Juvenile polyposis syndrome is one of the hamartomatous polyposis syndromes and demonstrates phenotypic heterogeneity. All patients with juvenile polyposis develop colorectal polyps and are at risk of colorectal cancer. Small-bowel involvement is variably described. Small-intestinal cancer is reported but is rare and there is no evidence-based protocol for small-intestinal surveillance. This case series reports the small-bowel capsule endoscopy findings and genetic mutational analyses of ten adults (7-male; median age 39.2 years, interquartile range 37.4 - 42.0 years) with documented juvenile polyposis syndrome. Two patients had small-bowel polyps beyond the range of standard gastroscopy identified at capsule endoscopy: a 6-mm ileal polyp in one, and 10-mm and 6-mm ileal polyps in the second (histology unknown). Duodenal polyps were detected in a third patient at capsule endoscopy. Three further patients had previously documented duodenal polyps at surveillance gastroscopy. A SMAD4 mutation was identified in seven patients but there was no obvious association with gastric/small-bowel polyp burden. In conclusion, capsule endoscopy provided information additional to conventional endoscopy in patients with juvenile polyposis syndrome and was well tolerated. However, no lesions requiring clinical intervention were identified and polyp numbers were small. Capsule endoscopy may appropriately be used as a baseline investigation for the identification of patients with large or dense small-bowel polyps for whom ongoing small-bowel investigation would be recommended. Patients in whom polyps are confined to the colon are unlikely to require ongoing small-bowel review.

The formation of a stoma is an essential part of many colorectal operations. Despite the frequency with which these surgeries are performed and the number of specialists involved in stoma care, complications are still common. This article investigates the most common complications, explains the reasons for their occurrence and suggests potential management options. Common stoma complications were identified by the colorectal/ stoma clinical nurse specialist (CSCNS) and a literature search was performed using a variety of online databases, including Medline and CINAHL using the keywords stoma, complications, prolapse, ischaemia, retraction, hernia and stenosis. Articles used were selected on the basis of relevance to the topic. The commonest complications of stomas included skin irritation, prolapse, retraction, ischaemia, hernia and stenosis.

Postpolypectomy bleeding is often an unpredictable event that creates great anxiety for all concerned and, like all complications, is best avoided. The study by Di Giorgio et al. [1] published in this month's edition of Endoscopy provides useful new evidence to guide us in strategies aimed at preventing bleeding after polypectomy.The incidence of postpolypectomy bleeding is between 0.2 % and 3 % [2], while the other significant complications ± namely, postpolypectomy coagulation syndrome (0.5 ± 1 %) [3] and perforation (0.5 %) [4] ± are less frequent. Postpolypectomy bleeding can be characterized in different ways. It is defined as ªimmedi-ateº when bleeding occurs during the procedure such that endoscopic intervention is required; or as ªdelayedº if it occurs after the colonoscopy has been completed. Delayed bleeding generally presents within the first few days [3,5], but has been reported to occur as long as 30 days after polypectomy [6]. Immediate bleeding is usually due to inadequate coagulation of vessels in the polyp stalk or base, whereas delayed bleeding is thought to relate to detachment of the eschar several days after polypectomy, when a significant submucosal vessel is exposed [5]. The risk of either immediate or delayed bleeding is therefore dependent, at least in part, on the amount of tissue coagulation ± too little and immediate bleeding is likely, too much and deep tissue injury with the risk of delayed bleeding may occur. The degree of tissue injury incurred depends on the power settings and duration of current application, the type of current used, and ± most importantly ± the force applied to the snare during closure. For this reason, we strongly recommend (and teach) that endoscopists should become familiar with closing the snare themselves during diathermy application, so that they can develop a ªfeelº to guide the speed of cutting, while also observing for visible whitening of the polyp stalk on the video monitor. Most colonic polypectomies can be carried out using low-power diathermy settings, predominantly set to a coagulating current. Polypectomy using pure cutting current, which vaporizes tissue, may be associated with a higher risk of immediate bleeding [5,7]. Coagulating current heat-seals the blood vessels and is ideal for resecting large, stalked polyps in which the feeding vessels are often sizeable and the risk of damage to the bowel wall, remote from the stalk, is small. Postpolypectomy bleeding can also be graded as mild, moderate, or severe, depending on alterations in the haemoglobin level, transfusion requirements, or whether angiography or surgery become necessary. Fortunately, the majority of postpolypectomy bleeds are mild and self-limiting [8], and conservative management is therefore usually sufficient. Only a few patients with persistent bleeding requiring repeat colonoscopy or other interventions.What are the risk factors for bleeding after polypectomy? There appear to be several that are worth considering. With regard to the polyp itself, size is important [9]. A pedu...

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Zusammenfassung Die Pillcam-Kolonkapselendoskopie (CCE) ist eine innovative, nicht invasive peroral applizierbare Kapseltechnik, die die Untersuchung des Kolons ohne Sedierung und Gasinsufflation erm?glicht. Obwohl sie in Europa und anderen L?ndern bereits verf?gbar ist, sind die klinischen Indikationen der CCE, die Befundung und das Vorgehen bei detektierten Ver?nderungen bisher nicht standardisiert. Das Ziel dieser evidenzbasierten, konsensuellen Leitlinie, die von der Europ?ischen Gesellschaft f?r Gastrointestinale Endoskopie (ESGE) in Auftrag gegeben worden ist, ist es, Anbieter im Gesundheitssystem mit einem umfassenden Rahmen f?r die potenzielle Implementierung dieser Technik in klinische Abl?ufe auszustatten.