OBJECTIVES: The removal of pre-malignant colorectal lesions prevents cancer. Hyoscine has been proposed as a means of improving diagnosis by reducing colonic movements. The aim of this study was to analyze whether this anti-spasmodic enhances the detection of pre-malignant colorectal lesions. METHODS: In a randomized, double-blinded fashion patients received hyoscine or a saline solution in all consecutive colonoscopies in which the cecum was reached. Lesions were analysed with respect to number, size, location, histology and capillary pattern. RESULTS: A total of 440 colonoscopies were randomized. The overall polyp detection rate (PDR) and the adenoma detection rate (ADR) were 65.2% and 49.3%, respectively. In the hyoscine group, non-polypoid lesions were detected significantly more often (p=0.01). In the placebo group 281 lesions were diagnosed (202 adenomas) and in the hyoscine group 282 lesions were detected (189 adenomas) (p=0.23). The PDR and ADR were similar between the placebo and hyoscine groups (64% vs 66% and 50% vs 47%, respectively). No differences were observed between the two groups in the advanced-ADR or advanced neoplasia detection rate, as well the mean numbers of polyps, adenomas, advanced adenomas and advanced neoplasias detected per patient. The administration of hyoscine also did not improve the diagnostic accuracy of digital chromoendoscopy. The presence of adenomatous polyps in the right colon was detected significantly more frequently in the hyoscine group (OR 5.41 95% CI 2.7 - 11; p<0.01 vs OR 2.3 95% CI 1.1 - 4.6; p=0.02). CONCLUSION: The use of hyoscine before beginning the withdrawal of the colonoscope does not seem to enhance the PDR and the ADR.

CONTEXTO: A mucosectomia endoscópica é uma técnica minimamente invasiva para o tratamento de neoplasias de cólon e reto, inclusive carcinomas precoces, de diferentes tamanhos e aspectos morfológicos. OBJETIVO: Avaliar a segurança, a eficácia, os resultados e a recurrência das lesões após mucosectomia. MÉTODOS: Entre maio de 2003 e maio de 2009 um total de 172 lesões em 156 pacientes foi incluído no estudo. Todas as lesões tinham padrão de criptas sugestivo de neoplasias (III-V), segundo a classificação de Kudo, com o diagnóstico feito por colonoscópios com magnificação de imagens e índigo-carmin. As lesões foram avaliadas quanto à macroscopia, tamanho, localização e histopatologia. Lesões com até 20 mm foram removidas em bloco e as maiores que 20 mm pela técnica de piecemeal. Complicações e recurrência foram analisadas. O seguimento foi de 18 meses. RESULTADOS: Este estudo identificou 83 (48,2%) lesões superficiais, sendo 57 (33,1%) deprimidas, além de 44 (25,6%) lesões de espraiamento lateral e 45 (26,2%) protrusas. O tamanho médio foi de 11,5 ± 9,6 mm (2-60 mm) e a idade média de 61,6 ± 12,5 anos (34-93 anos). No reto estavam 24 (14%) lesões, 68 (39,5%) no cólon esquerdo e 80 (46,5%) no cólon direito (transverso, ascendente e ceco). Foram 167 (97,1%) neoplasias, sendo 142 (82,5%) lesões adenomatosas, 24 (14,0%) carcinomas intramucosos e 1 (0,6%) carcinoma invasivo. Foram tratadas em bloco 158 (91,9%) lesões e 14 (8,1%), por piecemeal. Houve cinco casos (2,9%) de sangramento. A recurrência foi de 4,1% (5/122) e associada a lesões maiores que 20 mm (P<0,01), à técnica piecemeal (P<0,01), à neoplasia avançada (P = 0,01) e ao carcinoma quando comparado ao adenoma (P = 0,04). CONCLUSÕES: A mucosectomia endoscópica de lesões colorretais é procedimento seguro, eficaz, com baixo índice de complicações e recidiva local. A recidiva de lesão é associada a lesões maiores que 20 mm e aos carcinomas.

CONTEXT: Endoscopic mucosal resection is a minimally invasive technique used in the treatment of colorectal neoplasms, including early carcinomas of different size and morphology. OBJECTIVES: To evaluate procedure safety, efficacy, outcomes, and recurrence rate in endoscopic mucosal resection of colorectal lesions. METHODS: A total of 172 lesions in 156 patients were analyzed between May 2003 and May 2009. All lesions showed pit pattern suggestive of neoplasia (Kudo types III-V) at high-magnification chromocolonoscopy with indigo carmine. The lesions were evaluated for macroscopic classification, size, location, and histopathology. Lesions 20 mm or smaller were resected en bloc and lesions larger than 20 mm were removed using the piecemeal technique. Complications and recurrence were analyzed. Patients were followed up for 18 months. RESULTS: There were 83 (48.2%) superficial lesions, 57 (33.1%) depressed lesions, 44 (25.6%) laterally spreading tumors, and 45 (26.2%) protruding lesions. Mean lesion size was 11.5 mm ± 9.6 mm (2 mm-60 mm). Patients' mean age was 61.6 ± 12.5 years (34-93 years). Regarding lesion site, 24 (14.0%) lesions were located in the rectum, 68 (39.5%) in the left colon, and 80 (46.5%) in the right colon (transverse, ascending, and cecum). There were 167 (97.1%) neoplasms: 142 (82.5%) adenomatous lesions, 24 (14.0%) intramucosal carcinomas, and 1 (0.6%) invasive carcinoma. En bloc resection was performed in 158 (91.9%) cases and piecemeal resection in 14 (8.1%). Bleeding occurred in 5 (2.9%) cases. Recurrence was observed in 4.1% (5/122) of cases and was associated with lesions larger than 20 mm (P<0.01), piecemeal resection (P<0.01), advanced neoplasm (P = 0.01), and carcinoma compared to adenoma (P = 0.04). CONCLUSIONS: Endoscopic mucosal resection of colorectal lesions is a safe and effective procedure, with low complication and local recurrence rates. Recurrence is associated with lesions larger than 20 mm and carcinomas.