DOCSLIB.ORG

Colorectal Polypectomy and Endoscopic Mucosal Resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Colorectal Polypectomy and Endoscopic Mucosal Resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline Guideline Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline Authors 19 Department of Gastroenterology, Maria Sklodowska-Curie Monika Ferlitsch1,2,AlanMoss3,4,CesareHassan5,Pradeep Memorial Cancer Bhandari6, Jean-Marc Dumonceau7,GregoriosPaspatis8,Rodrigo Center and Medical Centre for Postgraduate Education, Jover9,CordLangner10,MaximeBronzwaer11, Kumanan Nalankilli3,4, Warsaw, Poland Paul Fockens11,RawiHazzan12,IanM.Gralnek12,Michael 20 Humanitas Research Hospital, Humanitas University, Rozzano, Gschwantler2, Elisabeth Waldmann1,2, Philip Jeschek1,2, Daniela Milan, Italy Penz1, 2,DenisHeresbach13, Leon Moons14, Arnaud Lemmers15, 21 School of Medicine, Pharmacy and Health, Durham University, Konstantina Paraskeva16, Juergen Pohl17, Thierry Ponchon18, Durham, UK Jaroslaw Regula19, Alessandro Repici20, Matthew D. Rutter21, 22 Department of Gastroenterology and Hepatology, Westmead Nicholas G. Burgess22,23, Michael J. Bourke22,23 Hospital, Sydney, Australia 23 University of Sydney, Sydney, Australia Institutions 1 Department of Internal Medicine III, Division of Bibliography Gastroenterology and Hepatology, Medical University of Vienna, DOI http://dx.doi.org/10.1055/s-0043-102569 Austria Published online: 2017 | Endoscopy 2 Quality Assurance Working Group of the Austrian Society of © Georg Thieme Verlag KG Stuttgart · New York Gastroenterology and Hepatology ISSN 0013-726X 3 Department of Endoscopic Services, Western Health, Melbourne, Australia Corresponding author 4 Department of Medicine, Melbourne Medical School Western Monika Ferlitsch, MD, Division of Gastroenterology and Hepatology, Precinct, The University of Melbourne, St. Albans, Victoria, Department of Internal Medicine III, Medical University of Vienna, Australia Waehringer Guertel 18–20, A-1090 Vienna, Austria 5 Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Fax: +43-40400-47350 Rome, Italy [email protected] 6 Solent Centre for Digestive Diseases, Queen Alexandra Hospital, Portsmouth, UK Appendix e1, e2 7 Gedyt Endoscopy Center, Buenos Aires, Argentina Online content viewable at: https://www.thieme-connect.com/ 8 Department of Gastroenterology, Benizelion General Hospital, DOI/DOI?10.1055/s-0043-102569 Heraklion, Crete, Greece 9 Unidad de Gastroenterología, Servicio de Medicina Digestiva, Instituto de Investigación Sanitaria ISABIAL, Hospital General MAIN RECOMMENDATIONS Universitario de Alicante, Alicante, Spain 1 ESGE recommends cold snare polypectomy (CSP) as the preferred 10 Department of Pathology, Medical University of Graz, Graz, technique for removal of diminutive polyps (size≤ 5mm).Thistech- Austria nique has high rates of complete resection, adequate tissue sam- 11 Department of Gastroenterology, Academic Medical Center, pling for histology, and low complication rates. (High quality evi- University of Amsterdam, Amsterdam, The Netherlands dence, strong recommendation.) This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. ’ 12 Institute of Gastroenterology and Hepatology, Ha Emek 2 ESGE suggests CSP for sessile polyps 6– 9mminsizebecauseof Medical Center, Afula, Israel and Rappaport Family Faculty of its superior safety profile, although evidence comparing efficacy Medicine Technion-Israel Institute of Technology, Haifa, Israel with hot snare polypectomy (HSP) is lacking. (Moderate quality evi- 13 Department of Digestive Endoscopy, University Hospital, CHU dence, weak recommendation.) Fort de France, France 3 ESGE suggests HSP (with or without submucosal injection) for re- 14 Department of Gastroenterology and Hepatology, University moval of sessile polyps 10– 19mm in size. In most cases deep ther- Medical Center Utrecht, Utrecht, Netherlands mal injury is a potential risk and thus submucosal injection prior to 15 Department of Gastroenterology, Hepatopancreatology and HSP should be considered. (Low quality evidence, strong recom- Digestive Oncology, Erasme Hospital, Université Libre de mendation.) Bruxelles (ULB), Brussels, Belgium 4 ESGE recommends HSP for pedunculated polyps. To prevent 16 Konstantopoulio General Hospital, Athens, Greece bleeding in pedunculated colorectal polyps with head≥ 20mm or a 17 Department of Gastroenterology, Asklepios Klinik Altona, stalk≥ 10mm in diameter, ESGE recommends pretreatment of the Hamburg, Germany stalk with injection of dilute adrenaline and/or mechanical hemo- 18 Department of Endoscopy and Gastroenterology, Edouard stasis. (Moderate quality evidence, strong recommendation.) Herriot Hospital, Lyon, France Ferlitsch Monika et al. Colorectal polypectomy and … Endoscopy 5 ESGE recommends that the goals of endoscopic mucosal resec- and size, morphology, site, and access (SMSA) level 4. (Moderate tion (EMR) are to achieve a completely snare-resected lesion in the quality evidence; strong recommendation.) safest minimum number of pieces, with adequate margins and 7 For intraprocedural bleeding, ESGE recommends endoscopic co- without need for adjunctive ablative techniques. (Low quality evi- agulation (snare-tip soft coagulation or coagulating forceps) or me- dence; strong recommendation.) chanical therapy, with or without the combined use of dilute adre- 6 ESGE recommends careful lesion assessment prior to EMR to naline injection. (Low quality evidence, strong recommendation.) identify features suggestive of poor outcome. Features associated with incomplete resection or recurrence include lesion size An algorithm of polypectomy recommendations according to shape > 40 mm, ileocecal valve location, prior failed attempts at resection, andsizeofpolypsisgiven(▶ Fig.1). This Guideline is an official statement of the European So- ciety of Gastrointestinal Endoscopy (ESGE). The Grading of ABBREVIATIONS Recommendations Assessment, Development, and Evaluati- ASGE American Society for Gastrointestinal Endos- on (GRADE) system was adopted to define the strength of copy recommendations and the quality of evidence. CBF cold biopsy forceps CI confidence interval CRC colorectal cancer Introduction CSP cold snare polypectomy The endoscopic removal of colorectal polyps reduces the inci- EMR endoscopic mucosal resection dence and mortality of colorectal cancer (CRC) and is consid- ESD endoscopic submucosal dissection ered an essential skill for all endoscopists who perform colonos- ESGE European Society of Gastrointestinal Endoscopy copy [1 – 3]. Various polypectomy techniques and devices are FICE flexible spectral imaging color enhancement available, their use often varying based on local preferences (also Fuji Intelligent Chromo Endoscopy) and availability [4– 6]. This evidence-based Guideline was com- GRADE Grading of Recommendations Assessment, missioned by the European Society of Gastrointestinal Endos- Development and Evaluation copy (ESGE). It addresses all major issues concerning the prac- HBF hot biopsy forceps tical use of polypectomy and endoscopic mucosal resection HD-WLE high definition white light endoscopy (EMR), to inform and underpin this fundamental technique in HSP hot snare polypectomy colonoscopy and in CRC prevention. IPB intraprocedural bleeding This Guideline does not address management of anticoagu- I-SCAN i-SCAN digital contrast (Pentax; image proces- lants and other medications in the periprocedural setting, nor sing providing digital image-enhanced endos- post-polypectomy surveillance or quality measurements, as copy [IEE]) these are addressed in separate Guidelines [7– 9]. LSL laterally spreading lesion LST laterally spreading tumor MP muscularis propria Methods NBI narrow-band imaging The European Society of Gastrointestinal Endoscopy (ESGE) NICE NBI International Colorectal Endoscopic commissioned this Guideline and appointed a Guideline leader Classification (M.F.) who invited the listed authors to participate in the pro- NPV negative predictive value ject development. The key questions were prepared by the co- PEC prophylactic endoscopic coagulation ordinating team (M.F, A.M., M.J.B., C.H.) and then approved PPB post polypectomy bleeding by the other members. The coordinating team formed task PPV positive predictive value This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. force subgroups, each with its own leader, and divided the RCT randomized controlled trial key topics (polyp classification, polypectomy for polyps sized RR relative risk <20mm, EMR for polyps ≥ 20mm, technical considerations, SMI submucosal invasion adverse events, histopathology) among these task forces (see SMSA size, morphology, site, and access Appendix 1, available online in Supplementary material). STSC snare-tip soft coagulation Each task force performed a systematic literature search to TEMS transanal endoscopic microsurgery prepare evidence-based and well-balanced statements on their WHO World Health Organization assigned key questions. Searches were performed in Medline. WLE white light endoscopy Articles were first selected by title; their relevance was then confirmed by review of the corresponding manuscripts, and ar- ticles with content that was considered irrelevant were exclud- comes, articles were individually assessed by the level of evi- ed. Evidence tables were generated for each key question, sum- dence and strength of recommendation according to the Grad- marizing the evidence of the available studies (see Appendix 2, ing of Recommendations Assessment, Development, and Eval- available online in Supplementary
Load more

Recommended publications
  • High Number of Endometrial Polyps Is a Strong Predictor of Recurrence: findings of a Prospective Cohort Study in Reproductive-Age Women
    ORIGINAL ARTICLE: GYNECOLOGY AND MENOPAUSE High number of endometrial polyps is a strong predictor of recurrence: findings of a prospective cohort study in reproductive-age women Fang Gu, M.D.,a Huanxiao Zhang, M.D.,b Simin Ruan, M.D.,c Jiamin Li, M.D.,d Xinyan Liu, M.D.,a Yanwen Xu, M.D.,a,e and Canquan Zhou, M.D.a,e a Center for Reproductive Medicine, Department of Obstetrics and Gynecology, b Division of Gynecology, Department of Obstetrics and Gynecology, and c Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University; d Department of Obstetrics and Gynecology, Second Affiliated Hospital of Guangzhou Medical College; and e Key Laboratory of Reproductive Medicine of Guangdong Province, Guangzhou, People's Republic of China Objective: To compare the incidence of recurrence between a cohort with a high number (R6) of endometrial polyps (EPs) and a single- EP cohort among reproductive-age patients after polypectomy. Design: Prospective observational cohort study. Setting: Single university center. Patient(s): Premenopausal women who underwent hysteroscopic endometrial polypectomy were recruited. Intervention(s): Patients underwent a transvaginal ultrasound scan every 3 months after polypectomy to detect EP recurrence. Kaplan- Meier and Cox regression models were used to compare the risk of recurrence between the two cohorts and analyze the potential risk factors for EP recurrence. Main Outcome Measure(s): EP recurrence rate. Result(s): The study enrolled 101 cases with a high number of EP and 81 cases with a single EP. All baseline parameters were similar except that the high number of EP cohort had a slightly lower mean age than the single EP cohort (33.5 [range 30.0–39.0] vs.
    [Show full text]
  • ANMC Specialty Clinic Services
    Cardiology Dermatology Diabetes Endocrinology Ear, Nose and Throat (ENT) Gastroenterology General Medicine General Surgery HIV/Early Intervention Services Infectious Disease Liver Clinic Neurology Neurosurgery/Comprehensive Pain Management Oncology Ophthalmology Orthopedics Orthopedics – Back and Spine Podiatry Pulmonology Rheumatology Urology Cardiology • Cardiology • Adult transthoracic echocardiography • Ambulatory electrocardiology monitor interpretation • Cardioversion, electrical, elective • Central line placement and venous angiography • ECG interpretation, including signal average ECG • Infusion and management of Gp IIb/IIIa agents and thrombolytic agents and antithrombotic agents • Insertion and management of central venous catheters, pulmonary artery catheters, and arterial lines • Insertion and management of automatic implantable cardiac defibrillators • Insertion of permanent pacemaker, including single/dual chamber and biventricular • Interpretation of results of noninvasive testing relevant to arrhythmia diagnoses and treatment • Hemodynamic monitoring with balloon flotation devices • Non-invasive hemodynamic monitoring • Perform history and physical exam • Pericardiocentesis • Placement of temporary transvenous pacemaker • Pacemaker programming/reprogramming and interrogation • Stress echocardiography (exercise and pharmacologic stress) • Tilt table testing • Transcutaneous external pacemaker placement • Transthoracic 2D echocardiography, Doppler, and color flow Dermatology • Chemical face peels • Cryosurgery • Diagnosis
    [Show full text]
  • Adherence to Surveillance Guidelines Following Colonic Polypectomy Is Abysmal
    170 Original Article Adherence to surveillance guidelines following colonic polypectomy is abysmal Frederick H. Koh1, Dedrick K. H. Chan1,2, Jingyu Ng3, Ker-Kan Tan1,2 1Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health Systems, Singapore, Singapore; 2Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; 3Division of Colorectal Surgery, Department of General Surgery, Ng Teng Fong General Hospital, Singapore, Singapore Contributions: (I) Conception and design: FH Koh, KK Tan; (II) Administrative support: All authors; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: FH Koh, DK Chan, J Ng; (V) Data analysis and interpretation: FH Koh, DK Chan, J Ng; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Ker-Kan Tan. Division of Colorectal Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore 119228, Singapore. Email: [email protected]. Background: Surveillance guidelines following excision of colonic tubular adenomas are well established. However, adherence to the guidelines are rarely audited. The aim of our study was to evaluate the rate of compliance to the recommended guidelines following polyp removal. Methods: A review of a prospectively collected colonoscopy database in a single tertiary institution was conducted for all patients who underwent polypectomy in 2008. We excluded patients who were diagnosed with or had prior history of colorectal malignancy. The frequency of subsequent colonoscopic were evaluated against the recommended guidelines based on the clinico-histological characteristics of the removed polyps. Results: There were 419 colonoscopies with polypectomies performed in 2008.
    [Show full text]
  • The Appropriate Time Interval Between Hysteroscopic Polypectomy and the Start of FET : a Retrospective Corchort Study
    The Appropriate Time Interval Between Hysteroscopic Polypectomy and the Start of FET : A Retrospective Corchort Study Zhong-Kai Wang Zhengzhou University Third Hospital and Henan Province Women and Children's Hospital Hong-Wu Qiao Zhengzhou University Third Hospital and Henan Province Women and Children's Hospital She-Ling Wu Zhengzhou University Third Hospital and Henan Province Women and Children's Hospital Wen Zhang Zhengzhou University Third Hospital and Henan Province Women and Children's Hospital Xiao-Na Yu Zhengzhou University Third Hospital and Henan Province Women and Children's Hospital Jing Li Zhengzhou University Third Hospital and Henan Province Women and Children's Hospital Xing-Ling Wang Zhengzhou University Third Hospital and Henan Province Women and Children's Hospital Hua Lou Zhengzhou University Third Hospital and Henan Province Women and Children's Hospital Yi-Chun Guan ( [email protected] ) Zhengzhou University Third Hospital and Henan Province Women and Children's Hospital https://orcid.org/0000-0002-0312-3984 Research Keywords: Endometrial polyps, hysteroscopy, polypectomy, Frozen-embryo transfer, timing Posted Date: November 19th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-110131/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/14 Abstract Objective: To investigate when is the appropriate time interval between hysteroscopic polypectomy and the start of FET cycles Design: Retrospective cohort study. Setting: Academic center. Patient(s): All patients diagnosed with endometrial polyps undergoing hysteroscopic polypectomy before FET. Intervention(s): Hysteroscopic polypectomy. MainOutcomeMeasure(s): Patients were divided into four groups based on the time interval between hysteroscopic polypectomy and the start of FET Demographics, baseline FET characteristics, pregnancy outcomes after FET were compared among the groups.
    [Show full text]
  • Post-Polypectomy Colonoscopy Surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020
    Guideline Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020 Authors Cesare Hassan1, Giulio Antonelli1, Jean-Marc Dumonceau2, Jaroslaw Regula3, Michael Bretthauer4,Stanislas Chaussade5, Evelien Dekker6, Monika Ferlitsch7, Antonio Gimeno-Garcia8,RodrigoJover9,MetteKalager4,Maria Pellisé10,ChristianPox11, Luigi Ricciardiello12, Matthew Rutter13, Lise Mørkved Helsingen4, Arne Bleijenberg6,Carlo Senore14, Jeanin E. van Hooft6, Mario Dinis-Ribeiro15, Enrique Quintero8 Institutions 13 Gastroenterology, University Hospital of North Tees, 1 Gastroenterology Unit, Nuovo Regina Margherita Stockton-on-Tees, UK and Northern Institute for Hospital, Rome, Italy Cancer Research, Newcastle University, Newcastle 2 Gastroenterology Service, Hôpital Civil Marie Curie, upon Tyne, UK Charleroi, Belgium 14 Epidemiology and screening Unit – CPO, Città della 3 Centre of Postgraduate Medical Education and Maria Salute e della Scienza University Hospital, Turin, Italy Sklodowska-Curie Memorial Cancer Centre, Institute of 15 CIDES/CINTESIS, Faculty of Medicine, University of Oncology, Warsaw, Poland Porto, Porto, Portugal 4 Clinical Effectiveness Research Group, Oslo University Hospital and University of Oslo, Norway Bibliography 5 Gastroenterology and Endoscopy Unit, Faculté de DOI https://doi.org/10.1055/a-1185-3109 Médecine, Hôpital Cochin, Assistance Publique- Published online: 22.6.2020 | Endoscopy 2020; 52: 1–14 Hôpitaux de Paris (AP-HP), Université Paris Descartes, © Georg Thieme Verlag
    [Show full text]
  • NOAC-Doacs Perioperative Management
    NOACS/DOACS*: PERIOPERATIVE MANAGEMENT OBJECTIVE: To provide guidance for the perioperative management of patients who are receiving a direct oral anticoagulant (DOAC) and require an elective surgery/procedure. For guidance on management of patients who require an urgent or emergency surgery/procedure, please refer to the Perioperative Anticoagulant Management Algorithm found on the Thrombosis Canada website under the “Tools” tab. BACKGROUND: Four DOACs (apixaban, dabigatran, edoxaban and rivaroxaban) are approved for clinical use in Canada based on findings from large randomized trials. The perioperative management of DOAC-treated patients aims to interrupt anticoagulant therapy (if necessary) so there is no (or minimal) residual anticoagulant effect at the time of surgery, and to ensure timely but careful resumption after surgery so as to not incur an increased risk for post- operative bleeding. There are 3 important considerations for perioperative management of patients taking a DOAC: 1) Reliable laboratory tests to confirm the absence of a residual anticoagulant effect of DOACs are not widely available. 2) Half-lives of DOACs differ and increase with worsening renal function, affecting when the drug should be stopped before surgery. 3) DOACs have rapid onset of action, with a peak anticoagulant effect occurring 1-2 hours after oral intake. In the absence of laboratory tests to reliably measure their anticoagulant effect, the perioperative administration of DOACs should be influenced by: 1) Drug elimination half-life (with normal renal function), 2) Effect of renal function on drug elimination half-life 3) Bleeding risk associated with the type of surgery/procedure and anesthesia (Table 1) 4) Whether patient is to receive spinal/epidural anesthesia EVIDENCE SUPPORTING PERIOPERATIVE MANAGEMENT OF PATIENTS TAKING A DOAC: There are emerging data relating to the efficacy and safety of the proposed perioperative management of DOAC-treated patients.
    [Show full text]
  • Issues in the Diagnosis and Management of Functional
    By BSc (Hons), Grad Dip Sc. Comm., Grad Dip Psych A thesis submitted for the degree of School of Medicine Faculty of Health Sciences June 2017 1 TABLE OF CONTENTS TABLE OF CONTENTS .............................................................................................................................2 LIST OF FIGURES AND TABLES ...................................................................................................................6 ABSTRACT ...........................................................................................................................................8 DECLARATION..................................................................................................................................... 10 ACKNOWLEDGEMENTS ........................................................................................................................... 11 CONFERENCE PRESENTATIONS ................................................................................................................. 12 ADDITIONAL PUBLICATIONS ARISING FROM THE PHD RESEARCH .......................................................................... 13 CHAPTER 1 : OVERVIEW ..................................................................................................... 14 References .................................................................................................................................. 17 CHAPTER 2 : INTRODUCTION .............................................................................................. 18
    [Show full text]
  • Laparoscopic Colorectal Surgery for Colorectal Polyps: Experience of Ten Years
    ACTA MEDICA LITUANICA. 2017. Vol. 24. No. 1. P. 18–24 © Lietuvos mokslų akademija, 2017 Laparoscopic colorectal surgery for colorectal polyps: experience of ten years Audrius Dulskas1, Background. Laparoscopy or its combination with endoscopy is the next step for “difficult” polyps. The purpose of the paper was to Žygimantas Kuliešius1, review the outcomes of the laparoscopic approach to the management of “difficult” colorectal polyps. Narimantas E. Samalavičius1, 2 Materials and methods. From 2006 to 2016, 58 patients who under- went laparoscopic treatment for “difficult” polyps that could not be treat- 1 Department of Abdominal and ed by endoscopy at the National Cancer Institute, Lithuania, were includ- General Surgery and Oncology, ed. The demographic data, the type of surgery, length of post-operative National Cancer Institute, stay, complications, and final pathology were reviewed prospectively. Vilnius, Lithuania Results. The mean patient was 65.9 ± 8.9 years of age. Laparoscop- ic mobilization of the colonic segment and colotomy with removal of 2 Clinic of Internal Diseases, Family Medicine and the polyp was performed in 15 (25.9%) patients, laparoscopic segmental Oncology, Faculty of Medicine, bowel resection in 41 (70.7%) cases: anterior rectal resection with par- Vilnius University tial total mesorectal excision in 18 (31.0%), sigmoid resection in nine Vilnius, Lithuania (15.5%), left hemicolectomy in seven (12.1%), right hemicolectomies in two (3.4%), ileocecal resection in two (3.4%), resection of transverse colon in two (3.4%), and sigmoid resection with transanal retrieval of specimen in one (1.7%). Two patients (3.4%) underwent laparoscopic- assisted endoscopic polypectomy. The mean post-operative hospital stay was 5.7 ± 2.4 days.
    [Show full text]
  • Risks Associated with Anesthesia Services During Colonoscopy Karen J
    Gastroenterology 2016;150:888–894 Risks Associated With Anesthesia Services During Colonoscopy Karen J. Wernli,1,2 Alison T. Brenner,2,3 Carolyn M. Rutter,1,4 and John M. Inadomi2,3 1Group Health Research Institute, Seattle, Washington; 2Department of Health Services, 3 CLINICAL AT Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington; 4RAND Corporation, Santa Monica, California This article has an accompanying continuing medical education activity on page e18. Learning Objective: Upon completion of this test, successful learners will be able to (1) list colonoscopy complications associated with anesthesia instead of IV conscious sedation; (2) describe geographic diversity in use of anesthesia services in performance of colonoscopy; (3) describe polypectomy complications associated with use of anesthesia for colonoscopy. Keywords: Anesthesia Services; Endoscopy; Propofol; See editorial on page 801. Gastroenterology. Watch this article’s video abstract and others at http://bit.ly/1q51BlW. BACKGROUND & AIMS: We aimed to quantify the difference Scan the quick response (QR) code to the left with your mobile device to watch this article’s in complications from colonoscopy with vs without anes- video abstract and others. Don’t have a QR code thesia services. METHODS: We conducted a prospective reader? Get one by searching ‘QR Scanner’ in ’ cohort study and analyzed administrative claims data from your mobile device s app store. Truven Health Analytics MarketScan Research Databases from 2008 through 2011. We identified 3,168,228 colonoscopy procedures in men and women, aged 40–64 years old. Colo- noscopy complications were measured within 30 days, olonoscopy is the most common colorectal cancer including colonic (ie, perforation, hemorrhage, abdominal C screening test in the United States among average- 1 pain), anesthesia-associated (ie, pneumonia, infection, com- risk adults.
    [Show full text]
  • SJH Procedures
    SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service ABLATION, LESION, CERVIX AND VULVA, USING CO2 LASER LASER VAPORIZATION CERVIX/VULVA W CO2 LASER 56501 Destruction of lesion(s), vulva; simple (eg, laser surgery, Gynecology electrosurgery, cryosurgery, chemosurgery) 56515 Destruction of lesion(s), vulva; extensive (eg, laser surgery, Gynecology electrosurgery, cryosurgery, chemosurgery) 57513 Cautery of cervix; laser ablation Gynecology BIOPSY OR EXCISION, LESION, FACE AND NECK EXCISION/BIOPSY (MASS/LESION/LIPOMA/CYST) FACE/NECK General, Gynecology, Plastics, ENT, Maxillofacial BIOPSY OR EXCISION, LESION, FACE AND NECK, 2 OR MORE EXCISE/BIOPSY (MASS/LESION/LIPOMA/CYST) MULTIPLE FACE/NECK 11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); General, Gynecology, single lesion Aesthetics, Urology, Maxillofacial, ENT, Thoracic, Vascular, Cardiovascular, Plastics, Orthopedics 11103 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); General, Gynecology, each separate/additional lesion (list separately in addition to Aesthetics, Urology, code for primary procedure) Maxillofacial, ENT, Thoracic, Vascular, Cardiovascular, Plastics, Orthopedics 11104 Punch biopsy of skin (including simple closure, when General, Gynecology, performed); single lesion Aesthetics, Urology, Maxillofacial, ENT, Thoracic, Vascular, Cardiovascular, Plastics, Orthopedics 11105 Punch biopsy of skin (including simple closure, when General, Gynecology, performed); each separate/additional lesion
    [Show full text]
  • Colon Polypectomy
    Colon Polypectomy What Is A Polypectomy? rectum and colon. If a polyp is found during your colonoscopy, your doctor can remove it during the procedure. Most of the Polyps are abnormal growths that involve the lining of the time, polyps are removed using a snare, biopsy forceps, and/ colon and grow into the inside (or the tube) of the colon or by burning the base of the polyp with an electric current. or rectum. While the majority of polyps are benign, certain This process is usually pretty quick and painless. types have the potential to become cancerous. Because of this, these growths are removed during a routine screening colonoscopy using a technique called polypectomy. A polypectomy is an important tool that doctors have for How Do I Prepare For A Polypectomy? preventing colorectal cancer, the second leading cause of Your colon must be completely cleaned out before you have cancer deaths in the US, by removing polyps before they can a colonoscopy. This gives your doctor the best chance of become cancerous. finding any polyps that you may have in your colon. To clean your colon, your doctor will give you a laxative regimen to take at home before your test, along with specific instructions to follow about how to take it. The laxative will cause significant Why Do I Need A Polypectomy? watery diarrhea, so you will need to remain close to a While most polyps are not cancerous, removing polyps bathroom after you take it. leads to a sizeable reduction in your chances of getting Also, it is common for your doctor to ask you to limit your diet colorectal cancer in the future.
    [Show full text]
  • Coverage of Colonoscopy in Nevada Under the Affordable Care Act's
    COVERAGE OF COLONOSCOPY IN NEVADA UNDER THE AFFORDABLE CARE ACT’S PREVENTION BENEFIT BACKGROUND According to the Centers for Disease Control and Prevention (CDC), Nevada’s colorectal cancer screening rate is 58%i for people ages 50-75 who report being “up-to-date” with colorectal cancer screening, far below the Healthy People 2020 goal of 70.5% or the 80% by 2018 goal set forth by the National Colorectal Cancer Roundtable. This includes having had a fecal occult blood test (FOBT) during the previous year, a sigmoidoscopy within the previous five years and a FOBT within the previous three years, or a colonoscopy within the previous 10 years.ii Each of these USPSTFiii recommended colorectal cancer screening methods are covered as a preventive service without any patient cost-sharing, such as copays or deductibles, under the Affordable Care Act’s (ACA) Essential Health Benefits.iv This requirement became effective for new plans sold or renewed on or after September 23, 2010.v Research has shown that out-of-pocket costs, such as copays, deductibles, and co-insurance, may prevent some individuals from obtaining preventive services, such as colorectal cancer screening.vi By eliminating cost-sharing for those preventive health services recommended as most effective by the USPSTF, the ACA has tried to remove barriers to these evidence-based services. However in the case of colonoscopy, there are instances when a service initiated as a preventive screening can result in unexpected cost-sharing for that patient. These instances include: 1) removal of a polyp during screening colonoscopy; 2) colonoscopy performed as part of a two-step screening following a positive stool blood test; or 3) colonoscopy performed on an individual at higher risk for colon cancer that requires earlier or more frequent screening.
    [Show full text]