Case Presentation A 65-year-old female presented to the emergency department with the chief complaint of intermittent, periumbilical abdominal pain that had been ongoing for about one year. [cureus.com]

At 20 h post-EMR, she had low-grade fever and localized rebound tenderness was present at McBurney’s point. [wjgnet.com]

In this case, Professor Yahagi presents the case of a 67-year-old male patient with an incidental finding of a large rectal polyp during an MRI study. [websurg.com]

Heterogeneity was markedly reduced, although still present (heterogeneity: Chi² = 25.62, df = 15 (P = 0.04); I² = 41%). [cochranelibrary.com]

Potential reasons for these differences in percentages include variations among study subjects or reference populations and variability of the screening procedure to detect lesions that are present. [nejm.org]

• Asymptomatic

  The patient was asymptomatic until developing mild right-lower abdominal pain 7 h after the EMR. At 20 h post-EMR, she had low-grade fever and localized rebound tenderness was present at McBurney’s point. [wjgnet.com]

  Polyps are generally asymptomatic but may occasionally ulcerate and bleed; uncommonly, they may result in obstruction if very large. [emedicine.medscape.com]

  Rostom, “The association of colonoscopy quality indicators with the detection of screen-relevant lesions, adverse events, and postcolonoscopy cancers in an asymptomatic Canadian colorectal cancer screening population,” Gastrointestinal Endoscopy, vol. [hindawi.com]

• Overeating

  Acute appendicitis following colonoscopy is thought to be caused by increased intra luminal pressure due to over-inflation with air and by secondary obstruction of the appendiceal orifice due to inflammation of intestinal contents, including fecaliths [wjgnet.com]

  She reported associated, intermittent diarrhea over the past year as well. She had one episode of bright red blood per rectum two days prior, for which she presented to the emergency department. [cureus.com]

  In the National Polyp Study, the estimated reduction in the incidence of colorectal cancer ranged from 76 to 90% over a prolonged period of surveillance after colonoscopic polypectomy.3 Large case–control studies of screening colonoscopy5 and flexible [nejm.org]

  All studies included in this meta‐analysis except one reported the advantage of water infusion over air insufflation. The heterogeneity of the trials, although low (I² = 35%), might be due to the varying levels of experience of the endoscopists. [cochranelibrary.com]

• Abdominal Pain

  There was no abdominal pain, and her bowel sounds were normal on abdominal examination. Additionally, plain abdominal radiology demonstrated normal gas. [wjgnet.com]

  Children often present with abdominal pain/cramping, vomiting, passage of bloody mucus, and at times with a palpable abdominal mass. [cureus.com]

  The most obvious benefit is the reduction of procedure‐related abdominal pain. This benefit alone may enhance the acceptance of screening/surveillance colonoscopy and may help to reduce the needed dose of analgesics/sedatives. [cochranelibrary.com]

• Withdrawn

  We defined colonoscopic insertion time as the time from insertion into the rectum to identification of the base of the cecum and withdrawal time as the time from cecal identification to the time when the colonoscope was withdrawn across the anus. [nejm.org]

• Leukocytosis

  Post-polypectomy coagulation syndrome (PPCS), also known as post-polypectomy syndrome or transmural burn syndrome, refers to the development of abdominal pain, fever, leukocytosis, and peritoneal inflammation in the absence of frank perforation following [wjgnet.com]

Prophylactic antibiotic administration prior to the treatment of an appendiceal LST may be effective in preventing appendicitis, and prompt diagnosis of appendicitis following EMR can facilitate medical treatment, without the need for surgical intervention [wjgnet.com]

Because of the infrequency of this phenomenon, there is still no optimal consensus regarding treatment strategy, which differs wildly from children. [cureus.com]

Although benign, they are the direct precursors of adenocarcinomas and follow a predictable cancerous temporal course unless interrupted by treatment. They can be either pedunculated or sessile. [emedicine.medscape.com]

Cluster‐randomization is most effective with large numbers of clusters to balance potentially confounding characteristics in the treatment and control arms of the study. [cochranelibrary.com]

Bretthauer, “Quality indicators in colonoscopy,” Current Treatment Options in Gastroenterology, vol. 15, no. 3, pp. 416–428, 2017. View at: Publisher Site | Google Scholar N. A. Villa, R. Pannala, S. F. Pasha, and J. A. [hindawi.com]

Early resection before the polyp undergoes malignant transformation is key to long-term survival and to a favorable prognosis. Endoscopic submucosal dissection (ESD) has been developed based on endoscopic mucosal resection (EMR) techniques. [websurg.com]

Prognosis Transformation to malignancy is a primary consideration in villous adenomas. Note the following: Villous adenomas have a malignant risk of 15-25%. The risk of adenocarcinoma approaches 40% in villous adenomas larger than 4 cm in diameter. [emedicine.medscape.com]

In contrast to children, the majority of adult intussusceptions have a conclusive etiology in about 70-90% of the cases. Of the colonic intussusceptions, up to two-thirds are likely to be of malignant etiology [4]. [cureus.com]

The loss of the normal DCC gene is important in the transition from an intermediate adenoma to a late adenoma. [6] Etiology Genetic factors From the NPS data, relatives of patients with polyps have an increased risk of carcinoma. [emedicine.medscape.com]

Epidemiology United States data The prevalence of adenomas closely parallels the risk of colorectal cancer in a region. Adenomas are found in 30-40% of persons aged 60 years or older; in some areas, as many as 50% have adenomas. [emedicine.medscape.com]

Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea Jun Haeng Lee, Young-Ho Kim, Dong Kyung Chang, Poong-Lyul Rhee, Jae J Kim, Jong Chul Rhee & Hee Jung Son Department of Medicine and Welch Center for Prevention, Epidemiology [bmcgastroenterol.biomedcentral.com]

Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, and Management. 6th ed. Philadelphia: WB Saunders; 1997. 467-71. Sandler RS, Halabi S, Baron JA, et al. [emedicine.medscape.com]

Sleisenger & Fordtran's gastrointestinal and liver disease: pathophysiology, diagnosis, management. 7th ed. Philadelphia: Saunders, 2002: 2175-214. 22. Atkin WS, Morson BC, Cuzick J. [nejm.org]

Colorectal cancer prevention: is an ounce of prevention worth a pound of cure? Semin Oncol. 2005 Feb;32(1):24-34. Review. 6. Dietary calcium supplementation for preventing colorectal cancer and adenomatous polyps. [passeportsante.net]

Currently, however, there are no uniformly accepted infection prevention techniques or electrocautery settings[11]. [wjgnet.com]

Abstracts: COLORECTAL CANCER PREVENTION Impact of Cecal Intubation Rate on Adenoma Detection Rate: Analysis of Average Risk Screening Colonoscopy Examinations 1989 Hmoud, Bashar MD; Guturu, Praveen MD; Kochar, Rajan MD, MPH; Jampana, Sarat MD; Shabot, [journals.lww.com]

However, colonoscopy may be considered a painful and embarrassing process, and this view may prevent patients from participating in the examination [13, 14]. [hindawi.com]

Discussion Physicians and patients have embraced colonoscopy as an effective preventive measure against colorectal cancer. [nejm.org]