1
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A Comparison of Endoscopic Closure and Laparoscopic Repair for Gastric Wall Defection. Gastroenterol Res Pract 2022; 2022:9963126. [PMID: 35663334 PMCID: PMC9159865 DOI: 10.1155/2022/9963126] [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: 03/16/2021] [Revised: 03/18/2022] [Accepted: 05/03/2022] [Indexed: 12/04/2022] Open
Abstract
Objective To compare the effectiveness and safety of endoscopic closure and laparoscopic repair for gastric wall defection. Method The clinical data of 120 patients with submucosal tumours enrolled at our hospital between January 2014 and December 2019 were retrospectively analysed. Patients were divided into two groups according to the surgery they underwent: an endoscopic closure group (n = 60) and a laparoscopic repair group (n = 60). The clinical characteristics, perioperative complications, and postoperative follow-up results of the two groups were analysed. Results The surgery time in the endoscopic closure group was 56.20 ± 11.25 minutes, which was significantly lower compared with that in the laparoscopic repair group (159.35 ± 23.18 minutes; P < 0.001). In addition, the postoperative stay in the endoscopic closure group was shorter than that in the laparoscopic repair group, and the intraoperative bleeding volume and incidence of enteral nutrition initiation after surgery were significantly lower. Medical expenses were also significantly lower in the endoscopic closure group than in the laparoscopic repair group (P < 0.001). Only one patient developed a postoperative fever in the endoscopic closure group; three patients developed a postoperative fever and one patient had postoperative bleeding in the laparoscopic repair group. However, there were no statistical differences between the two groups regarding the incidence of R0 resection, postoperative fever, postoperative bleeding, and closure failure (all P > 0.05). There were no local recurrences, distant metastases, or deaths in either of the groups during the two-year follow-up period. Conclusion Non-laparoscopic-assisted surgery may be quicker, safer, and more effective for gastric wall defection.
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Dahale AS, Srivastava S, Saluja SS, Sachdeva S, Dalal A, Varakanahalli S. Management of scope-induced type I duodenal perforations: Over-the-scope clip versus surgery. Indian J Gastroenterol 2021; 40:287-294. [PMID: 33974228 PMCID: PMC8195754 DOI: 10.1007/s12664-021-01152-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/18/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Scope-induced duodenal perforation is a life-threatening complication and surgery remains the standard of care. With the advent of over-the-scope clip (OTSC), scope-induced perforations are increasingly managed conservatively, though there is no study comparing this form of non-surgical treatment with surgery. We aimed to compare OTSC and surgery in the management of scope-induced perforation of the duodenum. METHODS We retrospectively collected data of scope-induced duodenal perforation patients. Perforations identified and treated within 24 h of procedure were analyzed. Factors analyzed were spectrum, etiology, baseline parameters, perforation size, outcome, comorbidities, and duration of hospital stay. RESULTS A total of 25 patients had type I duodenal perforations, out of whom five were excluded due to delayed diagnosis and treatment. Of the twenty, eight were treated with OTSC placement while the rest underwent surgery. Age was comparable and the majority were females. Baseline parameters and comorbidities were similar in both the groups. The median size of perforation was 1.5 cm in both the OTSC group and the surgical group. All patients were treated with standard of care according to institutional protocols. Patients in the OTSC group were started orally after 48 h of OTSC placement, while in the surgery group median time to oral intake was 7 days. Two patients in the surgical group died while there was no mortality in the OTSC group (p = 0.48). Median hospital stay was shorter in the OTSC group (2 days vs. 22 days, p = 0.003). CONCLUSIONS OTSC is a feasible and better option in type I duodenal perforations with a shorter hospital stay.
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Affiliation(s)
- Amol S. Dahale
- Department of Gastroenterology, Dr. D Y Patil Medical College and Hospital, Pimpri, Pune, 411 018 India
| | - Siddharth Srivastava
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002 India
| | - Sundeep Singh Saluja
- Department of Gastrointestinal Surgery, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, 110 002 India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002 India
| | - Ashok Dalal
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002 India
| | - Shivakumar Varakanahalli
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002 India
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3
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Paspatis GA, Arvanitakis M, Dumonceau JM, Barthet M, Saunders B, Turino SY, Dhillon A, Fragaki M, Gonzalez JM, Repici A, van Wanrooij RLJ, van Hooft JE. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement - Update 2020. Endoscopy 2020; 52:792-810. [PMID: 32781470 DOI: 10.1055/a-1222-3191] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
1: ESGE recommends that each center implements a written policy regarding the management of iatrogenic perforations, including the definition of procedures that carry a higher risk of this complication. This policy should be shared with the radiologists and surgeons at each center. 2 : ESGE recommends that in the case of an endoscopically identified perforation, the endoscopist reports its size and location, with an image, and statement of the endoscopic treatment that has been applied. 3: ESGE recommends that symptoms or signs suggestive of iatrogenic perforation after an endoscopic procedure should be rapidly and carefully evaluated and documented with a computed tomography (CT) scan. 4 : ESGE recommends that endoscopic closure should be considered depending on the type of the iatrogenic perforation, its size, and the endoscopist expertise available at the center. Switch to carbon dioxide (CO2) endoscopic insufflation, diversion of digestive luminal content, and decompression of tension pneumoperitoneum or pneumothorax should also be performed. 5 : ESGE recommends that after endoscopic closure of an iatrogenic perforation, further management should be based on the estimated success of the endoscopic closure and on the general clinical condition of the patient. In the case of no or failed endoscopic closure of an iatrogenic perforation, and in patients whose clinical condition is deteriorating, hospitalization and surgical consultation are recommended.
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Affiliation(s)
- Gregorios A Paspatis
- Gastroenterology Department, Venizelion General Hospital, Heraklion, Crete-Greece
| | - Marianna Arvanitakis
- Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Universite Libre de Bruxelles, Brussels, Belgium
| | - Jean-Marc Dumonceau
- Gastroenterology Service, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | | | - Brian Saunders
- St Mark's Hospital, Wolfson Unit for Endoscopy, North West London Hospitals University Trust, Harrow, London, UK
| | | | - Angad Dhillon
- St Mark's Hospital, Wolfson Unit for Endoscopy, North West London Hospitals University Trust, Harrow, London, UK
| | - Maria Fragaki
- Gastroenterology Department, Venizelion General Hospital, Heraklion, Crete-Greece
| | | | - Alessandro Repici
- Department of Gastroenterology, Digestive Endoscopy Unit, IRCCS Istituto Clinico Humanitas, Milan, Italy
| | - Roy L J van Wanrooij
- Department of Gastroenterology and Hepatology, AG&M Research Institute, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, The Netherlands
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4
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Gabr A. Sealing the hole: endoscopic management of acute gastrointestinal perforations. Frontline Gastroenterol 2020; 11:55-61. [PMID: 31885841 PMCID: PMC6914298 DOI: 10.1136/flgastro-2018-101136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/03/2019] [Accepted: 02/16/2019] [Indexed: 02/04/2023] Open
Abstract
Acute perforations are one of the recognised complications of both diagnostic and therapeutic gastrointestinal (GI) endoscopy. The incidence rate varies according to the type of procedure and the anatomical location within the GI tract. For decades, surgical treatment has been the standard of care, but endoscopic closure has become a more popular approach, due to feasibility and the reduction of the burden of surgery. Various devices are available now such as through-the-scope clips, over-the-scope clips, endoscopic suturing devices, stents, bands and omental patch. All have been tested in studies done on humans or animal models, with a reasonable overall technical and clinical success rate, proving efficiency and feasibility of endoscopic closure. The choice of which device to use depends on the site and the size of the perforation. It also depends on availability of thee device and the endoscopist's experience. A number of factors that could predict success of endoscopic closure or favour surgical treatment have been suggested in different studies. After successful endoscopic closure, patients are usually kept nil by mouth and receive antibiotics for a duration that varied between different studies.
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Affiliation(s)
- Ahmed Gabr
- Gastroenterology, Palestine Hospital, Cairo, Egypt
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5
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Singh RR, Nussbaum JS, Kumta NA. Endoscopic management of perforations, leaks and fistulas. Transl Gastroenterol Hepatol 2018; 3:85. [PMID: 30505972 DOI: 10.21037/tgh.2018.10.09] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 10/19/2018] [Indexed: 12/14/2022] Open
Abstract
The endoscopic management armamentarium of gastrointestinal disruptions including perforations, leaks, and fistulas has slowly but steadily broadened in recent years. Previously limited to surgical or conservative medical management, innovations in advanced endoscopic techniques like natural orifice transluminal endoscopic surgery (NOTES) have paved the path towards development of endoscopic closure techniques. Early recognition of a gastrointestinal defect is the most important independent variable in determining successful endoscopic closure and patient outcome. Some devices including through the scope clips and stents have been well studied for other indications and have produced encouraging results in closure of gastrointestinal perforations, leaks and fistulas. Over the scope clips, endoscopic sutures, vacuum therapy, glue, and cardiac device occluders are other alternative techniques that can be employed for successful endoscopic closure.
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Affiliation(s)
- Ritu Raj Singh
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeremy S Nussbaum
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nikhil A Kumta
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Yamamoto K, Shimoda R, Ogata S, Hara M, Ito Y, Tominaga N, Nakayama A, Sakata Y, Tsuruoka N, Iwakiri R, Fujimoto K. Perforation and Postoperative Bleeding Associated with Endoscopic Submucosal Dissection in Colorectal Tumors: An Analysis of 398 Lesions Treated in Saga, Japan. Intern Med 2018; 57:2115-2122. [PMID: 29607956 PMCID: PMC6120842 DOI: 10.2169/internalmedicine.9186-17] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective The aim of this study was to clarify the safety of colorectal endoscopic submucosal dissection (ESD) during the era of health insurance coverage starting from April 2012 in Japan. Methods Between April 2012 and May 2016, ESD was applied to 398 lesions in 373 patients. Risk factors for serious complications of colorectal ESD, perforation and post-ESD bleeding, were evaluated focusing on the resected specimen size, location, growth pattern, invasion depth, histopathology, postoperative clipping, and procedure time. In addition, the relationship between serious complications and patients' background characteristics was analyzed. Results Among 373 patients, perforation occurred in 12 patients and post-ESD bleeding in 19 patients. A univariate analysis showed that the risk factors for perforation were the lesion size, the resected specimen size, and a long operation time. A multivariate analysis showed that a long operation time was a risk factor for perforation during colorectal ESD. A univariate analysis indicated that significant risk factors for postoperative bleeding were a long operation time, rectal lesion, and cancer. All patients with serious complications were treated by an endoscopic procedure without blood transfusion or the need to convert to open surgery. Conclusion The present study suggests that colorectal ESD may be accepted with relative safety in Japan as a common therapeutic approach for early colorectal cancer.
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Affiliation(s)
- Koji Yamamoto
- Departments of Internal Medicine, Saga Medical School, Saga Medical School, Japan
- Department of Gastroenterology, Saga Prefectural Medical Center, Japan
| | - Ryo Shimoda
- Departments of Internal Medicine, Saga Medical School, Saga Medical School, Japan
| | - Shinichi Ogata
- Department of Gastroenterology, Saga Prefectural Medical Center, Japan
| | - Megumi Hara
- Departments of Preventive Medicine, Saga Medical School, Saga Medical School, Japan
| | - Yoichiro Ito
- Departments of Internal Medicine, Saga Medical School, Saga Medical School, Japan
- Department of Gastroenterology, Saga Prefectural Medical Center, Japan
| | - Naoyuki Tominaga
- Department of Gastroenterology, Saga Prefectural Medical Center, Japan
| | - Atsushi Nakayama
- Departments of Internal Medicine, Saga Medical School, Saga Medical School, Japan
- Department of Gastroenterology, Saga Prefectural Medical Center, Japan
| | - Yasuhisa Sakata
- Departments of Internal Medicine, Saga Medical School, Saga Medical School, Japan
| | - Nanae Tsuruoka
- Departments of Internal Medicine, Saga Medical School, Saga Medical School, Japan
| | - Ryuichi Iwakiri
- Departments of Internal Medicine, Saga Medical School, Saga Medical School, Japan
| | - Kazuma Fujimoto
- Departments of Internal Medicine, Saga Medical School, Saga Medical School, Japan
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7
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Yang TC, Hou MC, Chen PH, Hsin IF, Chen LK, Tsou MY, Lin HC, Lee FY. Clinical Outcomes and Complications of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasms in the Elderly. Medicine (Baltimore) 2015; 94:e1964. [PMID: 26554806 PMCID: PMC4915907 DOI: 10.1097/md.0000000000001964] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The number of elderly people with superficial gastric neoplasms is increasing, but the clinical outcome of endoscopic submucosal dissection (ESD) for treating elderly people with superficial gastric neoplasms remains unclear. We aimed to compare the efficacy and safety of ESD for patients with early gastric cancer (EGC) and precancerous lesions in elderly (≥75 years of age) and nonelderly (<75 years of age) patients.From October 2005 to December 2014, 83 consecutive patients with EGC and precancerous lesions (86 lesions) who were treated using ESD in our hospital were retrospectively reviewed. There were 44 lesions in 42 elderly patients who were at least 75-years old. The following parameters were compared between the 2 groups: preexisting comorbidities, performance status (PS), lesion inclusion criteria, lesion characteristics, treatment outcomes, surgery time, duration of hospitalization, complications, and intraoperative hemodynamic changes.Elderly patients had significantly higher preexisting comorbidity rates (90.9% vs 59.5%, P = 0.001), expanded lesion criteria rates (43.2% vs 19.0%, P = 0.016), and lower best PS rates (38.6% vs 81.0%, P < 0.001) than nonelderly patients. Lesion characteristics were similar in the 2 groups. The elderly had higher intraoperative hypotension rates (47.7% vs 21.4%, P = 0.011) and oxygen desaturation rates (9.1% vs 0.0%, P = 0.045) than nonelderly patients. In addition, the elderly also had a longer surgery time (107.0 ± 51.4 vs 91.5 ± 66.2 minutes, P = 0.049) and duration of hospitalization (7.5 ± 3.8 vs 5.9 ± 2.0 days, P = 0.016) than nonelderly patients. There were no differences in the prevalence rates of en-bloc resection, complete resection, bleeding, perforation, pneumonia, or intraabdominal free air between the 2 groups.Although elderly patients who underwent ESD for superficial gastric neoplasms had an increasing risk of intraoperative hypotension and oxygen desaturation, all patients were treated appropriately without postoperative sequelae. ESD is a safe and feasible intervention for elderly patients who have more comorbidity, a worse PS and more expanded lesions.
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Affiliation(s)
- Tsung-Chieh Yang
- From the Division of Gastroenterology, Department of Medicine (T-CY, M-CH, H-CL, F-YL); Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital (M-CH, P-HC, I-FH); School of Medicine (T-CY, M-CH, P-HC, I-FH, M-YT, H-CL, F-YL); Aging and Health Research Center, National Yang-Ming University (L-KC); Center for Geriatrics and Gerontology (L-KC); Department of Anesthesiology, Taipei Veterans General Hospital, Taipei (M-YT); and Division of Gastroenterology, Department of Medicine, Taoyuan Branch, Taipei Veterans General Hospital, Taoyuan, Taiwan (T-CY)
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8
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Verlaan T, Voermans RP, van Berge Henegouwen MI, Bemelman WA, Fockens P. Endoscopic closure of acute perforations of the GI tract: a systematic review of the literature. Gastrointest Endosc 2015; 82:618-28.e5. [PMID: 26005015 DOI: 10.1016/j.gie.2015.03.1977] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 03/25/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical repair of endoscopic perforations of the GI tract used to be the standard, but immediate, secure endoscopic closure has become an attractive alternative treatment with the potential to reduce morbidity and mortality. OBJECTIVE We aimed to perform a systematic review of the medical literature on endoscopic closure of acute iatrogenic perforations of the GI tract. DESIGN A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. SETTING Available medical literature from 1966 through November 2013. PATIENTS Patients with an acute perforation after an endoscopic procedure that was closed endoscopically. INTERVENTIONS Endoscopic closure of an acute perforation of the GI tract. MAIN OUTCOME MEASUREMENTS Clinically successful endoscopic closure. RESULTS In our search, we identified 726 studies, 702 of which had to be excluded. Twenty-four cohort studies (21 retrospective, 3 prospective) were included in the analysis. No randomized trials were identified. Overall, the methodological quality was low. The 24 studies included described 466 acute perforations in which endoscopic closure was attempted. Successful endoscopic closure was achieved in 419 cases (89.9%; 95% CI, 87%-93%). Successful closure was achieved in 90.2% (n = 359; 95% CI, 87%-93%) of cases by using endoclips, in 87.8% (n = 58; 95% CI, 78%-95%) by using the over-the-scope-clip, and in 100% (n = 2) by using a metal stent. LIMITATIONS Low methodological quality of included studies. CONCLUSION This systematic review suggests that endoscopic perforation closure is a safe and effective alternative for surgical intervention in selected cases; however, the overall methodological quality was low. Prospective, true consecutive studies are needed to define the definitive role of endoscopic closure of perforations.
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Affiliation(s)
- Tessa Verlaan
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Rogier P Voermans
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Willem A Bemelman
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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9
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Stavropoulos SN, Modayil R, Friedel D. Closing perforations and postperforation management in endoscopy: esophagus and stomach. Gastrointest Endosc Clin N Am 2015; 25:29-45. [PMID: 25442956 DOI: 10.1016/j.giec.2014.09.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Luminal perforation after endoscopy is a dreaded complication that is associated with significant morbidity and mortality, longer and more costly hospitalization, and the specter of potential future litigation. The management of such perforations requires a multidisciplinary approach. Until recently, surgery was required. However, nowadays the endoscopist has a burgeoning armamentarium of devices and techniques that may obviate surgery. This article discusses the approach to endoscopic perforations in the esophagus and stomach.
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Affiliation(s)
- Stavros N Stavropoulos
- Department of Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, 222 Station Plaza North, Suite 429, Mineola, NY 11501, USA.
| | - Rani Modayil
- Department of Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, 222 Station Plaza North, Suite 429, Mineola, NY 11501, USA
| | - David Friedel
- Department of Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, 222 Station Plaza North, Suite 429, Mineola, NY 11501, USA
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10
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Endoscopic hemoclips to immediately close gastric perforation from a failed attempt at PEG in a morbidly obese patient. Surg Obes Relat Dis 2014; 10:757-8. [PMID: 25224171 DOI: 10.1016/j.soard.2014.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 02/13/2014] [Accepted: 02/14/2014] [Indexed: 11/21/2022]
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11
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Min YW, Min BH, Lee JH, Kim JJ. Endoscopic treatment for early gastric cancer. World J Gastroenterol 2014; 20:4566-4573. [PMID: 24782609 PMCID: PMC4000493 DOI: 10.3748/wjg.v20.i16.4566] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/09/2013] [Accepted: 01/15/2014] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer remains one of the most common causes of cancer death. However the proportion of early gastric cancer (EGC) at diagnosis is increasing. Endoscopic treatment for EGC is actively performed worldwide in cases meeting specific criteria. Endoscopic mucosal resection can treat EGC with comparable results to surgery for selected cases. Endoscopic submucosal dissection (ESD) increases the en bloc and complete resection rates and reduces the local recurrence rate. ESD has been performed with expanded indication and is expected to be more widely used in the treatment of EGC through the technological advances in the near future. This review will describe the techniques, indications and outcomes of endoscopic treatment for EGC.
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12
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Gotoda T, Ho KY, Soetikno R, Kaltenbach T, Draganov P. Gastric ESD: current status and future directions of devices and training. Gastrointest Endosc Clin N Am 2014; 24:213-33. [PMID: 24679233 DOI: 10.1016/j.giec.2013.11.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endoscopic mucosal resection (EMR) of early gastric cancer, which has been proved to be safe and effective and is the established standard of care in Japan, has become increasingly established worldwide in the past decade. Endoscopic submucosal dissection (ESD) is superior to EMR, as it is designed to provide precise pathologic staging and long-term curative therapy based on an en bloc R0 specimen irrespective of the size and/or location of the tumor. However, ESD requires highly skilled and experienced endoscopists. The introduction of ESD to the Western world necessitates collaborations between Eastern and Western endoscopists, pathologists, and surgeons.
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Affiliation(s)
- Takuji Gotoda
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
| | - Khek-Yu Ho
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 10, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228
| | - Roy Soetikno
- Department of Gastroenterology and Hepatology, Veterans Affairs Palo Alto, Stanford University, 3801 Miranda Avenue, GI-111, Palo Alto, CA 94304, USA
| | - Tonya Kaltenbach
- Department of Gastroenterology and Hepatology, Veterans Affairs Palo Alto, Stanford University, 3801 Miranda Avenue, GI-111, Palo Alto, CA 94304, USA
| | - Peter Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, 1600 SW Archer Road, Room HD 602, PO Box 100214, Gainesville, FL 32610, USA
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13
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Gotoda T, Jung HY. Endoscopic resection (endoscopic mucosal resection/ endoscopic submucosal dissection) for early gastric cancer. Dig Endosc 2013; 25 Suppl 1:55-63. [PMID: 23362925 DOI: 10.1111/den.12003] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 10/04/2012] [Indexed: 12/12/2022]
Abstract
Endoscopic resection of early gastric cancer is a well-established standard therapy in Japan and Korea, and is increasingly used in other countries. Endoscopic resection should be curative for patients, and safe, easy and effective not only for patients, but also for endoscopists. Endoscopic submucosal dissection (ESD) is superior to standard endoscopic mucosal resection (EMR) as it is designed to provide en bloc R0 resection regardless of size and/or location. Correct pathological assessment of en bloc resected specimens is crucial for accurate diagnosis and patient stratification for the risk of metastasis. Outcome studies in Japan and Korea, countries with the highest incidence of gastric cancer, have shown that ESD is efficacious in leading to a good long-term outcome; however, ESD requires an experienced endoscopist with a high skill level. Expanded indications for endoscopic resection have been proposed, especially after large en bloc resection have been accomplished using ESD. The use of ESD could be of huge benefit for the management of gastrointestinal superficial neoplasms. However, for ESD to become a viable therapeutic option, it requires close and supportive working relationships between endoscopists, pathologists and surgeons.
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Affiliation(s)
- Takuji Gotoda
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan.
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14
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Abstract
Since the concept of early gastric cancer was first described in Japan in 1962, its treatment has evolved from curative surgical resection to endoscopic resection, initially with polypectomy to more recently with endoscopic submucosal dissection. As worldwide experience with these endoscopic techniques evolve and gain acceptance, studies have confirmed its comparable effectiveness with historical surgical outcomes in carefully selected patients. The criteria for endoscopic resection have expanded to offer more patients improved quality of life, avoiding the morbidity and mortality associated with surgery. This article summarizes the evolutional role of endoscopic and surgical therapy in early gastric cancer.
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Affiliation(s)
- Wataru Tamura
- Division of Gastroenterology & Hepatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO 80045, USA
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15
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Bonin EA, Bingener J, Rajan E, Knipschield M, Gostout CJ. Omentum patch substitute for facilitating endoscopic repair of GI perforations: an early laparoscopic pilot study with a foam matrix plug (with video). Gastrointest Endosc 2013; 77:123-30. [PMID: 23261102 DOI: 10.1016/j.gie.2012.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 09/17/2012] [Indexed: 01/07/2023]
Abstract
BACKGROUND Endoscopic perforations are surgically repaired by using an omentum patch. Omentum substitutes may have broader applications particularly in certain sites (eg, esophagus). OBJECTIVE Evaluate a self-expandable foam matrix plug as a synthetic omentum substitute for repairing iatrogenic gastric perforations in a 4-week survival pig model. DESIGN Experimental pilot study. SETTING Laboratory. INTERVENTION A laparoscopic plug repair of a 1-cm, full-thickness, gastric perforation was carried out by using either a polyurethane foam matrix plug (FMP, 8 animals) or an omentum plug (OP, 6 animals, control group). MAIN OUTCOME MEASUREMENTS Follow-up endoscopy was carried out at 1 and 4 weeks. At necropsy, the perforation site was evaluated for adhesions and histology by using hematoxylin and eosin analysis. A portion of the implant was sent for bacterial and fungal culture. RESULTS All procedures were technically simple and successful. Thirteen animals thrived well for 4 weeks. One animal from the FMP group died 3 days postoperatively from diffuse peritonitis because of a misplaced plug. All remaining FMPs were intact at 4 weeks and colonized with mixed bacteria, except one animal presenting with FMP migration after 1 week. Histologically, the FMP group had more prominent inflammation and suppuration as compared with the OP group, all limited to its adjacent tissue. LIMITATIONS Animal study. CONCLUSION The FMP offered a technically simple and feasible option for repairing iatrogenic gastric perforations. With effective sealing, the clinical outcome is similar to that of an omentum patch repair. Migration and inadequate sealing is a concern, which can lead to peritonitis and sepsis. Further development is needed to improve FMP performance.
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Affiliation(s)
- Eduardo A Bonin
- Developmental Endoscopy Unit, Mayo Clinic, Rochester, MN 55905, USA
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16
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Mangiavillano B, Pisani A, Viaggi P, Arena M, Opocher E, Mangano M, Santoro T, Masci E. Endoscopic sealing of a rectovesical fistula with a combination of an over the scope clip and cyano-acrylate injection. J Gastrointest Oncol 2012; 1:122-4. [PMID: 22811817 DOI: 10.3978/j.issn.2078-6891.2010.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 11/29/2010] [Indexed: 02/06/2023] Open
Affiliation(s)
- Benedetto Mangiavillano
- Gastrointestinal Endoscopy, San Paolo University Hospital, University of Milan, Milan, Italy
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17
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Hoppo T, Jobe BA. Endoscopy and role of endoscopic resection in gastric cancer. J Surg Oncol 2012; 107:243-9. [PMID: 22532029 DOI: 10.1002/jso.23126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 03/23/2012] [Indexed: 12/13/2022]
Abstract
Patient selection for endoscopic resection is based on meticulous endoscopic examination and histological assessment so as to avoid performing this procedure on patients with a high risk of lymph node involvement or metastatic disease. Currently, endoscopic mucosal resection (EMR) is used for tumors <2 cm, and endoscopic submucosal dissection (ESD) should be considered for tumors >2 cm. The advantage of ESD is that it achieves en-bloc resection of larger tumors, potentially reducing the risk of disease recurrence.
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Affiliation(s)
- Toshitaka Hoppo
- Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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18
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Kang KJ, Kim KM, Min BH, Lee JH, Kim JJ. Endoscopic submucosal dissection of early gastric cancer. Gut Liver 2011; 5:418-26. [PMID: 22195238 PMCID: PMC3240783 DOI: 10.5009/gnl.2011.5.4.418] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 03/18/2011] [Accepted: 04/23/2011] [Indexed: 12/21/2022] Open
Abstract
Gastric cancer is the most common cancer worldwide. The proportion of early gastric cancer (EGC) cases at diagnosis has increased because of the use of mass screening endoscopy in older adults. Endoscopic mucosal resection has become the standard treatment for EGC in cases with standard indications because of its low risk of lymph node metastasis. A new endoscopic method, endoscopic submucosal dissection, has recently become available. This method allows en bloc resection without limitation of the size of the lesion. The goal of this article is to review the history and methods of endoscopic treatment with EGC, the conventional and extended indications, the therapeutic outcomes, and the complication rates.
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Affiliation(s)
- Ki Joo Kang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lee HJ, Jang YJ, Kim JH, Park SS, Park SH, Park JJ, Kim SJ, Kim CS, Mok YJ. Clinical Outcomes of Gastrectomy after Incomplete EMR/ESD. J Gastric Cancer 2011; 11:162-6. [PMID: 22076221 PMCID: PMC3204469 DOI: 10.5230/jgc.2011.11.3.162] [Citation(s) in RCA: 18] [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: 06/10/2011] [Revised: 09/06/2011] [Accepted: 09/06/2011] [Indexed: 12/13/2022] Open
Abstract
Purpose Endoscopic resection is widely accepted as standard treatment for early gastric cancer (EGC) without lymph node metastasis. The procedure is minimally invasive, safe, and convenient. However, surgery is sometimes needed after endoscopic mucosal resection/endoscopic submucosal dissection endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD) due to perforation, bleeding, or incomplete resection. We evaluated the role of surgery after incomplete resection. Materials and Methods We retrospectively studied 29 patients with gastric cancer who underwent a gastrectomy after incomplete EMR/ESD from 2006 to 2010 at Korea University Hospital. Results There were 13 incomplete resection cases, seven bleeding cases, three metachronous lesion cases, three recurrence cases, two perforation cases, and one lymphatic invasion case. Among the incomplete resection cases, a positive vertical margin was found in 10, a positive lateral margin in two, and a positive vertical and lateral margin in one case. Most cases (9/13) were diagnosed as mucosal tumors by endoscopic ultrasonography, but only three cases were confirmed as mucosal tumors on final pathology. The positive residual tumor rate was two of 13. The lymph node metastasis rate was three of 13. All lymph node metastasis cases were submucosal tumors with positive lymphatic invasion and no residual tumor in the gastrectomy specimen. No cases of recurrence were observed after curative resection. Conclusions A gastrectomy is required for patients with incomplete resection following EMR/ESD due to the risk of residual tumor and lymph node metastasis.
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Affiliation(s)
- Hye-Jeong Lee
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
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Abstract
PURPOSE OF REVIEW Understanding the role of endoscopic closure techniques helps in expanding the endoscopist's role in the management of gastrointestinal neoplasia and explore new frontiers of minimally invasive endoluminal surgery. RECENT FINDINGS This article covers recent advances in endoscopic closure of various gastrointestinal perforations, with a special focus on devices, experimental evidence and clinical outcomes of endoscopic closure of gastrointestinal perforations. SUMMARY Endoscopic closure techniques help the endoscopist to walk on thin ice and save himself and the patient in the case of mishap.
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Kim SH, Moon JS, Youn YH, Lee KM, Lee SJ. Management of the complications of endoscopic submucosal dissection. World J Gastroenterol 2011; 17:3575-9. [PMID: 21987602 PMCID: PMC3180012 DOI: 10.3748/wjg.v17.i31.3575] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 08/12/2010] [Accepted: 08/19/2010] [Indexed: 02/06/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) is currently widely accepted as a standard treatment option for early gastrointestinal neoplasms in Korea. However, ESD has technical difficulties and a longer procedure time than conventional endoscopic resection. So it may have a higher risk of complications than conventional endoscopic resection techniques. We, the ESD study group of Korean Society of Gastrointestinal Endoscopy, have experienced many complications, mostly treated by endoscopic or conservative management. Here, we introduce and share our experiences for management of post ESD complications and review published papers on the topic.
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Moran EA, Gostout CJ, McConico AL, Michalek J, Huebner M, Bingener J. Assessing the invasiveness of NOTES perforated viscus repair: a comparative study of NOTES and laparoscopy. Surg Endosc 2011; 26:103-9. [PMID: 21792716 DOI: 10.1007/s00464-011-1834-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 06/22/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery (NOTES) repair of perforated peptic ulcers may decrease surgical invasiveness and improve patient outcomes. METHODS Full thickness gastrotomy was created laparoscopically in swine followed by soilage time. Repair proceeded with a laparoscopic (n = 14) or the NOTES (n = 14) approach. For NOTES repair, the omentum was endoscopically pulled into the gastric lumen and clipped. Intraoperative and postoperative parameters were recorded, including arterial blood gas (ABG) analysis and serum samples for white blood cell (WBC), TNF-α, IL-1, and IL-6 analysis. RESULTS Twenty-four of 28 animals thrived to study completion. NOTES repair could not be accomplished in one animal. At necropsy, all repairs were intact. Blood pressure was equivalent between groups. Pulse examined during the last 30 min of each procedure revealed a slightly higher mean pulse in the animals undergoing NOTES procedures (NOTES, 102 ± 28; laparoscopy, 83 ± 24). ABG obtained at the conclusion of the procedure revealed a pH of 7.47 in NOTES animals and 7.43 in the laparoscopy animals (p = 0.06), a change from baseline in both groups. The final pCO(2) was lower in the NOTES group (NOTES, 40.62; laparoscopy, 47.49, p = 0.03). WBC counts were comparable on postoperative day (POD) 1 (NOTES, 21.1; laparoscopy, 19.0; p = 0.49). Mean TNF-α serum levels were equivalent at all time points between groups; however, TNF-α varied significantly from baseline to POD 7 (p = 0.002). CONCLUSION NOTES omental repair appears comparable to that of laparoscopy. The lower arterial pCO(2) at the conclusion of the NOTES procedure may be advantageous in critically ill patients.
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Affiliation(s)
- E A Moran
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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23
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Iizuka H, Kakizaki S, Sohara N, Onozato Y, Ishihara H, Okamura S, Itoh H, Mori M. Stricture after endoscopic submucosal dissection for early gastric cancers and adenomas. Dig Endosc 2010; 22:282-8. [PMID: 21175480 DOI: 10.1111/j.1443-1661.2010.01008.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIM Stricture is a complication that may occur after endoscopic submucosal dissection (ESD) of gastric neoplasms. The goal of the present study was to investigate the incidence, risk factors and management of gastric stricture after ESD. METHODS The medical records of 308 patients who underwent ESD for gastric neoplasms were reviewed. Stricture is defined as having symptoms caused by an obstruction through which a 1-cm diameter endoscopic fiber cannot be passed. RESULTS Stricture was identified in six of 308 patients (1.9%). Three of the six lesions were located in the prepylorus, two cases in the antrum and one in the cardia. The mean longitudinal distance and the mean area of the resected specimens in the six cases with stricture (7.8 ± 2.0 cm, 34.0 ± 15.8cm(2) , respectively) was significantly larger than in those without stricture (4.5 ± 1.4cm, 12.7 ± 8.3cm(2) , respectively, P<0.01). The ratio of the resected circumference/whole circumference was 83.3±7.5% in those with stricture in comparison to 25.4 ± 16.3% in those without stricture (P<0.01). All six patients underwent endoscopic balloon dilations, and obtained relief from stricture. However, one patient experienced a gastric perforation and recovered following conservative therapy. CONCLUSION Sub-circumferential resection over 75% of the circumference by ESD in the prepylorus, antrum and cardia is a risk factor for the occurrence of stricture. Early intervention might be considered for this high-risk group to avoid a perforation during balloon dilation.
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Affiliation(s)
- Haruhisa Iizuka
- Department of Endoscopy and Endoscopic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
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24
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25
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Endoscopic-assisted closure of a chronic colocutaneous fistula. Gastrointest Endosc 2010; 72:662-4. [PMID: 20417508 DOI: 10.1016/j.gie.2009.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 12/16/2009] [Indexed: 02/08/2023]
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Risk factors for complications of endoscopic submucosal dissection in gastric tumors: analysis of 478 lesions. J Gastroenterol 2010; 45:30-6. [PMID: 19760133 DOI: 10.1007/s00535-009-0137-4] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 08/31/2009] [Indexed: 02/06/2023]
Abstract
PURPOSE Endoscopic submucosal dissection (ESD) technique has facilitated en bloc removal of widely spread lesions from the stomach. This retrospective study aimed to determine factors associated with serious complications of ESD. METHODS Between December 2001 and March 2007, we have performed ESD for 478 lesions in 436 patients. We experienced 39 patients with post-operative bleeding and 17 patients with perforation. Risk factors of patients who received ESD in gastric mucosal tumors for complications were evaluated, focusing on resected size, location, scar lesions, operation time, and experience of endoscopists. We evaluated the patients' background characteristics including sex, age, body mass index (kg/m(2)), drug history of anticoagulant, and underlying diseases including cerebrovascular disorder, ischemic heart disease, liver dysfunction, renal dysfunction, hyperuricemia, hypertension and diabetes mellitus. RESULTS Multivariate analysis indicated a risk factor for perforation was long operation time. Multivariate analysis indicated a significant risk factor for post-operative bleeding was size of the resected tumor. CONCLUSIONS This study indicated risk factors for serious complications of ESD. Large resected tumor size was a risk factor for post-operative bleeding, while long operation time was a risk factor for perforation. Information regarding operation risk factors should be useful for planning strategies for ESD.
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Zhou PH, Yao LQ, Qin XY, Xu MD, Zhong YS, Chen WF, Ma LL, Zhang YQ, Qin WZ, Cai MY, Ji Y. Advantages of endoscopic submucosal dissection with needle-knife over endoscopic mucosal resection for small rectal carcinoid tumors: a retrospective study. Surg Endosc 2010; 24:2607-12. [PMID: 20361212 DOI: 10.1007/s00464-010-1016-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 03/08/2010] [Indexed: 12/16/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is a new, widely accepted method for the treatment of early gastric cancer and was developed to increase the en bloc resection rate. This study aimed to evaluate the efficacy and safety of ESD compared with conventional endoscopic mucosal resection (EMR) for small rectal carcinoid tumors. METHODS A retrospective study was carried out that included 43 patients with small rectal carcinoid tumors (< 10 mm). The cohort comprised two groups: Group A (N = 23) underwent conventional EMR from January 2004 to August 2005, while group B (N = 20) underwent ESD with needle-knife from September 2005 to December 2006. The rate of curative en bloc resection, the procedure time, and the incidence of complications were evaluated. RESULTS The en bloc resection rate and the rate of completeness of resection of group B were higher than those of group A (100 vs. 87%, 100 vs. 52.5%, respectively). The average operation time required for resection was significantly longer in group B (28.4 ± 17.2 min) compared with group A (12.3 ± 15.4 min) (p < 0.05). None of the patients had immediate or delayed bleeding during the procedure. Perforation occurred in one case of group B and the patient recovered after several days of conservative treatment. Three patients had local recurrence after EMR, while no patient experienced recurrence after ESD. CONCLUSION ESD, compared with conventional EMR, increased en bloc and histologically complete resection rates and may reduce local recurrence rate for small rectal carcinoid tumors. Increased operation time and complication risks with ESD remain problematic. Further technique and investigation are required to confirm the safety and to assess the long-term prognosis of ESD.
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Affiliation(s)
- Ping-Hong Zhou
- Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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Mangiavillano B, Viaggi P, Masci E. Endoscopic closure of acute iatrogenic perforations during diagnostic and therapeutic endoscopy in the gastrointestinal tract using metallic clips: a literature review. J Dig Dis 2010; 11:12-8. [PMID: 20132426 DOI: 10.1111/j.1751-2980.2009.00414.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Iatrogenic perforations that occur during the endoscopic procedures are generally surgically managed, even if some authors prefer a non-surgical approach in selected cases. The endoscopic application of metallic clips has been widely used in the gastrointestinal (GI) tract for hemostasis and also for marking lesions. Since 1993 several series of endoscopic perforations treated with endoclips have been described in the literature. In this review we offer a descriptive analysis of the reported cases of the acute iatrogenic perforation, describing the closure of different perforations occurring in the GI tract, treated with metallic clips.
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Affiliation(s)
- Benedetto Mangiavillano
- Department of Gastroenterology and Gastrointestinal Endoscopy, San Paolo University Hospital, Milan, Italy.
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Moran EA, Gostout CJ, McConico AL, Bingener J. Natural orifice translumenal endoscopic surgery used for perforated viscus repair is feasible using lower peritoneal pressures than laparoscopy in a porcine model. J Am Coll Surg 2010; 210:474-9. [PMID: 20347740 DOI: 10.1016/j.jamcollsurg.2009.11.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 11/20/2009] [Accepted: 11/24/2009] [Indexed: 01/08/2023]
Abstract
BACKGROUND Procedure-related complications contribute to 1-year mortality in patients with perforated ulcers. Natural orifice translumenal endoscopic surgery (NOTES) might offer a new repair approach. STUDY DESIGN Swine were randomized to laparoscopic or NOTES repair. Laparoscopic gastrotomy creation (1 cm) was followed by 4 hours soilage time. After peritoneal cavity irrigation (per group assignment), repair proceeded with a laparoscopic or NOTES approach. For NOTES repair, omentum was endoscopically grasped, pulled into the gastric lumen, and fixed with metallic clips. Feasibility; time to complete procedures; pneumoperitoneal pressures; and clinical parameters, including necropsy and peritoneal culture at 2 weeks, were recorded. RESULTS NOTES repair failed in 1 animal (technical); repair was completed laparoscopically, and data were analyzed as intention to treat. Specific NOTES repair time (minutes) was comparable with laparoscopy (36 versus 46; p = 0.2). Mean abdominal pressure (mmHg) required to complete NOTES repair was lower than in laparoscopy (4 versus 12; p < 0.001). Nineteen of 23 animals thrived until necropsy at 2 weeks. Three animals succumbed to airway compromise in recovery; 1 NOTES animal failed to thrive on postoperative day 7. No intra-abdominal cause for these deaths was found. At necropsy all repairs were intact, and peritoneal cultures revealed a small and equivalent amount of colony-forming units in each group. CONCLUSIONS Endoscopic ulcer repair appears technically feasible with similar clinical and infectious outcomes to laparoscopy. The lower required pneumoperitoneal pressures used in these NOTES techniques are recognizable different outcomes from laparoscopy and can be advantageous in critically ill patients.
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Affiliation(s)
- Erica A Moran
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
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Hoteya S, Iizuka T, Kikuchi D, Yahagi N. Clinical advantages of endoscopic submucosal dissection for gastric cancers in remnant stomach surpass conventional endoscopic mucosal resection. Dig Endosc 2010; 22:17-20. [PMID: 20078659 DOI: 10.1111/j.1443-1661.2009.00912.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM Endoscopic submucosal dissection was developed to address the shortcomings of conventional endoscopic mucosal resection. The present study evaluated the benefits of endoscopic submucosal dissection compared with conventional endoscopic mucosal resection for the treatment of neoplasms arising from the remnant stomach after gastrectomy or esophagectomy. METHODS This study, which was designed as a historical control study, evaluated 22 gastric cancers in remnant cancers treated by conventional endoscopic mucosal resection and another 40 cancers treated by endoscopic submucosal dissection. RESULTS Patient characteristic between the two groups were not different except for tumor size, which was larger in patients with endoscopic submucosal dissection. The local complete resection rate and the curative resection rate were significantly higher in the endoscopic submucosal dissection group compared to those in the mucosal resection group (95.0% vs 40.9% and 80.0% vs 40.9%, respectively). Complication rate showed no significant difference in the two groups, although submucosal dissection required a longer operation time. CONCLUSION Endoscopic submucosal dissection represents a reliable treatment for gastric cancers in the remnant stomach, surpassing endoscopic mucosal resection.
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Affiliation(s)
- Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
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Liu M. Recent advances in endoscopic therapy for diagnostic and therapeutic endoscopy-associated perforations of the digestive tract. Shijie Huaren Xiaohua Zazhi 2009; 17:3123-3127. [DOI: 10.11569/wcjd.v17.i30.3123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
As diagnostic and therapeutic endoscopy is more widely applied in clinical practice, endoscopy-associated perforations of the digestive tract have become more and more common. Among patients with endoscopy-associated perforations, few can be cured by conservative therapy, and the majority need to undergo laparoscopic or surgical operations to avoid serious consequences. However, the development of new medical instruments makes it possible to effectively and promptly manage endoscopy-related perforations via endoscopic suturing and closure.
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Hoteya S, Iizuka T, Kikuchi D, Yahagi N. Endoscopic submucosal dissection for gastric submucosal tumor, endoscopic sub-tumoral dissection. Dig Endosc 2009; 21:266-9. [PMID: 19961528 DOI: 10.1111/j.1443-1661.2009.00905.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gastric submucosal tumor (SMT) is frequently found during screening endoscopy, but definitive diagnosis based on histological confirmation is relatively difficult. Even without accurate diagnosis before treatment, open or laparoscopic surgery is currently carried out to remove SMT. The purpose of this study was to demonstrate the feasibility of endoscopic submucosal dissection (ESD) in diagnostic treatment for submucosal tumor (SMT) of the stomach. Subjects in this case study comprised nine patients who had undergone ESD for gastric SMT. Before treatment, endoscopic ultrasonography was carried out in all cases to evaluate depth and origin of the SMT. Then ESD was only indicated for tumors of submucosal layer or muscularis mucosa origin. Using an endoscopic sub-tumoral dissection technique with a hook knife and a flex knife, local complete resections were achieved in all patients without severe complications. These results suggest the clinical benefits of ESD avoiding oversurgery for the diagnostic treatment of gastric SMT of the submucosal layer and muscularis mucosa origin.
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Affiliation(s)
- Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
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Abstract
Surgery has been the mainstay of therapy in patients with gastrointestinal perforations. This paradigm started to shift with the development of techniques for endoscopic closure of gastrointestinal perforations. A detailed review of the literature on this subject, along with a commentary on practical aspects in the management of patients with gastrointestinal leaks, is provided here.
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Zhou PH, Yao LQ, Qin XY. Endoscopic submucosal dissection for colorectal epithelial neoplasm. Surg Endosc 2009; 23:1546-51. [PMID: 19263116 DOI: 10.1007/s00464-009-0395-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 01/06/2009] [Accepted: 01/12/2009] [Indexed: 12/27/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD), a new widely accepted method for treating early gastric cancer, was developed to increase the en bloc rate, especially for lesions larger than 20 mm in diameter. This study aimed to evaluate the efficacy and safety of ESD for colorectal epithelial neoplasms. METHODS From July 2006 to December 2007, ESD was indicated for patients with colorectal epithelial neoplasms larger than 20 mm in diameter. The rates of curative en bloc resection, the procedure time, and the incidence of complications were investigated. RESULTS A total of 74 colorectal epithelial neoplasms were resected by ESD. The mean diameter of these lesions was 32.6 mm (range, 20-85 mm). The rate of en bloc resection was 93.2% (69/74), and the mean ESD procedure time was 110 min (range, 80-185 min). None of patients had massive hemorrhage during ESD, and only one patient (1.4%) bled 8 days after ESD. Six patients experienced perforation, and all except one recovered after several days of conservative treatment. The patient who did not recover underwent urgent surgery. The perforation rate was 8.1% (6/74). All the patients were followed up. Healing of the artificial ulcer was confirmed, and with no lesion residue or recurrence was found. CONCLUSIONS The findings show ESD to be effective for colorectal epithelial neoplasm, making it possible to resect the whole lesion in one piece and to provide precise histologic information.
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Affiliation(s)
- Ping-Hong Zhou
- Institute of Endsocopy, Zhongshan Hospital, Fudan University, Shanghai, China.
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Shimoda R, Iwakiri R, Sakata H, Ogata S, Ootani H, Sakata Y, Fujise T, Yamaguchi K, Mannen K, Arima S, Shiraishi R, Noda T, Ono A, Tsunada S, Fujimoto K. Endoscopic hemostasis with metallic hemoclips for iatrogenic Mallory-Weiss tear caused by endoscopic examination. Dig Endosc 2009; 21:20-3. [PMID: 19691796 DOI: 10.1111/j.1443-1661.2008.00825.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Applied endoscopic techniques including mucosal resection, sclerotherapy and endoscopic retrograde cholangiopancreatography (ERCP) have been advanced and iatrogenic complications including Mallory-Weiss tear (MWT) occasionally occur in daily endoscopic procedures. The present study aimed to examine the advantages of clipping for MWT complications that occur during endoscopic examination. METHODS Over 10 years, we experienced 47 patients with bleeding caused by MWT. Metallic hemoclips were applied for 38 patients for hemostasis. These patients were categorized into two groups: 18 patients in group A whose bleeding tear occurred during endoscopic examination in an iatrogenic condition, and 20 patients in group B visited the emergency unit due to other etiology of MWT. RESULTS The background characteristics, including length of tears, were not different between the two groups. Initial hemostasis was 100% in groups A and B. Rebleeding was 0/18 (0%) in group A and 1/20 (5 %) in group B. Number of patients who received blood transfusion was significantly higher in group B (group A: 0/18, group B: 4/20). Hemoglobin level before hemostasis was 12.5 g/dL in group A which was not different to that in group B, 10.9 g/dL. CONCLUSION Application of hemoclips was effective for bleeding MWT during endoscopic procedures, which warranted prophylactic application of hemoclips on MWT during endoscopic examination.
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Affiliation(s)
- Ryo Shimoda
- Department of Internal Medicine, Saga Medical School, Saga, Japan
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Natural orifice translumenal endoscopic surgery: a critical review. J Gastrointest Surg 2008; 12:1293-300. [PMID: 18057995 DOI: 10.1007/s11605-007-0424-4] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Accepted: 11/07/2007] [Indexed: 01/31/2023]
Abstract
Natural orifice translumenal endoscopic surgery (NOTES) involves the intentional puncture of one of the viscera (e.g., stomach, rectum, vagina, urinary bladder) with an endoscope to access the abdominal cavity and perform an intraabdominal operation. Early laboratory work focused on feasibility studies, including such accomplishments as pure transgastric splenectomy and gastrojejunostomy. Contemporary laboratory work is investigating the infectious and immunologic implications of NOTES and honing the tools and techniques required for complex abdominal operations. Today NOTES has entered the clinical arena in a few cases: the first clinical series of transgastric peritoneoscopy has recently been published; multiple groups are accumulating patients in studies of NOTES cholecystectomy, either via the transgastric or transvaginal route; and a series of transgastric appendectomies has been well publicized, yet it remains unpublished. Although clinical NOTES is gaining momentum, the field should remain in check while rigorous laboratory work is performed and cogent clinical trials are undertaken. The zeal for NOTES should not take precedence over the welfare of the patient.
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Mummadi RR, Groce JR, Raju GS, Gomez G. Endoscopic management of colocutaneous fistula in a morbidly obese woman (with video). Gastrointest Endosc 2008; 67:1207-8. [PMID: 18291390 DOI: 10.1016/j.gie.2007.10.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Accepted: 10/15/2007] [Indexed: 12/10/2022]
Affiliation(s)
- Rajasekhara R Mummadi
- Center for Endoscopic Research, Training, and Innovation, University of Texas Medical Branch, Galveston, Texas 77555-0764, USA
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Case series of endoscopic balloon dilation to treat a stricture caused by circumferential resection of the gastric antrum by endoscopic submucosal dissection. Gastrointest Endosc 2008; 67:979-83. [PMID: 18440388 DOI: 10.1016/j.gie.2007.12.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 12/17/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) plays an important role in the management of gastric neoplasms. There are few reports regarding stricture development caused by ESD of gastric neoplasms. OBJECTIVE The present study aimed to determine the incidence of gastric stricture formation after ESD of gastric neoplasms and to report on the outcome and management of this complication: endoscopic intervention (ie, balloon dilation) versus surgery; the outcome of balloon dilation (success or failure/perforation). DESIGN A case series from a retrospective review of gastric ESDs performed at Saga Medical School over a defined period of time. SETTING Double-center territory, referral hospital. PATIENTS An evaluation was performed in 532 patients with gastric mucosal tumors treated by ESD. A stricture was reported in 5 patients. All the 5 cases were located in the antrum. ESD that was performed in the cardia or the proximal stomach did not induce a stricture. RESULTS Of the 5 cases of symptomatic gastric outlet obstruction, 1 patient required surgical intervention because of a near total gastric outlet obstruction not amenable to endoscopic intervention. The 4 patients underwent step-serial through-the-scope balloon dilations; in 2 patients, the procedure was successful, but in the other 2 patients, the procedure was complicated by a gastric perforation (50% incidence of perforation). LIMITATION A retrospective study. CONCLUSIONS Circumferential or subcircumferential resection by ESD in the antrum caused a stricture. Balloon dilation of the ESD gastric outlet obstruction might be a choice, but it is a risky treatment.
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Abstract
BACKGROUND The use of endoclipping may minimize the risk of bleeding after endoscopic polypectomy of large pedunculated polyps. The aim of this study was to assess the safety and efficacy of endoclipping of the stalk before resection of large pedunculated colorectal polyps, drawing particular attention to the cases in which the use of this method could be very useful. PATIENTS AND METHODS This retrospective study included 17 patients [10 men, 7 women; median age: 62 y (range 38 to 79)] with 18 large pedunculated colorectal polyps, who underwent endoclipping-assisted endoscopic polypectomy between March 2003 and May 2006. The outcome of the technique and the technique-related complications were evaluated. RESULTS Application of the clips was possible in all patients. In 4 patients (23.5%), the endoclipping was performed via the more flexible gastroscope. En bloc resection of colon polyps was achieved in all patients. No immediate or late bleeding or perforation occurred. One patient (5.9%) developed postcoagulation syndrome and was successfully treated conservatively. Histologic examination showed in situ carcinoma in 6 polyps (33.3%). Follow-up colonoscopy demonstrated no recurrence of polyps or cancer development. CONCLUSIONS Endoclipping, followed by snare transection, may be safer than conventional polypectomy in large pedunculated colorectal polyps. Special attention is needed not to cut very close to clips to avoid thermal injury of colonic wall.
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40
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Peroral transgastric endoscopic procedures in pigs: feasibility, survival, questionings, and pitfalls. Surg Endosc 2008; 23:394-402. [DOI: 10.1007/s00464-008-9930-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Accepted: 02/24/2008] [Indexed: 11/25/2022]
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Tsunada S, Mannen K, Yamaguchi K, Aoki S, Uchihashi K, Toda S, Fujise T, Shimoda R, Sakata H, Iwakiri R, Fujimoto K. A case of advanced colonic cancer that developed from residual laterally spreading tumor treated by piecemeal endoscopic mucosal resection. Clin J Gastroenterol 2008; 1:18-22. [PMID: 26193355 DOI: 10.1007/s12328-008-0003-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Accepted: 02/01/2008] [Indexed: 12/19/2022]
Abstract
This case report showed a laterally spreading tumor treated by endoscopic mucosal resection that developed as an advanced colon cancer. A 74-year-old female was visited to treat a colon tumor that was pointed out at another hospital. Total colonoscopy revealed a laterally spreading tumor (LST) 25 mm in diameter in the cecum. The lesion was diagnosed as homogenous granular type LST (G-type LST) and treated by endoscopic piecemeal mucosal resection in January 2004. A tumor was recognized by follow-up endoscopic examination in April 2006. The scar of endoscopic piecemeal mucosal resection had developed to advanced colon cancer and was treated by laparoscopy-associated ileocecal resection with D3 lymph node resection. Previous reports indicated that G-type LST in the colon could be treated by piecemeal resection, but this report suggests that G-type LST resected by piecemeal endoscopic mucosal resection might develop to advanced colon cancer.
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Affiliation(s)
- Seiji Tsunada
- Department of Internal Medicine and Endoscopy, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Kotaro Mannen
- Department of Internal Medicine and Endoscopy, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Kanako Yamaguchi
- Department of Internal Medicine and Endoscopy, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Shigehisa Aoki
- Department of Pathology and Biodefense, Saga Medical School, Saga, Japan
| | | | - Shuji Toda
- Department of Pathology and Biodefense, Saga Medical School, Saga, Japan
| | - Takehiro Fujise
- Department of Internal Medicine and Endoscopy, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Ryo Shimoda
- Department of Internal Medicine and Endoscopy, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Hiroyuki Sakata
- Department of Internal Medicine and Endoscopy, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Ryuichi Iwakiri
- Department of Internal Medicine and Endoscopy, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Kazuma Fujimoto
- Department of Internal Medicine and Endoscopy, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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Choi KD, Jung HY, Lee GH, Oh TH, Jo JY, Song HJ, Hong SS, Kim JH. Application of metal hemoclips for closure of endoscopic mucosal resection-induced ulcers of the stomach to prevent delayed bleeding. Surg Endosc 2008; 22:1882-6. [PMID: 18270775 DOI: 10.1007/s00464-008-9743-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2007] [Revised: 09/08/2007] [Accepted: 11/28/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bleeding is a major complication of endoscopic mucosal resection (EMR). This study investigated whether the use of metal hemoclips to close EMR-induced ulcers after gastric EMR was effective in preventing delayed bleeding. METHODS This single-center study retrospectively examined the records for 150 lesions of 140 consecutive patients (107 men and 33 women) with a mean age of 61 years (range, 38-81 years) who underwent EMR. For 60 patients, moderate to severe immediate bleeding occurred during the procedure, and the ulcers had been closed using metal hemoclips (clip group). In the remaining 90 cases, the immediate bleeding was absent or mild, and hemoclips were not used (nonclip group). Postprocedure bleeding (delayed bleeding) was analyzed. RESULTS Overall, delayed bleeding occurred with 14 (9.3%) of the 150 lesions. Delayed bleeding occurred less frequently in the clip group (2 of 60 lesions; 3.3%) than in the nonclip group (12 of 90 lesions; 13.3%; p = 0.04). Of the 60 clip group ulcers, 37 (62%) were completely closed, and none showed delayed bleeding. The median number of hemoclips used for ulcer closure was 10 (range, 4-22), and the median time for ulcer closure was 14 min (range, 4-40 min). CONCLUSIONS Prophylactic closure of gastric EMR-induced ulcers with hemoclips reduced delayed bleeding.
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Affiliation(s)
- Kee Don Choi
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736, South Korea
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Endoscopic closure of fecal colo-cutaneous fistula by using metal clips. Surg Laparosc Endosc Percutan Tech 2008; 17:447-51. [PMID: 18049413 DOI: 10.1097/sle.0b013e3180dc9392] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fecal colo-cutaneous fistula often requires surgical intervention for successful closure increasing the morbidity and mortality associated with this condition. Endoscopic fistula closure can be a less invasive modality. We report successful closure of fecal colo-cutaneous fistula by endoscopic application of metal hemo-clips after failure of prolonged treatment including diverting proximal ileostomy in 2 consecutive patients after emergency primary repair of cecal perforation caused by stab injury of abdomen and iatrogenic fecal fistula after left hemicolectomy and colo-colic anastomosis for adenocarcinoma of descending colon, respectively. The endoscopic closure of fecal colo-cutaneous fistula by using metal clips is an effective, safe, and less invasive treatment modality. It can add to therapeutic armamentarium of surgeons and may obviate the need for additional surgical intervention and associated morbidity in a proportion of such patients.
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Ikehara H, Gotoda T, Ono H, Oda I, Saito D. Gastric perforation during endoscopic resection for gastric carcinoma and the risk of peritoneal dissemination. Br J Surg 2007; 94:992-5. [PMID: 17535014 DOI: 10.1002/bjs.5636] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The potential risk of peritoneal seeding following perforation caused by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is unknown. METHODS Between January 1991 and December 2003, 90 patients suffered gastric perforation during EMR or ESD at the National Cancer Centre Hospital, Tokyo. The clinical and pathological evidence for peritoneal dissemination in these patients was assessed retrospectively. RESULTS Eighty-four patients were followed up at this hospital for a median of 53.6 (range 7.0-136.6) months; the remaining six patients were followed up at other institutions. In 83 patients the perforation was repaired by endoscopic clip application and seven patients underwent emergency surgery. Gastrectomy was carried out in 33 patients who had non-curative endoscopic surgery. Among these, peritoneal fluid was sampled during operation in nine patients and was cytologically negative for malignancy. The other 24 patients who had a gastrectomy did not have ascites so cytology was not performed. No peritoneal dissemination was noted during follow-up. CONCLUSION This study suggests that perforation associated with EMR and ESD does not lead to peritoneal dissemination even in the long term.
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Affiliation(s)
- H Ikehara
- National Cancer Centre Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan.
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Taku K, Sano Y, Fu KI, Saito Y, Matsuda T, Uraoka T, Yoshino T, Yamaguchi Y, Fujita M, Hattori S, Ishikawa T, Saito D, Fujii T, Kaneko E, Yoshida S. Iatrogenic perforation associated with therapeutic colonoscopy: a multicenter study in Japan. J Gastroenterol Hepatol 2007; 22:1409-14. [PMID: 17593224 DOI: 10.1111/j.1440-1746.2007.05022.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Colonic perforation is the serious accidental complication. The aim of this study is to analyze the clinical presentation and management of recent iatrogenic perforations during therapeutic colonoscopy. METHODS Consecutive patients referred to four academic cancer centers in Japan were retrospectively reviewed using each center's endoscopy database of medical records. Data was obtained by means of an extensive data collection sheet. Since we evaluated the data including iatrogenic perforation during newly developed therapeutic procedure such as endoscopic submucosal dissection (ESD) or hemoclips, the collection of patient data was set from the period of the beginning of ESD technique in each hospital in this study. RESULTS The overall rate of occurrence of perforation was 0.15% (23/15, 160). Perforation rate for EMR (0.58%) showed a significantly higher rate (P < 0.0001) than that for hot biopsy and polypectomy. The rate for ESD (14%) showed a markedly higher rate (P < 0.0001) than that for other standard procedures. Of those perforations, endoscopic clipping was performed in 56.5% of the patients, and conservative treatment was successful in 100% of the patients with successful closure. Both CT scan findings and serology results (WBC, CRP) after perforation were poor predictors for need for surgery as opposed to conservative management. CONCLUSIONS Further improvements in EMR with special knife techniques are required to simply and safely remove large colorectal neoplasms, because perforation rate for ESD shows a markedly higher. Conservative management may be possible in patients who have undergone complete endoscopic clipping.
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Affiliation(s)
- Keisei Taku
- Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
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Larghi A, Waxman I. State of the art on endoscopic mucosal resection and endoscopic submucosal dissection. Gastrointest Endosc Clin N Am 2007; 17:441-69, v. [PMID: 17640576 DOI: 10.1016/j.giec.2007.05.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) provide new alternatives for minimally invasive treatment of superficial gastrointestinal malignancies. Evidence suggests that these techniques can be performed safely and have comparable outcomes to surgery with less morbidity and better quality of life due to their tissue-sparing nature when compared with conventional surgery. Although the techniques and accessories have become standardized, there is room for improvement, and further research and development are required. Current challenges facing American gastroenterologists or endoscopic surgeons include access to training and lack of appropriate reimbursement for these heavy-weighted and technically demanding procedures. Nevertheless, EMR and ESD are here to stay and are only the first steps toward true radical endoluminal resection of GI malignancies.
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Affiliation(s)
- Alberto Larghi
- Digestive Endoscopy Unit, Catholic University, Largo A. Gemelli 8, 00192 Rome, Italy
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Sano Y, Saitoh Y. RISK MANAGEMENT OF THERAPEUTIC COLONOSCOPY (HOT BIOPSY, POLYPECTOMY, ENDOSCOPIC MUCOSAL RESECTION AND ENDOSCOPIC SUBMUCOSAL DISSECTION). Dig Endosc 2007. [DOI: 10.1111/j.1443-1661.2007.00732.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Sumiyama K, Gostout CJ. Novel techniques and instrumentation for EMR, ESD, and full-thickness endoscopic luminal resection. Gastrointest Endosc Clin N Am 2007; 17:471-85, v-vi. [PMID: 17640577 DOI: 10.1016/j.giec.2007.05.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endoscopic intervention is evolving into an established therapeutic alternative for small superficial lesions, and an eventual application for en bloc resection of large lesions, deeper layers, and a reliable access to lesions outside of the gastrointestinal wall. Although further developmental and clinical evaluation is necessary, we believe endoscopic resection by the submucosal route and by full-thickness approaches will replace standard surgical procedures in the next several years.
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Affiliation(s)
- Kazuki Sumiyama
- Mayo Clinic, Developmental Endoscopy Unit, Charlton 8-A, 200 First Street, SW, Rochester, MN 55905, USA
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Abstract
Endoscopic closure of gastrointestinal perforations, fistulas, and anastomotic dehiscence is technically feasible. Endoluminal closure of the instrumental perforations of the gastrointestinal tract can be accomplished immediately after the recognition of perforation, while avoiding the delay of arranging surgery and the trauma associated with thoracotomy or laparotomy. In addition, endoscopic closure should be considered in patients with anastomotic dehiscence and chronic fistulas as this may avoid the risk associated with reoperation. The outcome of closure depends on the technical expertise in the proper selection and use of various endoluminal closure options. Training of the endoscopists in the use of this novel technology will enhance the quality of care of our patients.
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Affiliation(s)
- G S Raju
- Center for Endoscopic Research, Training, and Innovation (CERTAIN), Department of Internal Medicine, 4.106 McCullough Building, 301 University Boulevard, University of Texas Medical Branch, Galveston, TX 77555-0764, USA.
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Shimura T, Sasaki M, Kataoka H, Tanida S, Oshima T, Ogasawara N, Wada T, Kubota E, Yamada T, Mori Y, Fujita F, Nakao H, Ohara H, Inukai M, Kasugai K, Joh T. Advantages of endoscopic submucosal dissection over conventional endoscopic mucosal resection. J Gastroenterol Hepatol 2007; 22:821-6. [PMID: 17565635 DOI: 10.1111/j.1440-1746.2006.04505.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Endoscopic mucosal resection is an established method for treating intramucosal gastric neoplasms. Conventional endoscopic mucosal resection has predominantly been performed using strip biopsy, but local recurrence sometimes occurs due to such piecemeal resection. Endoscopic submucosal dissection has recently been performed in Japan using new devices such as an insulation-tip diathermic knife. The efficacy and problems associated with endoscopic submucosal dissection were evaluated by comparison with conventional endoscopic mucosal resection. METHODS Treatment consisted of conventional endoscopic mucosal resection for 48 lesions from January 1999 to October 2002, and endoscopic submucosal dissection for 59 lesions from November 2002 to June 2005. Endoscopic submucosal dissection was performed using an insulation-tip diathermic knife and flex and hook knives, as appropriate. RESULTS For lesions >or=11 mm in size, en bloc resection rates were significantly higher with endoscopic submucosal dissection than with conventional endoscopic mucosal resection, but treatment time was significantly longer. En bloc resection rates were higher with endoscopic submucosal dissection than with conventional endoscopic mucosal resection in all areas. Treatment of lesions in the upper one-third of the stomach took a long time using endoscopic submucosal dissection, and intraoperative bleeding was frequent. However, en bloc resection rates and intraoperative bleeding with endoscopic submucosal dissection were improved using various knives. CONCLUSIONS Endoscopic submucosal dissection can take a long time, but is superior to conventional endoscopic mucosal resection for treating intramucosal gastric neoplasms.
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Affiliation(s)
- Takaya Shimura
- Department of Internal Medicine and Bioregulation, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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