, 3, and 5 cm from the colonoscope’s tip. Participants were asked to estimate the diameter and volume of each polyp.
Results
Fifteen endoscopists from three large-volume centers participated in this study. With an intraclass correlation coefficient of 0.66 (95% confidence interval [CI], 0.62–0.71) for diameter and 0.56 (95% CI, 0.50–0.62) for volume. Polyp size estimated at 3 cm from the colonoscope’s tip yielded the best results. A lower distance between the tip and the polyp was associated with a larger estimated polyp size.
Conclusions
Correct endoscopic estimation of polyp size remains challenging. This finding can affect size estimation skills and future training programs for endoscopists.

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Endoscopic size measurement of colorectal polyps: a systematic review of techniques
Mahsa Taghiakbari, Roupen Djinbachian, Juliette Labelle, Daniel von Renteln
Endoscopy.2025;[Epub] CrossRef
Usefulness and Educational Benefit of a Virtual Scale Endoscope in Measuring Colorectal Polyp Size
Yudai Takehara, Ken Yamashita, Shin Morimoto, Fumiaki Tanino, Noriko Yamamoto, Yuki Kamigaichi, Hidenori Tanaka, Hidehiko Takigawa, Ryo Yuge, Yuji Urabe, Shiro Oka
Digestion.2024; 105(2): 73. CrossRef
Expert endoscopist assessment of colorectal polyp size using virtual scale endoscopy, visual or snare-based estimation: a prospective video-based study
Ioana Popescu Crainic, Roupen Djinbachian, Douglas K. Rex, Alan Barkun, Aasma Shaukat, James East, Cesare Hassan, Yuichi Mori, Heiko Pohl, Amit Rastogi, Prateek Sharma, Joseph C. Anderson, Mahsa Taghiakbari, Edgard Medawar, Daniel von Renteln
Scandinavian Journal of Gastroenterology.2024; 59(5): 608. CrossRef

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Dedicated Cold Snare vs. Traditional Snare for Polypectomy of Diminutive and Small Lesions in a Porcine Model: A Research Group for Endoscopic Instruments and Stents (REIS) Study: Han Hee Lee, Bo-In Lee, Jung-Wook Kim, Hyun Lim, Si Hyung Lee, Jun-Hyung Cho, Yunho Jung, Kyoung Oh Kim, Chan Gyoo Kim, Kee Myung Lee, Jong-Jae Park, Myung-Gyu Choi, Hoon Jai Chun, Ho Gak Kim; Clin Endosc 2021;54(3):390-396. Published online September 10, 2020; DOI: https://doi.org/10.5946/ce.2020.096

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: The aim of this in vivo animal study was to evaluate the effectiveness and safety of dedicated cold snare (DCS) compared with those of traditional snare (TS) for cold snare polypectomy (CSP).
Methods
A total of 36 diminutive (5 mm) and 36 small (9 mm) pseudolesions were made by electrocoagulation in the colons of mini-pigs.
Results
For the diminutive lesions, there were no significant differences in technical success rate, procedure time, or complete resection rate between the DCS and TS groups; the rate of uneven resection margin in the DCS group was significantly lower than that of the TS group. For small lesions, technical success rate and complete resection rate were significantly higher in the DCS group than in the TS group (100% [18/18] vs. 55.6% [10/18], p=0.003; 94.4% [17/18] vs. 40% [4/10], p=0.006). In addition, the procedure duration was significantly shorter, and the rate of uneven resection margin was significantly lower in the DCS group (28.5 sec vs. 66.0 sec, p=0.006; 11.1% [2/18] vs. 100% [10/10], p<0.001). Two cases of perforation occurred in the DCS group. Multivariate analysis revealed that DCS use was independently associated with complete resection.
Conclusions
DCS is superior to TS in terms of technical success, complete resection, and reducing the duration of the procedure for CSP of small polyps.

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Comparison of complete resection rates in cold snare polypectomy using two different wire diameter snares: A randomized controlled study
Toshiki Horii, Sho Suzuki, Akihiro Sugita, Misa Yamauchi, Hisatomo Ikehara, Chika Kusano, Takuji Gotoda
Journal of Gastroenterology and Hepatology.2023; 38(5): 752. CrossRef
Comparison of the clinical efficacy of cold snare polypectomy using a thin-wire snare and thick-wire snare for small colorectal polyps
Hong Jin Yoon, Yunho Jung, Young Sin Cho, Il-Kwun Chung
International Journal of Gastrointestinal Intervention.2023; 12(4): 183. CrossRef
Big Issues on Small Polyps: An Ideal Device, But Is It for an Ideal Indication?
Yoji Takeuchi
Clinical Endoscopy.2021; 54(3): 297. CrossRef
Cold versus hot polypectomy/endoscopic mucosal resection–A review of current evidence
Raquel Ortigão, Jochen Weigt, Ahmed Afifi, Diogo Libânio
United European Gastroenterology Journal.2021; 9(8): 938. CrossRef

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Endoscopic Findings in Children with Isolated Lower Gastrointestinal Bleeding: Ari Silbermintz, Manar Matar, Amit Assa, Noam Zevit, Yael Mozer Glassberg, Raanan Shamir; Clin Endosc 2019;52(3):258-261. Published online May 14, 2019; DOI: https://doi.org/10.5946/ce.2018.046

Abstract PDF PubReader ePub

Background
/Aims: Colorectal polyps are a common cause of lower gastrointestinal bleeding in children. Our aim was to study the causes of isolated lower gastrointestinal bleeding and to analyze the characteristics of the colorectal polyps found in our cohort.
Methods
We retrospectively reviewed colonoscopic procedures performed between 2007 and 2015. Children with isolated lower gastrointestinal bleeding were included in the study.
Results
A total of 185 colonoscopies were performed for isolated lower gastrointestinal bleeding. The median patient age was 8 years, and 77 patients (41.6%) were found to have colonic polyps. Normal colonoscopy findings were observed and acute colitis was detected in 77 (41.6%) and 14 (7.4%) patients, respectively. Single colonic polyps and 2–3 polyps were detected in 73 (94.8%) and 4 (5.2%) patients with polyps, respectively. Of the single polyps, 69 (94.5%) were juvenile polyps, among which 65 (94.2%) were located in the left colon.
Conclusions
Single left-sided juvenile polyps were the most common cause of isolated lower gastrointestinal bleeding in our study. It was rare to find multiple polyps and polyps proximal to the splenic flexure in our cohort. A full colonoscopy is still recommended in all patients in order to properly diagnose the small but significant group of patients with pathologies found proximal to the splenic flexure.

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Génesis Rojas, Dianora Navarro, Karolina López, Katiuska Belandria, Elennys Moya, Libia Alonso, Christian Núñez, Deivis Maury, Gleydis Villarroel
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Endoscopic features of solitary colorectal hamartomatous polyps: Solitary juvenile polyp and Peutz-Jeghers polyp
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Endoscopy International Open.2024;[Epub] CrossRef
Fecal Calprotectin Levels Significantly Correlate with Polyp Size in Children and Adolescents with Juvenile Colorectal Polyps
Yu Bin Kim, Ju Young Kim, Sujin Choi, Yoo Min Lee, So Yoon Choi, Soon Chul Kim, Hyo-Jeong Jang, Yoon Lee, In Sook Jeong, Dae Yong Yi, Yunkoo Kang, Kyung Jae Lee, Byung-Ho Choe, Ben Kang
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Endoscopic Mucosal Resection in Children
David S. Vitale, Kelly Wang, Laith H. Jamil, Kenneth H. Park, Quin Y. Liu
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Valeria Dipasquale, Claudio Romano, Mauro Iannelli, Andrea Tortora, Alessandro Princiotta, Marco Ventimiglia, Giuseppinella Melita, Socrate Pallio
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Yeoun Joo Lee, Jae Hong Park
Clinical Endoscopy.2019; 52(3): 207. CrossRef

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Endoscopic Mucosal Resection versus Endoscopic Submucosal Dissection for Large Polyps: A Western Colonoscopist’s View: Ian Holmes, Shai Friedland; Clin Endosc 2016;49(5):454-456. Published online August 26, 2016; DOI: https://doi.org/10.5946/ce.2016.077

Abstract PDF PubReader ePub

To discuss the rationale for the widespread application of endoscopic mucosal resection (EMR) rather than endoscopic submucosal dissection (ESD) in Western centers. In Western centers, EMR is the treatment of choice for most non-pedunculated colorectal adenomas >2 cm in size. EMR is sufficiently effective and safe to be performed without post-procedure hospitalization. Advances in EMR have led to reduced recurrence rates, and recent studies have demonstrated excellent outcomes with endoscopic treatment of recurrent adenomas. While studies from Asia have demonstrated lower recurrence rates with ESD, concern about the higher perforation risk and lengthy procedure time of ESD are two of the barriers preventing widespread adoption of ESD in the West. EMR is likely to continue as the dominant method for the treatment of large colorectal adenomas in Western centers until the limitations of ESD are overcome.

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Outcome after colorectal full-thickness resection and management of recurrence
Julius Mueller, Valentin Miedtke, Armin Kuellmer, Moritz Schiemer, Dominik Bettinger, Robert Thimme, Arthur Schmidt
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Identification of Iatrogenic Perforation in Pediatric Gastrointestinal Endoscopy
Oren Ledder, Marek Woynarowski, Diana Kamińska, Izabella Łazowska-Przeorek, Stanislaw Pieczarkowski, Claudio Romano, Raffi Lev-Tzion, Magdalena Holon, Andreia Nita, Anna Rybak, Elżbieta Jarocka-Cyrta, Bartosz Korczowski, Elzbieta Czkwianianc, Iva Hojsak,
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Current status of endoscopic full‐thickness resection with the full‐thickness resection device
Julius Mueller, Armin Kuellmer, Moritz Schiemer, Robert Thimme, Arthur Schmidt
Digestive Endoscopy.2023; 35(2): 232. CrossRef
Endoscopic mucosal resection and endoscopic submucosal dissection with an external additional working channel (EMR+ and ESD+) are equivalent to using a double-channel endoscope: a systematic evaluation in a porcine ex vivo model
Richard F. Knoop, Ahmad Amanzada, Golo Petzold, Volker Ellenrieder, Michael Engelhardt, Albrecht Neesse, Sebastian C. B. Bremer, Steffen Kunsch
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Mason Soeder, Alla Turshudzhyan, Lisa Rosenberg, Micheal Tadros
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Risk factors for local recurrence of large gastrointestinal lesions after endoscopic mucosal resection
Yasar Colak, Badar Hasan, Walid Hassaballa, Mamoon Ur Rashid, Victor Strassmann, Giovanna DaSilva, Steven D. Wexner, Tolga Erim
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Endoscopic submucosal dissection with an additional working channel (ESD+): a novel technique to improve procedure time and safety of ESD
Richard F. Knoop, Edris Wedi, Golo Petzold, Sebastian C. B. Bremer, Ahmad Amanzada, Volker Ellenrieder, Albrecht Neesse, Steffen Kunsch
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Mike T. Wei, George Triadafilopoulos, Shai Friedland
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Increased Detection of Colorectal Polyps in Screening Colonoscopy Using High Definition i-SCAN Compared with Standard White Light: Woo Jung Kim, Sang Young Park, Iksoo Park, Wook Jin Lee, Jaechan Park, Nuri Chon, Tak Geun Oh, Kwang Hyun Kim; Clin Endosc 2016;49(1):69-75. Published online January 28, 2016; DOI: https://doi.org/10.5946/ce.2016.49.1.69

Abstract PDF PubReader ePub

Background
/Aims: The aim of this study was to evaluate the efficacy of high definition (HD) i-SCAN for colorectal polyp detection in screening colonoscopy.
Methods
We retrospectively analyzed the records of 501 patients who had undergone screening colonoscopy performed by three endoscopists with either HD i-SCAN (n=149) or standard white light (n=352) from January 2, 2014 through June 30, 2014. Patient information and inter-endoscopist variation as well as polyp number, endoscopic findings, and pathologic characteristics were reviewed.
Results
The detection rates of colorectal and neoplastic polyps were significantly higher using HD i-SCAN than standard white light colonoscopy (52% vs. 38.1%, p=0.004 for colorectal polyps; and 37.2% vs. 27.9%, p=0.041 for neoplastic polyps). Analysis of endoscopic findings revealed no difference in detected polyp size between HD i-SCAN and standard white light colonoscopy (4.59±2.35 mm vs. 4.82±2.81 mm, p=0.739), but non-protruding polyps were more commonly detected by i-SCAN than by standard white light colonoscopy (24.6% vs. 13.5%, p=0.007).
Conclusions
Colonoscopy using HD i-SCAN had a significantly higher detection rate of colorectal polyps, including neoplastic polyps, because of improved sensitivity for detecting non-protruding lesions.

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Mucosal imaging in colon polyps: New advances and what the future may hold
Edward John Young, Arvinf Rajandran, Hamish Lachlan Philpott, Dharshan Sathananthan, Sophie Fenella Hoile, Rajvinder Singh
World Journal of Gastroenterology.2022; 28(47): 6632. CrossRef
Técnicas colonoscópicas para la detección de pólipos: un estudio egipcio
M. Abdelbary, S. Hamdy, H. Shehab, N. ElGarhy, M. Menesy, R. Marzaban
Revista de Gastroenterología de México.2021; 86(1): 36. CrossRef
Colonoscopic techniques in polyp detection: An Egyptian study
M. Abdelbary, S. Hamdy, H. Shehab, N. ElGarhy, M. Menesy, R. Marzaban
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Effect of I-scan Electronic Chromoendoscopy on Detection of Adenomas During Colonoscopy
Trilokesh D. Kidambi, Jonathan P. Terdiman, Najwa El-Nachef, Aparajita Singh, Michael G. Kattah, Jeffrey K. Lee
Clinical Gastroenterology and Hepatology.2019; 17(4): 701. CrossRef
Can technology increase adenoma detection rate?
Wee Sing Ngu, Colin Rees
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New technologies improve adenoma detection rate, adenoma miss rate, and polyp detection rate: a systematic review and meta-analysis
Daniel Castaneda, Violeta B. Popov, Elijah Verheyen, Praneet Wander, Seth A. Gross
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Yun Nah Lee, Jong Ho Moon, Hyun Jong Choi
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Enhanced flat adenoma detection rate with high definition colonoscopy plus i-scan for average-risk colorectal cancer screening
Antonio Rodríguez-D´Jesus, Esteban Saperas
Revista Española de Enfermedades Digestivas.2016;[Epub] CrossRef

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The Colonoscopist's Expertise Affects the Characteristics of Detected Polyps: Da Kyoung Jung, Tae Oh Kim, Mi Seon Kang, Mo Se Kim, Min Sik Kim, Young Soo Moon; Clin Endosc 2016;49(1):61-68. Published online January 28, 2016; DOI: https://doi.org/10.5946/ce.2016.49.1.61

Abstract PDF PubReader ePub

Background
/Aims: The influence of the endoscopist on the polyp detection rate (PDR) is underappreciated in clinical practice. Moreover, flat lesions or lesions of the proximal colon are more difficult to detect. Here, we evaluated the differences in the PDR and the characteristics of detected polyps according to the experience of the colonoscopist.
Methods
We collected data on 2,549 patients who underwent screening colonoscopy performed by three fellows. The PDR was calculated according to the percentage of patients who had at least one polyp (method A) and according to the percentage of detected lesions (method B). The primary outcome included the change in the PDR, and the secondary outcome included the change in the characteristics of the detected polyps with increasing experience of the colonoscopist.
Results
No proportional correlation was found between the PDR and increasing experience in colonoscopy with method A; however, with method B, the PDR increased after 400 colonoscopies (p=0.0209). With method B, the detection rates of small polyps (<5 mm) (p=0.0015) and polyps in proximal sites (p=0.0050) increased after 300 colonoscopies.
Conclusions
Our study demonstrated that the quality of a colonoscopy, measured by using the PDR, may increase when performed by experienced fellows.

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Lixia Fu, Mugen Dai, Junwei Liu, Hua Shi, Jundi Pan, Yanmei Lan, Miaoxia Shen, Xiaoduo Shao, Bin Ye
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Colonoscopy procedural volume increases adenoma and polyp detection rates in gastroenterologytrainees
Emad Qayed, Ravi Vora, Sara Levy, Roberd M Bostick
World Journal of Gastrointestinal Endoscopy.2017; 9(11): 540. CrossRef

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A Case of Mucosa-Associated Lymphoid Tissue Lymphoma of the Sigmoid Colon Presenting as a Semipedunculated Polyp: Myung Hwan Kim, Jin Tae Jung, Eui Jung Kim, Tae Won Kim, Seon Young Kim, Joong Goo Kwon, Eun Young Kim, Woo Jung Sung; Clin Endosc 2014;47(2):192-196. Published online March 31, 2014; DOI: https://doi.org/10.5946/ce.2014.47.2.192

Abstract PDF PubReader ePub

Mucosa-associated lymphoid tissue (MALT) lymphomas are characterized by lymphoepithelial lesions pathologically. Colonic MALT lymphomas are relatively rarer than lymphomas of the stomach or small intestine. Endoscopically, colonic MALT lymphoma frequently appears as a nonpedunculated protruding polypoid mass and/or an ulceration in the cecum and/or rectum. We report a unique case of a colonic MALT lymphoma presenting as a semipedunculated polyp. A 54-year-old man was found to have a 2-cm semipedunculated polyp in the sigmoid colon during screening colonoscopy. The polyp was removed by endoscopic mucosal resection. Histologic examination of the resected polyp revealed diffuse epithelial infiltration by discrete aggregates of lymphoma cells. We diagnosed the tumor as low-grade B-cell MALT lymphoma by immunohistochemical staining.

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T Zhu, H Lei, Y -H Wang, L -P Liu, Y -L Lei, N Wang, Y -H Zheng
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How Do I Manage Post-Polypectomy Bleeding?: Sung Pil Hong; Clin Endosc 2012;45(3):282-284. Published online August 22, 2012; DOI: https://doi.org/10.5946/ce.2012.45.3.282

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Colonoscopic polypectomy is an effective method for prevention of colorectal cancer and has become one of the most common procedures worldwide. Most colorectal polyps can be removed safely by various polypectomy techniques; however, serious complications can occur. Postpolypectomy bleeding is the most common complication of colonoscopic polypectomy, accounting for 0.3% to 6.1% of polypectomy. This issue summarizes various endoscopic techniques to treat postpolypectomy bleeding.

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A Case of Postpolypectomy Coagulation Syndrome Had a Hemicolectomy: Song Yi Song, M.D., Young Kyung Sung, M.D., Hye Jeong Kim, M.D., Soyoung Bae, M.D., Silvia Park, M.D., Yong Beom Cho, M.D.*, Jin Yong Kim, M.D. and Seung Min Chung, M.D.; Korean J Gastrointest Endosc 2010;41(4):236-239. Published online October 30, 2010

Abstract PDF: Colonoscopy is commonly used as a screening tool for colorectal polyps and cancer. It also offers a chance to remove polyps via the polypectomy technique. Colonoscopic polypectomy is a relatively safe procedure, yet there is the possibility of serious complications such as perforation and bleeding. Postpolypectomy coagulation syndrome presents with pain, fever, an elevated white blood cell count and signs of peritoneal irritation, and usually within 12 hours of the procedure. No free air is seen on plain films or a CT scan, which is different from frank bowel perforation. The management of postpolypectomy coagulation syndrome includes fasting, antibiotics and intravenous hydration. We report here on a case of a 53-year-old woman who underwent right hemicolectomy because she presented with fever, signs of peritoneal irritation and shock after colonoscopic polypectomy. The final diagnosis was postpolypectomy coagulation syndrome as there was no perforation in the resected specimen. (Korean J Gastrointest Endosc 2010;41:236-239)

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Endoscopic Resection of a Pedunculated Colonic Leiomyoma Resembling a Hyperplastic Polyp: Yong Wan Park, M.D., Young Seok Cho, M.D., Jin Soo Kim, M.D., Hye Sook Son, M.D., Hyung Keun Kim, M.D., Sung Soo Kim, M.D., Hiun Suk Chae, M.D. and Kyu Yong Choi, M.D.; Korean J Gastrointest Endosc 2008;37(3):218-221. Published online September 30, 2008

Abstract PDF: Colonic leiomyoma is a rare condition that accounts for 3% of all gastrointestinal leiomyomas. Many colonic leiomyomas are found incidentally and are sometimes confused with epithelial neoplasms. Most leiomyomas are removed surgically. However, a small peduculated leiomyoma can be removed endoscopically as it has the appearance of an adenomatous polyp. A 54 year-old man underwent a colonoscopic examination due to frequent loose stools. Colonoscopy demonstrated the presence of a small reddish polyp with a short stalk in the sigmoid colon. We performed a successful polypectomy by the use of colonoscopic snare electrocauterization. A pathological examination revealed the presence of a leiomyoma originating in the muscularis mucosa. We report a case of a small peduculated leiomyoma that was removed endoscopically, with a review of the literature. (Korean J Gastrointest Endosc 2008;37:218-221)

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The Colonoscopic Miss Rates of Colorectal Polyps as Determined by a Polypectomy: Se Young Park, M.D., Won Moon, M.D., Seun Ja Park, M.D., Moo In Park, M.D., Kyu Jong Kim, M.D., Sun Jung Kim, M.D., Hong Jun You, M.D. and Woo Seong Jeon, M.D.; Korean J Gastrointest Endosc 2008;36(3):132-137. Published online March 30, 2008

Abstract PDF: Background
/Aims: Colonoscopy is the most effective method to detect and remove colonic polyps and for colorectal cancer screening and prevention. However, polyps are frequently missed during colonoscopy. The aim of this study was to determine the miss rates of polyps by colonoscopy and to evaluate the factors that affect the miss rates. Methods: Within sixty days after a first-time colonoscopy, consecutive polypectomies were performed in 317 patients who had one or more colon polyps. Results: The overall miss rate for polyps was 26.6%. As the withdrawal time increased, the number of polyps detected on the first colonoscopy decreased, and the miss rate decreased significantly (respectively p=0.000, p=0.028). The withdrawal time for an expert operator was shorter than the withdrawal time for a beginner operator (p=0.001). The miss rate for a beginner operator and expert operator was not different (p=0.271) due to interference with withdrawal time. The most frequent location of a polyp was the ascending colon and the most frequent size of a polyp was ≤5 mm. Conclusions: Although colonoscopy is the gold standard for colorectal polyp detection, it is imperfect even when meticulously performed. To reduce the miss rates of polyps, it is important that a careful examination with sufficient withdrawal time is performed, the colonoscopy is complete to the cecum, and that the bowel preparation is adequate. (Korean J Gastrointest Endosc 2008;36:132-137)

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Characteristics of Early Colon Cancer in Korea: Heung Up Kim, M.D., Young-Ho Kim, M.D., Sang Yong Song, M.D.*, Chung Hwan Chung, M.D., Jong Hyung Kim, M.D., Kyung Hee Kim, M.D., Sang Goon Shim, M.D.^†, Hee Jung Son, M.D., Poong-Lyul Rhee, M.D., Jae J. Kim, M.D. and Jong Chul Rhee, M.D.; Korean J Gastrointest Endosc 2004;29(3):126-132. Published online September 30, 2004

Abstract PDF: Background
/Aims: Recently, early detection and treatment of early colon cancer (ECC) has increased, and the concept of de novo carcinogenesis of colon cancer was introduced. However there were few studies in Korea. So we tried to find the incidence of ECC and the possibility of de novo colon cancer (DCC) in Korea. Methods: From Jun 1995 to Jun 2003, 3072 patients who first treated as colon cancer at Samsung Medical Center were enrolled. We selected ECC by medical record review, and pathologic slides and endoscopic photos were reviewed to evaluate the underlying tissue of cancer focus and morphologic characteristics of ECCs. ECC was defined as the cancer confined to mucosa or submucosa, and DCC was defined as the cancer lesser than 1 cm but had no adenoma component. Results: The 192 patients (6.3%) had 196 cases of ECC. The ratio of mucosal and submucosal (SM) cancers was 36.7%:63.3%. The protruded type was the most frequent type (82.1%). The depressed type was the smallest (12.9⁑6.3 mm), in size and 100% showed and SM involvement. It has significantly higher rate of the cancer without underlying adenoma component (57.1%, p＜0.001). The DCC were 6 cases and all were SM cancer and had 3 cases of protruded and depressed type each other. Conclusions: The most common shape of ECC was protruded type. However, depressed type was smaller and had higher rate of SM involvment and no adenoma component around the cancers. And we found some of DCC although the frequency was very low. (Korean J Gastrointest Endosc 2004;29:126⁣132)

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내시경적 절제술을 시행받은 악성 대장 용종에 관한 분석: Korean J Gastrointest Endosc 2003;27(5):478-478. Published online November 20, 2003

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Diagnosis of Cowden's Disease Based on Gastrointestinal Manifestations: Il Gwon Park, M.D., Seung-Jae Myung, M.D., Suk-Kyun Yang, M.D., Hye-Sook Chang, M.D.,; Korean J Gastrointest Endosc 2003;26(4):183-191. Published online April 30, 2003

Abstract PDF: Backgroud/Aims: Cowden's disease is an autosomal dominant hereditary disease characterized by the various hamartomatous and neoplastic lesions of multiple organs. We analyzed gastrointestinal manifestations of 5 cases of Cowden's disease and suggest several findings which are helpful to gastroenterologists for the early diagnosis. Methods: The clinical characteristics of 5 unrelated patients with Cowden's disease were evaluated. Four patients were male, one patient was female, and their ages at the time diagnosis ranged from 17 to 49 years. All patients had the pathognomonic mucocutaneous lesions and thyroid nodules. Results: In all patients, the esophagus was affected by acanthosis. In 4 patients, the stomach was affected by numerous variable sized polyps. In 4 patients, the duodenum was involved by several polyps. In 4 patients, the entire small bowel and in one patients, only the terminal ileum was affected by numerous polyps. In all patients, the colon, especially the sigmoid colon and rectum, showed numerous variable sized polyps. Family history was positive for stomach cancer in two patients. Conclusions: Cowden's disease should be considered in patients with esophageal acanthosis among patients with colonic polyposis, although the mucocutaneous lesions, unfamiliar to gastroenterolgists, are pathognomonic criteria for the diagnosis. (Korean J Gastrointest Endosc 2003;26:183⁣191)

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A Case of Colonic Muco-Submucosal Elongated Polyp: Hyun Sung Lee, M.D., Bong Ki Choi, M.D., Woo Seon Seo, M.D., Min Ki Kim, M.D., Jae Kyeoung Lee, M.D., Sung Yeun Yang, M.D., Eun Taek Park, M.D., Yun Sik Jang, M.D., Sang Hyuk Lee, M.D., Sang Young Seol, M.D., Jung Myung Chung, M.D. and Hye Kyoung Yoon, M.; Korean J Gastrointest Endosc 2003;26(2):103-105. Published online February 28, 2003

Abstract PDF: Colonic muco-submucosal elongated polyp (CMSEP) is a rare disease which has been firstly reported by Matake. Only 21 cases have been reported since 1994. Although the mechanism of generation of such polyps remains unknown, their elongation may be caused by intestinal motion for a long period. The occurrence sites were distributed throughout the colon, excluding the rectum. CMSEP is coverd with normal mucosa and consisted of edematous, loose, fibrous, connective tissue and dense, fibrous submucosal layer, often dilatation of blood vessels and lymphatics. We present a case of CMSEP diagnosed by a colonoscopic polypectomy. (Korean J Gastrointest Endosc 2003;26:103⁣105)

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외래환자의 대장내시경 검사에서 용종제거술: Korean J Gastrointest Endosc 2001;23(5):348-348. Published online November 30, 2000

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대장 내시경을 이용한 용종 절제술의 합병증 ( Complicatian of Colonoscopic Polypectomy ): Korean J Gastrointest Endosc 2000;21(6):917-923. Published online November 30, 1999

Abstract PDF: Background
/Aims: Colonic adenomatous polyp is known as a premalignant lesion. Colonoscopic polypectomy, using for its removal and prevention of primary colon cancer has been considered as a effective and safe method. This study was conducted to assess its complication and safety of colonoscopic polypectomy. Methods: One thousand two hundred ninety three polypectomy were done using colonoscopic hot biopsy, snare polypectomy, endoscopic mucosal resection (EMR) and piecemeal polypectomy in 679 patients from 1983 to 1999, and postpolypectomy complications and its rate were evaluated. Results: 1) Postpolypectomy bleeding occured 18 cases of 1293 polypectomies (1.4%), including 10 cases of initial bleeding and 8 cases of delayed bleeding. In 9 cases (0.7%) of them hemostatic therapy were required. In delayed bleeding most cases (75%) of them occured within 66 hours after polypectomy. 2) Postpolypectomy bleeding occured in 10 cases of 982 polypectomies (1.0%) below 0.9 cm in polyp diameter, 5 cases of 242 polypectomies (2.1%) between 1.0 cm and 1.9 cm in polyp diameter and 3 cases of 69 polypectomies (4.3%) more than 2.0cm in polyp diameter (p<0.05). 3) There were no significant correlation between postpoiypectomy bleeding and polypectomy methods (p=0.06) and between postpolypectomy bleeding and gross type of polyps (p=0.40) statistically. 4) Postpolypectomy perforation occured in 1 case of 1293 polypectomies (0.1%). Estimated overall postpolypectomy complication rate including bleeding and perforation was 1.5%. Conclusions: Colonoscopic polypectomy is a relatively safe method in removing colonic polyp and its complication is related to size of polyp.

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내시경적 용종 절제술을 시행받은 대장용종 125예에 대한 후향적 연구 ( Retrospective Study of 125 Cases Colon Polyp Patients Who Underwent Colonscopic Polypectomy ): Korean J Gastrointest Endosc 2000;21(2):608-613. Published online November 30, 1999

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미세 대장 용종 : 병리조직 및 분포에 대한 임상 고찰 ( Small Colonic Polyps : Histopathology and Spatial Distribution ): Korean J Gastrointest Endosc 1999;19(1):46-50. Published online November 30, 1998

Abstract PDF: Background
/Aims: Our aims in this study were to determine histopathology and distri-bution of small colonic polyps (up to 6 mm). Small polyps were found frequently in the colon and rectum at colonoscopy. The size of polyps which should be removed endo-scopically has been controversial. Methods: Medical reports of all patients undergoing total colonoscopic examination during 8-year period were reviewed. Results: Eight hun-dred thirty-three small (up to 6 mm) colorectal polyps, removed during colonoscopy, have been analyzed. Of the small polyps, 58.8% were neoplastic, 17.7% were hyperplastic, 22.7% were inflammatory; 0.1% contained atypia, 0.1% were carcinoid, 0.6% were xan-thoma, 0.1% were adenocarcinoma. In the colon except rectum, neoplastic polyps were more common than non-neoplastic polyps. The difference in distribution of the major types of polyps in the right colon and transverse colon was significant (p ＜0.0001). Conclusions: Most small polyps proximal to the rectum are neoplastic. All polyps should be removed when encountered during colonoscopy due to the high prevalence of adenoma among small polyps. (Korean J Gastrointest Endosc 19: 46 ∼50, 1999)

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증례 : 식도 위장관 ; Segmental Non-familial Colonic Polyposis 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case Report of Segmental Non-Familial Colonic Polyposis ): Korean J Gastrointest Endosc 1996;16(5):787-792. Published online November 30, 1995

Abstract PDF: Segmental non-familial colonic polyposis was first reported by Chiang et al. in 1992. It is characterized by segmental distributlion of colonic polyposis usually confined to the descending colon, absence of family history of polyposis, large bowel malignancy, inflammatory bowel disease, or other pre-malignant colonic conditions. We experienced a nineteen-year-old male, who suffered from 2 years watery diarrhea about five to ten times a day, intermittent hematochezia, and weight loss of 12 kg in a year. He had no family history of colonic polyps, colon cancer, or inflammatory bowel disease. Colon study showed variable sized multiple colonic polyps on the rectum and sigmoid colon. Colonoscopy showed that 0.5 to 1.5 cm sized multiple polyps were scattered from the 6cm site to the 30cm site above the anal verge and the intervening mucosa between polyps was edematous. Colonoscopic biopsy revealed hyperplastic, adenomatous, and mixed hyperplastic and adenomatous polyps, After partial colectomy, we discovered 169 polyps from the resected specimen. After operation, diarrhea and abdominal pain had disappeared. We experienced a case of segmental non-familial polyposis and report it with review of the literatures related to it. (Korean J Gastrointest Endosc 16: 787~792, 1996)

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대장미소용종 ( 5 mm 이하 ) 의 내시경적 및 조직학적 검토 - 6 mm 이상의 용종과 비교하여 - ( Diminutive Colonic Polyps ( Less than 5 mm in diameter ) : Endoscopic and Histologic Study ): Korean J Gastrointest Endosc 1993;13(4):725-732. Published online November 30, 1992

Abstract PDF: A series of 241 polyps from 127 patients endoscopically removed during the period from march 1991 through July 1992 at our department were analysed. The following items were studied. 1) Incidence, age, and sex distrlbution of the patients 2) Number of the calonic polyps 3) Histologic classification and polyp size 4) Anatomic distribution and polyp size 5) Gross types and polyp size 6) Hietopathologic types and polyp size In conclusion, colonic diminutive polyps should not be ignored or overlooked clinically. The majority were neoplastic polyps. It is suggested that diminutive polyps should be removed endoscopically if possible

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대장 용종에서 겸자생검과 용종절제술 사이의 병리조직 소견의 비교 ( The Comparison of Pathologic Findings of Colonic Polyps between Forceps Biopsy and Polypectomy ): Korean J Gastrointest Endosc 1993;13(2):389-393. Published online November 30, 1992

Abstract PDF: Colonic palyps are one of the most risky factors for colon cancer. The pathology of the specimen obtained by forceps biopsy does not represent the whole specimen of the polyp obtained by polypectomy or surgery in some cases. To evaluate these pathologic differences. we analysed the 39 patients with colonic polyps who underwent forceps biopsy and polypectomy. (continue...)

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