Ch.5 - Endoscopic Mngmt

Question 1

Withdrawal time of 6min as indicator of quality colonoscopy came from what?

Answer 1

2002 Us Multi-society task force on colorectal cancer

Question 2

What is the prevalence of advance adenomas in asymptomatic adults >50 yrs

Answer 2

6-9%

Question 3

Based on US National Polyp Study, what is an advanced adenoma?

Answer 3

> 1cm

Question 4

[Left/Right] side is associated with advanced pathologic features of polyps

Over what age are polyps associated with advanced pathologic features?

Answer 4

Left side

Over 60

Question 5

Contraindication to colonoscopic polypectomy

Answer 5

1) if there are characteristics suspicious for malignancy (firm/hard, mucosal irregularity, ulceration, central umbilication, if the polyp does not lift with submucosal injection)
2) if appearance suggests penetration deeper than the submucosa

Question 6

Polypectomy is best performed with the polyp in what position?

Answer 6

5-7 o’clock position

Question 7

What % of polyps remain at the site after cold forcep biopsy?

What about after hot biopsy?

Answer 7

29-38% have residual polypoid tissue

17%

Question 8

Cold snare can get what kind of margin around a polyp?

Answer 8

1-2mm

Question 9

What layer does standard polypectomy vs EMR get down to?

Answer 9

Standard polypectomy: mucosal

EMR: deep submicosal

Question 10

Indications for ESD

Answer 10

Endoscopic Submucosal Dissection.

1) when an en Bloc resection cannot be done with EMR
2) for polyps with intramucosal to shallow submucosal invasion/Submucosal fibrosis that cannot be lifted with Submucosal injectionduring conventional EMR

Question 11

Three ways CELS can be helpful?

Answer 11

Combined Endoscopic/Laparoscopic Surgery

1) underlying colon can be invaginated to assist snaring
2) laparoscopic mobilization of flexures and angulated colon
3) full thickness injuries can be detected/repaired