BACKGROUND Endoscopic mucosal resection(EMR)is an effective and minimally invasive alternative to surgery for large polyps and laterally spreading lesions.Gross morphology and surface characteristics may help predict ...BACKGROUND Endoscopic mucosal resection(EMR)is an effective and minimally invasive alternative to surgery for large polyps and laterally spreading lesions.Gross morphology and surface characteristics may help predict submucosal invasion of the lesion(SMIL)during endoscopic evaluation.This is one of the largest singlecenter studies reporting endoscopic mucosal resection for larger(≥20 mm)colorectal lesions in the United States.AIM To determine the recurrence rate of adenomas and endoscopic features that may predict submucosal invasion of colonic mucosal neoplasia.METHODS This is a retrospective cohort study of all the patients referred for endoscopic mucosal resection for lesions≥20 mm,spanning a period from January 2013 to February 2017.The main outcome measure was identifying features that may predict submucosal invasion of mucosal lesions and predict recurrence of adenomas on follow-up surveillance colonoscopy performed at 4-6 mo.RESULTS A total of 480 patients with 500 lesions were included in the study.The median age was 68(Inter quantile range:14)with 52%males.The most common lesion location was ascending colon(161;32%).Paris classification 0-IIa(Flat elevation of mucosa-316;63.2%);Kudo Pit Pattern IIIs(192;38%)and Granular surface morphology(260;52%)were most prevalent.Submucosal invasion was present in 23(4.6%)out of 500 lesions.The independent risk factors for SMIL were Kudo Pit Pattern IIIL+IV and V(Odds ratio:4.5;P value<0.004)and Paris classification 0-IIc(Odds ratio:18.2;P value<0.01).Out of 500,354 post-endoscopic mucosal resection scars were examined at surveillance colonoscopy.Recurrence was noted in 21.8%(77 cases).CONCLUSION There was overall low prevalence of SMIL in our study.Kudo pit pattern(IIIL+IV and V)and Paris classification 0-IIc were the only factors identified as an independent risk factor for submucosal invasion.The independent risk factor for recurrence was adenoma size(>40 mm).Almost all recurrences(98.8%)were treated endoscopically.展开更多
AIM： To investigate the prevalence of cholelithiasis among patients treated with ezetimibe. METHODS： A retrospective, case-control study based on computerized medical records from patients of the Clalit Health Servi...AIM： To investigate the prevalence of cholelithiasis among patients treated with ezetimibe. METHODS： A retrospective, case-control study based on computerized medical records from patients of the Clalit Health Services, Sharon-Shomron region, from 2000 to 2009. Patients 20-85 years of age, who had been treated with ezetimibe and statins or statins only for at least 6 too, and who had an abdominal ultrasound were included in the study. Collected data included age, gender, ezetimibe treatment duration, presence of hypothyroidism or diabetes, and existence of cholelithiasis as determined by ultrasound. Ex- cluded were subjects after gallbladder resection, with hemolysis, myeloproliferative or inflammatory bowel diseases, and those treated with ursodeoxycholic acid and fibrates. Patients treated with statins and ezeti- mibe （study group） were compared to patients treated with statins only （control group）. RESULTS： The study group included 25 patients and the control group 168. All patients in the study were treated with statins. The study group included 13 males （52%） and 12 females （48%）, the control group 76 males （45%） and 92 （55%） females （P = 0.544）. The groups did not differ in age （mean age： 68 ± 8 years, range 53-85 years vs mean age： 71±8 years, range 51-85 years; P = 0.153） or in the rate of dia- betic and hypothyroid patients [11 （44%） vs 57 （33%）, P = 0.347 in the study group and 5 （20%） vs 23 （14%）, P = 0.449 in the control group, respectively]. Patients in the study group were treated with ezetimibe for an average of 798±379 d. Cholelithiasis was found in 4 （16%） patients in the study group and in 33 （20%） patients in the control group （P = 0.666）. CONCLUSION： Ezetimibe does not appear to influ- ence the prevalence of gallstones.展开更多
文摘BACKGROUND Endoscopic mucosal resection(EMR)is an effective and minimally invasive alternative to surgery for large polyps and laterally spreading lesions.Gross morphology and surface characteristics may help predict submucosal invasion of the lesion(SMIL)during endoscopic evaluation.This is one of the largest singlecenter studies reporting endoscopic mucosal resection for larger(≥20 mm)colorectal lesions in the United States.AIM To determine the recurrence rate of adenomas and endoscopic features that may predict submucosal invasion of colonic mucosal neoplasia.METHODS This is a retrospective cohort study of all the patients referred for endoscopic mucosal resection for lesions≥20 mm,spanning a period from January 2013 to February 2017.The main outcome measure was identifying features that may predict submucosal invasion of mucosal lesions and predict recurrence of adenomas on follow-up surveillance colonoscopy performed at 4-6 mo.RESULTS A total of 480 patients with 500 lesions were included in the study.The median age was 68(Inter quantile range:14)with 52%males.The most common lesion location was ascending colon(161;32%).Paris classification 0-IIa(Flat elevation of mucosa-316;63.2%);Kudo Pit Pattern IIIs(192;38%)and Granular surface morphology(260;52%)were most prevalent.Submucosal invasion was present in 23(4.6%)out of 500 lesions.The independent risk factors for SMIL were Kudo Pit Pattern IIIL+IV and V(Odds ratio:4.5;P value<0.004)and Paris classification 0-IIc(Odds ratio:18.2;P value<0.01).Out of 500,354 post-endoscopic mucosal resection scars were examined at surveillance colonoscopy.Recurrence was noted in 21.8%(77 cases).CONCLUSION There was overall low prevalence of SMIL in our study.Kudo pit pattern(IIIL+IV and V)and Paris classification 0-IIc were the only factors identified as an independent risk factor for submucosal invasion.The independent risk factor for recurrence was adenoma size(>40 mm).Almost all recurrences(98.8%)were treated endoscopically.
文摘AIM： To investigate the prevalence of cholelithiasis among patients treated with ezetimibe. METHODS： A retrospective, case-control study based on computerized medical records from patients of the Clalit Health Services, Sharon-Shomron region, from 2000 to 2009. Patients 20-85 years of age, who had been treated with ezetimibe and statins or statins only for at least 6 too, and who had an abdominal ultrasound were included in the study. Collected data included age, gender, ezetimibe treatment duration, presence of hypothyroidism or diabetes, and existence of cholelithiasis as determined by ultrasound. Ex- cluded were subjects after gallbladder resection, with hemolysis, myeloproliferative or inflammatory bowel diseases, and those treated with ursodeoxycholic acid and fibrates. Patients treated with statins and ezeti- mibe （study group） were compared to patients treated with statins only （control group）. RESULTS： The study group included 25 patients and the control group 168. All patients in the study were treated with statins. The study group included 13 males （52%） and 12 females （48%）, the control group 76 males （45%） and 92 （55%） females （P = 0.544）. The groups did not differ in age （mean age： 68 ± 8 years, range 53-85 years vs mean age： 71±8 years, range 51-85 years; P = 0.153） or in the rate of dia- betic and hypothyroid patients [11 （44%） vs 57 （33%）, P = 0.347 in the study group and 5 （20%） vs 23 （14%）, P = 0.449 in the control group, respectively]. Patients in the study group were treated with ezetimibe for an average of 798±379 d. Cholelithiasis was found in 4 （16%） patients in the study group and in 33 （20%） patients in the control group （P = 0.666）. CONCLUSION： Ezetimibe does not appear to influ- ence the prevalence of gallstones.
