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Santos CEOD, Malaman D, Sanmartin IDA, Leão ABHS, Bombassaro IZ, Pereira-Lima JC. COLD SNARE POLYPECTOMY: A SAFE PROCEDURE FOR REMOVING SMALL NON-PEDUNCULATED COLORECTAL LESIONS. Arq Gastroenterol 2023; 60:470-477. [PMID: 38018552 DOI: 10.1590/s0004-2803.23042023-115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/10/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Polypectomy is an important treatment option for preventing colorectal cancer. Incomplete polyp resection (IPR) is re-cognized as a risk factor for interval cancer. OBJECTIVE The primary objective was to evaluate the complete polyp resection (CPR) rate for cold snare polypectomy (CSP) in small non-pedunculated polyps and, secondarily, specimen retrieval and complication rates. METHODS We prospectively evaluated 479 polyps <10 mm removed by CSP in 276 patients by an inexperienced endoscopist. RESULTS A total of 476 polyps (99.4%) were resected en bloc. A negative margin (classified as CPR) was observed in 435 polyps (90.8%). An unclear or positive margin (classified as IPR) was observed in 43 cases (9.0%) and 1 case (0.2%), respectively, for an overall IPR rate of 9.2% (44/479). The IPR rate was 12.2% in the first half of cases and 5.9% in the second half (P=0.02). Dividing into tertiles, the IPR rate was 15.0% in the first tertile, 6.9% in the second tertile, and 5.7% in the third tertile (P=0.01). Dividing into quartiles, the IPR rate was 15.8% in the first quartile and 5.9% in the fourth quartile (P=0.03). The IPR rate was 6.3% for type 0-IIa lesions and 14.1% for type 0-Is lesions (P=0.01). For serrated and adenomatous lesions, the IPR rate was 9.2%. Specimen retrieval failed in 3.6% of cases. Immediate bleeding (>30 s) occurred in 1 case (0.2%), treated with argon plasma coagulation. No delayed bleeding or perforation occurred. CONCLUSION CSP is a safe technique that provides good results for the resection of small non-pedunculated polyps, with a short learning curve.
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Affiliation(s)
- Carlos Eduardo Oliveira Dos Santos
- Hospital Santa Casa de Caridade, Serviço de Endoscopia, Bagé, RS, Brasil
- Pontifícia Universidade Católica do Rio Grande do Sul, Departamento de Endoscopia, Porto Alegre, RS, Brasil
| | - Daniele Malaman
- Hospital Santa Casa de Caridade, Serviço de Endoscopia, Bagé, RS, Brasil
| | | | - Ari Ben-Hur Stefani Leão
- Pontifícia Universidade Católica do Rio Grande do Sul, Departamento de Endoscopia, Porto Alegre, RS, Brasil
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Oliveira Dos Santos CE, Malaman D, Arciniegas Sanmartin ID, Aleixo P, Lopes CV, Pereira-Lima JC. Antral plexiform fibromyxoma: case report of a rare mesenchymal neoplasm. Rev Gastroenterol Peru 2023; 43:364-367. [PMID: 38228303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Plexiform fibromyxoma (PF) is a rare mesenchymal neoplasm of the stomach usually arising in the gastric antrum, and its main differential diagnosis is gastrointestinal stromal tumor. Most common symptoms are hematemesis, anemia. Immunohistochemically, positivity for smooth muscle actin (SMA) and vimentin suggests the diagnosis of PF. We report the case of a 56-year-old female patient with a 30-day history of nausea at presentation 4 years ago. Gastroscopy at that time revealed a subepithelial lesion (SEL) in the gastric antrum, measuring approximately 20 mm in diameter, with leakage of serous fluid after biopsy. Histopathology showed only an inflammatory process. Follow-up gastroscopies were performed 24, 36, and 48 months later, with surveillance biopsy at each follow-up. The last gastroscopies showed changes in lesion appearance, reduction in size, and absence of fluid leakage. Histopathology showed bland spindle cell proliferation, with a vaguely plexiform/multinodular pattern, in a fibromyxoid stroma with an arborizing capillary network without mitoses. The tumor cells were positive for SMA and negative for DOG1, CD117, CD34, S100, desmin, EMA, CD10, calponin, and beta-catenin. The choice of treatment and follow-up depends on the SEL features, but because no cases of malignancy or metastatic disease have previously been reported, the patient chose a conservative approach.
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Affiliation(s)
- Carlos Eduardo Oliveira Dos Santos
- Department of Endoscopy, Santa Casa de Caridade Hospital. Bagé, Rio Grande do Sul, Brazil; Department of Endoscopy, Pontifícia Universidade Católica do Rio Grande do Sul. Porto Alegre, Rio Grande do Sul, Brazil
| | - Daniele Malaman
- Department of Endoscopy, Santa Casa de Caridade Hospital. Bagé, Rio Grande do Sul, Brazil
| | | | - Pedro Aleixo
- Department of Endoscopy, Santa Casa de Caridade Hospital. Bagé, Rio Grande do Sul, Brazil
| | - Cesar Vivian Lopes
- Department of Gastroenterology and Endoscopy, Santa Casa Hospital. Porto Alegre, Rio Grande do Sul, Brazil
| | - Júlio Carlos Pereira-Lima
- Department of Gastroenterology and Endoscopy, Santa Casa Hospital. Porto Alegre, Rio Grande do Sul, Brazil
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Pereira-Lima J, Arciniegas Sanmartin ID, Watte G, Contin I, Pereira-Lima G, Quadros Onófrio FD, Altmayer S, Oliveira Dos Santos CE. Biliary cannulation with contrast and guide-wire versus exclusive guide-wire: A prospective, randomized, double-blind trial. Pancreatology 2021; 21:459-465. [PMID: 33526383 DOI: 10.1016/j.pan.2020.12.018] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The use of exclusive guide-wire cannulation (e-GW) instead of contrast injection reduces post-ERCP pancreatitis (PEP) and pre-cutting and increases cannulation rate. Herein, we intend to compare e-GW with the hybrid technique (GW-C and/or contrast injection). METHODS Prospective single-center randomized comparative study, which included all patients referred to ERCP to our unit. Patients with non-naïve papilla; previous ERCP; direct infundibulotomy, ampullectomy, Billroth II gastrectomy or pancreatic sphincterotomy and patients lost to follow up were excluded. RESULTS 727 consecutive patients were assessed. Of these, 588 naïve papilla patients were included and randomized to receive e-GW (n = 299) or GW-C (n = 289) for selective biliary cannulation. The mean age was 60.3 years and 60.5% were women. PEP occurred in 15(5%) cases in e-GW group and 9(3.1%) in the GW-C group (p = 0.29). Time to reach deep cannulation was faster in the latter group (75% < 5 min vs. 50.2% < 5 min, p<0.001). > 10 min until cannulation was observed in 21% vs. 10% of the ERCPs (groups e-GW and GW-C, respectively, p < 0.001). Total ERCP time was also shorter in the GW-C group (12 vs. 10 min; p < 0.001). Pre-cut (23.8 vs.11.8%, p < 0.001) and pancreatic sphincterotomy as a pre-cut technique (15.8 vs. 5.6%, p < 0.001) were used more frequently in the e-GW group. CONCLUSIONS Compared to exclusive G-W- assisted biliary cannulation, the hybrid technique did not significantly reduce the PEP rate, however it promoted faster cannulation and, consequently, reduced the total procedure time and the use of pre-cut techniques.
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Affiliation(s)
- Julio Pereira-Lima
- Department of Gastroenterology and Hepatology, Division of Endoscopy, Santa Casa Hospital, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil.
| | - Ivan David Arciniegas Sanmartin
- Department of Gastroenterology and Hepatology, Division of Endoscopy, Santa Casa Hospital, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Guilherme Watte
- Department of Biostatistics and Epidemiology, Santa Casa Hospital and PUC, Porto Alegre, Brazil
| | - Isabela Contin
- Department of Gastroenterology and Hepatology, Division of Endoscopy, Santa Casa Hospital, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Guilherme Pereira-Lima
- Department of Gastroenterology and Hepatology, Division of Endoscopy, Santa Casa Hospital, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | | | - Stephan Altmayer
- Department of Biostatistics and Epidemiology, Santa Casa Hospital and PUC, Porto Alegre, Brazil
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Pereira Lima JC, Arciniegas Sanmartin ID, de Quadros Onófrio F, Contin I, Pereira Lima AP, Pereira Lima G, Watte G, Oliveira Dos Santos CE. Endoscopic Biliary Large Balloon Dilation Lithotripsy for Giant and Impacted Stones Removal: A Western Series. Dig Dis 2020; 39:391-398. [PMID: 32961532 DOI: 10.1159/000511766] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Endoscopic removal of packed, large, or impacted stones, in which a basket cannot be deployed or is unable to grasp the stone(s), is challenging and inevitably leads to repeated procedures such as stent insertion and extra- or intracorporal lithotripsy. In this study, we describe the results of an alternative stone disintegration technique in a considerable series of patients using an esophageal/pyloric balloon for stone fragmentation or making working space in the bile duct to allow the deployment of the basket, a technique we call endoscopic biliary large balloon lithotripsy. METHODS We retrieved data from 1,429 endoscopic retrograde cholangiopancreatographies (ERCPs) from 2 prospective trials performed between 2014 and 2019. Patients with difficult bile duct stones, in which a balloon dilator up to 15 mm was used to crush or increase the working space parallel to the stones in the common or hepatic duct, were included in the study. RESULTS From the 1,429 ERCPs, 299 had difficult stones (>1 cm, impacted or multiple stones). Large balloon lithotripsy was employed in 46 cases after endoscopic papillotomy and endoscopic biliary large balloon dilation with failed attempted balloon or basket stone(s) extraction. Failure to clear the bile duct at first ERCP occurred in 4 cases (91.3% of success). Complications were observed in 5 patients (10.8%; 1 perforation, 1 pancreatitis, and 3 bleedings), who were treated conservatively. CONCLUSIONS Large balloon lithotripsy, in order to crush the stones or make working room for baskets or balloons in the bile duct, is an effective, safe, and low cost technique for impacted, packed, or giant bile duct stones.
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Affiliation(s)
- Júlio Carlos Pereira Lima
- Endoscopy Division, Department of Gastroenterology, Federal University of Health Sciences of Porto Alegre / Santa Casa Hospital, Porto Alegre, Brazil
| | - Ivan David Arciniegas Sanmartin
- Endoscopy Division, Department of Gastroenterology, Federal University of Health Sciences of Porto Alegre / Santa Casa Hospital, Porto Alegre, Brazil,
| | | | - Isabela Contin
- Endoscopy Division, Department of Gastroenterology, Federal University of Health Sciences of Porto Alegre / Santa Casa Hospital, Porto Alegre, Brazil
| | - Ana Paula Pereira Lima
- Department of Biostatistics and Epidemiology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Guilherme Pereira Lima
- Endoscopy Division, Department of Gastroenterology, Federal University of Health Sciences of Porto Alegre / Santa Casa Hospital, Porto Alegre, Brazil
| | - Guilherme Watte
- Department of Biostatistics and Epidemiology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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Pereira Lima JC, Arciniegas Sanmartin ID, Latrônico Palma B, Oliveira Dos Santos CE. Risk Factors for Success, Complications, and Death after Endoscopic Sphincterotomy for Bile Duct Stones: A 17-Year Experience with 2,137 Cases. Dig Dis 2020; 38:534-541. [PMID: 32187605 DOI: 10.1159/000507321] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/17/2019] [Accepted: 03/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) complications are well-studied. However, risk factors for complications and success after endoscopic sphincterotomy (EST) for duct stones are poorly determined. This study aimed to verify risk factors for mortality, complications, and success after EST. METHODS A multivariate analysis was carried out in a dataset of ERCPs performed during 17 years. RESULTS A total of5,226 ERCPs were performed, of which 2,137 were in patients with bile duct stones (1,458 women and 679 men; mean age = 57 years) who underwent EST with attempted stone removal. There were 171 (8%) complications, with pancreatitis in 87 (4.1%), bleeding in 48 (2.2%), other complications in 36 (1.8%), and mortality of 0.6%. Successful stone(s) removal was obtained in 2,028 cases (94.9%). On multivariate analysis, mortality was associated with age >60 years (1 vs. 0.2%), cholangitis (4.3 vs. 0.3%), and EST-related complications (5.8 vs. 0.2%). Complications were associated with unsuccessful stone removal (13.4 vs. 7.5%) and difficult cannulation (13.9 vs. 5.4%). An unsuccessful EST was independently related to difficult cannulation (86.2 vs. 98.7%), precutting (79.4 vs. 96.4%), and complications (86.5 vs. 95.6%). CONCLUSIONS Risk factors for complications after EST for stones are delayed bile duct cannulation and failed stone retrieval. Mortality is higher in older patients, those who presented with an EST-related complication, or those who presented initially with cholangitis. Difficult cannulation, EST-related complications, and precutting were associated with an unsuccessful procedure. In this series, outpatient EST with attempted stone retrieval was found to be as safe as performing the procedure in hospitalized patients.
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Affiliation(s)
- Júlio Carlos Pereira Lima
- Department of Gastroenterology, Hepatology and Endoscopy, Santa Casa Hospital, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Ivan David Arciniegas Sanmartin
- Department of Gastroenterology, Hepatology and Endoscopy, Santa Casa Hospital, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil,
| | - Bruna Latrônico Palma
- Department of Gastroenterology, Hepatology and Endoscopy, Santa Casa Hospital, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
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Oliveira Dos Santos CE, Malaman D, Pereira-Lima JC, de Quadros Onófrio F, Ribas Filho JM. Impact of linked-color imaging on colorectal adenoma detection. Gastrointest Endosc 2019; 90:826-834. [PMID: 31302092 DOI: 10.1016/j.gie.2019.06.045] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/27/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Linked-color imaging (LCI) is a new technology that emphasizes changes in mucosal color by providing clearer and brighter images, thus allowing red and white areas to be visualized more clearly. We investigated whether LCI increases the detection of colorectal adenomas compared with white-light imaging (WLI) and blue-laser imaging (BLI)-bright. METHODS Consecutive patients undergoing colonoscopy were randomized (1:1:1) into examination by WLI, BLI-bright, or LCI during withdrawal of the colonoscope. The adenoma detection rate (ADR), mean number of adenomas per patient, and withdrawal time were evaluated. The lesions were evaluated according to size, morphology, location, and histology. RESULTS A total of 379 patients were randomized, and 412 adenomas were detected. The ADR was 43.2%, 54.0%, and 56.9% for WLI, BLI-bright, and LCI, respectively, and was significantly higher in the LCI group than in the WLI group (P = .03). No significant difference was observed between LCI and BLI-bright (P = .71) or BLI-bright and WLI (P = .09). The mean number of adenomas per patient was 0.82, 1.06, and 1.38 for WLI, BLI-bright, and LCI, respectively, with a significant difference between LCI and WLI (P = .03). Withdrawal time did not differ among the groups. A total of 102 adenomas were detected by WLI, 131 by BLI-bright, and 179 by LCI. LCI provided a higher rate of detection of adenomas ≤5 mm in size than WLI (P = .02), with a borderline significance for a higher detection of sessile serrated adenomas (P = .05). Nonpolypoid adenomas were more commonly located in the right colon segment and polypoid adenomas in the left colon segment, with a significant difference only between BLI-bright (P < .01) and LCI (P = .03). CONCLUSIONS Our findings show that LCI increases the detection of colorectal adenomas during colonoscopy. (Clinical trial registration number: RBR-9xg6dx.).
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Affiliation(s)
| | - Daniele Malaman
- Department of Endoscopy and Gastroenterology, Santa Casa de Caridade Hospital, Bagé, RS, Brazil
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