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Dong T, Wang H, Jing L, Zhou X, Wang Y, Xiao J. Water pressure method for endoscopic submucosal dissection of a rectal tumor on the gravitational side close to the dentate line. Endosc Int Open 2024; 12:E532-E534. [PMID: 38628389 PMCID: PMC11018390 DOI: 10.1055/a-2272-1012] [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] [Received: 01/02/2024] [Accepted: 02/16/2024] [Indexed: 04/19/2024] Open
Affiliation(s)
- Tao Dong
- Digestive Endoscopy Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Hanying Wang
- Digestive Endoscopy Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Lin Jing
- Digestive Endoscopy Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xuan Zhou
- Digestive Endoscopy Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yaohui Wang
- Department of Pathology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jun Xiao
- Digestive Endoscopy Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Andrisani G, Di Matteo FM. Endoscopic Submucosal Dissection of Superficial Colorectal Neoplasms at "Challenging Sites" Using a Double-Balloon Endoluminal Interventional Platform: A Single-Center Study. Diagnostics (Basel) 2023; 13:3154. [PMID: 37835897 PMCID: PMC10572117 DOI: 10.3390/diagnostics13193154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Colonic endoscopic submucosal dissection (ESD) at "challenging sites" such as the cecum, ascending colon, and colonic flexures could be difficult even for expert endoscopists due to poor endoscope stability/maneuverability, steep angles, and thinner wall thickness. A double-balloon endoluminal intervention platform (EIP) has been introduced in the market to fasten and facilitate ESD, particularly when located at difficult sites. Here, we report our initial experience with an EIP comparing the outcomes of an EIP versus standard ESD (S-ESD) at "challenging sites". MATERIALS AND METHODS We retrospectively collected data on consecutive patients with colonic lesions located in the right colon and at flexures who underwent ESD in our tertiary referral center between March 2019 and May 2023. Endoscopic and clinical outcomes (technical success, en bloc resection rate, R0 resection rate, procedure time, time to reach the lesion, and adverse events) and 6-month follow-up outcomes were analyzed. RESULTS Overall, 139 consecutive patients with lesions located at these challenging sites were enrolled (EIP: 31 and S-ESD: 108). Demographic characteristics did not differ between groups. En bloc resection was achieved in 92.3% and 93.5% of patients, respectively, in the EIP and S-ESD groups. Both groups showed a comparable R0 resection rate (EIP vs. S-ESD: 92.3% vs. 97.2%). In patients undergoing EIP-assisted ESD, the total procedure time was shorter (96.1 [30.6] vs. 113.6 [42.3] minutes, p = 0.01), and the mean size of the resected lesions was smaller (46.2 ± 12.7 vs. 55.7 ± 17.6 mm, p = 0.003). The time to reach the lesion was significantly shorter in the EIP group (1.9 ± 0.3 vs. 8.2 ± 2.7 min, p ≤ 0.01). Procedure speed was comparable between groups (14.9 vs. 16.6 mm2/min, p = 0.29). Lower adverse events were observed in the EIP patients (3.8 vs. 10.2%, p = 0.31). CONCLUSIONS EIP allows results that do not differ from S-ESD in the resection of colorectal superficial neoplasms localized in "challenging sites" in terms of efficacy and safety. EIP reduces the time to reach the lesions and may more safely facilitate endoscopic resection.
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Affiliation(s)
- Gianluca Andrisani
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
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Stéphane S, Timothée W, Jérémie A, Raphael O, Martin D, Emmanuelle P, Elodie L, Quentin D, Nikki C, Sonia B, Hugo L, Guillaume G, Romain L, Mathieu P, Sophie G, Jeremie J. Endoscopic submucosal dissection or piecemeal endoscopic mucosal resection for large superficial colorectal lesions: A cost effectiveness study. Clin Res Hepatol Gastroenterol 2022; 46:101969. [PMID: 35659602 DOI: 10.1016/j.clinre.2022.101969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/20/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Endoscopic management is preferred to surgical management for large superficial colorectal lesions. However, the optimal endoscopic resection strategy (piecemeal endoscopic mucosal resection [pEMR] or endoscopic submucosal dissection [ESD]) is still debated from an economical point of view. To date, in France, there is no Health Insurance reimbursement rate for the hospital stays related to ESD. We searched to estimate the global cost of colorectal ESD and to define the most cost-effectiveness endoscopic strategy. METHODS A model was created to compare the cost-effectiveness of ESD and pEMR according to optical diagnosis (Japan NBI Expert Team [JNET], laterally spreading tumour [LST], CONECCT). We distinguished three groups from the same multicentre ESD cohort and compared the medical and economic outcomes: real-life ESD data (Universal-ESD or U-ESD) compared to modelled selective ESD (S-ESD JNET; S-ESD LST; S-ESD CONECCT) and exclusive pEMR strategies (Universal-EMR or U-EMR). RESULTS The en-bloc, R0, and curative resection rates were 97.5%, 86.5%, and 82.6%, respectively in the real life French ESD cohort of 833 colorectal lesions. U-ESD was the least-expensive strategy, with a global cost of 2,858,048.17 €, i.e. 3,431.03 €/patient and was also the most effective strategy because it avoided 774 surgeries, which was more than any other strategy. It outperformed S-ESD CONNECT (global cost = 2,951,411.44 €, and 3,543.11 €/patient, 765 surgeries avoided, S-ESD LST (global cost = 3,055,951.53 €, and 3,668.61 €/patient, 749 surgeries avoided), and S-ESD JNET (global cost = 3,547,426.97 € and 4,258.62 €/patient, 704 surgeries avoided) and U-EMR (global cost = 4,060,547.62 € and 4,874.61 €/patient, 620 surgeries avoided). Even though a model which optimized pEMR results (0% technical failure, 0% primary surgery), U-EMR strategy remained the most expansive strategy and the one that avoided the least surgeries. CONCLUSION ESD for all LSTs upper than 20 mm is more cost-effective than pEMR, and S-ESD.
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Affiliation(s)
- Scheer Stéphane
- Gastroenterology Department, University Hospital of Poitiers, 86000 Poitiers, France
| | - Wallenhorst Timothée
- Gastroenterology Department, University Hospital of Rennes, 35000 Rennes, France
| | - Albouys Jérémie
- Gastroenterology Department, University Hospital of Limoges, 87042 Limoges, France
| | - Olivier Raphael
- Gastroenterology Department, University Hospital of Poitiers, 86000 Poitiers, France
| | - Dahan Martin
- Gastroenterology Department, University Hospital of Limoges, 87042 Limoges, France
| | | | - Leclerc Elodie
- Gastroenterology Department, University Hospital of Rennes, 35000 Rennes, France
| | - Denost Quentin
- Colorectal and Pelvic Surgery, Bordeaux University Hospital, 33604 Bordeaux, France
| | - Christou Nikki
- Digestive Surgery, Limoges University Hospital, 87042 Limoges, France
| | | | - Lepetit Hugo
- Gastroenterology Department, University Hospital of Limoges, 87042 Limoges, France
| | - Gschwind Guillaume
- Public Health Care Department, University Hospital of Limoges, 87042 Limoges, France
| | - Legros Romain
- Gastroenterology Department, University Hospital of Limoges, 87042 Limoges, France
| | - Pioche Mathieu
- Gastroenterology Department, Hospital Edouard Heriot, Hospices civils de Lyon, 69003 Lyon, France
| | - Geyl Sophie
- Gastroenterology Department, University Hospital of Limoges, 87042 Limoges, France
| | - Jacques Jeremie
- Gastroenterology Department, University Hospital of Limoges, 87042 Limoges, France.
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Symer M, Connolly J, Yeo H. Management of the Malignant Colorectal Polyp. Curr Probl Surg 2022; 59:101124. [DOI: 10.1016/j.cpsurg.2022.101124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Double-balloon endolumenal intervention platform with flexible grasper to expedite colonic endoscopic submucosal dissection. VideoGIE 2020; 6:144-146. [PMID: 33738368 PMCID: PMC7947717 DOI: 10.1016/j.vgie.2020.11.014] [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: 11/23/2022] Open
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Endoscopic submucosal dissection of large polyps in the right colon using an endoscopic snare with a double-balloon endolumenal interventional platform: an ex vivo study in a porcine colorectal model. Surg Endosc 2020; 35:6319-6328. [DOI: 10.1007/s00464-020-08100-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 10/15/2020] [Indexed: 02/06/2023]
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Ismail MS, Bahdi F, Mercado MO, Habazi R, Alexander A, Prabhu S, John S, Kovvali C, Othman MO. ESD with double-balloon endoluminal intervention platform versus standard ESD for management of colon polyps. Endosc Int Open 2020; 8:E1273-E1279. [PMID: 33015328 PMCID: PMC7508668 DOI: 10.1055/a-1226-6372] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/29/2020] [Indexed: 02/08/2023] Open
Abstract
Background and study aims Endoscopic submucosal dissection (ESD) with the double-balloon endoluminal intervention platform (DEIP) is a novel technique for removal of complex colon polyps (> 2 cm) or those located in anatomically difficult positions. DEIP helps create a therapeutic zone with improved visualization and stability, facilitating polyp removal. We aimed to compare the outcomes of DEIP with the conventional cap-assisted ESD (standard ESD) technique for colon polyp resection, in particular, the ability to complete the ESD procedure without resorting to hybrid ESD or piecemeal resection. Patients and methods This was a retrospective cohort of all patients who underwent colon ESD in a single large tertiary referral center between September 2016 and October 2019. Information was collected on patient demographics and study outcomes including procedure time, rates of en bloc and curative resection, operative and postoperative complications. All patients were followed up for 1 month after the procedure. Results 111 patients were included in the study (DEIP 60, standard ESD 51). There was no statistically significant difference between mean procedures time (± SD) in the two groups, mean (81.9 ± 35.4 min standard vs. 96.4 ± 42.2 min in DEIP). Mean polyp size (± SD) was similar between the two groups (7.6 ± 6.0 cm 2 vs. 6.2 ± 5.5 cm 2 , P = .2). There were no significant differences in en bloc and curative resection rates or operative and postoperative complications between the two techniques. Conclusion Procedure time was similar using both techniques. However, DEIP enabled the entire procedure to be performed using the ESD technique without resorting to snare resection, which may affect the en bloc and curative resection rate. There were no significant differences in en bloc and curative resection rates between the two groups, probably due to the small sample size.
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Affiliation(s)
- Mohamed Saleh Ismail
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas,Department of Internal medicine, Gastroenterology & Hepatology, Ain Shams University, Cairo, Egypt
| | - Firas Bahdi
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Randa Habazi
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas
| | - Angel Alexander
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas
| | - Sahana Prabhu
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas
| | - Sharon John
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas
| | - Chandra Kovvali
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas
| | - Mohamed O. Othman
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas,Baylor St Luke’s Medical Center, Houston, Texas
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Trindade AJ, Kumta NA, Bhutani MS, Chandrasekhara V, Jirapinyo P, Krishnan K, Melson J, Pannala R, Parsi MA, Schulman AR, Trikudanathan G, Watson RR, Maple JT, Lichtenstein DR. Devices and techniques for endoscopic treatment of residual and fibrotic colorectal polyps (with videos). Gastrointest Endosc 2020; 92:474-482. [PMID: 32641215 DOI: 10.1016/j.gie.2020.03.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Residual neoplasia after macroscopically complete EMR of large colon polyps has been reported in 10% to 32% of resections. Often, residual polyps at the site of prior polypectomy are fibrotic and nonlifting, making additional resection challenging. METHODS This document reviews devices and methods for the endoscopic treatment of fibrotic and/or residual polyps. In addition, techniques reported to reduce the incidence of residual neoplasia after endoscopic resection are discussed. RESULTS Descriptions of technologies and available outcomes data are summarized for argon plasma coagulation ablation, snare-tip coagulation, avulsion techniques, grasp-and-snare technique, EndoRotor endoscopic resection system, endoscopic full-thickness resection device, and salvage endoscopic submucosal dissection. CONCLUSIONS Several technologies and techniques discussed in this document may aid in the prevention and/or resection of fibrotic and nonlifting polyps.
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Affiliation(s)
- Arvind J Trindade
- Division of Gastroenterology, Mount Sinai Hospital, New York, New York, USA
| | - Nikhil A Kumta
- Department of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vinay Chandrasekhara
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kumar Krishnan
- Division of Gastroenterology, Department of Internal Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joshua Melson
- Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Rahul Pannala
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Mansour A Parsi
- Section for Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, Louisiana, USA
| | - Allison R Schulman
- Department of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Guru Trikudanathan
- Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rabindra R Watson
- Department of Gastroenterology, Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - John T Maple
- Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - David R Lichtenstein
- Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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