1
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Aziz M, Haghbin H, Gangwani MK, Beran A, Dahiya DS, Ali H, Sohail AH, Lee-Smith W, Hamdani SU, Kamal F, Adler DG. Efficacy and Safety of Endoscopic Through-the-Scope Suture System for Gastrointestinal Defects: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2024:00004836-990000000-00317. [PMID: 39008567 DOI: 10.1097/mcg.0000000000002019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/31/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVE Recently, a through-the-scope suturing (TTSS) system has received FDA approval and has been evaluated for closing mucosal defects postintervention. We hereby performed a systematic review and pooled meta-analysis of available studies to assess the safety and efficacy of this intervention. METHODS We queried the following databases through April 26, 2023: Embase, MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection. Endoscopists utilizing TTSS for the following reasons were included: endoscopic mucosal resection, endoscopic submucosal dissection, peroral endoscopic myotomy, perforation, fistula closure, and/or stent fixation. The outcomes assessed were technical success, primary clinical success (closure of defect without additional intervention), and overall clinical success (closure of defect with/without additional intervention). Random effects model with the DerSimonian Laird approach was used to report event rates expressed as proportions with a 95% CI. RESULTS A total of 12 studies with 512 patients (mean age of 61.5 ± 18.4 y, 54.6% females) were included. The technical success rate was 96.0% (CI: 94.3%-97.7%). The primary clinical success rate was 74.8% (CI: 65.5%-84.1%). The overall clinical success rate was 95.4% (CI: 92.6-98.2%). Only 1 mortality case unrelated to intervention was reported. CONCLUSION The TTSS appears safe and effective for closing mucosal defects after therapeutic endoscopic interventions. Further cost-effective studies should be performed comparing with endoclips for use in clinical settings.
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Affiliation(s)
- Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo, OH
| | - Hossein Haghbin
- Division of Gastroenterology and Hepatology, East Carolina University, Greenville, NC
| | - Manesh Kumar Gangwani
- Division of Gastroenterology and Hepatology, East Carolina University, Greenville, NC
| | | | - Dushyant Singh Dahiya
- Division of Gastroenterology and Hepatology, East Carolina University, Greenville, NC
| | - Hassam Ali
- Division of Gastroenterology and Hepatology, East Carolina University, Greenville, NC
| | | | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, OH
| | | | - Faisal Kamal
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA
| | - Douglas G Adler
- Centura Health, Center for Advanced Therapeutic Endoscopy, Englewood, CO
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2
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Zhou Y, Huang Y, Cheng W, Wang J, Liu X, Peng H, Zhang J, Feng Q. Safety and efficacy of a modified endoscopic full-thickness resection technique for gastric submucosal tumors: a case series. Front Oncol 2024; 14:1403517. [PMID: 39045560 PMCID: PMC11263104 DOI: 10.3389/fonc.2024.1403517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/07/2024] [Indexed: 07/25/2024] Open
Abstract
Objectives Endoscopic full-thickness resection (EFTR) has proven effective and economical for patients with gastric submucosal tumors (SMTs). However, the poor operative field of view, the risk of massive hemorrhage, and the difficulties in defect closure have limited its widespread application. Herein, we described a modified EFTR technique developed to simplify the dissection and defect closure procedures using common and economical endoscopic accessories. Methods Forty-two patients who underwent the modified EFTR for gastric SMTs in the Shenzhen Guangming District People's Hospital were enrolled in the case series. Following a cross incision to expose the intraluminal surface the tumors were captured by suction through a transparent cap and the roots were ligated using a loop. The tumors and part of the suction tissue were removed along the ligated root. A tension-relieving closure was performed by clipping the raised plica in four quadrants outside the ligated root. Patient demographics, tumor characteristics, and therapeutic outcomes were evaluated retrospectively. Results All tumors had an R0 resection. The median procedure time was 51.8 min (IQR 34.25 min). No severe perioperative adverse events occurred. No residual lesion or recurrence was reported during the follow-up period of 9.84 months (IQR 5.0 months). Conclusion The safety and practicability of Modified-EFTR could allow for wide clinical application in patients with micro-gastric SMTs.
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Affiliation(s)
| | | | - Wen Cheng
- Department of Gastroenterology, Shenzhen Guangming District People’s Hospital, Shenzhen, Guangdong, China
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3
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Yoo IK, Cho YK, Kim SW, Choi SY, Noh DS, Jang JY, Baik GH, Jang S, Vargo J, Cho JY. Is it enough to observe less than 2 cm sized gastric SET? Surg Endosc 2023; 37:6798-6805. [PMID: 37264226 DOI: 10.1007/s00464-023-10110-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/30/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND AIMS The recent surge in demand for screening endoscopy has led to an increased detection of gastric subepithelial tumors (SETs). According to current guideline, SETs less than 2 cm in size are recommended for periodic surveillance. In light of recent advancement in therapeutic endoscopy in resection of small SET, we analyzed the histopathological features and the effectiveness of endoscopic resection for these small SETs. METHODS Retrospectively study was performed on 74 patients who underwent endoscopic resection of gastric small (≤ 2 cm) upper gastrointestinal tract SETs. The outcomes including histopathology and en bloc resection were analyzed. RESULTS The mean SET size was 11.69 ± 5.11 mm. The mean procedure time was 81.26 ± 42.53 min. Of the 74 patients, 28 patients had leiomyomas, 26 had gastrointestinal stromal tumors (GISTs), 14 had ectopic pancreas, 4 had lipomas, and 2 had neuroendocrine tumors. Among those with GIST, two patients exhibited high-risk histology. All patients underwent successful and uneventful endoscopy. CONCLUSIONS Endoscopic resection can be recommended even for the small gastric SETs. In our study, we found that SETs with a size of less than 2 cm have significant proportion of GISTs which harbor malignant transformation potential.
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Affiliation(s)
- In Kyung Yoo
- Division of Gastroenterology, Department of Internal Medicine, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si, South Korea
| | - Young Kwan Cho
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Cha Medical Center, Cha University College of Medicine, 569, Nonhyon-ro Gangnam-gu, Seoul, South Korea
| | - Seong Whan Kim
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Cha Medical Center, Cha University College of Medicine, 569, Nonhyon-ro Gangnam-gu, Seoul, South Korea
| | - Seung Yoon Choi
- Division of Gastroenterology, Department of Internal Medicine, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si, South Korea
| | - Dae Suk Noh
- Division of Gastroenterology, Department of Internal Medicine, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si, South Korea
| | - Jae Young Jang
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Gwang Ho Baik
- Division of Gastroenterology, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - John Vargo
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Joo Young Cho
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Cha Medical Center, Cha University College of Medicine, 569, Nonhyon-ro Gangnam-gu, Seoul, South Korea.
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4
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Obri M, Ichkhanian Y, Brown P, Almajed MR, Nimri F, Taha A, Agha Y, Jesse M, Singla S, Piraka C, Zuchelli TE. Full-thickness resection device for management of lesions involving the appendiceal orifice: Systematic review and meta-analysis. Endosc Int Open 2023; 11:E899-E907. [PMID: 37810898 PMCID: PMC10558260 DOI: 10.1055/a-2131-4891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 07/11/2023] [Indexed: 10/10/2023] Open
Abstract
Background and study aims Endoscopic resection of lesions involving the appendiceal orifice is technically challenging and is commonly referred for surgical resection. However, post-resection appendicitis is a concern. Many studies have varying rates of post-procedure appendicitis. We aim to report the rate of post-resection appendicitis by performing a systematic review and meta-analysis. Methods Studies that involved the use of a full-thickness resection device (FTRD) for management of appendiceal polyps were included. The primary outcome was appendicitis after FTRD and a subgroup analysis was performed on studies that only included FTRD performed at the appendiceal orifice. Results Appendicitis was encountered in 15% (95%CI: [11-21]) of the patients with 61% (95% CI: [44-76]) requiring surgical management. Pooled rates of technical success, histologic FTR, and histologic R0 resection in this sub-group (n=123) were 92% (95% CI: [85-96]), 98% (95% CI: [93-100]), and 72% (95% CI: [64-84%]), respectively. Post-resection histopathological evaluation revealed a mean resected specimen size of 16.8 ± 5.4 mm, with non-neoplastic pathology in 9 (7%), adenomas in 103 (84%), adenomas + high-grade dysplasia (HGD) in nine (7%), and adenocarcinoma in two (2%). The pooled rate for non-appendicitis-related surgical management (technical failure and/or high-risk lesions) was 11 % (CI: 7-17). Conclusions FTRD appears to be an effective method for managing appendiceal lesions. However, appendicitis post-resection occurs in a non-trivial number of patients and the R0 resection rate in appendiceal lesions is only 72%. Therefore, caution should be employed in the use of this technique, considering the relative risks of surgical intervention in each patient.
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Affiliation(s)
- Mark Obri
- Internal Medicine, Henry Ford Health System, Detroit, United States
| | | | - Patrick Brown
- Division of Gastroenterology, Henry Ford Health System, Detroit, United States
| | | | - Faisal Nimri
- Division of Gastroenterology, Henry Ford Health System, Detroit, United States
| | - Ashraf Taha
- Division of Gastroenterology, Henry Ford Health System, Detroit, United States
| | - Yasmine Agha
- Division of Gastroenterology, Henry Ford Health System, Detroit, United States
| | - Michelle Jesse
- Internal Medicine, Henry Ford Health System, Detroit, United States
| | - Sumit Singla
- Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, United States
| | - Cyrus Piraka
- Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, United States
| | - Tobias E. Zuchelli
- Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, United States
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5
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Ullah S, Ali FS, Ostovan M, Liu BR. Helix tack-and-suture device for mucosal defect closure following colorectal endoscopic submucosal dissection: is it ready for global adoption? Endoscopy 2023; 55:780. [PMID: 37499653 DOI: 10.1055/a-2046-5159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Saif Ullah
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Faisal S Ali
- Gastroenterology, Hepatology, and Nutrition Department, University of Texas Health Science Center at Houston, Texas, United States
| | - Maral Ostovan
- School of International Education and School of Stomatology, Zhengzhou University, Zhengzhou, China
| | - Bing-Rong Liu
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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6
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Rinke A, Ambrosini V, Dromain C, Garcia-Carbonero R, Haji A, Koumarianou A, van Dijkum EN, O'Toole D, Rindi G, Scoazec JY, Ramage J. European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for colorectal neuroendocrine tumours. J Neuroendocrinol 2023; 35:e13309. [PMID: 37345509 DOI: 10.1111/jne.13309] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 06/23/2023]
Abstract
This ENETS guidance paper, developed by a multidisciplinary working group, provides an update on the previous colorectal guidance paper in a different format. Guided by key clinical questions practical advice on the diagnosis and management of neuroendocrine tumours (NET) of the caecum, colon, and rectum is provided. Although covered in one guidance paper colorectal NET comprises a heterogeneous group of neoplasms. The most common rectal NET are often small G1 tumours that can be treated by adequate endoscopic resection techniques. Evidence from prospective clinical trials on the treatment of metastatic colorectal NET is limited and discussion of patients in experienced multidisciplinary tumour boards strongly recommended. Neuroendocrine carcinomas (NEC) and mixed neuroendocrine non-neuroendocrine neoplasms (MiNEN) are discussed in a separate guidance paper.
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Affiliation(s)
- Anja Rinke
- Department of Gastroenterology, University Hospital Marburg and Philipps University Marburg, Marburg, Germany
| | - Valentina Ambrosini
- Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCSS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Clarisse Dromain
- Department of Radiology, CHUV Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Amyn Haji
- Department of Colorectal Surgery, King's College Hospital, London, UK
| | - Anna Koumarianou
- Hematology Oncology Unit, Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Els Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC, Amsterdam, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Dermot O'Toole
- NET Center of Excellence, St Vincent's University Hospital and St James Hospital Dublin 8 and Trinity College Dublin, Dublin, Ireland
| | - Guido Rindi
- Section of Anatomic Pathology, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore; Unit of Head and Neck, Thoracic and Endcorine Pathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS; Roma European NeuroEndocrine Tumor Society (ENETS) Center of Excellence, Rome, Italy
| | - Jean-Yves Scoazec
- Department of Pathology, Gustave Roussy Cancer Campus, Villejuif, France, Université Paris Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, Villejuif, France
| | - John Ramage
- Department of Gastroenterology, Hampshire Hospitals and ENETS Center, Kings Health Partners London, London, UK
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Chetcuti Zammit S, Sidhu R. Small bowel neuroendocrine tumours - casting the net wide. Curr Opin Gastroenterol 2023; 39:200-210. [PMID: 37144538 DOI: 10.1097/mog.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW Our aim is to provide an overview of small bowel neuroendocrine tumours (NETs), clinical presentation, diagnosis algorithm and management options. We also highlight the latest evidence on management and suggest areas for future research. RECENT FINDINGS Dodecanetetraacetic acid (DOTATATE) scan can detect NETs with an improved sensitivity than when compared with an Octreotide scan. It is complimentary to small bowel endoscopy that provides mucosal views and allows the delineation of small lesions undetectable on imaging. Surgical resection is the best management modality even in metastatic disease. Prognosis can be improved with the administration of somatostatin analogues and Evarolimus as second-line therapies. SUMMARY NETs are heterogenous tumours affecting most commonly the distal small bowel as single or multiple lesions. Their secretary behaviour can lead to symptoms, most commonly diarrhoea and weight loss. Metastases to the liver are associated with carcinoid syndrome.
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Affiliation(s)
| | - Reena Sidhu
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Department of Infection, Immunity and Cardiovascular Diseases, University of Sheffield, Sheffield, UK
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8
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Li MM, Zhang Y, Sun F, Huai MX, Zhang FY, Qu CY, Shen F, Li ZH, Xu LM. Feasibility and efficacy of endoscopic purse-string suture-assisted closure for mucosal defects induced by endoscopic manipulations. World J Gastroenterol 2023; 29:731-743. [PMID: 36742166 PMCID: PMC9896609 DOI: 10.3748/wjg.v29.i4.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/27/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Large or transmural defects induced by gastrointestinal endoscopic manipulations are difficult to close, although complete closure is recommended for better recovery. Endoscopic purse-string assisted suturing (EPSS) has been used in clinical practice and has proven to be an effective and safe technique for the closure of large mucosal defects. However, details regarding the efficacy of endoscopic pre-purse-string suture (P-EPSS) are unknown, especially that it offers several advantages over conventional EPSS (C-EPSS).
AIM To elucidate the outcomes of EPSS-assisted closure in different clinical situations, and evaluate the efficacy of P-EPSS.
METHODS This retrospective observational study included a total of 180 patients who underwent closure assisted by P-EPSS (n = 63) or C-EPSS (n = 117) between July 2014 and June 2020. The P-EPSS and C-EPSS groups were compared and the intergroup differences in aspects such as the lesion size, location, and mor-phology, incidence of complete closure, intraoperative perforation, and delayed adverse events were evaluated. Data on the features and clinical course of cases with adverse events were collected for further analysis.
RESULTS Patients with lesion size larger than 3 cm, lesions located at the fundus of stomach, or submucosal tumors originating from the deep mucosa were more likely to undergo P-EPSS-assisted closure. The P-EPSS group showed a sign-ificantly higher proportion of intraoperative perforation (56% vs 17%) and a much shorter procedure time (9.06 ± 6.14 min vs 14.84 ± 7.25 min). Among adverse events, the incidence of delayed perforation (5% vs 4%; P = 0.82) and delayed bleeding (3% vs 4%; P = 0.96) did not differ significantly between the groups. Multivariate analysis revealed that lesions with incomplete closure [odds ratio (OR) = 21.33; 95% confidence interval (CI): 5.45-83.45; P < 0.01] or size greater than 3 cm (OR = 3.14; 95%CI: 1.08-9.18; P = 0.039) showed a statistical tendency to result in an increase in delayed adverse events.
CONCLUSION The present study revealed that EPSS could achieve secure complete closure of mucosal defect. P-EPSS could shorten the procedure and yield complete closure of mucosal defects. Rather than closure-type selection, incomplete closure or lesion size larger than 3 cm were associated with worse outcomes.
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Affiliation(s)
- Ming-Ming Li
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Yi Zhang
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Fang Sun
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Man-Xiu Huai
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Fei-Yu Zhang
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Chun-Ying Qu
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Feng Shen
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Zheng-Hong Li
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Lei-Ming Xu
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
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9
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Wang K, Gao P, Cai M, Song B, Zhou P. Endoscopic full-thickness resection, indication, methods and perspectives. Dig Endosc 2023; 35:195-205. [PMID: 36355358 DOI: 10.1111/den.14474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022]
Abstract
Minimally invasive surgery has emerged as the dominant theme of modern surgery, in which endoscopic surgery plays a key role. The technique of endoscopic surgery has evolved continuously with extensive research, improving the treatment modalities as well as expanding the indications for its use. As an active perforation endoscopic technique, endoscopic full-thickness resection (EFTR) is mainly used in the treatment of submucosal tumors (SMTs) of the gastrointestinal tract. With decades of evolution, EFTR has gradually developed into a mature endoscopic operation. Based on clinical experience and current research, indications, techniques, clinical outcomes and future perspectives for EFTR are discussed in this paper. We performed a bibliometric study on EFTR literature and showed robust data through a brief meta-analysis on the topic.
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Affiliation(s)
- Kehao Wang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Pingting Gao
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Mingyan Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Baohui Song
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pinghong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
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10
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Cheema H, Raghavapuram S, Boston I, Cengiz C, Anastasiou J, Inamdar S, Tharian B. Resection of subepithelial lesions by a novel technique: "Band endoscopic full-thickness resection". Endoscopy 2022; 54:E972-E973. [PMID: 35913061 PMCID: PMC9736815 DOI: 10.1055/a-1882-5063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Hira Cheema
- Department of Internal Medicine, Baptist Health Medical Center, Little Rock, Arkansas, USA
| | - Saikiran Raghavapuram
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas, USA
| | - Iman Boston
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas, USA,Division of Gastroenterology and Hepatology, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Cem Cengiz
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas, USA,Division of Gastroenterology and Hepatology, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Jiannis Anastasiou
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas, USA,Division of Gastroenterology and Hepatology, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Sumant Inamdar
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas, USA,Division of Gastroenterology and Hepatology, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Benjamin Tharian
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas, USA,Division of Gastroenterology and Hepatology, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
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Inokuchi Y, Hayashi K, Kaneta Y, Okubo Y, Watanabe M, Furuta M, Machida N, Maeda S. Endoscopic mucosal resection using a ligation device for duodenal neuroendocrine tumors: a simple method. Ther Adv Gastrointest Endosc 2022; 15:26317745221103735. [PMID: 35706683 PMCID: PMC9189549 DOI: 10.1177/26317745221103735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/05/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction: Duodenal neuroendocrine tumors (DNETs) smaller than 1 cm in diameter, without invasion to the muscularis propria, have a low risk of metastasis. Therefore, DNETs are frequently resected endoscopically. However, among the various procedures, the best fit for DNET in terms of feasibility, effectiveness, and simplicity is unclear. Methods: Patients with DNET who underwent endoscopic submucosal resection using a ligation device (ESMR-L) at Kanagawa Cancer Center between May 2003 and December 2020 were studied retrospectively to evaluate clinical characteristics and short-term and long-term outcomes. Results: Eleven consecutive patients with 12 lesions were treated with 12 sessions of ESMR-L. Lesions were discovered in patients at a median age of 68 (range, 50–83) years. One patient had two lesions at the time of the initial ESMR-L session. Eleven of the 12 lesions (91.7%) existed in the duodenal bulb, of which 10 (83.3%) were in the anterior wall, and the remaining one (8.3%) existed in the descending part of the duodenum. The en bloc and R0 resection rates were 100% and 75%, respectively. The rates of bleeding and perforation were both 0%. Among the four patients who had non-curative resections, two patients underwent additional surgery after ESMR-L. One patient had a local remnant tumor, and the other had lymph node metastasis. In cases of local remnant tumors, the vertical margin was positive in the ESMR-L specimen. In that case, ligation by the O-ring was insufficient, retrospectively. All patients had no recurrence during the median follow-up period of 5.7 years. Discussion: ESMR-L was the best fit for DNET within the indications for endoscopic resection. It is a simple procedure that enables easy and complete resection of DNETs without complications.
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Affiliation(s)
- Yasuhiro Inokuchi
- Chief Doctor, Department of Gastroenterology, Kanagawa Cancer Center, 2-3-2 Asahi-ku, Nakao, Yokohama 241-8515, Kanagawa, Japan
| | - Kei Hayashi
- Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yoshihiro Kaneta
- Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yoichiro Okubo
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Japan
| | - Mamoru Watanabe
- Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan
| | - Mitsuhiro Furuta
- Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan
| | - Nozomu Machida
- Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University, Yokohama, Japan
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12
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Yamasaki Y, Ohmori M, Toyosawa J, Ako S, Okada H. Modified line-assisted complete closure of the defect after gastric endoscopic full-thickness resection: a pilot study in porcine models. Endosc Int Open 2022; 10:E609-E615. [PMID: 35571472 PMCID: PMC9106438 DOI: 10.1055/a-1785-8589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
Background and study aims Closure after endoscopic full-thickness resection (EFTR) is challenging. We previously developed a simple endoscopic closure method: line-assisted complete closure (LACC). We performed a pilot study using porcine models to evaluate the feasibility of modified LACC after gastric EFTR. Patients and methods Six live pigs were included. EFTR (greater curvature of the gastric antrum [n = 3] and anterior wall of the gastric body [n = 3]) was performed under general anesthesia and the defect after EFTR was closed by modified LACC. The pigs were observed until postoperative day 4 (Day 4). The closure site was endoscopically evaluated and the presence or absence of peritonitis and fluid leakage was evaluated. The outcomes were the success rate of modified LACC on the day of the procedure, maintenance of defect closure, presence of peritonitis or leakage, and clinical course. Results Once complete closure was successfully achieved in all cases, maintenance of closure on Day 4 was not achieved. However, there was neither peritonitis nor fluid leakage. The defect was completely covered by surrounding tissues on Day 4 and the clinical course was good in all cases. Conclusions The feasibility of modified LACC after gastric EFTR was demonstrated in porcine models. Further improvement is needed to maintain defect closure.
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Affiliation(s)
- Yasushi Yamasaki
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Masayasu Ohmori
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Junki Toyosawa
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Soichiro Ako
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
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13
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Papaefthymiou A, Laskaratos FM, Koffas A, Manolakis A, Gkolfakis P, Coda S, Sodergren M, Suzuki N, Toumpanakis C. State of the Art in Endoscopic Therapy for the Management of Gastroenteropancreatic Neuroendocrine Tumors. Curr Treat Options Oncol 2022; 23:1014-1034. [PMID: 35511346 DOI: 10.1007/s11864-022-00986-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 12/13/2022]
Abstract
OPINION STATEMENT Gastroenteropancreatic neuroendocrine neoplasms (GEP NENs) comprise a heterogeneous group of slow growing tumors arising from the neuroendocrine cells of the gastrointestinal (GI) tract. Although they are considered relatively rare, their incidence is rising and it is believed that the more frequent use of endoscopy and imaging studies have at least in part contributed to the increased diagnosis especially of localized neoplasms. The management of these neoplasms should be guided by a multidisciplinary NEN team following appropriate staging investigations. Localized neoplasms of the GI tract may be suitable for endoscopic therapy, while patients with pancreatic NENs, unsuitable for surgery, should be considered for endoscopic ultrasound (EUS)-guided ablation. In this review, we discuss the evidence regarding endoscopic resection of luminal NENs and EUS-guided therapy of pancreatic NENs. The efficacy, safety, and other longer-term outcomes of these techniques are summarized. In conclusion, this review of endoscopic therapies for localized NENs may be a useful guide for NEN clinicians and endoscopists who are considering these therapeutic options for the management of focal GEP NENs.
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Affiliation(s)
- Apostolis Papaefthymiou
- Department of Gastroenterology, General University Hospital of Larisa, Mezourlo, 41110, Larisa, Greece.,First Laboratory of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Macedonia, Greece
| | | | - Apostolos Koffas
- Department of Gastroenterology, General University Hospital of Larisa, Mezourlo, 41110, Larisa, Greece
| | - Anastasios Manolakis
- Department of Gastroenterology, General University Hospital of Larisa, Mezourlo, 41110, Larisa, Greece
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, 1070, Brussels, Belgium
| | - Sergio Coda
- Digestive Diseases Centre, Barking Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Mikael Sodergren
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Noriko Suzuki
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, London, UK
| | - Christos Toumpanakis
- Neuroendocrine Tumour Unit (ENETS Centre of Excellence) Centre for Gastroenterology, Royal Free Hospital, London, UK
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14
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Dalal I, Andalib I. Advances in endoscopic resection: a review of endoscopic submucosal dissection (ESD), endoscopic full thickness resection (EFTR) and submucosal tunneling endoscopic resection (STER). Transl Gastroenterol Hepatol 2022; 7:19. [PMID: 35548477 PMCID: PMC9081920 DOI: 10.21037/tgh-2020-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/21/2020] [Indexed: 08/30/2023] Open
Abstract
Subepithelial lesions are often detected incidentally in patients undergoing an endoscopy. They are common tumors of the gastrointestinal (GI) tract which can originate from different layers of the GI tract wall. These lesions can be further classified based on GI layer of origin and unique histochemical staining. While most are benign and asymptomatic, some of these lesions have malignant potential with distant metastases. However, current diagnostic modalities including endoscopy with biopsy or endoscopic ultrasound with fine needle aspiration are not always reliable. In addition, management of these lesions has historically involved surgical resection via open or laparoscopic approaches. In recent years, with advancement in endoscopic techniques and improvement in endoscopists' skills, less invasive procedures such as endoscopic submucosal dissection (ESD), endoscopic full thickness resection (EFTR) and submucosal tunneling endoscopic resection (STER) have been developed and now are being used by endoscopists worldwide. Upon reviewing the literature, multiple studies have shown the advantages of these endoscopic techniques when compared with surgical treatment. As a result, there has been a dramatic shift towards minimally invasive endoscopic procedures for the management of these subepithelial lesions. In this review article, we will discuss these endoscopic resection techniques in detail, their safety and efficacy, as well as comparison studies to other therapeutic modalities.
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Affiliation(s)
- Ishita Dalal
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson, New Brunswick, New Jersey, USA
| | - Iman Andalib
- Department of Gastroenterology and Hepatology, Mount Sinai South Nassau, Oceanside, New York, USA
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15
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Hayat M, Azeem N, Bilal M. Colon Polypectomy with Endoscopic Submucosal Dissection and Endoscopic Full-Thickness Resection. Gastrointest Endosc Clin N Am 2022; 32:277-298. [PMID: 35361336 DOI: 10.1016/j.giec.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endoscopic resection has become the gold standard for the management of most of the large colorectal polyps. Various endoscopic resection techniques include endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and endoscopic full-thickness resection (EFTR). ESD is a minimally invasive method for the resection of advanced lesions in the gastrointestinal (GI) tract to achieve en-bloc resection. While, EFTR is more commonly used in lesions with suspected deeper submucosal invasion, lesions originating from muscularis propria, or those with advanced fibrosis. This article reviews the indications, technique, and adverse events for use of ESD and EFTR in the colon.
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Affiliation(s)
- Maham Hayat
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, 800 Stanton L Young Boulevard, Oklahoma City, OK 73104, USA
| | - Nabeel Azeem
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN 55455, USA
| | - Mohammad Bilal
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN 55455, USA; Advanced Endoscopy, Division of Gastroenterology & Hepatology, Minneapolis Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN 55417, USA.
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16
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Dwyer S, Mok S. Endoscopic full-thickness resection of well-differentiated T2 neuroendocrine tumors in the duodenal bulb: a case series. VideoGIE 2022; 7:196-199. [PMID: 35585893 PMCID: PMC9108274 DOI: 10.1016/j.vgie.2021.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background and Aims Endoscopic therapies have moved to the forefront in the removal of small, well-differentiated duodenal neuroendocrine tumors (NETs). Classic procedures used to address small tumors, especially those less than 1 cm in diameter, are banding without resection, ligation endoscopic mucosal resection, or endoscopic submucosal dissection. Endoscopic full-thickness resection (EFTR) is a procedure developed recently that allows for sealing off of the tissue surrounding the tumor before full-thickness removal. Although surgical resection is typically recommended for NETs measuring 2 cm and larger, this may not always be possible given patients’ ages or comorbidities. We present the cases of 3 patients with well-differentiated NETs of the duodenal bulb measuring greater than 2 cm who were poor candidates for surgery and were thus offered EFTR for excision of their tumors. Methods Three patients with well-differentiated, stage II NETs of the duodenal bulb underwent chromoendoscopy and narrow-band imaging, EUS, prophylactic dilation of the upper esophageal sphincter and pylorus, and EFTR using an over-the-scope clip system. Results In each case, there was no residual mass seen on endoscopy, Ga-68 Dotatate positron emission tomography-CT imaging, or biopsy up to 1 year after the procedure. Two of the 3 cases had normal chromogranin A levels at all follow-up points, and the third case had chromogranin A levels that trended down to a near-normal level of 145 ng/mL. Conclusions Three patients with NETs of the duodenal bulb who were poor surgical candidates underwent successful EFTR using a full-thickness resection device. At 1-year follow-up, they have no evidence of disease recurrence on imaging and pathology after EFTR.
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Affiliation(s)
- Sarah Dwyer
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
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17
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Ichkhanian Y, Barawi M, Seoud T, Thakkar S, Kothari TH, Halabi ME, Ullah A, Edris W, Aepli P, Kowalski T, Shinn B, Shariaha RZ, Mahadev S, Mosko JD, Andrisani G, Di Matteo FM, Albrecht H, Giap AQ, Tang SJ, Naga YM, van Geenen E, Friedland S, Tharian B, Irani S, Ross AS, Jamil LH, Lew D, Nett AS, Farha J, Runge TM, Jovani M, Khashab MA. Endoscopic full-thickness resection of polyps involving the appendiceal orifice: a multicenter international experience. Endoscopy 2022; 54:16-24. [PMID: 33395714 DOI: 10.1055/a-1345-0044] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Endoscopic resection of lesions involving the appendiceal orifice remains a challenge. We aimed to report outcomes with the full-thickness resection device (FTRD) for the resection of appendiceal lesions and identify factors associated with the occurrence of appendicitis. METHODS This was a retrospective study at 18 tertiary-care centers (USA 12, Canada 1, Europe 5) between November 2016 and August 2020. Consecutive patients who underwent resection of an appendiceal orifice lesion using the FTRD were included. The primary outcome was the rate of R0 resection in neoplastic lesions, defined as negative lateral and deep margins on post-resection histologic evaluation. Secondary outcomes included the rates of: technical success (en bloc resection), clinical success (technical success without need for further surgical intervention), post-resection appendicitis, and polyp recurrence. RESULTS 66 patients (32 women; mean age 64) underwent resection of colonic lesions involving the appendiceal orifice (mean [standard deviation] size, 14.5 (6.2) mm), with 40 (61 %) being deep, extending into the appendiceal lumen. Technical success was achieved in 59/66 patients (89 %), of which, 56 were found to be neoplastic lesions on post-resection pathology. Clinical success was achieved in 53/66 (80 %). R0 resection was achieved in 52/56 (93 %). Of the 58 patients in whom EFTR was completed who had no prior history of appendectomy, appendicitis was reported in 10 (17 %), with six (60 %) requiring surgical appendectomy. Follow-up colonoscopy was completed in 41 patients, with evidence of recurrence in five (12 %). CONCLUSIONS The FTRD is a promising non-surgical alternative for resecting appendiceal lesions, but appendicitis occurs in 1/6 cases.
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Affiliation(s)
- Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA.,Department of Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohammed Barawi
- Division of Gastroenterology and Hepatology, Ascension St. John Hospital, Detroit, Michigan, USA
| | - Talal Seoud
- Center for Advanced Endoscopy, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Shyam Thakkar
- Center for Advanced Endoscopy, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Truptesh H Kothari
- Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, New York, USA
| | - Maan El Halabi
- Department of Internal Medicine, Mount Sinai West, New York, New York, USA
| | - Asad Ullah
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
| | - Wedi Edris
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
| | - Patrick Aepli
- Department of Gastroenterology and Hepatology, Luzerner Kantonsspital, Luzerne, Switzerland
| | - Thomas Kowalski
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Brianna Shinn
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Reem Z Shariaha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine/New York, Presbyterian Hospital, New York, New York, USA
| | - Srihari Mahadev
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine/New York, Presbyterian Hospital, New York, New York, USA
| | - Jeffrey D Mosko
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gianluca Andrisani
- Digestive Endoscopy Unit, Campus Bio-Medico, University of Rome, Rome, Italy
| | | | - Heinz Albrecht
- Department of Medicine, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Andrew Q Giap
- Department of Gastroenterology, Kaiser Permanente, Anaheim, California, USA
| | - Shou-Jiang Tang
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Yehia M Naga
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Shai Friedland
- Division of Gastroenterology, Department of Medicine, Stanford University, Stanford, California, USA
| | - Benjamin Tharian
- Department of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Shayan Irani
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Andrew S Ross
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Laith H Jamil
- Section of Gastroenterology and Hepatology, Beaumont Health-Royal Oak, Royal Oak, Michigan, USA.,Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Daniel Lew
- Pancreatic and Biliary Diseases Program, Cedars-Sinai Medical Center, West Hollywood, California, USA
| | - Andrew S Nett
- Division of Gastroenterology, Sutter Health, Sacramento, California, USA
| | - Jad Farha
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Thomas M Runge
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA.,Division of Gastroenterology and Hepatology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Manol Jovani
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
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18
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Keane MG, Mony S, Wood LD, Kumbhari V, Khashab MA. Prophylactic appendiceal retrograde intraluminal stent placement (PARIS). VideoGIE 2021; 6:552-554. [PMID: 34917867 PMCID: PMC8646081 DOI: 10.1016/j.vgie.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Margaret G Keane
- Johns Hopkins Hospital, Department of Gastroenterology and Hepatology, Baltimore, Maryland
| | - Shruti Mony
- Johns Hopkins Hospital, Department of Gastroenterology and Hepatology, Baltimore, Maryland
| | - Laura D Wood
- Sol Goldamn Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, Maryland
| | - Vivek Kumbhari
- Johns Hopkins Hospital, Department of Gastroenterology and Hepatology, Baltimore, Maryland
| | - Mouen A Khashab
- Johns Hopkins Hospital, Department of Gastroenterology and Hepatology, Baltimore, Maryland
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19
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Wei Y, Zhou Q, Ji M, Zhang S, Li P. Over-the-scope clip-assisted endoscopic full-thickness resection has potential to treat complex nonampullary duodenal lesions: a single-center case series. BMC Gastroenterol 2021; 21:476. [PMID: 34911448 PMCID: PMC8675504 DOI: 10.1186/s12876-021-02068-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/13/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND AIMS The duodenum is considered a challenging area for the endoscopic resection of lesions. This study aimed to evaluate the efficacy and safety of over-the-scope clip (OTSC)-assisted endoscopic full-thickness resection (EFTR) for complex nonampullary duodenal lesions unsuitable for conventional resection techniques. METHODS AND PATIENTS We conducted a retrospective case review of 13 consecutive patients with complex nonampullary duodenal tumors that were unsuitable for conventional resection techniques; these patients underwent EFTR assisted with OTSC at Beijing Friendship Hospital, Capital Medical University from September 2015 to September 2020. The OTSC device was placed, and tumors were resected after the lesions were identified. Data were abstracted for demographics, lesion features, histopathologic diagnoses, technical success rates, complete resection (R0 resection) rates, and complications. RESULTS Thirteen patients with duodenal lesions (6 adenomas and 7 submucosal tumors with nonlifting signs, incomplete lifting signs, difficult locations, failed ESD/EMR attempts or suspected origin in the muscularis propria) subjected to EFTR were included. The sizes of all the lesions evaluated by endoscopy were smaller than 20 mm, and most of them (84.6%, 11/13) were smaller than 12 mm. All 13 applications of the clips, endoscopic resection and full-thickness resection were successful (13/13, 100%). Complete resection was achieved in 12 patients (12/13, 92.3%). There were no immediate or delayed complications, including bleeding, infection and perforation. CONCLUSIONS OTSC -assisted EFTR appears to be effective and safe for complex nonampullary duodenal lesions smaller than 20 mm (particularly those ≤ 10-12 mm) that are unsuitable for conventional resection techniques.
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Affiliation(s)
- Yongqiu Wei
- Department of Gastroenterology, Beijing Friendship Hospital, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Capital Medical University, No. 95, Yongan Road, Xicheng District, Beijing, 10050, China
| | - Qiaozhi Zhou
- Department of Gastroenterology, Beijing Friendship Hospital, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Capital Medical University, No. 95, Yongan Road, Xicheng District, Beijing, 10050, China
| | - Ming Ji
- Department of Gastroenterology, Beijing Friendship Hospital, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Capital Medical University, No. 95, Yongan Road, Xicheng District, Beijing, 10050, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Capital Medical University, No. 95, Yongan Road, Xicheng District, Beijing, 10050, China
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Capital Medical University, No. 95, Yongan Road, Xicheng District, Beijing, 10050, China.
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20
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Hoffman A, Atreya R, Rath T, Neurath MF. Current Endoscopic Resection Techniques for Gastrointestinal Lesions: Endoscopic Mucosal Resection, Submucosal Dissection, and Full-Thickness Resection. Visc Med 2021; 37:358-371. [PMID: 34722719 DOI: 10.1159/000515354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/15/2021] [Indexed: 12/12/2022] Open
Abstract
Background Endoscopic resection of dysplastic lesions in early stages of cancer reduces mortality rates and is recommended by many national guidelines throughout the world. Snare polypectomy and endoscopic mucosal resection (EMR) are established techniques of polyp removal. The advantages of these methods are their relatively short procedure times and acceptable complication rates. The latter include delayed bleeding in 0.9% and a perforation risk of 0.4-1.3%, depending on the size and location of the resected lesion. EMR is a recent modification of endoscopic resection. A limited number of studies suggest that larger lesions can be removed en bloc with low complication rates and short procedure times. Novel techniques such as endoscopic submucosal dissection (ESD) are used to enhance en bloc resection rates for larger, flat, or sessile lesions. Endoscopic full-thickness resection (EFTR) is employed for non-lifting lesions or those not easily amenable to resection. Procedures such as ESD or EFTR are emerging standards for lesions inaccessible to EMR techniques. Summary Endoscopic treatment is now regarded as first-line therapy for benign lesions. Key Message Endoscopic resection of dysplastic lesions or early stages of cancer is recommended. A plethora of different techniques can be used dependent on the lesions.
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Affiliation(s)
- Arthur Hoffman
- Department of Internal Medicine III, Aschaffenburg-Alzenau Clinic, Aschaffenburg, Germany
| | - Raja Atreya
- First Department of Medicine, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Deutsches Zentrum Immuntherapie, DZI, Erlangen, Germany
| | - Timo Rath
- First Department of Medicine, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Deutsches Zentrum Immuntherapie, DZI, Erlangen, Germany
| | - Markus Ferdinand Neurath
- First Department of Medicine, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Deutsches Zentrum Immuntherapie, DZI, Erlangen, Germany
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21
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Tashima T, Ryozawa S, Tanisaka Y, Fujita A, Miyaguchi K, Ogawa T, Mizuide M, Mashimo Y, Kawasaki T, Yasuda M. Endoscopic resection using an over-the-scope clip for duodenal neuroendocrine tumors. Endosc Int Open 2021; 9:E659-E666. [PMID: 33937505 PMCID: PMC8062228 DOI: 10.1055/a-1374-6141] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/20/2021] [Indexed: 12/18/2022] Open
Abstract
Background and study aims Endoscopic resection of duodenal neuroendocrine tumors (DNETs) remains controversial, and its indications are still unclear. This study aimed to evaluate short-term outcomes of a newly developed endoscopic muscularis resection (EMR) method that utilizes an over-the-scope clip (OTSC), termed EMRO, for treating DNETs. Patients and methods In total, 13 consecutive patients with 14 small (≤ 10 mm) DNETs who underwent EMRO from September 2017 to March 2020 were retrospectively enrolled. EMRO was performed by a single experienced endoscopist. Patients' characteristics and treatment outcomes were assessed. Results The En bloc and R0 resection rates were 100 % (14/14) and 92.9 % (13/14), respectively. The median pathological resected specimen size was 10 mm, with a median pathological resected tumor size of 6 mm. During the EMRO procedure, there was no occurrence of misplacement of the OTSC to the target lesion. With respect to the pathological resection depth, nine cases (64.3 %) and five cases (35.7 %) were categorized as deep submucosal resection and muscularis resection, respectively, whereas no case was categorized as full-thickness resection. There were no intraoperative or delayed perforations. However, delayed bleeding occurred in two cases. At a median follow-up of 12 months (range 7-36) after EMRO, there was no incidence of local recurrence. At the first follow-up endoscopy performed at 6 months after EMRO, the OTSC was retained in place in two of 14 DNETs (14.3 %). Conclusions EMRO can be performed safely, by an experienced endoscopist, for small (≤ 10 mm) DNETs.
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Affiliation(s)
- Tomoaki Tashima
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yuki Tanisaka
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Akashi Fujita
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kazuya Miyaguchi
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tomoya Ogawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Masafumi Mizuide
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yumi Mashimo
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tomonori Kawasaki
- Department of Pathology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Masami Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, Saitama, Japan
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22
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Hernandez A, Marya NB, Sawas T, Rajan E, Gades NM, Wong Kee Song LM, Abu Dayyeh BK, Buttar N, Storm AC. Gastrointestinal defect closure using a novel through-the-scope helix tack and suture device compared to endoscopic clips in a survival porcine model (with video). Endosc Int Open 2021; 9:E572-E577. [PMID: 33860074 PMCID: PMC8041572 DOI: 10.1055/a-1370-9256] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022] Open
Abstract
Background and aims Endoscopic resections are associated with bleeding and perforation and may be managed with through-the-scope (TTS) clips, over-the-scope clips and endoscopic suturing. The aim of this preclinical study was to compare technical success of closure using a novel TTS tissue helix tack and suture device (X-Tack) to TTS clips in a porcine model. Materials and methods Four subjects underwent 40 mucosal resections, diameter range 25-50 mm, in the stomach (n = 24) and colon (n = 16). Closures were randomized to X-Tack (n = 24) or clip (n = 16). Animals underwent weekly endoscopic follow-up for 4 weeks. Results Technical closure with X-Tack was successful in 24 of 24 (100 %) cases and with clips in 13 of 16 cases (81.3 %) ( P = 0.0001). One colonic perforation occurred and was successfully managed using X-Tack. The rate of healing was not statistically different between the groups, and all sites healed at 4 weeks including the perforation and were confirmed by histology. Conclusions Compared to TTS clip, X-Tack is superior for effecting large mucosal defect closure, including durable sealing of full-thickness perforation. There was no difference in rate of healing between devices.
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Affiliation(s)
- Ariosto Hernandez
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota, United States,Mayo Clinic Developmental Endoscopy Unit, Rochester, Minnesota, United States
| | - Neil B. Marya
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| | - Tarek Sawas
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| | - Elizabeth Rajan
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota, United States,Mayo Clinic Developmental Endoscopy Unit, Rochester, Minnesota, United States
| | - Naomi M. Gades
- Department of Comparative Medicine, Mayo Clinic, Scottsdale, Arizona, United States
| | - Louis M. Wong Kee Song
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| | - Barham K. Abu Dayyeh
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| | - Navtej Buttar
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| | - Andrew C. Storm
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota, United States,Mayo Clinic Developmental Endoscopy Unit, Rochester, Minnesota, United States
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23
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Hernandez-Lara AH, de Paredes AGG, Song LMWK, Rowan DJ, Graham RP, Levy MJ, Gleeson FC, Kamboj AK, Mara KC, Abu-Dayyeh BK, Chandrasekhara V, Iyer PG, Storm AC, Rajan E. Outcomes of endoscopic ultrasound and endoscopic resection of gastrointestinal subepithelial lesions: a single-center retrospective cohort study. Ann Gastroenterol 2021; 34:516-520. [PMID: 34276190 PMCID: PMC8276353 DOI: 10.20524/aog.2021.0621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/03/2021] [Indexed: 11/11/2022] Open
Abstract
Background Endoscopic resection (ER) is an emerging therapeutic alternative for subepithelial gastrointestinal lesions (SELs). We aimed to determine whether size, layer of origin, and histology based on endoscopic ultrasound (EUS) and EUS-guided sampling (EUS-GS) influenced the outcomes and selection of patients for ER. Methods We performed a retrospective review of patients who underwent EUS, EUS-GS and resection of SELs from 2012-2019. Two pathologists reviewed the histology and layer of origin of all resected specimens, serving as the criterion for EUS accuracy. Results Seventy-three patients were included, of whom 59 (81%) were gastric SELs. Per EUS, median lesion size was 21 mm (interquartile range 15-32), and 63 (86%) originated from the 4th layer. The overall accuracy of EUS and EUS-GS in predicting the layer of origin and histology was 88% (95% confidence interval [CI] 77-94%) and 96% (95%CI 87-98%), respectively. Based on EUS, 18 (25%) patients were referred for ER, 5 (7%) to laparoscopic-endoscopic cooperative surgery, and 50 (68%) to surgery. Size >20 mm was associated with the type of resection approach (P=0.005), while layer of origin and histology were not (P=0.06 and P=0.09, respectively). When SELs were inaccurately classified (n=4) there were no adverse events or revision of the resection approach. Conclusions EUS plays an important role in the outcome of resection approach for SELs, with size significantly influencing the selection for ER. In patients undergoing ER, no revised resections were needed when EUS was inaccurate.
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Affiliation(s)
- Ariosto H Hernandez-Lara
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
| | - Ana Garcia Garcia de Paredes
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
| | - Louis M Wong Kee Song
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
| | - Daniel J Rowan
- Department of Anatomic Pathology (Daniel J. Rowan, Rondell P. Graham)
| | - Rondell P Graham
- Department of Anatomic Pathology (Daniel J. Rowan, Rondell P. Graham)
| | - Michael J Levy
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
| | - Ferga C Gleeson
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
| | - Amrit K Kamboj
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
| | - Kristin C Mara
- Department of Biomedical Statistics and Informatics (Kristin C. Mara), Mayo Clinic, Rochester, Minnesota, USA
| | - Barham K Abu-Dayyeh
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
| | - Vinay Chandrasekhara
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
| | - Prasad G Iyer
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
| | - Elizabeth Rajan
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
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24
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Yoon JY, Kumta NA, Kim MK. The Role of Endoscopy in Small Bowel Neuroendocrine Tumors. Clin Endosc 2021; 54:818-824. [PMID: 33794563 PMCID: PMC8652151 DOI: 10.5946/ce.2020.296] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/30/2020] [Indexed: 02/06/2023] Open
Abstract
Small bowel neuroendocrine tumors (NETs) represent approximately one-third of NETs of the gastrointestinal tract, and their incidence is increasing. When determining if endoscopic resection is appropriate, endoscopic ultrasound is used to assess the lesion size and depth of invasion for duodenal NETs. A number of techniques, including endoscopic mucosal resection (EMR), band-assisted EMR (band-EMR), endoscopic submucosal dissection (ESD), and over-the-scope clip-assisted endoscopic full-thickness resection (EFTR), have been studied; however, the best technique for endoscopic resection remains unclear. The vast majority of currently available data are retrospective, and prospective studies with longer follow-up times are required. For jejunal and ileal NETs, endoscopic techniques such as video capsule endoscopy (VCE) and balloon enteroscopy (BE) assist in diagnosis. This includes localization of the primary NET in metastatic disease where initial workup has been negative, and the identification of multifocal disease, which may change management and prognostication.
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Affiliation(s)
- Ji Yoon Yoon
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nikhil A Kumta
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle Kang Kim
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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25
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Schmidbaur S, Wannhoff A, Walter B, Meier B, Schäfer C, Meining A, Caca K. Risk of appendicitis after endoscopic full-thickness resection of lesions involving the appendiceal orifice: a retrospective analysis. Endoscopy 2021; 53:424-428. [PMID: 32894866 DOI: 10.1055/a-1227-4555] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Conventional endoscopic resection of lesions affecting the appendiceal orifice is difficult. Endoscopic full-thickness resection (EFTR) is a novel technique in interventional endoscopy. As EFTR near the appendiceal orifice is associated with a subtotal appendectomy, it remains unclear whether the risk of developing appendicitis is increased. We conducted a retrospective analysis of lesions involving the appendiceal orifice treated by EFTR. METHODS This was a multicenter retrospective analysis of patients (n = 50) treated with EFTR for lesions involving the appendiceal orifice between 2014 and 2019. The objective was to evaluate the occurrence of appendicitis. RESULTS Acute appendicitis occurred in seven patients (14 %) during follow-up. Conservative treatment was sufficient in four cases, and three patients underwent appendectomy. CONCLUSIONS EFTR of lesions involving the appendiceal orifice may be associated with an imminent risk of developing appendicitis and a consecutive need for appendectomy. Patients should be informed about this specific risk prior to resection. It is unclear why some patients develop appendicitis while the majority remains asymptomatic.
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Affiliation(s)
| | - Andreas Wannhoff
- Klinikum Ludwigsburg, Klinik für Innere Medizin, Gastroenterologie, Hämato-Onkologie, Pneumologie, Diabetologie und Infektiologie, Ludwigsburg, Germany
| | - Benjamin Walter
- Universitätsklinik Ulm, Klinik für Innere Medizin I, Ulm, Germany
| | - Benjamin Meier
- Klinikum Ludwigsburg, Klinik für Innere Medizin, Gastroenterologie, Hämato-Onkologie, Pneumologie, Diabetologie und Infektiologie, Ludwigsburg, Germany
| | - Claus Schäfer
- Kliniken des Landkreises Neumarkt i.d. OPf., Neumarkt, Germany
| | - Alexander Meining
- Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II, Gastroenterologie, Würzburg, Germany
| | - Karel Caca
- Klinikum Ludwigsburg, Klinik für Innere Medizin, Gastroenterologie, Hämato-Onkologie, Pneumologie, Diabetologie und Infektiologie, Ludwigsburg, Germany
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26
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Guo JT, Zhang JJ, Wu YF, Liao Y, Wang YD, Zhang BZ, Wang S, Sun SY. Endoscopic full-thickness resection using an over-the-scope device: A prospective study. World J Gastroenterol 2021; 27:725-736. [PMID: 33716450 PMCID: PMC7934006 DOI: 10.3748/wjg.v27.i8.725] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/13/2020] [Accepted: 01/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic submucosal dissection to treat mucosal and submucosal lesions sometimes results in low rates of microscopically margin-negative (R0) resection. Endoscopic full-thickness resection (EFTR) has a high R0 resection rate and allows for the definitive diagnosis and treatment of selected mucosal and submucosal lesions that are not suitable for conventional resection techniques.
AIM To evaluate the efficacy and safety of EFTR using an over-the-scope clip (OTSC).
METHODS This prospective, single-center, non-randomized clinical trial was conducted at the endoscopy center of Shengjing Hospital of China Medical University. The study included patients aged 18-70 years who had gastric or colorectal submucosal tumors (SMTs) (≤ 20 mm in diameter) originating from the muscularis propria based on endoscopic ultrasound (EUS) and patients who had early-stage gastric or colorectal cancer (≤ 20 mm in diameter) based on EUS and computed tomography. All lesions were treated by EFTR combined with an OTSC for wound closure between November 2014 and October 2016. We analyzed patient demographics, lesion features, histopathological diagnoses, R0 resection (negative margins) status, adverse events, and follow-up results.
RESULTS A total of 68 patients (17 men and 51 women) with an average age of 52.0 ± 10.5 years (32-71 years) were enrolled in this study, which included 66 gastric or colorectal SMTs and 2 early-stage colorectal cancers. The mean tumor diameter was 12.6 ± 4.3 mm. The EFTR procedure was successful in all cases. The mean EFTR procedure time was 39.6 ± 38.0 min. The mean OTSC defect closure time was 5.0 ± 3.8 min, and the success rate of closure for defects was 100%. Histologically complete resection (R0) was achieved in 67 (98.5%) patients. Procedure-related adverse events were observed in 11 (16.2%) patients. The average post-procedure length of follow-up was 48.2 ± 15.7 mo. There was no recurrence during follow-up.
CONCLUSION EFTR combined with an OTSC is an effective and safe technique for the removal of select subepithelial and epithelial lesions that are not amenable to conventional endoscopic resection techniques.
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Affiliation(s)
- Jin-Tao Guo
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Jing-Jing Zhang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yu-Fan Wu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Ye Liao
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yi-Dan Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Bao-Zhen Zhang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Sheng Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Si-Yu Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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27
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Bartell N, Bittner K, Kaul V, Kothari TH, Kothari S. Clinical efficacy of the over-the-scope clip device: A systematic review. World J Gastroenterol 2020; 26:3495-3516. [PMID: 32655272 PMCID: PMC7327783 DOI: 10.3748/wjg.v26.i24.3495] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/19/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The over-the-scope clip (OTSC) system has been increasingly utilized as a non-surgical option to endoscopically manage refractory gastrointestinal (GI) hemorrhage, perforations/luminal defects and fistulas. Limited data exist evaluating the efficacy and safety of OTSC.
AIM To determine the clinical success and adverse event (AE) rates of OTSC across all GI indications.
METHODS A PubMed search was conducted for eligible articles describing the application of the OTSC system for any indication in the GI tract. Any article or case series reporting data for less than 5 total patients was excluded. The primary outcome was the rate of clinical success. Secondary outcomes included: Technical success rate, OTSC-related AE rate and requirement for surgical intervention despite-OTSC placement. Pooled rates (per-indication and overall) were calculated as the number of patients with the event of interest divided by the total number of patients.
RESULTS A total of 85 articles met our inclusion criteria (n = 3025 patients). OTSC was successfully deployed in 94.4% of patients (n = 2856/3025). The overall rate of clinical success (all indications) was 78.4% (n = 2371/3025). Per-indication clinical success rates were as follows: (1) 86.0% (1120/1303) for GI hemorrhage; (2) 85.3% (399/468) for perforation; (3) 55.8% (347/622) for fistulae; (4) 72.6% (284/391) for anastomotic leaks; (5) 92.8% (205/221) for defect closure following endoscopic resection (e.g., following endoscopic mucosal resection or endoscopic submucosal dissection); and (6) 80.0% (16/20) for stent fixation. AE’s related to the deployment of OTSC were only reported in 64 of 85 studies (n = 1942 patients), with an overall AE rate of 2.1% (n = 40/1942). Salvage surgical intervention was required in 4.7% of patients (n = 143/3025).
CONCLUSION This systematic review demonstrates that the OTSC system is a safe and effective endoscopic therapy to manage GI hemorrhage, perforations, anastomotic leaks, defects created by endoscopic resections and for stent fixation. Clinical success in fistula management appears limited. Further studies, including randomized controlled trials comparing OTSC with conventional and/or surgical therapies, are needed to determine which indication(s) are the most effective for its use.
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Affiliation(s)
- Nicholas Bartell
- Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Krystle Bittner
- Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Vivek Kaul
- Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Truptesh H Kothari
- Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Shivangi Kothari
- Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY 14642, United States
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28
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Li LY, Li BW, Mekaroonkamol P, Chen HM, Shen SS, Luo H, Dacha S, Xue Y, Cristofaro S, Keilin S, Willingham F, Cai Q. Mucosectomy device-assisted endoscopic resection of gastric subepithelial lesions. J Dig Dis 2020; 21:215-221. [PMID: 32129564 DOI: 10.1111/1751-2980.12856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Some gastrointestinal subepithelial tumors (SETs) have malignant potential and complete resection may be required. However, endoscopic submucosal dissection (ESD) can be a tedious procedure and requires a long and extensive training to master. Devices for endoscopic full-thickness resection (EFTR) are limited and are not widely available. We report here a simpler endoscopic method to resect small SETs using a commercially available endoscopic mucosal resection (EMR) kit and enucleation technique. METHODS All patients with SET who underwent device-assisted resection at our tertiary care hospital from April 2015 to November 2016 were enrolled in this retrospective study. All procedures were performed by a single expert endoscopist with an advanced endoscopy trainee. A mucosectomy and a limited dissection under mucosa were performed to preserve the mucosa before a device-assisted enucleation of the tumor to facilitate endoscopic closure of the defect closure in all cases. RESULTS A total of 12 patients aged 38-70 y, of whom six were males, were included. Most of the tumors originated from the muscularis propria and were located at the proximal gastric body. The mean procedural duration was 53 minutes (range 23-91 min). The average size of the lesions was 13 mm (range 9-21 mm). The mean duration of hospitalization was 1.3 days. Bleeding and intentional perforation were all successfully managed during the procedure and did not result in any clinically significant adverse event. CONCLUSION A device-assisted EFTR using a commercially available EMR kit is a safe and feasible method for the endoscopic resection of small gastric extrovert SETs.
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Affiliation(s)
- Lian Yong Li
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.,Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bai Wen Li
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.,Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Parit Mekaroonkamol
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Hui Min Chen
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.,Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shan Shan Shen
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.,Department of Gastroenterology, Drum Tower Hospital affiliated to the Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Hui Luo
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.,Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Sunil Dacha
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Yue Xue
- Department of Pathology, Emory University School of Medicine, Atlanta, GA
| | - Sarah Cristofaro
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Steven Keilin
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Field Willingham
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Qiang Cai
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
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29
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Tang SJ, Naga YM, Wu R, Zhang S. Over-the-scope clip-assisted endoscopic full thickness resection: a video-based case series. Surg Endosc 2020; 34:2780-2788. [PMID: 32189117 DOI: 10.1007/s00464-020-07481-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 02/26/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND In the management of mucosal neoplasm and early cancer, therapeutic gastrointestinal endoscopy evolved from simply polypectomy, endoscopic mucosal resection, endoscopic submucosal dissection (ESD), to endoscopic full thickness resection (EFTR). Full thickness clip closure followed by transmural resection mimics surgical principles. It is safe, effective, and technically less demanding compared to other techniques. Over-the-scope clip (OTSC)-assisted EFTR or OTSC-EFTR enables the endoscopists to manage difficult lesions. METHODS We video recorded and report our 1-year single center experience of 12 consecutive EFTR cases since the dedicated OTSC-EFTR device was approved in the USA. RESULTS We demonstrate that OTSC-EFTR can be very useful to manage residual neoplastic tissue that cannot be removed during conventional mucosal resection due to deeper invasion, submucosal fibrosis, scaring from prior intervention, and appendiceal involvement. Caution should be used for EFTR of the ileocecal valve lesions. CONCLUSION We propose that layered or stacked biopsy of the appendiceal stump after EFTR should be performed to rule out a positive residual base. Due to the limited size of the FTRD resection hood (13 mm internal diameter × 23 mm depth), for larger sessile adenomas in the colon, we propose a hybrid approach for complete removal: piecemeal EMR for tumor debulking followed by OTSC-EFTR to achieve R0 resection. We believe OTSC-EFTR offers safety and efficiency with very high success rate.
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Affiliation(s)
- Shou-Jiang Tang
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Yehia M Naga
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Ruonan Wu
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Shengyu Zhang
- Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China
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30
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Brewer Gutierrez OI, Akshintala VS, Ichkhanian Y, Brewer GG, Hanada Y, Truskey MP, Agarwal A, Hajiyeva G, Kumbhari V, Kalloo AN, Khashab MA, Ngamruengphong S. Endoscopic full-thickness resection using a clip non-exposed method for gastrointestinal tract lesions: a meta-analysis. Endosc Int Open 2020; 8:E313-E325. [PMID: 32118105 PMCID: PMC7035039 DOI: 10.1055/a-1073-7593] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/18/2019] [Indexed: 02/08/2023] Open
Abstract
Background and study aims Endoscopic full-thickness resection (EFTR) allows for treatment of epithelial and sub-epithelial lesions (SELs) unsuitable to conventional resection techniques. This meta-analysis aimed to assess the efficacy and safety of clip-assisted method for non-exposed EFTR using FTRD or over-the-scope clip of gastrointestinal tumors. Methods A comprehensive literature search was performed. The primary outcome of interest was the rate of histologic complete resection (R0). Secondary outcomes of interest were the rate of enbloc resection, FTR, adverse events, and post-EFTR surgery. Random-effects model was used to calculate pooled estimates and generate forest plots. Results Eighteen studies with 730 patients and 733 lesions were included in the analyses. Indications for EFTR were difficult/residual colorectal adenoma, adenoma at a diverticulum or appendiceal orifice and early cancer (n = 634), colorectal SELs (n = 42), and upper gastrointestinal lesions (n = 51), other colonic lesions (n = 6). Median size of lesions was 13.5 mm. There were 22 failed EFTR attempts. Pooled overall R0 resection rate was 82 % (95 % CI: 75, 89). The pooled overall FTR rate was 83 % (95 % CI: 77, 89). The pooled overall enbloc resection rate was 95 (95 % CI: 92, 96). The pooled estimates for perforation and bleeding were < 0.1 % and 2 %, respectively. Following EFTR, a total of 110 patients underwent surgery for any reason [pooled rate 7 % (95 % 2, 14). The pooled rates for post-EFTR surgery due to invasive cancer, for non-curative endoscopic resection and for adverse events were 4 %, < 0.1 % and < 0.1 %, respectively. No mortality related to EFTR was noted. Conclusions EFTR appears to be safe and effective for gastrointestinal lesions that are not amenable to conventional endoscopic resection. This technique should be considered as an alternative to surgery in selected cases.
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Affiliation(s)
- Olaya I. Brewer Gutierrez
- Division of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Venkata S. Akshintala
- Division of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Yervant Ichkhanian
- Division of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Gala G. Brewer
- Division of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Yuri Hanada
- Department of Internal Medicine, Johns Hopkins Hospital Baltimore, Maryland, United States
| | - Maria P. Truskey
- William H. Welch Medical Library, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | - Amol Agarwal
- Department of Internal Medicine, Johns Hopkins Hospital Baltimore, Maryland, United States
| | - Gulara Hajiyeva
- Department of Internal Medicine, Johns Hopkins Hospital Baltimore, Maryland, United States
| | - Vivek Kumbhari
- Division of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Anthony N. Kalloo
- Division of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Mouen A. Khashab
- Division of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Saowanee Ngamruengphong
- Division of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
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Goenka MK, Rodge GA, Tiwary IK. Endoscopic Management with a Novel Over-The-Scope Padlock Clip System. Clin Endosc 2019; 52:574-580. [PMID: 31766822 PMCID: PMC6900306 DOI: 10.5946/ce.2019.122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023] Open
Abstract
Background/Aims: The Padlock clip is a recently introduced over-the-scope clip (OTSC) that requires the use of an alternate technique and has a different design from previous OTSCs. However, data regarding its clinical use are limited. The aim of this study is to present our clinical experience using this novel Padlock clip system.
Methods: Between September 2018 and June 2019, 7 consecutive patients underwent Padlock clip application at our center by an experienced endoscopist. A Padlock clip was used for achieving hemostasis in 4 patients presenting with gastrointestinal (GI) bleeding, as well as for endoscopic full-thickness resection in the remaining 3 patients.
Results: All 7 patients achieved technical as well as clinical success, with absence of complications or rebleeding, during a follow-up of a minimum of 3 weeks. All patients were hospitalized post procedure for a minimum of 48 hours, and an absence of adverse events was noted in our patient population throughout the procedure and post-procedure period. Antiplatelet therapy was reinstated shortly after the application of the Padlock clip, with no GI bleeding observed.
Conclusions: The Padlock clip is a novel OTSC, with benefits that include safe, simple, and rapid deployment. Antiplatelet therapy may be reinstated for patients, when necessary, shortly after applying the Padlock clip due to full-thickness closure of the tissue.
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Affiliation(s)
- Mahesh Kumar Goenka
- Institute of Gastrosciences and Liver, Apollo Gleneagles Hospital, Kolkata, India
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Andrisani G, Di Matteo FM. Endoscopic full-thickness resection of duodenal lesions (with video). Surg Endosc 2019; 34:1876-1881. [PMID: 31768725 DOI: 10.1007/s00464-019-07269-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 11/12/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM The endoscopic treatment of non-lifting or submucosal duodenal lesions is associated with a high risk of incomplete resection and adverse events. Clip-assisted endoscopic full-thickness resection (EFTR) is a new approach for en bloc removal of neoplastic lesions in the GI tract. The aim of this study was to investigate its efficacy and safety in the duodenum. MATERIALS AND METHODS We retrospectively collected all consecutive patients with duodenal lesions who underwent EFTR with OTSC (Ovesco Endoscopy, Tübingen, Germany) or the new full-thickness resection device (FTRD; Ovesco Endoscopy, Tübingen, Germany). Complete resection rate was defined as histologically-verified R0 resection. Main endoscopic and clinical outcomes (technical success, rate of EFTR, adverse events) were systematically assessed at 3 and 6 months. RESULTS Between May 2017 and January 2019, 10 patients with duodenal lesions underwent EFTR (5 non-lifting adenomas, 2 adenomas recurrence/relapse and 3 subepithelial tumours). Technical success was overall achieved in 8/10 cases (80%). The two FTRD failed cases were completed with snare resection. The complete full-thickness resection rate was achieved in 8/10 (80%), while in two cases it was limited to mucosal or submucosal layer. R0 resection rate was achieved in 8/10 (80%) patients. The mean procedure time was 75 min (range 53-120 min). There were no major adverse events. At 3 and 6-month follow-up, no recurrence was observed. CONCLUSIONS Clip-assisted EFTR is a feasible and effective technique for en bloc resection of "difficult" superficial neoplasia and submucosal lesions in the duodenum, representing another technique that must be part of the endoscopist's armamentarium.
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Affiliation(s)
- Gianluca Andrisani
- Digestive Endoscopy Unit, Campus Bio-Medico, University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy.
| | - Francesco Maria Di Matteo
- Digestive Endoscopy Unit, Campus Bio-Medico, University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
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Ge N, Hu JL, Yang F, Yang F, Sun SY. Endoscopic full-thickness resection for treating small tumors originating from the muscularis propria in the gastric fundus: An improvement in technique over 15 years. World J Gastrointest Oncol 2019; 11:1054-1064. [PMID: 31798785 PMCID: PMC6883187 DOI: 10.4251/wjgo.v11.i11.1054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/31/2019] [Accepted: 09/12/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The fundus of the stomach is regarded as a difficult area for endoscopic resection of small tumors originating from the muscularis propria (MP tumors). Three endoscopic resection techniques have been developed to treat these tumors, including ligation-assisted endoscopic full-thickness resection (L-EFTR), snare-assisted EFTR (S-EFTR), and endoscopic submucosal dissection-assisted EFTR (E-EFTR). To date, no studies have compared these techniques.
AIM We aimed to evaluate and compare S-EFTR with L-EFTR and E-EFTR for treating small MP tumors in the gastric fundus.
METHODS We retrospectively reviewed patients with primary small MP tumors in the gastric fundus and treated by these three techniques between January 2016 and December 2018 at Shengjing Hospital, China. Standard demographic and clinicopathologic data, including sex, age, tumor size, surgeon details, and pathological results, were collected. Data regarding operation duration, cost, en-bloc resection, and severe complications were also extracted and compared.
RESULTS A total of 36 patients (27 women) with a mean age of 55.8 ± 10.20 years were included in this study. The mean tumor size was 9.0 ± 3.98 mm. All the methods showed a 100% en-bloc resection rate and 0% severe complication rate. There was no statistically significant difference among the three groups in the operation duration (P = 0.148). The cost comparison for the whole procedure was as follows: E-EFTR > L-EFTR > S-EFTR (5837.5 ± 7212.96 CNY, 5970.7 ± 3465.27 CNY, 5852.0 ± 6438.25 CNY, respectively, P < 0.001).
CONCLUSION S-EFTR, L-EFT, and E-EFTR are all effective for resection of small MP tumors in the gastric fundus. S-EFTR is superior in terms of cost-effectiveness.
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Affiliation(s)
- Nan Ge
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Jin-Long Hu
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Fei Yang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Fan Yang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Si-Yu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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Ge N, Hu JL, Yang F, Yang F, Sun SY. Endoscopic full-thickness resection for treating small tumors originating from the muscularis propria in the gastric fundus: An improvement in technique over 15 years. World J Gastrointest Oncol 2019. [DOI: 10.4251/wjo.v11.i11.1054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Snare-assisted endoscopic resection of gastric subepithelial tumors originating from the muscularis propria layer: a multicenter study. Surg Endosc 2019; 34:3827-3832. [PMID: 31617089 DOI: 10.1007/s00464-019-07147-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Although successful endoscopic resection of gastric subepithelial tumors (SETs) originating from the muscularis propria (MP) layer has been frequently reported, it requires a relatively complicated technique and has a high perforation rate. In this retrospective study, we evaluated the efficacy and safety of the snare-assisted endoscopic resection (SAER) method which is performed using a snare and insulated-tip (IT) knife via a single-channel endoscope to reduce the perforation rate. METHODS In this study, fifty-six patients with gastric SETs originating from the MP layer treated by the SAER method at three institutions between July 2017 and December 2017 were reviewed. The procedure involved multiple steps as shown in Fig. 2. Data were obtained on demographics, SET features, histopathological diagnoses, procedure time, en bloc resection rate, R0 resection (negative margins) status, and adverse events. RESULTS Endoscopic resection was successfully performed in all patients. The median overall procedure time was 43.5 min (range 26-106 min). The mean size of resected specimens was 19.73 mm (range 10-33 mm). The overall rate of en bloc resection was 96.4% (54/56). In addition, the perforation rate was 7.1% (4/56), and defects in the stomach wall were very small and easily closed using metallic clips. No postprocedural bleeding occurred in any case. CONCLUSIONS The SAER method is an effective, safe, less costly technique for the removal of some gastric SETs originating from the MP layer with an appropriate size.
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von Helden A, Hildenbrand R, Sido B, Dumoulin FL. Endoscopic full-thickness resection using an over-the-scope device for treatment of recurrent / residual colorectal neoplasia: a single-center case series. BMC Gastroenterol 2019; 19:121. [PMID: 31291893 PMCID: PMC6617569 DOI: 10.1186/s12876-019-1043-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 07/03/2019] [Indexed: 01/03/2023] Open
Abstract
Background Endoscopic mucosal resection (EMR) in piecemeal technique is the treatment standard for larger flat or sessile colorectal lesions. The method is burdened by a high recurrence rate mostly presenting as difficult to resect lesions. In these situations, endoscopic full thickness resection (EFTR) with an over-the-scope device offers the option of complete resection despite scar formation. Methods We conducted a retrospective case review of 30 consecutive EFTR interventions on small (< 20 mm), difficult to resect recurrent / residual colorectal neoplastic lesions treated by EFTR. Results EFTR was technically feasible in 28/30 (93,3%) of the cases with an R0 resection in 24/30 (80%) and a median procedure time (marking to full thickness resection) of 34,5 min (11–120). After the first 15 procedures, the per-protocol rate increased from 13/15 to 15/15 and the R0 resection rate increased from 9/15 (69,2%) to 15/15 (100,0%; p < 0.01). One patient suffered from a delayed perforation the day after the procedure and needed emergency surgery (3,6%). Minor bleeding occurred in 3/28 patients (10,7%) and post-interventional fever in one patient (3,6%). The 30-day mortality rate was 0%. Conclusions EFTR with an over-the-scope device is a useful method for endoscopic resection of difficult to treat recurrent or residual colorectal neoplasia after previous endoscopic therapy. High R0 resection rates were observed after a relatively short learning curve. The complication rate in this series seems acceptable given the complexity of the resected lesions.
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Affiliation(s)
- Annabell von Helden
- Department of Medicine and Gastroenterology, Gemeinschaftskrankenhaus Bonn, Academic Teaching Hospital, University of Bonn, Bonner Talweg 4-6, 53113, Bonn, Germany
| | - Ralf Hildenbrand
- Institute for Pathology Bonn-Duisdorf, Heilsbachstr. 15, 53123, Bonn, Germany
| | - Bernd Sido
- Department of General and Abdominal Surgery, Gemeinschaftskrankenhaus Bonn, Academic Teaching Hospital, University of Bonn, Bonner Talweg 4-6, 53113, Bonn, Germany
| | - Franz Ludwig Dumoulin
- Department of Medicine and Gastroenterology, Gemeinschaftskrankenhaus Bonn, Academic Teaching Hospital, University of Bonn, Bonner Talweg 4-6, 53113, Bonn, Germany.
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Abstract
With the development of reliable endoscopic closure techniques and tools, endoscopic full-thickness resection (EFTR) is emerging as a therapeutic option for the treatment of subepithelial tumors and epithelial neoplasia with significant fibrosis. EFTR may be categorized as "exposed" and "nonexposed." In exposed EFTR, the full-thickness resection is undertaken with a tunneled or nontunneled technique, with subsequent closure of the defect. In nonexposed EFTR, a secure serosa-to-serosa apposition is achieved before full-thickness resection of the isolated lesion. This document reviews current techniques and devices used for EFTR and reviews clinical applications and outcomes.
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Key Words
- EFTR, endoscopic full-thickness resection
- ESD, endoscopic submucosal dissection
- GIST, GI stromal tumor
- NOTES, natural orifice transluminal endoscopic surgery
- OTSC, over-the-scope clip
- POEM, per-oral endoscopic myotomy
- PTFE, polytetrafluoroethylene
- SET, subepithelial tumor
- STER, submucosal tunnel endoscopic resection
- TTS, through-the-scope
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Dellatore P, Bhagat V, Kahaleh M. Endoscopic full thickness resection versus submucosal tunneling endoscopic resection for removal of submucosal tumors: a review article. Transl Gastroenterol Hepatol 2019; 4:45. [PMID: 31304422 DOI: 10.21037/tgh.2019.05.03] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 05/07/2019] [Indexed: 12/15/2022] Open
Abstract
Submucosal tumors (SMT) are protuberant lesions with intact mucosa that have a wide differential. These lesions may be removed by standard polypectomy, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or surgically. However, in lesions that arise from the muscularis propria, full thickness resection is recommended. This can be completed using either endoscopic full thickness resection (EFTR) or submucosal tunneling endoscopic resection (STER). EFTR can be accomplished by completing a full thickness resection followed by defect closure or by securing gastrointestinal wall patency before resection. STER is an option that first creates a mucosal dissection proximal to the lesion to allow a submucosal tunnel to be created. Using this tunnel, the lesion may be resected. When comparing STER to EFTR, there was no significant difference when evaluating tumor size, operation time, rate of complications, or en bloc resection rate. However, suture time, amount of clips used, and overall hospital stay were decreased in STER. With these differences, EFTR may be more efficacious in certain parts of the gastrointestinal tract where a submucosal tunnel is harder to accomplish.
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Affiliation(s)
- Peter Dellatore
- Department of Gastroenterology and Hepatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Vicky Bhagat
- Department of Gastroenterology and Hepatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Michel Kahaleh
- Department of Gastroenterology and Hepatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Wang W, Li P, Ji M, Wang Y, Zhu S, Liu L, Zhang S. Comparison of two methods for endoscopic full-thickness resection of gastrointestinal lesions using OTSC. MINIM INVASIV THER 2019; 28:268-276. [PMID: 30987491 DOI: 10.1080/13645706.2019.1602544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background and aims: The aim of this study was to compare and analyze the feasibility and safety of two methods of endoscopic full-thickness resection (EFTR) for the management of challenging epithelial and subepithelial neoplasms that are not amenable to resection techniques.Material and methods: This was a retrospective case series study of patients who underwent one of two methods of EFTR, resection using ESD knives and post-resection closure with OTSC (Group 1), or closure with OTSC and secondary EFTR with snare (Group 2).Results: Of 11 patients, six were in Group 1 and five in Group 2. The mean time of the EFTR procedure was 76.83 ± 34.97 min in Group 1 which is significantly longer than that of Group 2 (p = .0128). The mean time of OSTC closure and length of hospital stay of Group 1 were also longer compared to Group 2, but the difference was not significant. Complete resection (R0) and technical success rates of Group 1 and Group 2 were 83.3% and 100% (p = .338), respectively. VAS scores of Group 1 immediately after the operation and after 24 h are significantly higher than those of Group 2 (p = .047 and p = .009, respectively). In Group 1, one patient had delayed perforation which led to fever and pneumoperitoneum, and one patient developed abdominal pain. No complications associated with the endoscopic procedure were observed in Group 2.Conclusion: EFTR of pre-resection closure are potentially faster compared with the concept of applying closure after EFTR. Larger prospective controlled studies comparing these two techniques are warranted in the future.
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Affiliation(s)
- Wenhai Wang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
| | - Ming Ji
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
| | - Yongjun Wang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
| | - Shengtao Zhu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
| | - Lihua Liu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
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Fragaki M, Voudoukis E, Chliara E, Dimas I, Mpitouli A, Velegraki M, Vardas E, Theodoropoulou A, Karmiris K, Giannikaki L, Paspatis G. Complete endoscopic mucosal resection of malignant colonic sessile polyps and clinical outcome of 51 cases. Ann Gastroenterol 2019; 32:174-177. [PMID: 30837790 PMCID: PMC6394258 DOI: 10.20524/aog.2018.0343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/26/2018] [Indexed: 12/27/2022] Open
Abstract
Background Meta-analyses and guidelines recommend that deep submucosal invasion (>1 mm) of malignant sessile colonic polyps is an important risk factor for lymph node metastasis. However, existing data are based on small retrospective studies with marked heterogeneity. We herein aimed to investigate the long-term outcomes of patients who underwent complete endoscopic mucosal resection (EMR) of malignant colonic sessile polyps invading the submucosal layer. Methods Endoscopy records for the period 2000-2016 were reviewed retrospectively. All enrolled patients exhibited an endoscopically resected malignant colonic sessile polyp. All patients were advised to undergo surgery, but some opted for conservative treatment and endoscopic follow up. Results Fifty-one patients with confirmed infiltrative submucosal adenocarcinoma in sessile colonic polyps that had undergone complete EMR were detected. A total of 32 (62.7%) patients opted for surgery after EMR and 19 (37.3%) chose endoscopic follow up. In 44 (86.3%) patients the submucosal invasion was >1 mm. Residual malignant disease was identified in the surgical pathological specimen of only 1 patient. During a median follow up of 23.41 months (interquartile range 33.45, range 1.84-144.92), no local recurrences or lymph node metastasis were identified. Forty-nine patients are alive without evidence of disease and 2 died of other causes (without evidence of local or metastatic disease at last follow up). Conclusion Our data suggest that complete EMR of cancerous colonic sessile polyps, even in cases of submucosal invasion >1 mm carries a low risk of recurrence and therefore may need further evaluation as an alternative strategy to surgical resection.
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Affiliation(s)
- Maria Fragaki
- Department of Gastroenterology (Maria Fragaki, Evangelos Voudoukis, Ioannis Dimas, Afroditi Mpitouli, Magdalini Velegraki, Emmanouil Vardas, Angeliki Theodoropoulou, Konstantinos Karmiris, Gregorios Paspatis), Venizeleion General Hospital, Heraklion, Greece
| | - Evangelos Voudoukis
- Department of Gastroenterology (Maria Fragaki, Evangelos Voudoukis, Ioannis Dimas, Afroditi Mpitouli, Magdalini Velegraki, Emmanouil Vardas, Angeliki Theodoropoulou, Konstantinos Karmiris, Gregorios Paspatis), Venizeleion General Hospital, Heraklion, Greece
| | - Evdoxia Chliara
- Histopathology (Evdoxia Chliara, Linda Giannikaki), Venizeleion General Hospital, Heraklion, Greece
| | - Ioannis Dimas
- Department of Gastroenterology (Maria Fragaki, Evangelos Voudoukis, Ioannis Dimas, Afroditi Mpitouli, Magdalini Velegraki, Emmanouil Vardas, Angeliki Theodoropoulou, Konstantinos Karmiris, Gregorios Paspatis), Venizeleion General Hospital, Heraklion, Greece
| | - Afroditi Mpitouli
- Department of Gastroenterology (Maria Fragaki, Evangelos Voudoukis, Ioannis Dimas, Afroditi Mpitouli, Magdalini Velegraki, Emmanouil Vardas, Angeliki Theodoropoulou, Konstantinos Karmiris, Gregorios Paspatis), Venizeleion General Hospital, Heraklion, Greece
| | - Magdalini Velegraki
- Department of Gastroenterology (Maria Fragaki, Evangelos Voudoukis, Ioannis Dimas, Afroditi Mpitouli, Magdalini Velegraki, Emmanouil Vardas, Angeliki Theodoropoulou, Konstantinos Karmiris, Gregorios Paspatis), Venizeleion General Hospital, Heraklion, Greece
| | - Emmanouil Vardas
- Department of Gastroenterology (Maria Fragaki, Evangelos Voudoukis, Ioannis Dimas, Afroditi Mpitouli, Magdalini Velegraki, Emmanouil Vardas, Angeliki Theodoropoulou, Konstantinos Karmiris, Gregorios Paspatis), Venizeleion General Hospital, Heraklion, Greece
| | - Angeliki Theodoropoulou
- Department of Gastroenterology (Maria Fragaki, Evangelos Voudoukis, Ioannis Dimas, Afroditi Mpitouli, Magdalini Velegraki, Emmanouil Vardas, Angeliki Theodoropoulou, Konstantinos Karmiris, Gregorios Paspatis), Venizeleion General Hospital, Heraklion, Greece
| | - Konstantinos Karmiris
- Department of Gastroenterology (Maria Fragaki, Evangelos Voudoukis, Ioannis Dimas, Afroditi Mpitouli, Magdalini Velegraki, Emmanouil Vardas, Angeliki Theodoropoulou, Konstantinos Karmiris, Gregorios Paspatis), Venizeleion General Hospital, Heraklion, Greece
| | - Linda Giannikaki
- Histopathology (Evdoxia Chliara, Linda Giannikaki), Venizeleion General Hospital, Heraklion, Greece
| | - Gregorios Paspatis
- Department of Gastroenterology (Maria Fragaki, Evangelos Voudoukis, Ioannis Dimas, Afroditi Mpitouli, Magdalini Velegraki, Emmanouil Vardas, Angeliki Theodoropoulou, Konstantinos Karmiris, Gregorios Paspatis), Venizeleion General Hospital, Heraklion, Greece
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Tian XL, Huang YH, Yao W, Li Y, Lu JJ. [Comparative treatment analysis of upper gastroenterology submucosal tumors originating from muscularis propria layer: submucosal tunneling endoscopic resection versus endoscopic submucosal excavation]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:171-176. [PMID: 30773563 DOI: 10.19723/j.issn.1671-167x.2019.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of submucosal tunneling endoscopic resection (STER) and endoscopic submucosal excavation (ESE) for upper gastroenterology submucosal tumors (SMT) originating from the muscularis propria (MP) layer. METHODS Clinicopathological and endoscopic data of 42 cases with upper gastroenterology tumors originating from the MP layer who were treated with STER (n=28) or ESE (n=14) between April 2013 and December 2016 in Peking University Third Hospital were retrospectively analyzed. The treatment and complications of the two groups were compared. RESULTS In the study, 42 cases were all resected by therapeutic endoscopy successfully.There was no significant difference (STER vs. ESE) in gender, age, mean tumor size [1.5 (1.0-6.0) cm vs. 1.3 (0.5-2.0) cm, P=0.056]. STER was superior to ESE with reduced sutured time [3.5 (1.0-11.0) min vs. 8.0 (2.0-33.0) min, P=0.006], but more resection time [46.5 (11.0-163.0) min vs.19.5 (6.0-56.0) min, P=0.007]. There was statistical difference between the two groups in resection time or sutured time, but no significant difference (STER vs. ESE) in total operative time [52.0 (14.0-167.0) min vs. 31.5 (10.0-88.0) min, P=0.080]. En bloc resection rates (92.9% vs. 85.7%), hospital stay duration and complications (10.7 vs. 0.0) were similar in the STER and ESE groups. One case developed mediastinal emphysema and 2 pneumonia after operation in STER group, and all of them recovered uneventfully after conservative treatments; There were no complications in the ESE group. After operation, 28 cases of leiomyoma and 14 cases of stromal tumor were diagnosed by routine pathological and immunohistochemical staining. Among them, 6 cases of stromal tumors in group STER were all extremely low risk, 4 cases of stromal tumors in group ESE were extremely low risk, 4 cases of stromal tumors in group ESE were medium risk (the size of the lesion was about 1.0-2.0 cm, and mitotic figures counted (6-8)/50 high power field). The median follow-up time of all the patients was 46.5 (24-60) months, and the shortest follow-up time for medium risk stromal tumors was 32 months. No residual tumor, recurrence and implantation in the tunnel were observed. CONCLUSION STER or ESE can be used as an effective and safe option for treatment of submucosal tumors originating from the muscularis propria of the upper digestive tract. Compared with STER, ESE had shorter resection time but longer wound closure time. There was no significant difference in total operation time.
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Affiliation(s)
- X L Tian
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
| | - Y H Huang
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
| | - W Yao
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
| | - Y Li
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
| | - J J Lu
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
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Nassri AB, Alkhasawneh A, Scolapio JS, Malespin MH, Ribeiro BDS. Safety and efficacy of over-the-scope clip-assisted full thickness resection of duodenal subepithelial tumors: A case report. World J Gastrointest Endosc 2019; 11:168-173. [PMID: 30788035 PMCID: PMC6379745 DOI: 10.4253/wjge.v11.i2.168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/15/2019] [Accepted: 01/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Over-the-scope clip-assisted endoscopic full thickness resection (eFTR) of subepithelial tumors is a novel and promising endoscopic technique. Recently, there have been prospective studies investigating its use for colonic masses, but data regarding its use and efficacy in the duodenum are limited to a few reports.
CASE SUMMARY A 65-year-old African American female presents for evaluation of persistent gastroesophageal reflux disease not responsive to medical treatment. A 1 cm nodule was incidentally found in the duodenum and biopsies revealed a low grade well differentiated neuroendocrine tumor. The nodule was removed using over-the-scope clip-assisted eFTR and pathology revealed clear margins. We review the available literature with a discussion on the efficacy and safety of clip-assisted eFTR s of subepithelial lesions in the duodenum.
CONCLUSION Clip assisted eFTR appears to be a safe and efficacious treatment approach to duodenal subepithelial lesions. Further prospective studies are needed to investigate the long-term utility and safety of clip-assisted eFTR in the management of subepithelial duodenal lesions.
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Affiliation(s)
- Ammar B Nassri
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Florida Health at Jacksonville, Jacksonville, FL 32209, United States
| | - Ahmad Alkhasawneh
- Department of Pathology and Laboratory Medicine, University of Florida Health at Jacksonville, Jacksonville, FL 32209, United States
| | - James S Scolapio
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Florida Health at Jacksonville, Jacksonville, FL 32209, United States
| | - Miguel H Malespin
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Florida Health at Jacksonville, Jacksonville, FL 32209, United States
| | - Bruno de Souza Ribeiro
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Florida Health at Jacksonville, Jacksonville, FL 32209, United States
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Dumoulin FL, Hildenbrand R. Endoscopic resection techniques for colorectal neoplasia: Current developments. World J Gastroenterol 2019; 25:300-307. [PMID: 30686899 PMCID: PMC6343101 DOI: 10.3748/wjg.v25.i3.300] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/30/2018] [Accepted: 12/13/2018] [Indexed: 02/06/2023] Open
Abstract
Endoscopic polypectomy and endoscopic mucosal resection (EMR) are the established treatment standards for colorectal polyps. Current research aims at the reduction of both complication and recurrence rates as well as on shortening procedure times. Cold snare resection is the emerging standard for the treatment of smaller (< 5mm) polyps and is possibly also suitable for the removal of non-cancerous polyps up to 9 mm. The method avoids thermal damage, has reduced procedure times and probably also a lower risk for delayed bleeding. On the other end of the treatment spectrum, endoscopic submucosal dissection (ESD) offers en bloc resection of larger flat or sessile lesions. The technique has obvious advantages in the treatment of high-grade dysplasia and early cancer. Due to its minimal recurrence rate, it may also be an alternative to fractionated EMR of larger flat or sessile lesions. However, ESD is technically demanding and burdened by longer procedure times and higher costs. It should therefore be restricted to lesions suspicious for high-grade dysplasia or early invasive cancer. The latest addition to endoscopic resection techniques is endoscopic full-thickness resection with specifically developed devices for flexible endoscopy. This method is very useful for the treatment of smaller difficult-to-resect lesions, e.g., recurrence with scar formation after previous endoscopic resections.
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Affiliation(s)
- Franz Ludwig Dumoulin
- Department of Medicine and Gastroenterology, Gemeinschaftskrankenhaus Bonn, Bonn 53113, Germany
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44
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Bazarbashi AN, Thompson CC. Training and development in endoscopic full thickness resection. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Chiu PWY. Future of full thickness resection – Devices, indications, robotics, what is missing. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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46
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Fazlollahi L, Remotti HE. Pathology perspective on endoscopic full thickness resection. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mão de-Ferro S, Castela J, Pereira D, Chaves P, Dias Pereira A. Endoscopic Full-Thickness Resection of Colorectal Lesions with the New FTRD System: Single-Center Experience. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2018; 26:235-241. [PMID: 31328137 DOI: 10.1159/000493808] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/14/2018] [Indexed: 12/26/2022]
Abstract
Background and Aims Endoscopic full-thickness resection (EFTR) is an emerging technique for the treatment of various conditions for which classic endoscopic resection techniques have failed or were considered to be at high risk for perforation. The full-thickness resection device (FTRD) is an over-the-scope system which allows a single-step EFTR. The aim of our study is to describe our experience in EFTR of colorectal lesions using the FTRD. Methods Nine patients (10 colorectal lesions) were proposed for EFTR. Safety, R0 resection and endoscopic treatment success were evaluated. Results Reasons for referral included nonlifting adenomas (n = 4), nonlifting adenoma recurrence (n = 5), and submucosal lesion (n = 1). EFTR was technically successful in all patients. The mean duration of the procedure was 55 min. R0 resection was obtained in all patients. No major complications were detected. All lesions were successfully treated by the endoscopic technique and no patient was referred for surgery. In patients with available follow-up (n = 6), no recurrence was detected. Conclusions EFTR is a feasible, reasonable time-consuming, safe, and promising endoscopic resection technique. Key Messages FTRD is an additional tool for difficult-to-treat colorectal lesions.
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Affiliation(s)
- Susana Mão de-Ferro
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa Dr. Francisco Gentil, EPE, Lisbon, Portugal
| | - Joana Castela
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa Dr. Francisco Gentil, EPE, Lisbon, Portugal
| | - Daniela Pereira
- Pathology Department, Instituto Português de Oncologia de Lisboa Dr. Francisco Gentil, EPE, Lisbon, Portugal
| | - Paula Chaves
- Pathology Department, Instituto Português de Oncologia de Lisboa Dr. Francisco Gentil, EPE, Lisbon, Portugal
| | - António Dias Pereira
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa Dr. Francisco Gentil, EPE, Lisbon, Portugal
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Dumoulin FL, Gorris DG, Berger S, Hildenbrand R, Sido B. Full-thickness resection with an over-the-scope device: possible translocation of adenoma tissue in a case of an incomplete resection at the appendix. Endosc Int Open 2018; 6:E622-E624. [PMID: 29756021 PMCID: PMC5943692 DOI: 10.1055/a-0589-9850] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/12/2018] [Indexed: 01/10/2023] Open
Abstract
Background and study aims Clip-assisted endoscopic full-thickness resection has great potential for treatment of difficult-to-resect colorectal neoplasia. Here, we report on endoscopic full-thickness resection at the appendiceal orifice with the appendix in situ requiring emergency surgery due to acute appendicitis. Final histopathology showed appendicitis and residual serrated adenoma within the appendiceal stump, but unexpectedly, also a displaced adenoma fragment at the serosal surface of the cecum. Given the transmural placement of the clip prior to snare resection, translocation of neoplastic tissue to the extra luminal site in cases of incomplete adenoma/carcinoma resection could be a concern.
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Affiliation(s)
- Franz Ludwig Dumoulin
- Department of Medicine and Gastroenterology, Gemeinschaftskrankenhaus Bonn, Bonn, Germany,Corresponding author Prof. Dr. Franz Ludwig Dumoulin Department of Medicine and GastroenterologyGemeinschaftskrankenhaus BonnBonner Talweg 4-6, D-53113BonnGermany+49-228-508-1562
| | - Dominik G. Gorris
- Department of Medicine and Gastroenterology, Gemeinschaftskrankenhaus Bonn, Bonn, Germany
| | - Susanne Berger
- Office for Internal Medicine, Cardiology and Gastroenterology, St. Augustin, Germany
| | | | - Bernd Sido
- Department of General and Abdominal Surgery, Gemeinschaftskrankenhaus Bonn, Bonn, Germany
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Rajan E, Wong Kee Song LM. Endoscopic Full Thickness Resection. Gastroenterology 2018; 154:1925-1937.e2. [PMID: 29486198 DOI: 10.1053/j.gastro.2018.02.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/04/2018] [Accepted: 02/05/2018] [Indexed: 02/06/2023]
Abstract
Recent advances in minimally invasive endoscopic approaches have pushed the boundaries of well-established resection techniques for therapeutic and diagnostic applications. Endoscopic full thickness resection techniques are a key development in the management of challenging epithelial and subepithelial lesions that are not amenable to conventional endoscopic resection methods and previously required a surgical approach. Endoscopic full thickness biopsy represents a paradigm shift in tissue acquisition and will enhance our understanding of the pathophysiology, and guide therapy, of gastrointestinal neuromuscular diseases, as well as other inflammatory and neoplastic conditions. This review highlights current tools and techniques available for endoscopic full thickness resection and biopsy, as well as outcomes from such interventions.
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Affiliation(s)
- Elizabeth Rajan
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Boda K, Oka S, Tanaka S, Tanaka H, Matsumoto K, Yamashita K, Sumimoto K, Hirano D, Tamaru Y, Ninomiya Y, Hayashi N, Chayama K. Short-term outcomes of endoscopic submucosal dissection for superficial cecal tumors: a comparison between extension and nonextension into the appendiceal orifice. Therap Adv Gastroenterol 2018; 11:1756284818772794. [PMID: 29899756 PMCID: PMC5991193 DOI: 10.1177/1756284818772794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/28/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Few studies have investigated the use of endoscopic submucosal dissection (ESD) for cecal tumors extending into the appendiceal orifice. Herein, we assessed the feasibility and safety of ESD for cecal tumors extending into the appendiceal orifice. METHODS We retrospectively examined the outcomes of ESD for 78 patients with 78 cecal tumors (male/female ratio, 40/38; mean [standard deviation, SD] age, 67 [9] years; mean [SD] tumor size, 32 [15] mm), who underwent ESD at the Hiroshima University Hospital between October 2008 and March 2016. The indication for ESD in cecal tumors extending into the appendiceal orifice was recognition of the distal edge of the lesion in the appendix. They were classified into two groups: patients with cecal tumors extending (Group A: 29 patients, 29 tumors) and not extending (Group B: 49 patients, 49 tumors) into the appendiceal orifice. We compared the outcomes of ESD between both groups. RESULTS No significant differences in clinicopathological characteristics were observed between both groups. The rate of severe submucosal fibrosis in Group A (48%) was significantly higher than that in Group B (24%) (p < 0.05). The mean (SD) procedure speed in Group A (14 [10] mm2/min) was significantly slower than that in Group B (23 [16] mm2/min) (p < 0.01). The en bloc resection rates in Groups A and B were 90% and 96%, respectively. There were no significant differences in adverse events reported between both groups. CONCLUSIONS ESD for cecal tumors with extension into the appendiceal orifice is effective and safe.
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Affiliation(s)
- Kazuki Boda
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Hidenori Tanaka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Kenta Matsumoto
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Ken Yamashita
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Kyoku Sumimoto
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Daiki Hirano
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuzuru Tamaru
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuki Ninomiya
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Nana Hayashi
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
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