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Safatle-Ribeiro AV, Ribeiro U, Lata J, Baba ER, Lenz L, da Costa Martins B, Kawaguti F, Moura RN, Pennacchi C, Gusmon C, de Lima MS, de Paulo GA, Nahas CS, Marques CF, Imperiale AR, Cotti GC, Maluf-Filho F, Nahas SC. The Role of Probe-Based Confocal Laser Endomicroscopy (pCLE) in the Diagnosis of Sustained Clinical Complete Response Under Watch-and-Wait Strategy After Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Adenocarcinoma: a Score Validation. J Gastrointest Surg 2023; 27:1903-1912. [PMID: 37291428 DOI: 10.1007/s11605-023-05732-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/01/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Watch-and-wait strategy has been increasingly accepted for patients with clinical complete response (cCR) after multimodal treatment for locally advanced rectal adenocarcinoma. Close follow-up is essential to the early detection of local regrowth. It was previously demonstrated that probe-based confocal laser endomicroscopy (pCLE) scoring using the combination of epithelial and vascular features might improve the diagnostic accuracy of cCR. AIM To validate the pCLE scoring system in the assessment of patients with cCR after neoadjuvant chemoradiotherapy (nCRxt) for advanced rectal adenocarcinoma. METHODS Digital rectal examination, pelvic magnetic resonance imaging (MRI), and pCLE were performed in 43 patients with cCR, who presented either a scar (N = 33; 76.7%) or a small ulcer with no signs of tumor, and/or biopsy negative for malignancy (N = 10; 23.3%). RESULTS Twenty-five (58.1%) patients were men, and the mean age was 58.4 years. During the follow-up, 12/43 (27.9%) patients presented local regrowth and underwent salvage surgery. There was an association between pCLE diagnostic scoring and final histological report (for patients who underwent surgical resection) or final diagnosis at the latest follow-up (p = 0.0001), while this association was not observed with MRI (p = 0.49). pCLE sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 66.7%, 93.5%, 80%, 88.9%, and 86%, respectively. MRI sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 66.7%, 48.4%, 66.7%, 78.9%, and 53.5%, respectively. CONCLUSIONS pCLE scoring system based on epithelial and vascular features improved the diagnosis of sustained cCR and might be recommended during follow-up. pCLE might add some valuable contribution for identifying local regrowth. Trial Registration This protocol was registered at the Clinical Trials (ClinicalTrials.gov identifier NCT02284802).
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Affiliation(s)
- Adriana Vaz Safatle-Ribeiro
- Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Universidade de São Paulo (ICESP-HCFMUSP), São Paulo, Brazil.
| | - Ulysses Ribeiro
- Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Universidade de São Paulo (ICESP-HCFMUSP), São Paulo, Brazil
| | - John Lata
- Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Universidade de São Paulo (ICESP-HCFMUSP), São Paulo, Brazil
| | - Elisa Ryoka Baba
- Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Universidade de São Paulo (ICESP-HCFMUSP), São Paulo, Brazil
| | - Luciano Lenz
- Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Universidade de São Paulo (ICESP-HCFMUSP), São Paulo, Brazil
| | - Bruno da Costa Martins
- Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Universidade de São Paulo (ICESP-HCFMUSP), São Paulo, Brazil
| | - Fábio Kawaguti
- Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Universidade de São Paulo (ICESP-HCFMUSP), São Paulo, Brazil
| | - Renata Nobre Moura
- Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Universidade de São Paulo (ICESP-HCFMUSP), São Paulo, Brazil
| | - Caterina Pennacchi
- Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Universidade de São Paulo (ICESP-HCFMUSP), São Paulo, Brazil
| | - Carla Gusmon
- Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Universidade de São Paulo (ICESP-HCFMUSP), São Paulo, Brazil
| | - Marcelo Simas de Lima
- Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Universidade de São Paulo (ICESP-HCFMUSP), São Paulo, Brazil
| | - Gustavo Andrade de Paulo
- Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Universidade de São Paulo (ICESP-HCFMUSP), São Paulo, Brazil
| | - Caio Sérgio Nahas
- Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Universidade de São Paulo (ICESP-HCFMUSP), São Paulo, Brazil
| | - Carlos Frederico Marques
- Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Universidade de São Paulo (ICESP-HCFMUSP), São Paulo, Brazil
| | - Antônio Rocco Imperiale
- Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Universidade de São Paulo (ICESP-HCFMUSP), São Paulo, Brazil
| | - Guilherme C Cotti
- Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Universidade de São Paulo (ICESP-HCFMUSP), São Paulo, Brazil
| | - Fauze Maluf-Filho
- Endoscopy Unit, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Universidade de São Paulo (ICESP-HCFMUSP), São Paulo, Brazil
| | - Sérgio Carlos Nahas
- Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Universidade de São Paulo (ICESP-HCFMUSP), São Paulo, Brazil
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Coutinho LMA, Lenz L, Kawaguti FS, Martins BC, Baba E, Gusmon C, Andrade G, Simas M, Safatle-Ribeiro A, Maluf-Filho F, Rodrigues R, Ribeiro U. UNDERWATER ENDOSCOPIC MUCOSAL RESECTION FOR SMALL RECTAL NEUROENDOCRINE TUMORS. Arq Gastroenterol 2021; 58:210-213. [PMID: 34133614 DOI: 10.1590/s0004-2803.202100000-37] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/02/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND A common site of neuroendocrine tumors (NETs) is the rectum. The technique most often used is endoscopic mucosal resection with saline injection. However, deep margins are often difficult to obtain because submucosal invasion is common. Underwater endoscopic mucosal resection (UEMR) is a technique in which the bowel lumen is filled with water rather than air, precluding the need for submucosal lifting. OBJECTIVE This study aimed to evaluate the efficacy and safety of UEMR for removing small rectal neuroendocrine tumors (rNETs). METHODS Retrospective study with patients who underwent UEMR in two centers. UEMR was performed using a standard colonoscope. No submucosal injection was performed. Board-certified pathologists conducted histopathologic assessment. RESULTS UEMR for small rNET was performed on 11 patients (nine female) with a mean age of 55.8 years and 11 lesions (mean size 7 mm, range 3-12 mm). There were 9 (81%) patients with G1 rNET and two patients with G2, and all tumors invaded the submucosa with only one restricted to the mucosa. None case showed vascular or perineural invasion. All lesions were removed en bloc. Nine (81%) resections had free margins. Two patients had deep margin involvement; one had negative biopsies via endoscopic surveillance, and the other was lost to follow-up. No perforations or delayed bleeding occurred. CONCLUSION UEMR appeared to be an effective and safe alternative for treatment of small rNETs without adverse events and with high en bloc and R0 resection rates. Further prospective studies are needed to compare available endoscopic interventions and to elucidate the most appropriate endoscopic technique for resection of rNETs.
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Affiliation(s)
- Lara Meireles Azeredo Coutinho
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (ICESP), Serviço de Endoscopia, São Paulo, SP, Brasil
| | - Luciano Lenz
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (ICESP), Serviço de Endoscopia, São Paulo, SP, Brasil.,Fleury Medicina e Saúde, São Paulo, SP, Brasil
| | - Fabio S Kawaguti
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (ICESP), Serviço de Endoscopia, São Paulo, SP, Brasil.,Fleury Medicina e Saúde, São Paulo, SP, Brasil
| | - Bruno Costa Martins
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (ICESP), Serviço de Endoscopia, São Paulo, SP, Brasil.,Fleury Medicina e Saúde, São Paulo, SP, Brasil
| | - Elisa Baba
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (ICESP), Serviço de Endoscopia, São Paulo, SP, Brasil
| | - Carla Gusmon
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (ICESP), Serviço de Endoscopia, São Paulo, SP, Brasil
| | - Gustavo Andrade
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (ICESP), Serviço de Endoscopia, São Paulo, SP, Brasil
| | - Marcelo Simas
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (ICESP), Serviço de Endoscopia, São Paulo, SP, Brasil
| | - Adriana Safatle-Ribeiro
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (ICESP), Serviço de Endoscopia, São Paulo, SP, Brasil
| | - Fauze Maluf-Filho
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (ICESP), Serviço de Endoscopia, São Paulo, SP, Brasil
| | | | - Ulysses Ribeiro
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (ICESP), Serviço de Endoscopia, São Paulo, SP, Brasil
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Lenz L, Martins B, Kawaguti FS, Tellian A, Pennachi CMPS, Sorbello M, Gusmon C, Paulo GAD, Uemura R, Geiger S, Lima MSD, Safatle-Ribeiro A, Baba E, Hashimoto CL, Maluf-Filho F, Ribeiro U. UNDERWATER ENDOSCOPIC MUCOSAL RESECTION FOR NON-PEDUNCULATED COLORECTAL LESIONS. A PROSPECTIVE SINGLE-ARM STUDY. Arq Gastroenterol 2020; 57:193-197. [PMID: 32609162 DOI: 10.1590/s0004-2803.202000000-37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/27/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Underwater endoscopic mucosal resection (UEMR) has emerged as a revolutionary method allowing resection of colorectal lesions without submucosal injection. Brazilian literature about this technique is sparse. OBJECTIVE The aim of this study was evaluate the efficacy and safety of UEMR technique for removing non-pedunculated colorectal lesions in two Brazilian tertiary centers. METHODS This prospective study was conducted between June 2016 and May 2017. Naïve and non-pedunculated lesions without signs of submucosal invasion were resected using UEMR technique. RESULTS A total of 55 patients with 65 lesions were included. All lesions, except one, were successfully and completely removed by UEMR (success rate 98.5%). During UEMR, two cases of bleeding were observed (3.0%). One patient had abdominal pain on the day after resection without pneumoperitoneum. There was no perforation or delayed bleeding. CONCLUSION This study supports the existing data indicating acceptable rates of technical success, and low incidence of adverse events with UEMR. The results of this Brazilian study were consistent with previous abroad studies.
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Affiliation(s)
- Luciano Lenz
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil.,Fleury Medicina e Saúde, São Paulo, SP, Brasil
| | - Bruno Martins
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil.,Fleury Medicina e Saúde, São Paulo, SP, Brasil
| | - Fabio Shiguehisa Kawaguti
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil.,Fleury Medicina e Saúde, São Paulo, SP, Brasil
| | - Alexandre Tellian
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Divisão de Gastroenterologia e Hepatologia Clínica, Centro de Diagnóstico em Gastroenterologia, São Paulo, SP, Brasil
| | - Caterina Maria Pia Simoni Pennachi
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | - Mauricio Sorbello
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Divisão de Gastroenterologia e Hepatologia Clínica, Centro de Diagnóstico em Gastroenterologia, São Paulo, SP, Brasil
| | - Carla Gusmon
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | - Gustavo Andrade de Paulo
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil.,Hospital Israelita Albert Einstein, Serviço de Endoscopia, São Paulo, SP, Brasil
| | - Ricardo Uemura
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | - Sebastian Geiger
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | - Marcelo Simas de Lima
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | - Adriana Safatle-Ribeiro
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Divisão de Gastroenterologia e Hepatologia Clínica, Centro de Diagnóstico em Gastroenterologia, São Paulo, SP, Brasil.,Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - Elisa Baba
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | - Claudio Lyoiti Hashimoto
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Divisão de Gastroenterologia e Hepatologia Clínica, Centro de Diagnóstico em Gastroenterologia, São Paulo, SP, Brasil.,Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - Fauze Maluf-Filho
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | - Ulysses Ribeiro
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
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Safatle-Ribeiro AV, Ryoka Baba E, Corsato Scomparin R, Friedrich Faraj S, Simas de Lima M, Lenz L, Costa Martins B, Gusmon C, Shiguehissa Kawaguti F, Pennacchi C, Zilberstein B, Ribeiro U, Maluf-Filho F. Probe-based confocal endomicroscopy is accurate for differentiating gastric lesions in patients in a Western center. Chin J Cancer Res 2018; 30:546-552. [PMID: 30510366 PMCID: PMC6232359 DOI: 10.21147/j.issn.1000-9604.2018.05.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective Probe-based confocal laser endomicroscopy (pCLE) technique may improve the diagnosis of gastric mucosal lesions allowing acquisition of high-resolution in vivo images at the cellular and microvascular levels. This study aims to evaluate the accuracy of pCLE for the differential diagnosis of non-neoplastic and neoplastic gastric lesions. Methods Twenty gastric mucosal lesions from 10 patients were evaluated during endoscopic procedure and were examined by pCLE. Diagnostic pCLE was followed by biopsies or endoscopic resection of suspected lesions. A senior pathologist evaluated the specimens and was blinded to the pCLE results. Results Patients' mean age was 68.3 (range, 42-83) years and six were men. Thirteen suspicious flat or elevated lesions (classified as 0-Is, 0-IIa or 0-IIa + IIc) and seven pre-malignant lesions (atrophy and intestinal metaplasia) were evaluated. One patient was studied during his long-term follow-up after partial gastrectomy and presented severe atrophy, intestinal metaplasia, and xanthomas at the stump mucosa. The location of gastric lesions was in the body (n=10 lesions), the antrum (n=9) and the incisura angularis (n=1). All neoplastic lesions and all but one benign lesion were properly diagnosed by pCLE. pCLE incorrectly diagnosed one small antrum lesion as adenoma, however the final diagnosis was intestinal metaplasia. The final histological diagnosis was neoplastic in 9 and benign lesions in 11. In this small case series, pCLE accuracy was 95% (19/20 lesions). Conclusions pCLE is accurate for real time histology of gastric lesions. pCLE may change the management of patients with gastric mucosal lesions, guiding biopsies and endoscopic resection, and avoiding further diagnostic workup or unnecessary therapy.
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Affiliation(s)
- Adriana Vaz Safatle-Ribeiro
- Endoscopy Unit of Department of Gastroenterology, São Paulo Cancer Institute, University of São Paulo Medical School (ICESP-HCFMUSP), São Paulo 01246-000, Brazil
| | - Elisa Ryoka Baba
- Endoscopy Unit of Department of Gastroenterology, São Paulo Cancer Institute, University of São Paulo Medical School (ICESP-HCFMUSP), São Paulo 01246-000, Brazil
| | - Rodrigo Corsato Scomparin
- Endoscopy Unit of Department of Gastroenterology, São Paulo Cancer Institute, University of São Paulo Medical School (ICESP-HCFMUSP), São Paulo 01246-000, Brazil
| | - Sheila Friedrich Faraj
- Endoscopy Unit of Department of Gastroenterology, São Paulo Cancer Institute, University of São Paulo Medical School (ICESP-HCFMUSP), São Paulo 01246-000, Brazil
| | - Marcelo Simas de Lima
- Endoscopy Unit of Department of Gastroenterology, São Paulo Cancer Institute, University of São Paulo Medical School (ICESP-HCFMUSP), São Paulo 01246-000, Brazil
| | - Luciano Lenz
- Endoscopy Unit of Department of Gastroenterology, São Paulo Cancer Institute, University of São Paulo Medical School (ICESP-HCFMUSP), São Paulo 01246-000, Brazil
| | - Bruno Costa Martins
- Endoscopy Unit of Department of Gastroenterology, São Paulo Cancer Institute, University of São Paulo Medical School (ICESP-HCFMUSP), São Paulo 01246-000, Brazil
| | - Carla Gusmon
- Endoscopy Unit of Department of Gastroenterology, São Paulo Cancer Institute, University of São Paulo Medical School (ICESP-HCFMUSP), São Paulo 01246-000, Brazil
| | - Fábio Shiguehissa Kawaguti
- Endoscopy Unit of Department of Gastroenterology, São Paulo Cancer Institute, University of São Paulo Medical School (ICESP-HCFMUSP), São Paulo 01246-000, Brazil
| | - Caterina Pennacchi
- Endoscopy Unit of Department of Gastroenterology, São Paulo Cancer Institute, University of São Paulo Medical School (ICESP-HCFMUSP), São Paulo 01246-000, Brazil
| | - Bruno Zilberstein
- Endoscopy Unit of Department of Gastroenterology, São Paulo Cancer Institute, University of São Paulo Medical School (ICESP-HCFMUSP), São Paulo 01246-000, Brazil
| | - Ulysses Ribeiro
- Endoscopy Unit of Department of Gastroenterology, São Paulo Cancer Institute, University of São Paulo Medical School (ICESP-HCFMUSP), São Paulo 01246-000, Brazil
| | - Fauze Maluf-Filho
- Endoscopy Unit of Department of Gastroenterology, São Paulo Cancer Institute, University of São Paulo Medical School (ICESP-HCFMUSP), São Paulo 01246-000, Brazil
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5
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Retes FA, Kawaguti FS, de Lima MS, da Costa Martins B, Uemura RS, de Paulo GA, Pennacchi CM, Gusmon C, Ribeiro AV, Baba ER, Geiger SN, Sorbello MP, Kulcsar MA, Ribeiro U, Maluf-Filho F. Comparison of the pull and introducer percutaneous endoscopic gastrostomy techniques in patients with head and neck cancer. United European Gastroenterol J 2016; 5:365-373. [PMID: 28507748 DOI: 10.1177/2050640616662160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/04/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Percutaneous endoscopic gastrostomy (PEG) in head and neck cancer (HNC) patients is associated with higher complication and mortality rates when compared to a general patient population. The pull technique is still the preferred technique worldwide but it has some limitations. The aim of this study is to compare the pull and introducer PEG techniques in patients with HNC. PATIENTS AND METHODS This study is based on a retrospective analysis of a prospectively collected database of 309 patients with HNC who underwent PEG in the Cancer Institute of São Paulo. RESULTS The procedure was performed with the standard endoscope in 205 patients and the introducer technique was used in 137 patients. There was one procedure-related mortality. Age, sex and albumin level were similar in both groups. However in the introducer technique group, patients had a higher tumor stage, a lower Karnofsky status, and presented more frequently with tracheostomy and trismus. Overall, major, minor, immediate and late complications and 30-day mortality rates were similar but the introducer technique group presented more minor bleeding and tube dysfunctions. CONCLUSION The push and introducer PEG techniques seem to be both safe and effective but present different complication profiles. The choice of PEG technique in patients with HNC should be made individually.
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Affiliation(s)
- Felipe A Retes
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Fabio S Kawaguti
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Marcelo S de Lima
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Bruno da Costa Martins
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Ricardo S Uemura
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Gustavo A de Paulo
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Caterina Mp Pennacchi
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Carla Gusmon
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Adriana Vs Ribeiro
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Elisa R Baba
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Sebastian N Geiger
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Mauricio P Sorbello
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Marco A Kulcsar
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Ulysses Ribeiro
- Gastrointestinal Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Fauze Maluf-Filho
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil
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