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Moroi R, Shiga H, Nochioka K, Chiba H, Shimoyama Y, Onodera M, Naito T, Tosa M, Kakuta Y, Sato Y, Kayaba S, Takahashi S, Miyata S, Kinouchi Y, Masamune A. A Phase II Clinical Trial to Study the Safety of Triamcinolone after Endoscopic Radial Incision and Cutting Dilatation for Benign Stenosis of the Lower Gastrointestinal Tract: A Study Protocol. Kurume Med J 2024; 70:53-60. [PMID: 38508736 DOI: 10.2739/kurumemedj.ms7012005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Lower gastrointestinal tract stenosis is commonly diagnosed and is typically treated with surgery or endoscopic balloon dilation (EBD). Radial incision and cutting (RIC) is a novel treatment approach that has several benefits compared with EBD and surgery. Although RIC has demonstrated a high technical success rate and has been shown to improve subjective symptoms, previous studies revealed that restenosis after RIC remain unsolved. Herein, we report the design of a prospective, multicenter, single-arm, interventional, phase II trial to evaluate the safety of local triamcinolone acetonide (TA) administration and its feasibility in preventing restenosis after RIC for lower gastrointestinal tract stenosis. METHODS The major inclusion criteria are age 20-80 years and the presence of benign stenosis in the lower gastrointestinal tract accessible by colonoscope. We will perform RIC followed by local administration of TA to 20 participants. The primary outcome is the safety of local TA administration, which will be assessed by determining the frequency of adverse events of special interest. The secondary outcomes are the technical success rate of RIC, duration of procedure, improvement in subjective symptoms, and duration of hospitalization. The outcomes, improvement in subjective symptoms, and long-term results will be evaluated using descriptive statistics, Student's t-test, and Kaplan-Meier curve, respectively. DISCUSSION This explorative study will provide useful information regarding the safety of TA administration after RIC, which may contribute to further investigations.
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Affiliation(s)
- Rintaro Moroi
- Division of Gastroenterology, Tohoku University Hospital
| | - Hisashi Shiga
- Division of Gastroenterology, Tohoku University Hospital
| | - Kotaro Nochioka
- Clinical Research, Innovation and Education Center, Tohoku University Hospital
| | - Hirofumi Chiba
- Division of Gastroenterology, Iwate Prefectural Isawa Hospital
| | | | | | - Takeo Naito
- Division of Gastroenterology, Tohoku University Hospital
| | - Masaki Tosa
- Division of Gastroenterology, Iwaki City Medica Center
| | - Yoichi Kakuta
- Division of Gastroenterology, Tohoku University Hospital
| | - Yuichiro Sato
- Division of Gastroenterology, Osaki Citizen Hospital
| | - Shoichi Kayaba
- Division of Gastroenterology, Iwate Prefectural Isawa Hospital
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2
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Nakamura H, Morita R, Ito R, Sakurada A, Tomita N, Hirata Y, Kanari Y, Komatsu Y, Takanashi K, Anbo T, Katsuki S. Feasibility and safety of 0.6% sodium alginate in endoscopic submucosal dissection for colorectal neoplastic lesion: A pilot study. DEN OPEN 2024; 4:e313. [PMID: 37927953 PMCID: PMC10625103 DOI: 10.1002/deo2.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
Objectives The usefulness of 0.6% sodium alginate (SA) as a submucosal (SM) injection solution for endoscopic SM dissection (ESD) has gained attention over the past few years. However, using ESD for colorectal neoplastic lesions is not explicitly researched as yet. Thus, we conducted this study to determine the feasibility and safety of 0.6% SA solution for colorectal ESD. Methods In this single-center, retrospective pilot study, a total of 100 cases treated with ESD using 0.6% SA as a SM injection solution for colorectal neoplasia at our institute were retrospectively reviewed to clarify the clinical feasibility and safety of 0.6% SA. The primary endpoint was to evaluate the complication rate, and the secondary endpoint was to determine the procedure time and the amount of solution used. Results Intraoperative perforation was observed in 1 case (1.0%), 2 cases (2.0%) presented with postprocedural hemorrhage, and no lethal adverse events were observed. The median ESD procedure times were 39.5 min (10-150), and the amount of solution used was less than 20 mL in 67 cases (67.0%). En-bloc resection could be achieved in 97 cases (97.0%). Although six cases underwent subsequent surgery due to the deep SM invasion (>1000 μm), there were no cases with nodal involvement, confirmed through histopathological evaluation. Conclusions Our findings indicate that 0.6% SA can potentially ensure safe and secure ESD for colorectal neoplasia.
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Affiliation(s)
- Hajime Nakamura
- Department of GastroenterologyOtaru Ekisaikai HospitalHokkaidoJapan
- Department of Medical OncologySapporo Medical University School of MedicineHokkaidoJapan
| | - Rie Morita
- Department of GastroenterologyOtaru Ekisaikai HospitalHokkaidoJapan
| | - Ryo Ito
- Department of GastroenterologyOtaru Ekisaikai HospitalHokkaidoJapan
| | - Akira Sakurada
- Department of GastroenterologyOtaru Ekisaikai HospitalHokkaidoJapan
| | - Natsumi Tomita
- Department of GastroenterologyOtaru Ekisaikai HospitalHokkaidoJapan
| | - Yuya Hirata
- Department of GastroenterologyOtaru Ekisaikai HospitalHokkaidoJapan
| | - Yusuke Kanari
- Department of GastroenterologyOtaru Ekisaikai HospitalHokkaidoJapan
| | - Yuya Komatsu
- Department of GastroenterologyOtaru Ekisaikai HospitalHokkaidoJapan
| | | | - Tomonori Anbo
- Department of GastroenterologyOtaru Ekisaikai HospitalHokkaidoJapan
| | - Shinichi Katsuki
- Department of GastroenterologyOtaru Ekisaikai HospitalHokkaidoJapan
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Mendes RR, Barreiro P, Mascarenhas A, Franco AR, Carvalho L, Chagas C. Endoscopic Submucosal Dissection for Resections Larger than 10 cm: Outcomes from a Portuguese Center. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2024; 31:33-40. [PMID: 38476306 PMCID: PMC10928864 DOI: 10.1159/000528102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/23/2022] [Indexed: 03/14/2024]
Abstract
Background Endoscopic submucosal dissection (ESD) is a minimally invasive technique for en bloc resection of superficial neoplastic lesions, independent of their size. However, for giant gastrointestinal superficial neoplasia, the risk of invasive cancer is higher, and ESD is typically challenging. Despite the increasing literature on giant resections, data on their efficacy and safety are still lacking. Objective The aim of this study was to describe ESD outcomes from a Portuguese center, compare them with other international studies, and analyze the possible risk factors influencing outcomes. Methods We conducted a retrospective single-center review using a prospectively collected database, including patients with rectal ESD resections larger than 10 cm, between January 2016 and December 2021. Clinical, procedural, and pathological data were collected and analyzed. Revision of the literature for comparison with international results was done through PubMed. Data were analyzed and statistical analysis performed, using Microsoft Excel and SPSS, to identify significant risk factors. Results The study included 15 rectal resections, with a mean diameter of 140.9 mm (range 105-270), corresponding to lesions of 125.9 mm (87-238). The overall en bloc resection rate was 100% (n = 15). According to ESGE criteria, procedure was considered curative in 53.3% (n = 8), non-curative with high risk in 13.3% (n = 2), and local-risk recurrence in 33.3% (n = 5). Adverse events occurred in 26.7% (n = 4): 1 minor perforation and 3 stenosis, most endoscopically managed. For non-curative resections with local-risk recurrence, surveillance without adjuvant therapy was performed in all cases. For high-risk non-curative resections, surgery was performed in 1 patient and adjuvant chemoradiation therapy in another. Follow-up (mean 16 months) demonstrated a recurrence rate of 0%. Statistical analysis revealed resection size ≥20 cm as a risk factor for perforation (p value 0.067), and involvement of ≥90% of the circumference and procedural time ≥4 h as risk factors for stenosis (p value 0.029 and 0.009, respectively). Conclusions Although challenging, ESD for giant lesions seems effective and safe, with a still relevant rate of complications, which were mostly endoscopically treated. Rigorous characterization of lesions is crucial to predict and avoid complications or the need for therapy escalation.
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Affiliation(s)
- Raquel R. Mendes
- Gastroenterology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Pedro Barreiro
- Gastroenterology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Lisbon Advanced Endoscopy Center, Hospital Lusíadas, Lisbon, Portugal
| | - André Mascarenhas
- Gastroenterology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana Rita Franco
- Gastroenterology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Liliana Carvalho
- Gastroenterology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Cristina Chagas
- Gastroenterology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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4
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Hanevelt J, Leicher LW, Moons LMG, Vleggaar FP, Huisman JF, van Westreenen HL, de Vos Tot Nederveen Cappel WH. Colonoscopic-assisted laparoscopic wedge resection versus segmental colon resection for benign colonic polyps: a comparative cost analysis. Colorectal Dis 2023; 25:2147-2154. [PMID: 37814456 DOI: 10.1111/codi.16757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/15/2023] [Accepted: 09/05/2023] [Indexed: 10/11/2023]
Abstract
AIM The colonoscopic-assisted laparoscopic wedge resection (CAL-WR) is proven to be an effective and safe alternative to a segmental colon resection (SCR) for large or complex benign colonic polyps that are not eligible for endoscopic removal. This analysis aimed to evaluate the costs of CAL-WR and compare them to the costs of an SCR. METHOD A single-centre 90-day 'in-hospital' comparative cost analysis was performed on patients undergoing CAL-WR or SCR for complex benign polyps between 2016 and 2020. The CAL-WR group consisted of 44 patients who participated in a prospective multicentre study (LIMERIC study). Inclusion criteria were (1) endoscopically unresectable benign polyps; (2) residual or recurrence after previous polypectomy; or (3) irradically resected low risk pT1 colon carcinoma. The comparison group, which was retrospectively identified, included 32 patients who underwent an elective SCR in the same period. RESULTS Colonoscopic-assisted laparoscopic wedge resection was associated with significantly fewer complications (7% in the CAL-WR group vs. 45% in the SCR group, P < 0.001), shorter operation time (50 min in the CAL-WR group vs. 119 min in the SCR group, P < 0.001), shorter length of hospital stay (median length of stay 2 days in the CAL-WR group vs. 4 days in the SCR group, P < 0.001) and less use of surgical resources (reduction in costs of 32% per patient), resulting in a cost savings of €2372 (£2099 GBP) per patient (P < 0.001). CONCLUSION Given the clinical and financial benefits, CAL-WR should be recommended for complex benign polyps that are not eligible for endoscopic resection before major surgery is considered.
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Affiliation(s)
- Julia Hanevelt
- Department of Gastroenterology and Hepatology, Isala, Zwolle, The Netherlands
| | - Laura W Leicher
- Department of Gastroenterology and Hepatology, Isala, Zwolle, The Netherlands
| | - Leon M G Moons
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Frank P Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Jelle F Huisman
- Department of Gastroenterology and Hepatology, Isala, Zwolle, The Netherlands
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Jacques J, Neuhaus H, Enderle MD, Biber U, Linzenbold W, Schenk M, Khalaf K, Repici A. Colorectal Endoscopic Submucosal Dissection: Performance of a Novel Hybrid-Technology Knife in an Animal Trial. Diagnostics (Basel) 2023; 13:3347. [PMID: 37958243 PMCID: PMC10650536 DOI: 10.3390/diagnostics13213347] [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: 09/25/2023] [Revised: 10/18/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) was developed for the removal of benign and early malignant lesions in the gastrointestinal tract. We aimed to evaluate the performance and safety of a novel high-pressure waterjet-assisted ESD knife in colorectal applications. Six female German Landrace pigs with an average weight of 62 kg (range 60-65 kg) were used in this prospective, randomized, and controlled study. Twenty-four ESDs were performed by three endoscopists: Twelve each with the new Erbe HYBRIDknife® flex T-Type (HK-T) and the Olympus DualKnife® J (DK-J), including six rectal and six colonic ESDs per instrument. The order of performance was randomized regarding anatomic position and instrument. As the primary endpoint, ESD knife performance characteristics were combined and rated on a 5-point Likert scale, with 5 Likert points (LP) representing the best response (5 = very good). The HK-T was rated significantly better than the DK-J (4.7 LP versus 4.4 LP, p = 0.0295), mainly because of HK-T injection ability (5 LP versus 3 LP, p < 0.0001) and hemostasis (5 LP versus 4 LP, p = 0.0452). There was no difference in procedure time (HK-T: 35 min versus DK-J: 34 min, p = 0.8005), resection diameter (3.1 cm versus 2.8 cm, p = 0.3492), injection volume (41 mL versus 46 mL, p = 0.5633), and complication rates. HK-T is as effective as DK-J in colorectal ESD in terms of dissection quality but has better injection and hemostatic properties. The impact of these technical advantages on the ESD treatment of patients with large superficial colorectal lesions remains to be clinically verified.
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Affiliation(s)
- Jérémie Jacques
- Department of Hepato-Gastro-Enterology, University Hospital Center, 87042 Limoges, France
| | - Horst Neuhaus
- Medical Clinic for Gastroenterology at the Hospital Duesseldorf, 40225 Duesseldorf, Germany
| | | | - Ulrich Biber
- Erbe Elektromedizin GmbH, 72072 Tuebingen, Germany
| | | | - Martin Schenk
- Department of Experimental Medicine, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Kareem Khalaf
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, 20089 Milan, Italy
- Department of Biomedical Science, Humanitas University, 20072 Milan, Italy
| | - Alessandro Repici
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, 20089 Milan, Italy
- Department of Biomedical Science, Humanitas University, 20072 Milan, Italy
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6
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Gweon TG, Yang DH. Management of complications related to colorectal endoscopic submucosal dissection. Clin Endosc 2023; 56:423-432. [PMID: 37501624 PMCID: PMC10393575 DOI: 10.5946/ce.2023.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023] Open
Abstract
Compared to endoscopic mucosal resection (EMR), colonoscopic endoscopic submucosal dissection (C-ESD) has the advantages of higher en bloc resection rates and lower recurrence rates of colorectal neoplasms. Therefore, C-ESD is considered an effective treatment method for laterally spread tumors and early colorectal cancer. However, C-ESD is technically more difficult and requires a longer procedure time than EMR. In addition to therapeutic efficacy and procedural difficulty, safety concerns should always be considered when performing C-ESD in clinical practice. Bleeding and perforation are the main adverse events associated with C-ESD and can occur during C-ESD or after the completion of the procedure. Most bleeding associated with C-ESD can be managed endoscopically, even if it occurs during or after the procedure. More recently, most perforations identified during C-ESD can also be managed endoscopically, unless the mural defect is too large to be sutured with endoscopic devices or the patient is hemodynamically unstable. Delayed perforations are quite rare, but they require surgical treatment more frequently than endoscopically identified intraprocedural perforations or radiologically identified immediate postprocedural perforations. Post-ESD coagulation syndrome is a relatively underestimated adverse event, which can mimic localized peritonitis from perforation. Here, we classify and characterize the complications associated with C-ESD and recommend management options for them.
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Affiliation(s)
- Tae-Geun Gweon
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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7
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Kim IK, Ju YT, Kim HG, Lee JK, Kim DC, Kim JM, Cho JK, Park JH, Kim JY, Jeong CY, Hong SC, Kwag SJ. Experience of surgical treatment in a granular cell tumor in the ascending colon: a case report. Ann Coloproctol 2023; 39:275-279. [PMID: 34228911 PMCID: PMC10338165 DOI: 10.3393/ac.2020.00836.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 10/20/2022] Open
Abstract
We report a case about successful surgical treatment of a granular cell tumor in the ascending colon. A 36-year-old man underwent screening colonoscopy. An endoscopic examination revealed a 10-mm yellowish and hemispheric mass in the ascending colon, and lower endoscopic ultrasonography revealed a hypoechoic-to-isoechoic mass invaded the submucosal layer. The mass was suspected to be a colonic carcinoid tumor. Based on the preoperative evaluation, endoscopic complete resection was considered difficult. Therefore, the lesion was removed via laparoscopic right hemicolectomy. Histological examination revealed that the tumor consisted of nests of polygonal cells with abundant granular eosinophilic cytoplasm. Immunohistochemical staining revealed diffuse positivity for S100 and CD68. Therefore, the tumor was diagnosed as a granular cell tumor. We suggest that surgical resection should be considered if it is located in the thin-walled ascending colon prone to perforation, difficult to rule out malignant tumor due to submucosal invasion, or to remove endoscopically.
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Affiliation(s)
- In-Kyeong Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Young-Tae Ju
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Han-Gil Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jin-Kwon Lee
- Department of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Dong-Chul Kim
- Department of Pathology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jae-Myung Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jin Kyu Cho
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Ji-Ho Park
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Ju-Yeon Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Chi-Young Jeong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Soon-Chan Hong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Seung-Jin Kwag
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
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Meiborg M, Mechie NC, Blasberg T, Weber M, Wedi E. A novel strategy to perform endoscopic full-thickness resection at the ileocecal valve and securing the orifice with a double-pigtail catheter. Endoscopy 2023; 55:583-584. [PMID: 37230074 PMCID: PMC10212650 DOI: 10.1055/a-2031-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Moritz Meiborg
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
| | - Nicolae-Catalin Mechie
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
| | - Tobias Blasberg
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
| | - Marie Weber
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
| | - Edris Wedi
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
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9
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Sun J, Xie X, Liu Y, Hao X, Yang G, Zhang D, Nan Q. Complications after endoscopic submucosal dissection for early colorectal cancer (Review). Oncol Lett 2023; 25:264. [PMID: 37216158 PMCID: PMC10193368 DOI: 10.3892/ol.2023.13850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/11/2023] [Indexed: 05/24/2023] Open
Abstract
Colorectal cancer (CRC) is a gastrointestinal malignancy that seriously threatens human life and health, resulting in a heavy disease burden. Endoscopic submucosal dissection (ESD) is widely used in clinical practice and is an effective treatment for early CRC (ECC). Colorectal ESD is a challenging operation, and the incidence of postoperative complications is relatively high because of the thin intestinal wall and limited space for endoscopic operations. Systematic reports on the postoperative complications of colorectal ESD, such as fever, bleeding and perforation, from both China and elsewhere are lacking. In the present review, progress in research on postoperative complications after ESD for ECC is summarized.
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Affiliation(s)
- Jianhui Sun
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
- Yunnan Provincial Clinical Research Center for Digestive Diseases, Kunming, Yunnan 650032, P.R. China
- Graduate School of Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Xinyuan Xie
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
- Yunnan Provincial Clinical Research Center for Digestive Diseases, Kunming, Yunnan 650032, P.R. China
- Graduate School of Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Yangcheng Liu
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
- Yunnan Provincial Clinical Research Center for Digestive Diseases, Kunming, Yunnan 650032, P.R. China
| | - Xianglin Hao
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
- Yunnan Provincial Clinical Research Center for Digestive Diseases, Kunming, Yunnan 650032, P.R. China
- Graduate School of Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Gang Yang
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
- Yunnan Provincial Clinical Research Center for Digestive Diseases, Kunming, Yunnan 650032, P.R. China
| | - Dan Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
- Yunnan Provincial Clinical Research Center for Digestive Diseases, Kunming, Yunnan 650032, P.R. China
- Graduate School of Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Qiong Nan
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
- Yunnan Provincial Clinical Research Center for Digestive Diseases, Kunming, Yunnan 650032, P.R. China
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10
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Meiborg M, Mechie NC, Blasberg T, Weber M, Wedi E. A novel strategy to perform endoscopic full-thickness resection at the ileocecal valve and securing the orifice with a double-pigtail catheter. Endoscopy 2023; 55:E375-E376. [PMID: 36720264 PMCID: PMC9889166 DOI: 10.1055/a-1986-7240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Moritz Meiborg
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
| | - Nicolae-Catalin Mechie
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
| | - Tobias Blasberg
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
| | - Marie Weber
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
| | - Edris Wedi
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
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11
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Hamada K, Shiwa Y, Kurita A, Todate Y, Horikawa Y, Techigawara K, Ishikawa M, Nagahashi T, Takeda Y, Fukushima D, Nishino N, Sakuma H, Honda M. Delayed Perforation of Colorectal Endoscopic Submucosal Dissection Treated by Endoscopic Ultrasound-Guided Drainage. Case Rep Gastroenterol 2023; 17:148-154. [PMID: 36879581 PMCID: PMC9984940 DOI: 10.1159/000529480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/12/2023] [Indexed: 03/06/2023] Open
Abstract
We report a case of a 70-year-old male with delayed perforation in the cecum treated by endoscopic ultrasonography-guided drainage for a pelvic abscess. The lesion was a 50-mm laterally spreading tumor, and endoscopic submucosal dissection (ESD) was performed. No perforation was detected during the operation, and en bloc resection was achieved. He had fever and abdominal pain on postoperative day (POD) 2. Computed tomography (CT) revealed the intra-abdominal free air, leading to a diagnosis of delayed perforation after ESD. Vital signs were stable, the perforation was considered minor, and endoscopic closure was attempted. The colonoscopy under fluoroscopy showed no perforation in the ulcer and no leakage of the contrast medium. He was managed conservatively with antibiotics and nothing per os. Symptoms improved; however, a follow-up CT on POD 13 revealed a 65-mm pelvic abscess, and endoscopic ultrasound (EUS)-guided drainage was successfully performed. The follow-up CT on POD 23 showed the reduction of abscess, and the drainage tubes were removed. Emergent surgical treatment is crucial in delayed perforation because it has a poor prognosis, and reports of conservative therapy for colonic ESD with delayed perforation are few. The present case was managed with antibiotics and EUS-guided drainage. Thus, EUS-guided drainage can be a treatment option for delayed perforation after colorectal ESD, if the abscess is localized.
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Affiliation(s)
- Koichi Hamada
- Department of Gastroenterology, Southern-Tohoku General Hospital, Fukushima, Japan.,Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Yoshiki Shiwa
- Department of Gastroenterology, Southern-Tohoku General Hospital, Fukushima, Japan
| | - Akira Kurita
- Department of Gastroenterology and Hepatology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Yukitoshi Todate
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan.,Department of Surgery, Southern-Tohoku General Hospital, Fukushima, Japan
| | - Yoshinori Horikawa
- Department of Gastroenterology, Southern-Tohoku General Hospital, Fukushima, Japan
| | - Kae Techigawara
- Department of Gastroenterology, Southern-Tohoku General Hospital, Fukushima, Japan
| | - Masafumi Ishikawa
- Department of Gastroenterology, Southern-Tohoku General Hospital, Fukushima, Japan
| | - Takayuki Nagahashi
- Department of Gastroenterology, Southern-Tohoku General Hospital, Fukushima, Japan
| | - Yuki Takeda
- Department of Gastroenterology, Southern-Tohoku General Hospital, Fukushima, Japan
| | - Daizo Fukushima
- Department of Gastroenterology, Southern-Tohoku General Hospital, Fukushima, Japan
| | - Noriyuki Nishino
- Department of Gastroenterology, Southern-Tohoku General Hospital, Fukushima, Japan
| | - Hideo Sakuma
- Department of Pathology, Southern-Tohoku General Hospital, Fukushima, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan.,Department of Surgery, Southern-Tohoku General Hospital, Fukushima, Japan
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12
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Chow CWS, Fung TLD, Chan PT, Kwok KH. Endoscopic submucosal dissection for colorectal polyps: outcome determining factors. Surg Endosc 2023; 37:1293-1302. [PMID: 36192659 PMCID: PMC9529320 DOI: 10.1007/s00464-022-09672-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/24/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) has gained increasing popularity in the management of complicated colorectal polyps. However, clinical outcomes for ESD have remained highly inconsistent worldwide. This study investigated and analysed factors that significantly affect ESD outcomes. METHODS We conducted a single-centred retrospective study on 220 colorectal polyps removed by ESD from 1st January 2016 to 31st December 2020. Data were collected and retrieved from clinical records. Variables studied included patient demographics, ESD technicalities and polyp characteristics. The primary outcome was completeness of resection based on en bloc and R0 resection rates. The secondary outcomes were recurrence, complications and hospital stay. Further analysis was performed for significant outcome determining factors. RESULTS The en bloc resection and R0 resection rates were 97.3% and 65% respectively. Intraprocedural and delayed perforation rates were 3.2% and 0.5% respectively. Intraprocedural and delayed bleeding rates were both 1.8%. Post-polypectomy syndrome rate was 2.7%. The median hospital stay was 4 days. Submucosal fibrosis was a significant determining factor for lower en bloc resection (p = 0.004), lower R0 resection (p = 0.002), intraprocedural perforation (p = 0.001), intraprocedural bleeding (p = 0.025) and post-polypectomy syndrome (p = 0.039). Hybrid snaring was associated with lower en bloc resection (p < 0.001), while longer ESD time was associated with lower R0 resection (p = 0.003) and post-polypectomy syndrome (p = 0.025). Other significant factors for post-polypectomy syndrome included young age (p = 0.021) and large polyp size (p = 0.018). Secondary analysis showed that submucosal fibrosis was significantly associated with non-granular lesions (p < 0.001) and prior biopsy (p = 0.003). CONCLUSION Submucosal fibrosis, hybrid snaring, ESD time, age and polyp size were significant outcome determining factors for ESD. By identifying these factors, strategies may be formulated to improve ESD outcomes.
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Affiliation(s)
- Chi Woo Samuel Chow
- Department of Surgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong, China.
| | - Tak Lit Derek Fung
- Department of Surgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong, China
| | - Pak Tat Chan
- Department of Surgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong, China
| | - Kam Hung Kwok
- Department of Surgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong, China
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13
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Ko CY, Yao CC, Li YC, Lu LS, Chou YP, Hu ML, Chiu YC, Chuah SK, Tai WC. Clinical outcomes of endoscopic submucosal dissection for colorectal neoplasms: A single-center experience in Southern Taiwan. PLoS One 2022; 17:e0275723. [PMID: 36206286 PMCID: PMC9543958 DOI: 10.1371/journal.pone.0275723] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022] Open
Abstract
Background and aims Endoscopic submucosal dissection (ESD) as an advanced endoscopic procedure can be considered for the removal of colorectal lesions with high suspicion of limited submucosal invasion or cannot be optimally removed by snare-based techniques. We aimed to analyze the clinical outcomes of ESD for colorectal neoplasms in our hospital. Methods We retrospectively enrolled 230 patients with 244 colorectal neoplasms who received ESD procedures from April 2012 to October 2020 at Kaohsiung Chang Gung Memorial Hospital. Clinicopathological data were collected by chart review. We also recorded ESD-related complications and clinical outcomes. Results The average age was 64 years old, with a mean follow-up time of 22.59 months. There was a loss of follow-up in 34 lesions. Most lesions were lateral spreading tumors of the non-granular type. The average ESD time was 51.9 minutes. Nine cases (3.7%) had procedure-related complications, including two intra-procedure perforations (0.8%) and seven delayed bleeding (2.9%) without procedure-related mortality. 241 lesions (98.8%) achieved en-bloc resection, while 207 lesions (84.8%) achieved R0 resection. Most lesions were tubulo-(villous) adenoma. Malignancy included 35 adenocarcinomas and 5 neuroendocrine tumors. No local recurrence was developed during follow-up. Multivariate analysis for long ESD time revealed significance in size ≥ 10 cm2 and endoscopist’s experience < 3 years. Pre-ESD endoscopic ultrasound revealed good prediction in discrimination of mucosal (sensitivity: 0.90) and submucosal lesion (specificity: 0.67). Conclusions ESD for colorectal neoplasms is an effective and safe technique. Size ≥ 10 cm2 and endoscopist’s experience < 3 years were significantly associated with long procedure time. Pre-ESD EUS provided a good prediction for colorectal neoplasms in invasion depth.
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Affiliation(s)
- Chen-Yu Ko
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Chien Yao
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Chi Li
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Lung-Sheng Lu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yeh-Pin Chou
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ming-Luen Hu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Chun Chiu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Seng-Kee Chuah
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Chen Tai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
- * E-mail:
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14
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Romo JA, Peña JD, López LA, Figueroa C, Garzon H, Recamán A. Post-polypectomy syndrome—a rare complication in colonoscopy procedures: a case report. J Surg Case Rep 2022; 2022:rjac369. [PMID: 36051004 PMCID: PMC9427180 DOI: 10.1093/jscr/rjac369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/27/2022] [Indexed: 11/24/2022] Open
Abstract
Post-polypectomy syndrome (PPS) is a complication that may arise after some colonoscopy procedures that require electrocoagulation, due to a transmural burn, which irritates the serous membrane. Its clinical presentation is similar to the one of intestinal perforation, but it has a favorable prognosis, and does not require surgical treatment. We report the case of a 55-year-old woman diagnosed with a polyp in the ascending colon, who was admitted for an endoscopic resection. After the procedure, she complained of nausea, emesis and abdominal pain in the right iliac fossa. She was transferred to the emergency department. An abdominal tomography showed cecal wall thickening without pneumoperitoneum. Therefore, the diagnosis of PPS was made and was managed with bowel rest, parenteral fluids and antibiotics, with full recovery. Despite of its low incidence, it is important to suspect this syndrome to avoid unnecessary surgical treatment and initiate medical management right away.
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Affiliation(s)
- Julián A Romo
- School of Medicine, Universidad del Rosario , Bogota D.C. , Colombia
| | - Jorge David Peña
- School of Medicine, Universidad del Rosario , Bogota D.C. , Colombia
| | - Laura A López
- School of Medicine, Universidad del Rosario , Bogota D.C. , Colombia
| | - Carlos Figueroa
- Department of Coloproctology, Hospital Universitario Mayor Méderi , Bogota D.C. , Colombia
| | - Horacio Garzon
- Department of Coloproctology, Hospital Universitario Mayor Méderi , Bogota D.C. , Colombia
| | - Andrea Recamán
- School of Medicine, Universidad del Rosario, Bogota D.C., Colombia
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15
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BUYRUK AM, LİVAOĞLU A, AKTAŞ A. Kolorektal lateral yayılımlı tümörlerde başarısız endoskopik mukozal rezeksiyon sonrası endoskopik submukozal diseksiyonun uygulanabilirliği: tek merkez deneyimi. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1125260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: Endoscopic mucosal resection might technically be unsuccessful (interrupted endoscopic mucosal resection) in some cases when treating large colorectal laterally spreading tumors. In the literature, data on the outcomes of the endoscopic submucosal dissection method in endoscopic mucosal resection interrupted tumors are lacking. In this study, we evaluated the results of patients who underwent endoscopic submucosal dissection for endoscopic mucosal resection interrupted laterally spreading tumors.
Materials and Methods: Between February 2019 and April 2021, 8 patients with endoscopic mucosal resection interrupted colorectal laterally spreading tumors underwent endoscopic submucosal dissection. The primary endpoint was en bloc, R0, and curative resection rates of endoscopic submucosal dissection.
Results: In all cases, endoscopic submucosal dissection was successfully completed. The mean tumor size was 61.5 mm (35–100 mm). The rate of en bloc resection, R0 resection and curative resection was 100%, 87.5% and 87.5% respectively. Intra-procedural perforation occurred in 1 patient (12.5%) and was successfully treated with clip application. Delayed bleeding occurred in 1 patient (12.5%), and was successfully treated with endoluminal hemostasis. Furthermore, histopathological examination revealed that laterally spreading tumors in 4 patients (50.0%) had submucosal invasion. Surgical resection was performed after endoscopic submucosal dissection in 1 patient owing to the presence of deep submucosal invasion.
Conclusion: Endoscopic submucosal dissection is an effective and relatively safe method in endoscopic mucosal resection interrupted colorectal laterally spreading tumors.
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Affiliation(s)
| | - Ayten LİVAOĞLU
- Trabzon Kanuni Training and Research Hospital, Trabzon, Turkiye
| | - Aydın AKTAŞ
- Trabzon Kanuni Training and Research Hospital, Trabzon, Turkiye
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16
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Moroi R, Shiga H, Nochioka K, Shimoyama Y, Kuroha M, Kakuta Y, Kinouchi Y, Masamune A. A pilot study investigating the safety and feasibility of endoscopic dilation using a radial incision and cutting technique for benign strictures of the small intestine: a study protocol. Pilot Feasibility Stud 2022; 8:85. [PMID: 35440064 PMCID: PMC9017048 DOI: 10.1186/s40814-022-01046-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Small benign intestinal stenosis is usually treated by endoscopic balloon dilation (EBD) or surgery. Although EBD and surgery are able to resolve the stenosis in most cases, they are associated with several problems such as insufficient dilation and surgical stress, respectively. On the contrary, a novel approach called radial incision and cutting (RIC) is reported to have several benefits when compared to EBD and surgery. We can currently adopt RIC only for the strictures in the colon or terminal ileum and not for those stenotic lesions present further in the small intestine where balloon-assisted endoscopy is utilized, because the long-type electric knife is currently not approved for use in Japan. We will herein conduct a pilot study to investigate the safety and feasibility of RIC for treating the benign stenoses of the small intestine using the long-type electric knife. Methods This will be a single-center, single-arm, interventional trial. The major criteria for inclusion will be age ranging from 20 to 80 years and the presence of benign stenosis in the small intestine. We will perform RIC on 10 participants. The primary outcome is the safety of this procedure, which will be assessed by measuring the frequency of adverse events of special interest. The secondary outcomes will be technical success rate, improvement in subjective symptoms, procedure time, and duration of hospitalization. Discussion This pilot study will provide useful information that will aid in adopting RIC for treating the benign strictures present in the small intestine. Trial registration jRCT Identifier, jRCTs022200040. Registered on 1 March 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01046-8.
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Affiliation(s)
- Rintaro Moroi
- Division of Gastroenterology, Tohoku University Hospital, 1-1, Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan.
| | - Hisashi Shiga
- Division of Gastroenterology, Tohoku University Hospital, 1-1, Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan
| | - Kotaro Nochioka
- Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Yusuke Shimoyama
- Division of Gastroenterology, Tohoku University Hospital, 1-1, Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan
| | - Masatake Kuroha
- Division of Gastroenterology, Tohoku University Hospital, 1-1, Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan
| | - Yoichi Kakuta
- Division of Gastroenterology, Tohoku University Hospital, 1-1, Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan
| | - Yoshitaka Kinouchi
- Division of Gastroenterology, Tohoku University Hospital, 1-1, Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Hospital, 1-1, Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan
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17
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Achkasov SI, Shelygin YA, Likutov AA, Mtvralashvili DA, Veselov VV, Mainovskaya OA, Nagudov MA, Chernyshov SV. [One thousand endoscopic submucosal dissections. Experience of the national center]. Khirurgiia (Mosk) 2022:5-11. [PMID: 35920217 DOI: 10.17116/hirurgia20220815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is a perspective method of organ-sparing treatment of benign colon tumors. MATERIAL AND METHODS The study included 1.000 patients with colon neoplasms who underwent ESD between October 2016 and October 2021. All surgeries were performed under intravenous sedation. RESULTS Mean dimension of tumors was 3.4 cm, median of surgery time - 51 (31; 101) minutes. Conversion of endoscopic approach occurred in 7.6% of cases. The main cause of conversion was unsatisfactory lifting in submucosal injection process. Incidence of en bloc and R0 resections was 84.1% and 68.3%, respectively. Postoperative morbidity was 2.9% that correlates with the world literature data. CONCLUSION Endoscopic submucosal dissection is an effective and safe method for benign colon neoplasms. Considering high incidence of en bloc resection and low rate of local recurrence in benign neoplasms, further research of efficacy and safety of ESD in early colon cancer is needed.
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Affiliation(s)
- S I Achkasov
- Ryzhikh National Medical Research Center, Moscow, Russia
| | - Yu A Shelygin
- Ryzhikh National Medical Research Center, Moscow, Russia
| | - A A Likutov
- Ryzhikh National Medical Research Center, Moscow, Russia
| | | | - V V Veselov
- Ryzhikh National Medical Research Center, Moscow, Russia
| | | | - M A Nagudov
- Ryzhikh National Medical Research Center, Moscow, Russia
| | - S V Chernyshov
- Ryzhikh National Medical Research Center, Moscow, Russia
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18
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Brinkmann F, Hüttner R, Mehner PJ, Henkel K, Paschew G, Herzog M, Martens N, Richter A, Hinz S, Groß J, Schafmayer C, Hampe J, Hendricks A, Schwandner F. Temperature profile and residual heat of monopolar laparoscopic and endoscopic dissection instruments. Surg Endosc 2022; 36:4507-4517. [PMID: 34708296 PMCID: PMC9085678 DOI: 10.1007/s00464-021-08804-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/17/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Endoscopic and laparoscopic electrosurgical devices (ED) are of great importance in modern medicine but can cause adverse events such as tissue injuries and burns from residual heat. While laparoscopic tools are well investigated, detailed insights about the temperature profile of endoscopic knives are lacking. Our aim is to investigate the temperature and the residual heat of laparoscopic and endoscopic monopolar instruments to increase the safety in handling ED. METHODS An infrared camera was used to measure the temperature of laparoscopic and endoscopic instruments during energy application and to determine the cooling time to below 50 °C at a porcine stomach. Different power levels and cutting intervals were studied to investigate their impact on the temperature profile. RESULTS During activation, the laparoscopic hook exceeded 120 °C regularly for an up to 10 mm shaft length. With regards to endoknives, only the Dual Tip Knife showed a shaft temperature of above 50 °C. The residual heat of the laparoscopic hook remained above 50 °C for at least 15 s after activation. Endoknives cooled to below 50 °C in 4 s. A higher power level and longer cutting duration significantly increased the shaft temperature and prolonged the cooling time (p < 0.001). CONCLUSION Residual heat and maximum temperature during energy application depend strongly on the chosen effect and cutting duration. To avoid potential injuries, the user should not touch any tissue with the laparoscopic hook for at least 15 s and with the endoknives for at least 4 s after energy application. As the shaft also heats up to over 120 °C, the user should be careful to avoid tissue contact during activation with the shaft. These results should be strongly considered for safety reasons when handling monopolar ED.
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Affiliation(s)
- Franz Brinkmann
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany ,Chair of Microsystems, Faculty of Electrical and Computer Engineering, Technische Universität Dresden (TU Dresden), Dresden, Germany ,Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden (TU Dresden), Dresden, Germany ,Department of Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden (TU Dresden), Fetscherstr. 74, 01307 Dresden, Germany
| | - Ronny Hüttner
- Chair of Microsystems, Faculty of Electrical and Computer Engineering, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Philipp J. Mehner
- Chair of Microsystems, Faculty of Electrical and Computer Engineering, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Konrad Henkel
- Chair of Microsystems, Faculty of Electrical and Computer Engineering, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Georgi Paschew
- Chair of Microsystems, Faculty of Electrical and Computer Engineering, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Moritz Herzog
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany ,Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Nora Martens
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany ,Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Andreas Richter
- Chair of Microsystems, Faculty of Electrical and Computer Engineering, Technische Universität Dresden (TU Dresden), Dresden, Germany ,Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Sebastian Hinz
- Department of General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
| | - Justus Groß
- Department of General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
| | - Clemens Schafmayer
- Department of General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
| | - Jochen Hampe
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany ,Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Alexander Hendricks
- Department of General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
| | - Frank Schwandner
- Department of General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
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19
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A patient-like swine model of gastrointestinal fibrotic strictures for advancing therapeutics. Sci Rep 2021; 11:13344. [PMID: 34172773 PMCID: PMC8233336 DOI: 10.1038/s41598-021-92628-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 06/01/2021] [Indexed: 11/08/2022] Open
Abstract
Gastrointestinal (GI) strictures are difficult to treat in a variety of disease processes. Currently, there are no Food and Drug Administration (FDA) approved drugs for fibrosis in the GI tract. One of the limitations to developing anti-fibrotic drugs has been the lack of a reproducible, relatively inexpensive, large animal model of fibrosis-driven luminal stricture. This study aimed to evaluate the feasibility of creating a model of luminal GI tract strictures. Argon plasma coagulation (APC) was applied circumferentially in porcine esophagi in vivo. Follow-up endoscopy (EGD) was performed at day 14 after the APC procedure. We noted high grade, benign esophageal strictures (n = 8). All 8 strictures resembled luminal GI fibrotic strictures in humans. These strictures were characterized, and then successfully dilated. A repeat EGD was performed at day 28 after the APC procedure and found evidence of recurrent, high grade, fibrotic, strictures at all 8 locations in all pigs. Pigs were sacrificed and gross and histologic analyses performed. Histologic examination showed extensive fibrosis, with significant collagen deposition in the lamina propria and submucosa, as well as extensive inflammatory infiltrates within the strictures. In conclusion, we report a porcine model of luminal GI fibrotic stricture that has the potential to assist with developing novel anti-fibrotic therapies as well as endoscopic techniques to address recurring fibrotic strictures in humans.
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20
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Walter B, Krieger YS, Wilhelm D, Feussner H, Lueth TC, Meining A. Evaluation of improved bi-manual endoscopic resection using a customizable 3D-printed manipulator system designed for use with standard endoscopes: a feasibility study using a porcine ex-vivo model. Endosc Int Open 2021; 9:E881-E887. [PMID: 34079871 PMCID: PMC8159599 DOI: 10.1055/a-1395-7089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/03/2021] [Indexed: 12/27/2022] Open
Abstract
Background and study aims A major drawback of endoscopic en-bloc resection technique is its inability to perform bimanual tasks. Although endoscopic platforms that enable bimanual tasks are commercially available, they are neither approved for various locations nor adaptable to specific patients and indications. Methods Based on evolution of an adaptive 3D-printable platform concept, system variants with different characteristic properties were evaluated for ESD scenarios, ex-vivo in two locations in the stomach and colorectum. Results In total 28 ESDs were performed (7 antrum, 7 corpus in inversion, 7 cecum, 7 rectum) in a porcine ex-vivo setup. ESD was feasible in 21 cases. Investigated manipulator variants are differently well suited for performing ESD within the varying interventions scenarios. Dual-arm manipulators allowed autonomous ESD, while single-arm flexible manipulators could be used more universally due to their compact design, especially for lesions difficult to access. Pediatric scopes were too frail to guide the overtube-manipulators in extremely angled positions. Working in the rectum was impaired using long-sized manipulator arms. Conclusions The presented endoscopic platform based on 3D-printable and customizable manipulator structures might be a promising approach for future improvement of ESD procedure. With regard to localization, especially flexible manipulators attached to standard endoscopes appear to be most promising for further application of specific and individualised manipulator systems.
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Affiliation(s)
- Benjamin Walter
- Department of Internal Medicine I, University Hospital of Ulm, Ulm, Germany
| | - Yannick S. Krieger
- Department of Mechanical Engineering, Institute of Micro Technology and Medical Device Technology (MIMED), Technical University of Munich, Munich Germany
| | - Dirk Wilhelm
- MITI Research Group, Department of General and Visceral Surgery, Technical University of Munich, Munich, Germany
| | - Hubertus Feussner
- MITI Research Group, Department of General and Visceral Surgery, Technical University of Munich, Munich, Germany
| | - Tim C. Lueth
- Department of Mechanical Engineering, Institute of Micro Technology and Medical Device Technology (MIMED), Technical University of Munich, Munich Germany
| | - Alexander Meining
- Medical Clinic and Policlinic II, University Hospital Würzburg, Würzburg, Germany
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21
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Hanada Y, Wang KK. Safety and feasibility of same-day discharge after esophageal endoscopic submucosal dissection. Gastrointest Endosc 2021; 93:853-860. [PMID: 32721491 DOI: 10.1016/j.gie.2020.07.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/15/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Endoscopic submucosal dissection (ESD) is used for treating early luminal GI cancers. ESD is the standard of care in Asia, where it results in multiday admissions for observation. The goal of our study was to evaluate the safety and feasibility of same-day discharge (SDD) after ESD. METHODS This is a retrospective cohort study of adults who underwent similar esophageal ESD with a Clutch Cutter device (DP2618DT; Fujifilm) at the Mayo Clinic (Rochester, Minn, USA) from 2017 to 2019 with a single endoscopist. The primary end point was postprocedural adverse events within 7 days of ESD. RESULTS Of 96 patients (75% male, mean age, 70 ± 10.3 years) undergoing a total of 140 ESDs, 85 were SDD versus 55 admissions. Of the 55 admits, 53 were discharged within 24 hours, whereas 2 were admitted for 2 to 3 days for reasons unrelated to the ESD procedure. Admissions were more likely to have a history of antiplatelet/anticoagulant use (56.4% vs 34.1%; P = .01) and higher mean American Society of Anesthesiologists (ASA) score (3.2 vs 2.9; P = .007). Admissions had larger resections (28.6 vs 20.1 mm; P < .0001) with longer procedural durations (103.4 vs 62 minutes; P < .0001). Among SDDs, no intraprocedural or postprocedural adverse events were seen. Among admissions, 1 (1.8% vs 0%; P = .39) experienced intraprocedural bleeding requiring endoscopic intervention, 1 required transfusion before discharge within 24 hours of ESD (1.8% vs 0%; P = .39), and 1 required rehospitalization and endoscopic intervention within 7 days to address an active bleed along the resection margin (1.8% vs 0%; P = .39). CONCLUSIONS SDD after esophageal ESD is safe and feasible. An experienced endoscopist can determine if SDD can be considered in patients with ASA physical classification status ≤2 who undergo resections off antiplatelet/anticoagulant therapy and do not experience intraprocedural adverse events.
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Affiliation(s)
- Yuri Hanada
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kenneth K Wang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Evaluations on laser ablation of ex vivo porcine stomach tissue for development of Ho:YAG-assisted endoscopic submucosal dissection (ESD). Lasers Med Sci 2020; 36:1437-1444. [PMID: 33156475 DOI: 10.1007/s10103-020-03182-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023]
Abstract
Endoscopic submucosal dissection (ESD) is clinically used to remove early gastric cancer in stomach. The aim of the current study is to examine a therapeutic capacity of pulsed Ho:YAG laser for the development of laser-assisted ESD under various surgical parameters. Ex vivo porcine stomach tissue was ablated with 1-J Ho:YAG pulses at 10 Hz at different number of treatments (NT = 1, 2, and 3) and treatment speeds (TS = 0.5, 1, and 2 mm/s) without and with saline injection. Regardless of saline injection, straight tissue ablation showed that ablation depth increased with increasing NT and decreasing TS. At NT = 3 and TS = 0.5 mm/s, no saline injection yielded the maximum ablation depth (3.4 ± 0.3 mm), partially removing muscularis propria. However, saline injection confined the tissue ablation within a submucosal layer (2.1 ± 0.3 mm). Thermal injury was found to be 0.7~1.1 mm in the adjacent tissue with superficial carbonization. Circular tissue ablation (2 cm in diameter) at NT = 3 and TS = 0.5 mm/s presented that no saline injection yielded a reduction in the lesion area, whereas saline injection maintained the ablated lesion area. Histological analysis revealed that unlike no saline injection, saline injection ablated the entire mucosal layer without perforation in the muscular propria. The pulsed Ho:YAG laser can be a potential surgical tool for clinical ESD to incise a target lesion without adverse perforation. Further investigations will validate the efficacy and safety of the Ho:YAG laser-assisted ESD in in vivo porcine stomach models for clinical translation.
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Kuo E, Wang K, Liu X. A Focused Review on Advances in Risk Stratification of Malignant Polyps. Gastroenterology Res 2020; 13:163-183. [PMID: 33224364 PMCID: PMC7665855 DOI: 10.14740/gr1329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022] Open
Abstract
Colorectal cancer is the third most common cancer in both men and women in the United States, with most cases arising from precursor adenomatous polyps. Colorectal malignant polyps are defined as cancerous polyps that consist of tumor cells invading through the muscularis mucosae into the underlying submucosa (pT1 tumor). It has been reported that approximately 0.5-8.3% of colorectal polyps are malignant polyps, and the potential for lymph node metastasis in these polyps ranges from 8.5% to 16.1%. Due to their clinical significance, recognition of malignant polyps is critical for clinical teams to make treatment decisions and establish appropriate surveillance schedules after local excision of the polyps. There is a rapidly developing interest in malignant polyps within the literature as a result of an increasing number of identifiable adverse histologic features and recent advancements in endoscopic treatment techniques. The purpose of this paper is to have a focused review of the recent histopathologic literature of malignant polyps.
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Affiliation(s)
- Enoch Kuo
- Department of Pathology, Immunology & Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA.,Both authors contributed equally to this manuscript
| | - Kai Wang
- Department of Pathology, Immunology & Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA.,Both authors contributed equally to this manuscript
| | - Xiuli Liu
- Department of Pathology, Immunology & Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
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Review on colorectal endoscopic submucosal dissection focusing on the technical aspect. Surg Endosc 2020; 34:3766-3787. [PMID: 32342217 DOI: 10.1007/s00464-020-07599-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) enables removal of broad-based colorectal polyps or lateral spreading tumors with a higher rate of en bloc resection and a lower risk of local recurrence. However, it is technically demanding. Over the past 20 years, various equipment and innovative techniques have been developed to reduce the difficulty of ESD. The information in the literature is scattered. Our aim is to provide a comprehensive review on the setup and technical aspects of colorectal ESD. METHODS We searched the PubMed database and systemically reviewed all original and review articles related to colorectal ESD. Further manual search according to reference lists of identified articles were done. The selected articles were categorized and reviewed. Original figures were created to help readers understand some of the ESD techniques. RESULTS A total of 216 articles were identified, in which 25 of them were review articles and 191 of them were original articles. They were categorized and reviewed. An in-depth appraisal of the setting, equipment, and technical aspects of colorectal ESD was performed. CONCLUSIONS Although ESD is a technically demanding procedure that requires expert endoscopic skills, it can be mastered. With good peri-procedural preparation, sufficient knowledge of the equipment, and thorough understanding of the useful endoscopic tricks and maneuvers, colorectal ESD can be performed smoothly and safely.
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Park M, Kim JW, Shin JH. Endovascular hemostasis for endoscopic procedure-related gastrointestinal bleeding. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2019. [DOI: 10.18528/ijgii190009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Minho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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