Browsing by Author "Ponugoti, Prasanna L."

Now showing 1 - 7 of 7
  • Thumbnail Image
    Item
    Cold snare polypectomy effectively reduces polyp burden in familial adenomatous polyposis
    (Thieme Publishing Group, 2016-04) Patel, Nedhi J.; Ponugoti, Prasanna L.; Rex, Douglas K.; Department of Medicine, IU School of Medicine
    BACKGROUND AND STUDY AIMS: Familial adenomatous polyposis (FAP) is generally managed by colectomy, but in some cases surgery is delayed and polyp burdens are managed endoscopically. We aimed to describe the use of cold snare polypectomy to control the polyp burden in selected patients with FAP. PATIENTS AND METHODS: This was a retrospective cohort study. Polyps were counted and the range of polyp size recorded at each examination. Patients with a reduction in polyp number and mean size were considered to have successful endoscopic reduction of their polyp burdens. RESULTS: Of 79 patients with FAP, 21 had an attempt at delaying surgery by cold snaring of at least 30 adenomas, and had at least one follow-up at our institution. Ten patients had intact colons, 6 had intact rectums, and 5 had heavy polyp burdens in an ileo-anal pouch. Among the 21 patients, the mean number of polyps resected at the first examination was 85, range 30 - 342. Nineteen of 21 patients had fewer polyps at the second examination, and of those, only one had any persistence of adenomas ≥ 1 cm in size. During follow-up, two patients underwent surgical resection and the remainder had reductions in their polyp burdens at follow-up endoscopy. CONCLUSIONS: Cold snare polypectomy effectively reduces polyp burden in selected FAP patients.
  • Thumbnail Image
    Item
    Endoscopic management of large ileocecal valve lesions over an 18-year interval
    (Thieme Open, 2019) Ponugoti, Prasanna L.; Broadley, Heather M.; Garcia, Jonathan; Rex, Douglas K.; Medicine, School of Medicine
    Background and study aims Ileocecal valve (ICV) lesions are challenging to remove endoscopically. Patients and methods This was a retrospective cohort study, performed at an academic tertiary US hospital. Sessile polyps or flat ICV lesions ≥ 20 mm in size referred for endoscopic mucosal resection (EMR) were included. Successful resection rates, complication rates and recurrence were compared to lesions ≥ 20 mm in size not located on the ICV. Results During an 18-year interval, there were 118 ICV lesions ≥ 20 mm with mean size 28.6 mm (44.9 % females; mean age 71.6 years), comprising 9.03 % of all referred polyps. Ninety ICV lesions (76.3 %) were resected endoscopically, compared to 91.3 % of non-ICV lesions (P < 0.001). However, in the most recent 8 years, successful EMR of ICV lesions increased to 93 %. Conventional adenomas comprised 92.2 % of ICV lesions and 7.8 % were serrated. Delayed hemorrhage and perforation occurred in 3.3 % and 0 % of ICV lesions, respectively, compared to 4.8 % and 0.5 % in the non-ICV group. At first follow-up, rates of residual polyp in the ICV and non-ICV groups were 16.5 % and 13.6 %, respectively (P = 0.485). At second follow-up residual rates in the ICV and non-ICV lesion groups were 18.6 % and 6.7 %, respectively (P = .005). Conclusions Large ICV polyps are a common source of tertiary referrals. Over an 18-year experience, risk of EMR for ICV polyps was numerically lower, and risk of recurrence was numerically higher at first follow and significantly higher at second follow-up compared to non-ICV polyps.
  • Thumbnail Image
    Item
    High yield of synchronous lesions in referred patients with large lateral spreading colorectal tumors
    (Elsevier, 2017-01) Bick, Benjamin L.; Ponugoti, Prasanna L.; Rex, Douglas K.; Department of Medicine, School of Medicine
    Background and Aims There are few data on the prevalence of synchronous colorectal lesions in patients who have large lateral spreading tumors (LLSTs). We sought to describe the rate of synchronous lesions found in patients who underwent endoscopic resection of large sessile adenomas and serrated lesions. Methods This is a retrospective assessment of a prospectively created database of 728 consecutive patients with resected LLSTs who underwent complete clearing of the colon during 2 colonoscopies by a single expert endoscopist. Results The 728 patients with resected LLSTs and complete clearing had 4578 synchronous lesions, including 584 patients (80.2%) with at least 1 synchronous conventional adenoma, 132 (18.1%) with at least 1 synchronous conventional adenoma ≥ 20 mm in size, 294 (40.4%) with at least 1 synchronous advanced conventional adenoma, and 6 patients with a synchronous lesion with cancer. Patients with an index large sessile conventional adenoma compared with those with an index large serrated lesion had on average more synchronous conventional adenomas (4.8 vs 2.9, P = .001) and fewer synchronous serrated lesions (1.4 vs 4.5, P < .001). Of the 97 patients with a serrated class index lesion, 28 (28.9%) met criteria for serrated polyposis. Conclusions There is a very high prevalence of synchronous lesions, including other large and advanced synchronous lesions, in patients with flat or sessile conventional adenomas and serrated colorectal polyps. Patients with LLSTs in the colon need detailed clearing of the rest of the colon. Patients referred for endoscopic resection of serrated lesions ≥ 20 mm have a very high prevalence of serrated polyposis. This study has potential implications for further stratification of high-risk patient groups in postpolypectomy surveillance guidelines.
  • Thumbnail Image
    Item
    High-definition colonoscopy versus Endocuff versus EndoRings versus Full-Spectrum Endoscopy for adenoma detection at colonoscopy: a multicenter randomized trial
    (Elsevier, 2018) Rex, Douglas K.; Repici, Alessandro; Gross, Seth A.; Hassan, Cesare; Ponugoti, Prasanna L.; Garcia, Jonathan R.; Broadley, Heather M.; Thygesen, Jack C.; Sullivan, Andrew W.; Tippins, William W.; Main, Samuel A.; Eckert, George J.; Vemulapalli, Krishna C.; Medicine, School of Medicine
    Background Devices used to improve polyp detection during colonoscopy have seldom been compared with each other. Methods We performed a 3-center prospective randomized trial comparing high-definition (HD) forward-viewing colonoscopy alone to HD with Endocuff to HD with EndoRings to the Full Spectrum Endoscopy (FUSE) system. Patients were age ≥50 years and had routine indications and intact colons. The study colonoscopists were all proven high-level detectors. The primary endpoint was adenomas per colonoscopy (APC) Results Among 1,188 patients who completed the study, APC with Endocuff (APC Mean ± SD 1.82 ± 2.58), EndoRings (1.55 ± 2.42), and standard HD colonoscopy (1.53 ± 2.33) were all higher than FUSE (1.30 ± 1.96,) (p<0.001 for APC). Endocuff was higher than standard HD colonoscopy for APC (p=0.014) . Mean cecal insertion times with FUSE (468 ± 311 seconds) and EndoRings (403 ± 263 seconds) were both longer than with Endocuff (354 ± 216 seconds) (p=0.006 and 0.018, respectively). Conclusions For high-level detectors at colonoscopy, forward-viewing HD instruments dominate the FUSE system, indicating that for these examiners image resolution trumps angle of view. Further, Endocuff is a dominant strategy over EndoRings and no mucosal exposure device on a forward-viewing HD colonoscope.
  • Thumbnail Image
    Item
    Perforation during underwater EMR
    (Elsevier, 2016-09) Ponugoti, Prasanna L.; Rex, Douglas K.; Department of Medicine, IU School of Medicine
    Underwater EMR is effective and safe and does not require submucosal injection. Here, we describe the first perforation during underwater EMR.
  • Thumbnail Image
    Item
    Risk of cancer in small and diminutive colorectal polyps
    (Elsevier, 2017-01) Ponugoti, Prasanna L.; Cummings, Oscar W.; Rex, Douglas K.; Department of Medicine, School of Medicine
    The prevalence of cancer in small and diminutive polyps is relevant to “resect and discard” and CT colonography reporting recommendations. We evaluated a prospectively collected colonoscopy polyp database to identify polyps <10 mm and those with cancer or advanced histology (high-grade dysplasia or villous elements). Of 32,790 colonoscopies, 15,558 colonoscopies detected 42,630 polyps <10 mm in size. A total of 4790 lesions were excluded as they were not conventional adenomas or serrated class lesions. There were 23,524 conventional adenomas <10 mm of which 22,952 were tubular adenomas. There were 14,316 serrated class lesions of which 13,589 were hyperplastic polyps and the remainder were sessile serrated polyps. Of all conventional adenomas, 96 had high-grade dysplasia including 0.3% of adenomas ≤5 mm in size and 0.8% of adenomas 6–9 mm in size. Of all conventional adenomas, 2.1% of those ≤5 mm in size and 5.6% of those 6–9 mm in size were advanced. Among 36,107 polyps ≤5 mm in size and 6523 polyps 6–9 mm in size, there were no cancers. These results support the safety of resect and discard as well as current CT colonography reporting recommendations for small and diminutive polyps.
  • Thumbnail Image
    Item
    Yield of a second screening colonoscopy 10 years after an initial negative examination in average-risk individuals
    (Elsevier, 2017-01) Ponugoti, Prasanna L.; Rex, Douglas K.; Department of Medicine, School of Medicine
    Background and Aims Current guidelines recommend screening colonoscopy at 10-year intervals in average-risk individuals who had baseline screening colonoscopy (no polyps or only hyperplastic polyps ≤5 mm in the recto-sigmoid colon), but the yield of repeat screening at 10 years is unknown. Our aim was to describe the yield of second screening colonoscopy in average-risk individuals performed at least 8 years after a first screening colonoscopy had shown no polyps or only distal hyperplastic polyps ≤5 mm in size. Methods This was a review of a database for colonoscopies performed at Indiana University Hospital between January 1999 and November 2015. Results A total of 4463 individuals underwent screening colonoscopy between January 1999 and July 2007, of which 1566 individuals had no polyps, and 334 individuals had only distal hyperplastic polyps ≤5 mm; 378 individuals (58.4% female) had follow-up screening at least 8 years after the baseline screening examination, with a mean (± standard deviation [SD]) interval of 9.74 years (± 1.2 years; range 8-15 years). Mean (± SD) age at baseline screening examination was 56.7 years (± 5.5 years) and at follow-up screening examination was 66.4 years (± 5.6 years). At the second screening, there were 224 patients (59.3%) with at least 1 polyp, including 144 (38.1%) with at least 1 conventional adenoma. The adenoma detection rate at the second screening examination was 36.1% and 56.8% in the groups with no polyp at baseline and with only distal hyperplastic polyps, respectively. There were 15 advanced neoplasms in 13 individuals (3.4%), of which 12 lesions were proximal to the sigmoid colon. There were no cancers at follow-up. Conclusions Among individuals aged ≥50 years, with normal baseline screening colonoscopy results, the incidence of advanced lesions at a second screening colonoscopy at least 8 years later was comparable to that in baseline screening studies. Our findings support current recommendations for screening at 10-year intervals in average-risk individuals.