Background/Aims: The removal of small colon polyps by hot snare polypectomy (HP) is a commonly used method. Polypectomy with a cold snare (CP) has been increasingly utilized in recent years. Each method has its own advantages and disadvantages. Herein, we explored the efficacy and safety of each method. Materials and Methods: Between January 1, 2012 and June 30, 2012, 97 consecutive patients with small colorectal polyps ranging from 5-9 mm in size were separated into either the CP or HP group. Demographic data, the duration of polypectomy, and pathology reports were recorded. Results: Seventy-seven polyps were removed from 49 patients in the CP group, and 71 polyps were removed from 48 patients in the HP group. There was no significant difference between the groups with respect to gender, age distribution, number of polyps, or indications for colonoscopy. The mean polyp size was 7.21±1.4 mm in the CP group and 7.56±1.45 mm in the HP group (p=0.111). There was a significant difference in the mean procedure time between the two groups (CP, 25.71±4.3 sec; HP, 70.28±11.3 sec, p<0.001). One patient (1.3/1.4%) from each group developed post-polypectomy bleeding that required treatment. Histological evaluation revealed that 10 of the polyps (6.75%) were advanced adenomas. Pathological examination showed that the polyps were not completely removed in 4 patients (5.13%) in the CP group and 4 patients (5.63%) in the HP group (p=0.89). Conclusion: CP is an effective and safe method that shortens the polypectomy duration in small polyps (≤9 mm) compared to HP.

RFITT is efficacious, well tolerated by patients and has a low incidence of procedure-related post-operative complications.

For the first time efficacy and safety of a new prostaglandin E1 (PGE1) regimen in the treatment of intermittent claudication were evaluated in a randomized, double-blind, placebo-controlled multicenter clinical trial. The study involved 213 outpatients with a maximum walking distance of 50 to 200 m measured on the treadmill (3 km/hr, 12% grade). After a 2-week run-in phase they received a 2-hour intravenous infusion of 60 micrograms PGE1 or placebo 5 days a week for 4 weeks. It was followed by a 4-week interval treatment with the same medication administered only twice a week. Patients were monitored for 3 months when they received no study medication. In the PGE1 group the intention-to-treat analysis (n = 208) revealed an increase in walking distance after 4 weeks of 75% (placebo, 43%). At the end of the interval treatment the walking distance had improved to 101% (placebo, 60%). The results remained virtually constant during follow-up (PGE1, 104%, placebo, 63%). Between-group comparisons showed significant differences in favor of PGE1 for all three time points of measurement (p < 0.05, p < 0.01, and p < 0.05). PGE1 was well tolerated; the rate of adverse reactions related to the treatment was 12.8% (placebo, 7.7%). In summary, these results show that the new PGE1 regimen is effective and safe in the treatment of outpatients with intermittent claudication.

Different methods such as standard, hot, and jumbo forceps are used in endoscopic treatment of diminutive colon polyps. In the current study, it was aimed to compare efficacy and safety of standard and jumbo forceps polypectomy methods in treatment of diminutive colon polyps of ≤5 mm. Polyps with ≤5 mm which were excised during colonoscopy by using standard or jumbo forceps were evaluated. Standard and jumbo forceps polypectomy methods were randomly performed in 212 consecutive patients with diminutive colorectal polyp. One-bite polypectomy and complete resection rates were also determined among polypectomy methods. Results of 161 standard forceps polypectomy and 102 jumbo forceps polypectomy were retrospectively evaluated. Both one-bite polypectomy and complete resection rates were significantly higher in the jumbo forceps polypectomy group than the standard forceps polypectomy group (P < 0.001). In the subgroup analysis performed according to polyp sizes, complete resection rate among polyps with 3mm diameter was determined as 100%. However, numbers of bites in 4-mm and 5-mm polyps were higher in the standard forceps polypectomy group, and complete resection rate was lower than in the jumbo forceps polypectomy group (P < 0.001). Both endoscopic treatment methods may be employed in treatment of diminutive colon polyps with ≤5 mm. However, jumbo forceps polypectomy is a more effective treatment method in 4- to 5-mm polyps with high one-bite polypectomy and complete resection rate.

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The outcome of our series underscores the therapeutic value of balloon angioplasty in cases of severe PFAOD, as bailout treatment in critical limb ischaemia patients with technically demanding open profunda repair. This procedure can be repeated easily if significant restenosis occurs and provides a useful tool in selected cases.

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SummaryEndoluminal techniques such as laser therapy, radiofrequency therapy and sclerotherapy are increasingly replacing classic stripping for the treatment of incompetent saphenous veins. Interim results of the ongoing international, multicentre BRITTIV study to investigate the effectiveness and tolerability of the minimally invasive bipolar radiofrequency-induced thermal therapy (RFITT) are presented. Patients, methods: A flexible bipolar RFITT applicator is passed under ultrasound control into the affected vein of patients with varicosis of the great saphenous vein (GSV) or small saphenous vein (SSV). The vein is occluded by impedance-controlled release of radiofrequency energy as the RFITT applicator is slowly and smoothly withdrawn. The effectivness and tolerability of RFITT is checked over a one-year period by regular follow-ups. Results: To date a total of 345 saphenous veins (90% GSV, 10% SSV) in 271 patients (average age 50 years, 63% women, mean CEAP score 2.8) have been treated with RFITT in eight European hospitals. 72% of patients underwent general anaesthesia (18% spinal, 11% local) and tumescent anaesthesia was also used in 83% of the veins (mean length 45 cm). The average application time was 1.4 s/cm with a mean power output of 24 Watt. At the interim analysis after an average follow-up of 103 days, 90% of 335 treated veins were occluded. Differential analysis showed that partial (P) and complete (C) recurrences occurred significantly less often when longer application times had been used, whereby complete recurrences showed a greater reduction in frequency than partial. The total recurrence rate with an application time < 1 s/cm was 22% (P = 10%, C = 12%); with an application time between 1.0 and 1.4 s/cm it had already fallen to 9% (P = 6%, C = 3%) and with a time greater than 1.4 s/cm it was only 4% (P = 3%, C = 1%). According to subjective pain assessment on a visual analogue scale (VAS) of 0 to 10 (corresponding to no pain up to the strongest conceivable pain), by the first day after treatment already 74% of those questioned had only slight remaining pain or none at all (VAS 0–2). This generally low subjective pain sensation continued to fall at subsequent followups and at the 6-month follow-up, 99% of patients reported a VAS score of 0. Nearly all patients (99%) were satisfied with the treatment and would recommend it to others. Conclusions: With the same power output, even a minor increase in the application time to more than 1.4 s/cm can markedly reduce recurrence rate. In summary, the ongoing BRITTIV study illustrates the potential of RFITT for use in phlebology as it combines a spatially-defined obliteration of incompetent saphenous veins with overall moderate side effects and impressive results.