cold snare polypectomy 1) DDWD. K. Rex10mm cold snare polypectomy clean colon Cold snare polypectomy polypectomy 2) polypectomy 1cold snare pol
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1 87 1 Cold Snare/Forceps Polypectomy polypectomy hot biopsy 10mm 87 Cold Polypectomy cold polypectomy0mm cold polypectomy 87 1 Cold Polypectomy cold snare polypectomy cold forceps polypectomy5 cold polypectomy Japan Polyp Study cold forceps polypectomycold snare polypectomy
2 cold snare polypectomy 1) DDWD. K. Rex10mm cold snare polypectomy clean colon Cold snare polypectomy polypectomy 2) polypectomy 1cold snare polypectomy cold snare polypectomy polypectomy cold snare polypectomy 40 2 polypectomy820cold snare polypectomy12.5 cold snare polypectomy polypectomy1 3) cold Transmural burnpostpolypectomy syndrome cold snare polypectomy cold snare polypectomy polypectomy cold snare polypectomy 1 polypectomy 20 polypectomycold snare polypectomy cold 26cold cold cold 2 4) cold snare polypectomy 00 2 (N=40) (N=40) P < / 0 0 1(2.5%) 8(20%) / 0 3 / 1 5 Ichise Y, Horiuchi A, et al. Digestion 2011; 84: (N=35) (N=35) :10 24: INR (mm) (%) < (5.7%) 8(23%) (0%) 5(14%) /72(22%) 29/75(39%) Horiuchi A, et al. GIE 2014; 79: p
3 cold snare polypectomy snare 1 Captivator TM Small Hex polypectomy Cold snare polypectomy 1polypectomy cold snare cold snare polypectomy polypectomy mm 3 3) Cold snare polypectomy10mm cold snare polypectomy clean colon 1) Horiuchi A, et al. Digestion 2008; 78: ) Kazuhiko Shioji, et.al. Gastrointest Endosc 2003; 57: ) Ichise T, Horiuchi A, et al. Digestion 2011; 84: ) Horiuchi A, et al. GIE 2014; 79: cold Comparison of newly found polyps at follow-up colonoscopy after cold snare polypectomy and conventional polypectomy Group Cold Conventional p Total number of polyps newly found Pathology Adenoma Hyperplastic p 0 3 Size < 5 mm Shape Flat Sessile 9 8 Location Right colon Left colon 4 3 Japan Polyp Study cold polypectomy5mm Japan Polyp Study JPS ESD/EMR6mm 5mm JPS 2 1, mm Index Lesion ;IL 3 1 Cold polypectomy JPS6,102 5mm3, ,784 Index Lesion JPS: Per-protocol Analysis Randomized Pts 1464 CS: 1Y and 3Y 701 CS: 3Y 763 Newly detected adenomatous polyp 50.1% (n=351) 37.9% (n=289) Index Lesions (ILs) 1.7% (n=12) 2.1% (n=16) (Matsuda T, et al. DDW2014)
4 M80.2SM Index Lesion Non-index Lesion 2 JPS1 TCS mm 6-9 mm 10 mm Total Adenoma 3818 (99.8%) 1300 (96.9%) 641 (68.9%) 5759 LG* 3784 (98.9%) 1216 (90.7%) 480 (51.6%) 5480 HG** 34 (0.9%) 84 (6.3%) 161 (17.2%) 279 Tis (M) 8 (0.2%) 37 (2.8%) 184 (19.7%) 229 T1 (SM) 1 (0.03%) 4 (0.3%) 63 (6.7%) 68 ADV*** (4.9%) 46 Total 3827 (62.7%) 1341 (22.0%) 934 (15.3%) 6102 * LG: low-grade adenoma, ** HG: high-grade adenoma, *** ADV: pmp or deeper (. INTESTINE vol.18, No.3, 2014) 0.2 cold polypectomy 2 mm Non-IL (%) ORs (95%CI) IL(%) ORs (95%CI) ( ) ( ) ( ) ( ) ( ) 0 0 ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ( ) (. INTESTINE vol.18, No.3, 2014) 5mm Non-IL0mm 1.8IL 2 5mm SM 5mm 2009DISCARD 1) cold polypectomy mm SM polypoid growthpg non-polypoid growthnpg SM 5mm SM mm 0.54SM.551 SM SM / 0.14% 9/6657 5mm 0.54% 9/1669 SM 1.55% 9/583 5mm, % SM 0.54 SM NPGPGSM 94 SM 4 SM5mm 0.54SMNPG SM SMSM
5 444/9 SM 92 SM EMR SM NPG cold polypectomy SM22 Case 2: T/C, Is, 5mm, Adenoma EMR Case 2: NPG type, tub1, pt1b (SM1750 m), ly0, v0, pn0 1) Detect Inspect Characterize Resect and Discard 2 SM ly v pn Budding (Endoscopy, in press) ( m) 1 M 67 A Ip 5 Ad PO Op tub1 NPG G1 High 2 M 85 T Is 5 Ad EMR Op tub1 NPG G1 High 3 M 76 NET T Is 5 Ad EMR tub1 NPG N/E G1 Low 4 F 86 RS Is 4 Ad EMR tub1 NPG 1370 HM1 0 0 N/E G1 High 5 M 71 T Is 5 Ad EMR tub1 NPG N/E G1 Low 6 M 57 S IIc 5 M-Ca EMR tub1 NPG N/E G1 Low 7 M 53 S IIc 5 M-Ca EMR tub1 NPG N/E G1 Low 8 F 61 S IIa+IIc 5 SM-Ca Op tub1 NPG 3500 N/E 1 0 N/E G1 High 9 M 63 S IIa+IIc 5 Ad EMR tub1 NPG N/E G1 Low (Endoscopy, in press, ) 3 cold polypectomy Jumbocold forceps polypectomy 25 1 Third Eye NBI AFI NBI 5mm NBI 2) NBI5mm EMR polypectomy hot biopsy cold forceps polypectomy cold polypectomy hot biopsy cold forceps polypectomy hot biopsy cold forceps polypectomy cold forceps polypectomy Jumbo Cold forceps polypectomy Radial Jaw 4 Jumbo20135mm 1 2mmJumbo 5mm ) Cold Forceps Polypectomy Hot Biopsy Cold Forceps Polypectomy Hot Biopsy
6 2 3 Jumbo 5mm cold forceps polypectomy223 3) cold forceps polypectomy 4, cold forceps polypectomy hot biopsy Jumbo 8.8mm 1) Rex DK, et al. Gastroenterology 1997; 45(6): Postic G, et al. Am J Gastroenterol 2002; 97(12): Heresbach D, et al. Endoscopy 2008; 40(4): ) Ikematsu H, Saito Y, et al. J Gastroenterol 2012; 47(10): ) Uraoka T, et al. Dig Endosc 2014 Apr; 26 Suppl 2: Radial Jaw 4 Jumbo Radial Jaw 4 Standard Capacity Radial Jaw 3 Standard Capacity 12.4mm 3 5.3mm 3 5.3mm mm 10.2mm 11.0mm 2.8mm 2.2mm 2.2mm 3.2mm 2.8mm 2.8mm 8.8mm 7.1mm 7.3mm Jumbo cold forceps polypectomy Rate of one-bite polypectomy using Jumbo biopsy forceps according to lesion size Lesion size(mm) Rate of one-bite polypectomy 1 100% (4/4) 2 100% (31/31) 3 96% (103/107) 4 88% (45/51) 5 70% (21/30) Overall rate 91% (204/223) Radial Jaw 4 Jumbo Biopsy Forceps (Boston Scientific, Marlborough, MA, USA). Uraoka T, et al. Dig Endosc 2014 Apr; 26 Suppl 2: Cold Snare Polypectomy Cold snare polypectomy polypectomy 3, ) cold snare polypectomy 2,3,4) cold snare polypectomypolypectomycold snare polypectomy Cold snare polypectomy Cold snare polypectomy100 3) 5) cold snare polypectomy0mm1, ) cold snare polypectomy cold snare polypectomy 4 cold snare polypectomy % cold cold / Hb -2.0g/dL 1/1 0.8 Hb 3/ m m
7 % SM Captivator Profile Profile cold snare polypectomy 1 20 Cold snare polypectomy cold polypectomy19 EMRpolypectomy3S 2 cold snare polypectomy 0mm 1) Heldwein W, et al. Endoscopy 2005; 37(11): ) Deenadayalu VP, Rex DK. Gastrointestinal Endosc 2005; 62: ) Ichise Y, Horiuchi A, et al. Digestion 2011; 84: ) Paspatis GA, et al. Colorectal Disease 2011; 13: ) Hewett DG, et al. Clin Gastroenterol Hepatol 2011; 9(2): ) Repici A, et al. Endoscopy 2011; 44: Cold snare polypectomy Cold snare polypectomy S10mm s S9mm sp S7mm s R10mm sp 5mm 6-9mm 10mm Cold Snare polypectomy EMR/ESD SM MM m MM220 m MM230 m MM120 m MM280 m? SM Q1 5mm Japan Polyp Study 60TCS 5mms NBI D E serrated lesion
8 S serrated lesion 5mmserrated lesion 6mm serrated lesion Q1 Q2 1 Cold Forceps Polypectomy 2 Hot Biopsy 3 Cold Snare Polypectomy 4 Polypectomy 5 EMR EMR 5mmJumbo snare forcepscold polypectomy cold polypectomy low grade adenoma EMR SM 5mm NBI cold polypectomy NBI AFI BLI wider angle endoscopy NPV cold polypectomy Resect & DiscardResect Up date: New screening colonoscopy ADR or PDR using technology assisted endoscopy NBI (290) AFI BLI Wider angle endoscopy (FUSE etc ) Increasing number of ADR or PDR Assist:Precise optical diagnosis meet PIVI statement (NPV>90%) NBI CLM Magnifying chromoendoscopy Cost effectiveness colonoscopy Cold snare/forceps polypectomy Resect & discard Quality assurance: Education Training module & Discard 5mm recommendation 0 Endoscopic management for polyp 5mm & surveillance interval Endoscopic intervention Surveillance interval recommendation Evidence in Japan Polyp 5mm Follow? (-) Prevention for CRC Probably Low** Resect 3 years* JPS* High* Resect & Discard? (-) Probably High *: After 2 times clean colon, **: NPS data 220ABBZX B1X SC 3B1X B1X Boston Scientific Corporation or its affiliates. All rights reserved. Captivator TM, Radial Jaw TM, Profile TM Boston Scientific Corporation
Ⅱ Hb 4.1g/dl S LST G S ESD 10 S S 4 4 S D mL tub1 muc SS ly0 v0 PM0 DM0 N0 0/27 S tub1 tub2 SS
92 183 188 2016 1 1,2) 1) 1) 1) 1) 1) 3) 1) 2016 2 1 2016 3 11 84 S 2011 10 S 30 40 2 tub1 muc SS ly0 v0 PM0 DM0 N0 0/27 S 30 30 2 tub1 tub2 SS ly0 v0 PM0 DM0 N0 0/19 stage tub1 M ly0 v0 HM0 VM0 stage
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The Japanese Association for Behavior Analysis Newsletter, No. 35 The Japanese Association for Behavior Analysis Newsletter, No. 35 The Japanese Association for Behavior Analysis Newsletter, No. 35 Table
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