Post-polypectomy surveillance: the present and the future

An appropriate post-polypectomy surveillance program requires the effectiveness of reducing colorectal cancer and safety. In addition, the post-polypectomy surveillance program should consider the burden of limited medical resource capacity, cost-effectiveness, and patient adherence. In this sense, a risk-stratified surveillance program based on baseline colonoscopy results is ideal. Major international guidelines for post-polypectomy surveillance, such as those from the European Union and the United States, have recommended risk-stratified surveillance programs. Both guidelines have recently been updated to better differentiate between high- and low-risk individuals. In both updated guidelines, more individuals have been downgraded to lower-risk groups that require less frequent or no surveillance. Furthermore, increased attention has been paid to the surveillance of patients who undergo serrated polyp removal. Previous guidelines in Japan did not clearly outline the risk stratification in post-polypectomy surveillance. However, the new colonoscopy screening and surveillance guidelines presented by the Japan Gastroenterological Endoscopy Society include a risk-stratified post-polypectomy surveillance program. Further discussion and analysis of unresolved issues in this field, such as the optimal follow-up after the first surveillance, the upper age limit for surveillance, and the ideal method for improving adherence to surveillance guidelines, are warranted

Effects of Abietane diterpenes from Rosmarinus officinalis on guinea pig hearts

A plant in the Lamiaceae family, rosemary ( Rosmarinus officinalis ) is a perennial shrub native to the Mediterranean region. The current study used right atrial specimens from guinea pigs to assess the biological activity of 3 catechol diterpenes with an abietane skeleton―carnosic acid (CA ― 1), demethylsalvicanol (DS ― 1), and carnosol (CN ― 1)―contained in rosemary. Administration of CA ― 1 had a positive inotropic effect (PIE) while administration of CN ― 1 conversely had a negative inotropic effect (NIE). Administration of DS ― 1 resulted in no changes in myocardial contractility. Administration of CA ― 1 or DS ― 1 did not result in significant changes in heart rate. However, administration of CN ― 1 had a negative chronotropic effect (NCE), and administration of CN ― 1 at a final concentration of 10 － 4 M caused cardiac arrest. In addition, the PIE of CA ― 1 was inhibited by prior administration of the phosphodiesterase (PDE) inhibitor IBMX (5 μM)

Recurrent advanced colonic cancer occurring 11 years after initial endoscopic piecemeal resection: a case report

<p>Abstract</p> <p>Background</p> <p>The high frequency of local recurrence occurring after endoscopic piecemeal resection (EPMR) for large colorectal tumors is a serious problem. However, almost all of these cases of local recurrence can be detected within 1 year and cured by additional endoscopic resection. We report a rare case of recurrent advanced colonic cancer diagnosed 11 years after initial EPMR treatment.</p> <p>Case presentation</p> <p>A 65-year-old male was diagnosed with a sigmoid colon lesion following a routine health check-up. Total colonoscopy revealed a 12 mm type 0-Is lesion in the sigmoid colon, which was diagnosed as an adenoma or intramucosal cancer and treated by EPMR in 1996. The post-resection defect was closed completely using metallic endoclips to avoid delayed bleeding. In 2007, at the third follow up, colonoscopy revealed a 20 mm submucosal tumor (SMT) like recurrence at the site of the previous EPMR. The recurrent lesion was treated by laparoscopic assisted sigmoidectomy with lymph node dissection.</p> <p>Conclusion</p> <p>When it is difficult to evaluate the depth and margins of resected tumors following EPMR, it is important that the defect is not closed in order to avoid tumor implantation, missing residual lesions and to enable earlier detection of recurrence. It is crucial that the optimal follow-up protocol for EPMR cases is clarified, particularly how often and for how long they should be followed.</p