Recent advances in the management of large and complex colonic polyps

The endoscopic management of large colonic polyps is a rapidly changing field. Rapid evolution in endoscopic techniques and skills has resulted in diminishing the role of surgery in the management of larger and complex polyps. This is resulting in organ preservation for many who otherwise would have undergone surgery. However, it also poses new challenges. This article reviews these new advances and the developments which are overcoming these difficulties

Video_1_Endoscopic ultrasound guided therapy of gastric varices: Initial experience in the Arab world (with video).mp4

Background and objectivesGastric varices (GV) bleeding is a catastrophic complication of portal hypertension and is associated with significant morbidity and mortality. There are limited effective therapeutic interventions for the management of bleeding GV. Recently, EUS-guided therapy has been shown to be effective and safe intervention for such patients. However, there are no data to describe the feasibility and safety of EUS-guided therapy for GV in Arab population. The aim of this study is to describe our initial experience of EUS-guided therapy for GV in Kuwait.MethodsA case-series of patients that underwent EUS-guided therapy for clinically significant GV. All patients underwent EUS-guided therapy including Cyanoacrylate (CYA) injection with or without coil embolization. Patients were followed post procedure to document GV obliteration and monitor for any adverse events.ResultsIn total, 15 patients were included in this study (80% male) with mean age of 58 ± 12 years. The main indication for therapy was active GV bleeding (53.3%) followed by secondary prophylaxis (33.3%). Most patients had GOV-2 (80%) with mean GV size of 24.9 ± 7.9 mm. Combined EUS coil-CYA was used in most patients (80%), mean volume of CYA injected was 1.5 ± 0.74ml and mean number coils used of 1.5 ± 1.4. The technical success rate was 100% and all patients achieved GV obliteration after a median of 1 session (range 1-2). There were no major adverse events.ConclusionAmong Arab population with portal hypertension, EUS-guided therapy is highly effective and safe option for the managements of clinically significant GV.</p

Association between sleep duration and dental caries in a nationally representative U.S. population

Abstract Background Dental caries is considered one of the most prevalent chronic diseases worldwide despite all dental public health efforts. Short sleep duration has been established as a risk factor for several medical conditions. In this study, we aimed to examine the relationship between sleep duration and dental caries. Methods Data were collected from the 2017–2018 cycle of the National Health and Nutrition Examination Survey, a nationally representative health survey conducted in the United States. Participants who completed sleep questionnaires were examined by dentists using standardized clinical criteria. Analysis was limited to Individuals aged ≥ 16 years with complete clinical oral examination data and who completed the sleep questionnaire (N = 5,205). The data were weighted to provide a national estimate, and multiple potential covariates were included in the analysis to account for the complex sample design. The main outcomes of the study were untreated dental caries and dental caries experience. The main predictor variables were average sleep hours/night and a binary variable with 7 h/night as a cut off. Multiple weighted Poisson and logistic regression analyses were conducted to test the hypothesis that people with short sleep duration are more likely to exhibit dental caries. Results This study showed a statistically significant negative relationship between sleep duration and dental caries amongst all weighted adjusted analyses conducted. For a one hour increase in average sleep hours, the Adjusted Odds Ratio (AOR) of having a dental caries experience might decrease by 0.86 (AOR = 0.86, 95% CI = 0.75–0.98, P < 0.05). Individuals who reported an average sleep of ≥ 7 h were less likely to have a dental caries experience compared to individuals who reported an average sleep of < 7 h (AOR = 0.52, 95% CI = 0.33–0.82, P < 0.05). For a one hour increase in average sleep hours, the Adjusted Mean Ratio (AMR) of having a dental caries experience might decrease by 0.97 (AMR = 0.97, 95% CI = 0.96–0.99, P < 0.05), and was lower for those who reported sleeping ≥ 7 h/night than individuals who reported sleeping < 7 h/night (AMR = 0.92, 95% CI = 0.87–0.99, P < 0.05). Conclusion Findings of this cross-sectional representative study of the U.S. population revealed a statistically significant negative association between sleep duration and dental caries. In this study, individuals who slept < 7 h/night were more likely to exhibit dental caries

OTH-004 blue light imaging for optical diagnosis of colorectal polyps: the impact of a training intervention

Introduction: the advent of image enhanced endoscopic modalities have paved the way for better optical diagnosis of colorectal polyps. Blue Light Imaging (BLI) is a new technology that utilises powerful light emitting diode technology to enhance mucosal surface and vessel patterns. A specific BLI classification has recently been developed to enable better characterisation of colorectal polyps (BLI Adenoma Serrated International Classification - BASIC) The aim of our study was to investigate the diagnostic ability of BLI before and after training using this classification in experienced and non-experienced endoscopists.Methods: BLI images from 45 polyps were shown to 10 endoscopists (5 with experience of advanced endoscopic imaging and 5 trainees with limited experience). They independently classified each of the images as adenoma or hyperplastic initially without any focused training on interpretation of BLI images. A training module on BASIC was developed and each endoscopist undertook a face to face training session where direct feedback was given. All endoscopists then repeated the image classification exercise. The sensitivity, specificity, accuracy, negative (NPV) and positive predictive value (PPV) for adenoma detection was calculated.Results: in both groups of endoscopists, there was a significant improvement in sensitivity and NPV of adenoma detection (p&lt;0.05) following training and utilisation of a dedicated BLI classification system (see table below). This improvement was greater in the experienced endoscopist cohort where overall higher accuracy rates were achieved with no decrease in specificity. [OTH-004 Table 1 not included].Conclusions: the use of a bespoke BLI classification system with adequate training can significantly improve the sensitivity and NPV of adenoma detection in both experienced and non-experienced endoscopists thereby enabling the full potential of this novel imaging technology to be realised

A novel self-assembling peptide for hemostasis during endoscopic submucosal dissection: a randomised controlled trial

Background  Endoscopic submucosal dissection (ESD) is associated with a risk of bleeding. Bleeding is usually treated with diathermy, although this does carry a risk of mucosal thermal injury. Purastat is a topical hemostat that may be effective in controlling bleeding during ESD, thereby reducing the use of heat therapy. The aim of this study was to assess the reduction in heat therapy used in the interventional group (Purastat) compared with the control group. The secondary aims were to compare the procedure length, time for hemostasis, delayed bleeding rate, adverse events, and wound healing between the groups. Methods  This was a single-center randomized controlled trial of 101 patients undergoing ESD. Participants were randomized to a control group where diathermy was used to control bleeding or an interventional group where Purastat could be used. Follow-up endoscopy was performed at 4 weeks to assess wound healing. Results  There was a significant reduction in the use of heat therapy for intraprocedural hemostasis in the interventional group compared with controls (49.3 % vs. 99.6 %, P  &lt; 0.001). There were no significant differences in the procedure length, time for hemostasis, and delayed bleeding rate between the groups. Complete wound healing at 4 weeks was noted in 48.8 % of patients in the interventional group compared with 25.0 % of controls (P  = 0.02). Conclusions  This study has demonstrated that Purastat is an effective hemostat that can reduce the need for heat therapy for bleeding during ESD. It may also have a role in improving post-resection wound healing.</p

Optical diagnosis of colorectal polyps with Blue Light Imaging using a new international classification

Background: Blue Light Imaging (BLI) is a new imaging technology that enhances mucosal surface and vessel patterns. A specific BLI classification was recently developed to enable better characterisation of colorectal polyps (BLI Adenoma Serrated International Classification (BASIC)). The aim of this study was to validate the diagnostic performance of BASIC in predicting polyp histology in experienced and trainee endoscopists. Methods: Five experienced and five trainee endoscopists evaluated high-definition white light (HDWL) and BLI images from 45 small polyps to assess baseline accuracy, sensitivity, specificity, and positive and negative predictive values (NPVs) of polyp histology. Each endoscopist was trained with the BLI classification before repeating the exercise. Results were compared pre- and post-training. Results: The overall pre-training accuracy improved from 87% to 94%. The sensitivity and NPV of adenoma diagnosis also improved significantly from 79% to 96% and 81% to 95% with BASIC training. This improvement was noted in both groups. The interobserver level of agreement was very good (K = 0.90) in the experienced cohort and good (K = 0.66) in the trainee group post-training. Conclusions: BLI is a useful tool for optical diagnosis, and the use of BASIC with adequate training can significantly improve the accuracy, sensitivity and NPV of adenoma diagnosis.status: publishe