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简介：Standardizedapproachtopolypectomyofdiminutivecolorectalpolyps(DCPs)islackingsincecoldbiopsyforcepshavebeenassociatedwithhighlevelsofrecurrence,hotbiopsyforcepsareconsideredinadequateandriskyandcoldsnaringiscurrentlyunderinvestigationforitsefficacyandsafety.Thishasledtoconfusionandagapinclinicalpractice.ThisarticlediscussestheusefulnessandcontemporarypracticalapplicabilityofhotbiopsyforcepsandprovideswellintentionedcriticismofthenewEuropeanguidelinesforthetreatmentofDCPs.Diminutivecolorectalpolypsareasourceoffrustrationfortheendoscopistsincetheirsmallsizeisaccompaniedbyaconsiderableriskofpremalignantneoplasiaandasmallbutnonnegligibleriskofadvancedneoplasiaandevencancer.Sincetheproportionofdiminutivecolorectalpolypsissubstantialandexceedsthatoflargerpolyps,theireffectiveremovalposesaconsiderableworkloadandatherapeuticchallenge.Duringthelastdecade,theintroductionofcoldsnaringtoroutineendoscopypracticehasattemptedtoovercometheuseofpriortechniques,suchashotbiopsyforceps.Itisimportanttorecognizethatwiththeexceptionofendoscopicmethodsthatareobviouslyunsafeandinadequatetoservetheirpurpose,allotherinterventionalendoscopicmethodsareoperator-dependentinthesensethatspecificexpertiseandtrainingareobligatoryforthesuccessofanytherapeuticintervention.Sincerelevantpublicationsonhotbiopsyforcepsarestillinfavorofitscarefuluse,asithasnotyetdemonstratedinferioritycomparedwithnewertechniques,itwouldbeprudentforanymedicalpractitionertoevaluatetheavailabletoolsandjudgeanynewproposedtechniquebasedontheevidencebeforeitisadopted.

简介：AIMToverifythevalidityoftheendoscopyguidelinesforpatientstakingwarfarinordirectoralanticoagulants(DOAC).METHODSWecollecteddatafrom218patientsreceivingoralanticoagulants(73DOACusers,145warfarinusers)and218patientsnotreceivinganyantithrombotics(age-andsexmatchedcontrols)whounderwentpolypectomy.(1)Weevaluatedpost-polypectomybleeding(PPB)riskinpatientsweassessedtherisksofPPBandthromboembolismbetweenthreeACmanagementmethods:DiscontinuingACwithheparinbridge(HPB)(endoscopyguidelinerecommendation),continuingAC,anddiscontinuingACwithoutHPB.RESULTSPPBratewassignificantlyhigherinwarfarinusersandDOACuserscomparedwithcontrols(13.7%and13.7%vs0.9%,P<0.001),butwasnotsignificantlydifferentbetweenrivaroxaban(13.2%),dabigatran(11.1%),andapixaban(13.3%)users.Twothromboemboliceventsoccurredinwarfarinusers,butnoneinDOACusers.Comparedwiththecontinuinganticoagulantgroup,thediscontinuinganticoagulantwithHPBgroup(guidelinerecommendation)hadahigherPPBrate(10.8%vs19.6%,P=0.087).ThesefindingsweresignificantlyevidentinwarfarinbutnotDOACusers.OnethromboticeventoccurredinthediscontinuinganticoagulantwithHPBgroupandthediscontinuinganticoagulantwithoutHPBgroup;noneoccurredinthecontinuinganticoagulantgroup.CONCLUSIONPPBriskwassimilarbetweenpatientstakingwarfarinandDOAC.Thromboembolismwasobservedinwarfarinusersonly.TheguidelinerecommendationsforHPBshouldbere-considered.

简介：病人是有便血的一个33岁的人。结肠镜检查与流血揭示了分成小叶的梗节的息肉，在直径的大约40公里，在上升冒号。息肉有红、白的部件和一个马赛克模式。放大观察与扩大回合或卵形的地窟开始揭示了一个红崎岖表面部件，和光滑的白小瘤。内视镜的polypectomy被执行。标本的组织学的检查与膀胱的变化在薄板propria，平滑肌的增长，和增生的腺揭示了煽动性的肉芽组织。这息肉作为煽动性的myoglandular息肉(IMGP)被诊断。在上升冒号的由小叶片组成类型的IMGP是稀罕的。