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Shiwaku H, Okada H, Shiwaku A, Kusaba H, Maki K, Shimaoka H, Hashimoto Y, Yamada T, Yoshimura F, Hasegawa S. A case of endoscopic full-thickness resection for gastric gastrointestinal stromal tumor in the submucosal tunnel. DEN Open 2024; 4:e282. [PMID: 37644960 PMCID: PMC10461039 DOI: 10.1002/deo2.282] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
The patient was a 49-year-old female with a submucosal tumor (12×12 mm) located in the lesser curvature side of the stomach. The diagnosis by endoscopic ultrasound fine-needle aspiration was of a gastrointestinal stromal tumor. Computed tomography and endoscopic ultrasound showed gastrointestinal stromal tumor with an intra-luminal growth type. Endoscopic full-thickness resection was then performed. To achieve good counter traction, enough safety margin, and minimal defect of muscle, full-thickness resection via creating a submucosal tunnel was performed as a new technique. The final histological diagnosis was gastrointestinal stromal tumor with R0 resection.
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Affiliation(s)
- Hironari Shiwaku
- Department of Gastroenterological SurgeryFukuoka University Faculty of MedicineFukuokaJapan
| | - Hiroki Okada
- Department of Gastroenterological SurgeryFukuoka University Faculty of MedicineFukuokaJapan
| | - Akio Shiwaku
- Department of Gastroenterological SurgeryFukuoka University Faculty of MedicineFukuokaJapan
| | - Hiroshi Kusaba
- Department of Gastroenterological SurgeryFukuoka University Faculty of MedicineFukuokaJapan
| | - Kenji Maki
- Department of Gastroenterological SurgeryFukuoka University Faculty of MedicineFukuokaJapan
| | - Hideki Shimaoka
- Department of Gastroenterological SurgeryFukuoka University Faculty of MedicineFukuokaJapan
| | - Yasuhiro Hashimoto
- Department of Gastroenterological SurgeryFukuoka University Faculty of MedicineFukuokaJapan
| | - Teppei Yamada
- Department of Gastroenterological SurgeryFukuoka University Faculty of MedicineFukuokaJapan
| | - Fumihiro Yoshimura
- Department of Gastroenterological SurgeryFukuoka University Faculty of MedicineFukuokaJapan
| | - Suguru Hasegawa
- Department of Gastroenterological SurgeryFukuoka University Faculty of MedicineFukuokaJapan
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2
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Shiwaku H, Shiwaku A, Okada H, Kusaba H, Maki K, Shimaoka H, Yamauchi K, Hashimoto Y, Yamada T, Yoshimura F, Hasegawa S. Endoscopic ligation technique for refractory gastrotracheal fistula. DEN Open 2024; 4:e320. [PMID: 38023664 PMCID: PMC10664741 DOI: 10.1002/deo2.320] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/23/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023]
Abstract
Endoscopic therapy has recently undergone remarkable progress, including the use of suturing procedures within the gastrointestinal tract using flexible endoscopes. However, existing suturing techniques primarily involve closure using instruments or continuous sutures using an endoscopic needle holder, leaving a gap in nodal suturing methods with extracorporeal ligation. This paper introduces a novel approach, the endoscopic ligation technique, wherein a flexible endoscope is utilized for nodal suturing through extracorporeal ligation.
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Affiliation(s)
- Hironari Shiwaku
- Department of Gastroenterological SurgeryFukuoka University Faculty of MedicineFukuokaJapan
| | - Akio Shiwaku
- Department of Gastroenterological SurgeryFukuoka University Faculty of MedicineFukuokaJapan
| | - Hiroki Okada
- Department of Gastroenterological SurgeryFukuoka University Faculty of MedicineFukuokaJapan
| | - Hiroshi Kusaba
- Department of Gastroenterological SurgeryFukuoka University Faculty of MedicineFukuokaJapan
| | - Kenji Maki
- Department of Gastroenterological SurgeryFukuoka University Faculty of MedicineFukuokaJapan
| | - Hideki Shimaoka
- Department of Gastroenterological SurgeryFukuoka University Faculty of MedicineFukuokaJapan
| | - Kosuke Yamauchi
- Department of Gastroenterological SurgeryFukuoka University Faculty of MedicineFukuokaJapan
| | - Yasuhiro Hashimoto
- Department of Gastroenterological SurgeryFukuoka University Faculty of MedicineFukuokaJapan
| | - Teppei Yamada
- Department of Gastroenterological SurgeryFukuoka University Faculty of MedicineFukuokaJapan
| | - Fumihiro Yoshimura
- Department of Gastroenterological SurgeryFukuoka University Faculty of MedicineFukuokaJapan
| | - Suguru Hasegawa
- Department of Gastroenterological SurgeryFukuoka University Faculty of MedicineFukuokaJapan
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3
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Jirapinyo P, Thompson CC. Development of a novel endoscopic suturing simulator: validation and impact on clinical learning curve (with video). Gastrointest Endosc 2024; 99:41-49. [PMID: 37536634 PMCID: PMC10994561 DOI: 10.1016/j.gie.2023.07.045] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/23/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND AIMS Endoscopic suturing is a complex skill with broad applications. The aim of this study was to develop and validate a novel endoscopic suturing simulator and scoring system for the purse-string suture pattern. METHODS This was a prospective study of an endoscopic suturing simulator that consists of a circular opening representing a dilated gastrojejunal anastomosis of Roux-en-Y gastric bypass with 12 small target holes around its circumference. Purse-string suturing is performed in a counterclockwise fashion. Time allotted is 5 minutes, and each successful bite is awarded 10 points. Participants were divided into the novice, intermediate, and experienced groups. Validity evidence based on content, validity evidence based on other variables, and validity evidence based on consequences of testing were assessed. RESULTS Seventeen subjects (3 novice, 7 intermediate, and 7 experienced) participated in the study. Validity evidence based on content: The content validity index for realism, relevance, and representativeness was 0.89, 1.00, and 1.00, respectively. Validity evidence based on other variables: The novice, intermediate, and experienced groups scored 30.0 ± 8.2, 57.1 ± 28.1, and 131.2 ± 51.7 (P = .001). Validity evidence based on consequences of testing: The simulator group required 5 ± 5 transoral outlet reduction cases before being able to independently complete an entire purse-string, whereas the non-simulator group required 38 ± 11 clinical cases (P < .0001). CONCLUSIONS This novel endoscopic suturing simulator seems realistic, relevant, and representative of the clinical suturing experience. In addition, it seems effective at objectively assessing suturing skills and shortening the clinical learning curve.
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Affiliation(s)
- Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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4
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Haseeb M, Thompson CC. Endoscopic therapy for gastroesophageal reflux disease: where are we, where are we going? Curr Opin Gastroenterol 2023; 39:381-389. [PMID: 37523156 PMCID: PMC10629818 DOI: 10.1097/mog.0000000000000968] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
PURPOSE OF REVIEW Gastroesophageal reflux disease (GERD) is the most common chronic condition with increasing prevalence in the Western world. Despite medical therapy, a considerable proportion of patients continue to experience symptoms, thus fueling the demand for minimally invasive GERD treatment options. This review will assess the currently available endoscopic approaches by analyzing their outcomes data, indication for use and limitations. RECENT FINDINGS With increasing evidence of the safety and efficacy of endoscopic therapies, recent guidelines and consensus society documents have updated their recommendations for the endoscopic treatment of GERD. In this review, we have comprehensively assessed the current landscape of endoscopic approaches for the treatment of GERD and provided insight into future directions. SUMMARY Endoscopic therapies for GERD show promise as new treatments emerge and existing therapies evolve into safer and more reproducible options. They are well positioned to cater to a large subset of the population suffering from chronic condition of GERD.
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Affiliation(s)
- Muhammad Haseeb
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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5
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Meyers MH, Swei EC, Tarter W, Schoen J, Rothchild K, Pratap A, Sullivan SA. Factors Associated with Weight Loss After Endoscopic Transoral Outlet Reduction (TORe). J Gastrointest Surg 2023; 27:1587-1593. [PMID: 37237090 PMCID: PMC10215034 DOI: 10.1007/s11605-023-05695-9] [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: 08/10/2022] [Accepted: 04/01/2023] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Endoscopic transoral outlet reduction (TORe) has emerged as a safe and effective treatment option for weight regain after Roux-en-Y Gastric Bypass (RYGB). Factors that predict successful weight loss after TORe are incompletely understood. The aims of this study were to evaluate procedural factors and patient factors that may affect percent total body weight loss (%TBWL) after TORe. METHODS A retrospective cohort study was performed on patients after TORe. The primary outcomes were %TBWL at 6 and 12 months based on four procedural factors: purse-string (PS) vs. non-purse-string (NPS) suture pattern, gastric pouch sutures (N), change in the diameter of the gastrojejunal anastomosis, and change in the length of the gastric pouch. Secondary outcomes included patient factors that affected weight loss. RESULTS Fifty-one patients underwent TORe. Weight loss for completers was 11.3 ± 7.6% and 12.2 ± 9.2% at 6 and 12 months. There was a correlation between %TBWL and change in pouch length at 6 and 12 months and number of sutures in the pouch at 6 months. The difference in %TBWL between PS and NPS groups at 6 months (PS, n=21, 12.3 ± 8.5% and NPS, n=8, 8.7 ± 3.7%) and 12 months (PS, n=21, 13.5 ± 9.2% and NPS, n=5, 7.0 ± 7.9%) did not reach statistical significance. For secondary outcomes, depression was associated with %TBWL. CONCLUSION Change in pouch length and number of sutures in the pouch correlated positively while depression correlated negatively with weight loss after TORe. Further studies are needed to understand these effects.
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Affiliation(s)
- Matthew H Meyers
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Eric C Swei
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Wyatt Tarter
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Jonathan Schoen
- Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Kevin Rothchild
- Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Akshay Pratap
- Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Shelby A Sullivan
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
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6
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Miller C, Magarinos J, Akcelik A, Bakhos C, Abbas A, Petrov R. Endoscopic tissue approximation in clinical practice and the OverStitch device: a narrative review. Ann Esophagus 2023; 6:21. [PMID: 37113383 PMCID: PMC10128618 DOI: 10.21037/aoe-21-50] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Objective The current article describes modern endoscopic technologies that allow for advanced endoscopic tissue approximation and suturing. These technologies include such devices as through the scope and over the scope clips, endoscopic suturing OverStitch device and through the scope suturing X-Tack device. Background Since the original introduction of the diagnostic endoscopy, progress in the field has been astonishing. Over the past several decades endoscopy has made numerous advancements allowing for a minimally invasive mechanism to treat life threatening conditions such as gastrointestinal (GI) bleeding, full thickness injuries, as well as chronic medical conditions such as morbid obesity and achalasia. Methods A narrative review of all relevant and available literature on endoscopic tissue approximation devices over the last 15 years ago was conducted. Conclusions Multiple new devices, including endoscopic clips and endoscopic suturing devices, have been developed for endoscopic tissue approximation that allow advanced endoscopic management of a wide variety of GI tract conditions. It is critical for practicing surgeons to actively participate in the development and use of these new technologies and devices in order to maintain leadership in the field, hone expertise, and to drive innovation. Further research in minimally invasive applications for these devices is needed as they continue to be refined. This article provides a general overview of the devices available and their clinical applications.
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Affiliation(s)
- Claire Miller
- Department of General Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Jessica Magarinos
- Department of General Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Andrew Akcelik
- Department of General Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Charles Bakhos
- Division of Thoracic Surgery, Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Abbas Abbas
- Division of Thoracic Surgery, Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Roman Petrov
- Division of Thoracic Surgery, Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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7
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Andreone M, Megna B, McDonald N, Sunjaya D, Hanson B, Bilal M. Use of Endoscopic Suturing for the Treatment of Malignant Gastric Ulcer-Related Hemorrhage. ACG Case Rep J 2023; 10:e01047. [PMID: 37180465 PMCID: PMC10171711 DOI: 10.14309/crj.0000000000001047] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Gastrointestinal bleeding secondary to malignancy can be difficult to manage with traditional endoscopic therapies. Endoscopic suturing is a relatively new technology with limited data available regarding its use for bleeding related to peptic ulcer disease. We describe a case where endoscopic suturing was successfully used to control gastrointestinal hemorrhage from a previously known malignant ulceration that was refractory to traditional interventions.
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Affiliation(s)
- Michael Andreone
- Department of Internal Medicine, University of Minnesota, Minneapolis, MN
| | - Bryant Megna
- Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minneapolis, MN
| | - Nicholas McDonald
- Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minneapolis, MN
| | - Dharma Sunjaya
- Department of Gastroenterology and Hepatology, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, MN
| | - Brian Hanson
- Department of Gastroenterology and Hepatology, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, MN
| | - Mohammad Bilal
- Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minneapolis, MN
- Department of Gastroenterology and Hepatology, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, MN
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8
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Richardson CM, Zopf DA, Ikeda AK, van Horn A, Cohen K, Nourmohammadi Z, Nassar M, Park JS, Johnson KE. A Validated 3D Printed Laryngeal Suturing Simulator for Endoscopic Laryngeal Cleft Repair. Laryngoscope 2023; 133:785-791. [PMID: 35932231 DOI: 10.1002/lary.30320] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Endoscopic laryngeal cleft repair (ELCR) with endolaryngeal suturing is an advanced surgical skill. This study objective was to assess the validity of 3-dimensionally (3D) printed laryngeal suturing simulator for ELCR. STUDY DESIGN Development and validation of a simulator for ELCR. METHODS An ELCR model was developed using 3D printed and readily available materials. Participants were surveyed before and after a simulation session using five-point Likert scale questions. Performance data was assessed using blinded expert video review and rated using a novel objective structured assessment of technical skills (OSATS) for endoscopic laryngeal suturing. RESULTS Twenty-one participants ranging from residents to attendings completed the simulation session. Survey respondents reported on a five-point Likert scale that the model was "easy to use" and "quite realistic" (both mean of 4). Confidence improved significantly in 86% of participants (p < 0.01). Overall OSATS scores (out of a total of 55) showed a median improvement in technical skills of 11.7 points (p = 0.004). OSATS demonstrated good intra-rater (κ = 0.689 and 0.677) and moderate inter-rater (κ = 0.573) reliability. Completion times improved from the first to the last suture by a median time of 512 to 350 s (decrease of 202 s, p = 0.002). Participants with no prior ELCR experience improved more than those with in vivo experience. CONCLUSION This study demonstrates the validity of a simulator utilizing 3D printed larynges for ELCR. A novel OSATS for endoscopic laryngeal suturing was successfully implemented. Confidence, technical skills, and completion times improved with the use of the model across a variety of participants. Laryngoscope, 133:785-791, 2023.
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Affiliation(s)
- Clare M Richardson
- Division of Pediatric of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - David A Zopf
- Division of Pediatric of Otolaryngology - Head and Neck Surgery, CS Mott Children's Hospital, Ann Arbor, Michigan, USA.,Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Allison K Ikeda
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Adam van Horn
- Division of Otolaryngology - Head and Neck Surgery, Marshall University, Huntington, West Virginia, USA
| | - Katheryn Cohen
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Zahra Nourmohammadi
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michel Nassar
- Department of Otolaryngology - Head and Neck Surgery, Montefiore Medical Center, New York City, New York, USA
| | - Jason S Park
- Department of Otolaryngology - Head and Neck Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kaalan E Johnson
- Division of Pediatric of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington, USA
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Nomura T, Sugimoto S, Temma T, Oyamada J, Ito K, Kamei A. Suturing techniques with endoscopic clips and special devices after endoscopic resection. Dig Endosc 2023; 35:287-301. [PMID: 35997063 DOI: 10.1111/den.14427] [Citation(s) in RCA: 1] [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: 07/11/2022] [Accepted: 08/21/2022] [Indexed: 12/07/2022]
Abstract
Endoscopic submucosal dissection is an established method for complete resection of large and early gastrointestinal tumors. However, methods to reduce bleeding, perforation, and other adverse events after endoscopic resection (ER) have not yet been defined. Mucosal defect closure is often performed endoscopically with a clip. Recently, reopenable clips and large-teeth clips have also been developed. The over-the-scope clip enables complete defect closure by withdrawing the endoscope once and attaching the clip. Other methods involve attaching the clip-line or a ring with an anchor to appose the edges of the mucosal defect, followed by the use of an additional clip for defect closure. Since clips are limited by their grasping force and size, other methods, such as endoloop closure, endoscopic ligation with O-ring closure, and the reopenable clip over-the-line method, have been developed. In recent years, techniques often utilized for full-thickness ER of submucosal tumors have been widely used in full-thickness defect closure. Specialized devices and techniques for defect closure have also been developed, including the curved needle and line, stitches, and an endoscopic tack and suture device. These clips and suture devices are applied for defect closure in emergency endoscopy, accidental perforations, and acute and chronic fistulas. Although endoscopic defect closure with clips has a high success rate, endoscopists need to simplify and promote endoscopic closure techniques to prevent adverse events after ER.
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Affiliation(s)
- Tatsuma Nomura
- Department of Gastroenterology, Mie Prefectural Shima Hospital, Mie, Japan.,Department of Gastroenterology, Ise Red Cross Hospital, Mie, Japan
| | - Shinya Sugimoto
- Department of Gastroenterology, Ise Red Cross Hospital, Mie, Japan
| | - Taishi Temma
- Department of Gastroenterology, Ise Red Cross Hospital, Mie, Japan
| | - Jun Oyamada
- Department of Gastroenterology, Ise Red Cross Hospital, Mie, Japan
| | - Keichi Ito
- Department of Gastroenterology, Ise Red Cross Hospital, Mie, Japan
| | - Akira Kamei
- Department of Gastroenterology, Ise Red Cross Hospital, Mie, Japan
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Zotarelli-Filho IJ, de Quadros LG, Neto MG, Rajapaksa SW, Vidanapathirana J, Filho DR, Nogueira-de-Almeida CA. Prospective Meta-analysis of Weight Loss Regained and Success Rate of Argon Plasma Coagulation to Suture and Surgery Procedures Post-bariatric Surgery: Status of the Art of Endoscopic Treatment. Rev Recent Clin Trials 2023; 18:239-250. [PMID: 37608668 DOI: 10.2174/1574887118666230822110724] [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] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/14/2023] [Accepted: 07/11/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND This study performed a meta-analysis to compare the safety and efficacy of argon plasma coagulation (APC) concerning suture (SUT) and surgery (SUR). METHODS The One-Way tests were applied, with p <0.05 significant. The value of R2 was analyzed (heterogeneity), and the risk of bias of articles was evaluated. RESULTS A total of 34 studies were found, eight about APC, twenty about SUT, and six about SUR. For the percentage of Weight Loss Regained (%WLR), the means for APC, SUT, and SUR were 19.39 ± 10.94, 26.06 ± 16.71, and 17.05 ± 9.85, and for success rate (%SR), the means were 89.75 ± 16.75, 86.80 ± 11.44, and 76.00 ± 21.57, respectively with p >0.05, with R2 ≥ 50%. CONCLUSION The APC proved to be efficient and safe like the other techniques.
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Affiliation(s)
- Idiberto José Zotarelli-Filho
- Faculty of Medicine of Sao Jose do Rio Preto/SP, Brazil
- Associação Brasileira de Nutrologia/Brazilian Association of Nutrology, Catanduva, Sao Paulo, Brazil
- College of Palliative Medicine of Sri Lanka, Colombo, Sri Lanka
| | - Luiz Gustavo de Quadros
- Kaiser Day Hospital, Sao Jose do Rio Preto, Sao Paulo, Brazil
- ABC Medical School, Surgery Department, Santo Andre, Sao Paulo, Brazil
| | | | | | - Janaki Vidanapathirana
- College of Palliative Medicine of Sri Lanka, Colombo, Sri Lanka
- Director of Policy Analysis & Development, Ministry of Health, Sri Lanka
| | - Durval Ribas Filho
- Faculty of Medicine of Sao Jose do Rio Preto/SP, Brazil
- Associação Brasileira de Nutrologia/Brazilian Association of Nutrology, Catanduva, Sao Paulo, Brazil
| | - Carlos Alberto Nogueira-de-Almeida
- Associação Brasileira de Nutrologia/Brazilian Association of Nutrology, Catanduva, Sao Paulo, Brazil
- Federal University of Sao Carlos, Department of Medicine, Sao Carlos, Sao Paulo, Brazil
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11
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Halvax P, Nemeth B, Kiss I, Papp A, Vereczkei A. Endoluminal Suture-technique for the Stomach Closure of an Experimental Model. Anticancer Res 2023; 43:59-61. [PMID: 36585160 DOI: 10.21873/anticanres.16134] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIM In the modern minimally invasive era, diagnostic and therapeutic endoscopic interventions are one of the most emerging fields. For the new operational techniques, it is a major aim to develop reliable instruments, such as suturing devices for flexible endoscopes. The aim of this study was to assess the feasibility of a safe and reproducible suturing technique with an endoluminal suturing device. MATERIALS AND METHODS The evaluation of the technique was performed in twenty explanted special prepared porcine stomachs. Three different techniques were compared, single stitches, figure-of-eight, or Z-pattern and running sutures in terms of suturing time and bursting pressure. After verification of the reliability of the method, a 3 cm long full thickness incision on the stomach was closed with the endoscopic suturing device in four surviving animals. RESULTS In our ex vivo studies, we have shown that the figure of 8 or Z- technique is the most optimal for stomach closure without considerable time-cost, thus this technique was chosen as the standard method for the in vivo study. The endoscopic stomach wall suturing was successful in all four cases, the postoperative period was uneventful and ended on the tenth postoperative day with autopsy. CONCLUSION With the applied suturing device, the endoscopic suturing of the stomach is safe and reproducible, thus a human application may also be justified.
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Affiliation(s)
- Peter Halvax
- Department of Surgery, Medical School, University of Pécs, Pécs, Hungary;
| | - Balazs Nemeth
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Istvan Kiss
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Andras Papp
- Department of Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Andras Vereczkei
- Department of Surgery, Medical School, University of Pécs, Pécs, Hungary
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12
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Raiter A, Pawlak KM, Kozłowska-Petriczko K, Petriczko J, Szełemej J, Wiechowska-Kozłowska A. On the Track of New Endoscopic Alternatives for the Treatment of Selected Gastric GISTs-A Pilot Study. ACTA ACUST UNITED AC 2021; 57:medicina57060625. [PMID: 34208475 PMCID: PMC8234534 DOI: 10.3390/medicina57060625] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 12/04/2022]
Abstract
Background and Objectives: GISTs (Gastrointestinal stromal tumors) are the most common mesenchymal gastrointestinal tract tumours and are mainly located in the stomach. Their malignant potential depends on size, location, and type. Endoscopic techniques are a less invasive modality for patients not eligible for surgery. ESD (endoscopic submucosal dissection) is mainly used for the removal of smaller GISTs, with intraluminal growth and a more superficial location. Thus, R0 resection capability in some cases may be not sufficient, limited by tumour size, location in the gastric wall, and its connection level with the muscularis propria. In such cases, an endoscopic full-thickness resection can become a new alternative. In this retrospective pilot study, we evaluated ESD and hybrid resection techniques in terms of safety, efficacy, and disease recurrence for selected types of gastric GISTs. Materials and Methods: A retrospective comparison was conducted in a group of patients who underwent ESD or a hybrid technique combining endoscopic resection with endoscopic suturing using the OverStitch system (HT) for type II or III gastric GISTs. A total of 21 patients aged 70 ± 8 years underwent endoscopic resection. Seventeen lesions were treated with ESD and four with the HT. Results: R0 resection was achieved in all patients treated using HT (type III lesions) and in 53% of those treated with ESD (p = 0.08). None of the type III lesions treated with ESD were excised with R0. Lesions treated with R0 ESD resections were significantly smaller (1.76 ± 0.35 cm) than those with R1 ESD resections (2.39 ± 0.40 cm) (p < 0.01). The mean lesion size treated with the HT was 2.88 ± 0.85 cm. Conclusions: HT may be a new resection modality for large gastric GISTs with high muscularis propria connection grades. Further studies are required to evaluate its safety and efficacy and to form precise inclusion criteria for endoscopic resection techniques.
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Affiliation(s)
- Artur Raiter
- Department of Endoscopy, Specialist Hospital of Alfred Sokolowski, 58-309 Wałbrzych, Poland; (A.R.); (J.S.)
| | - Katarzyna M. Pawlak
- Endoscopy Unit, Department of Gastroenterology, Ministry of Interior and Administration, ul. Jagiellońska 44, 70-382 Szczecin, Poland;
- Correspondence: ; Tel.: +48-601447543
| | | | - Jan Petriczko
- Department of Plastic, Endocrine and General Surgery, Pomeranian Medical University, 70-382 Szczecin, Poland;
| | - Joanna Szełemej
- Department of Endoscopy, Specialist Hospital of Alfred Sokolowski, 58-309 Wałbrzych, Poland; (A.R.); (J.S.)
| | - Anna Wiechowska-Kozłowska
- Endoscopy Unit, Department of Gastroenterology, Ministry of Interior and Administration, ul. Jagiellońska 44, 70-382 Szczecin, Poland;
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13
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Itani MI, Farha J, Sartoretto A, Abbarh S, Badurdeen D, de Moura DTH, Kumbhari V. Endoscopic sleeve gastroplasty with argon plasma coagulation: A novel technique. J Dig Dis 2020; 21:664-667. [PMID: 32916766 DOI: 10.1111/1751-2980.12939] [Citation(s) in RCA: 4] [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: 07/15/2020] [Revised: 08/22/2020] [Accepted: 09/08/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure in which the anterior and posterior aspects of the greater curvature are stitched endoscopically, producing a sleeve-like anatomy mimicking that in a sleeve gastrectomy. However, suture dehiscence and enlargement of the stomach within months of the procedure have been observed. Argon plasma coagulation (APC) is widely used in gastrointestinal endoscopy and is able to induce scarring and fibrosis. We coupled ESG with APC to evaluate its potential to improve durability. METHODS A 46-year-old woman with obesity presented for ESG. Her pre-procedure weight was 117 kg with a body mass index (BMI) of 41.4 kg/m2 . After each plication was complete, APC (60 W, argon flow rate 1.2 L/min) was used to ablate the mucosal surface of the exposed plicated mucosa. APC was applied until the mucosal color was dark brown, indicating adequate and successful mucosal and submucosal ablation. RESULTS The procedure was successful, and the patient recovered without peri- or post-operative complications. The procedure time was 47 minutes. A total of seven sutures were used. At 6-month follow-up the patient had lost 17 kg (37.5 lbs), equivalent to 14.5% total weight loss and had a BMI of 35.4 kg/m2 . Endoscopic follow-up at 6 months revealed enhanced fibrosis along the plications, resulting in a superior, sleeve-like lumen. CONCLUSIONS The combination of ESG with APC may act synergistically to reduce weight without adding significant procedure time. Further investigation is needed to determine whether it should be widely recommended.
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Affiliation(s)
- Mohamad I Itani
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Jad Farha
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | | | - Shahem Abbarh
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Dilhana Badurdeen
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Diogo T H de Moura
- Gastroenterology Department, Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vivek Kumbhari
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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14
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Kumar S, Youn YH, Lee JH. Life on a knife edge: the optimal approach to the management of perforations during endoscopic submucosal dissection (ESD). Expert Rev Gastroenterol Hepatol 2020; 14:965-973. [PMID: 32658593 DOI: 10.1080/17474124.2020.1791085] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Endoscopic submucosal dissection (ESD) is a well-established procedure that can provide curative resection of malignant and premalignant lesions endoscopically, thereby offering patients an effective non-operative option. Though ESD is safe and highly effective when performed in appropriately selected patients by an experienced ESD expert, it carries risks including intraprocedural and delayed perforation. AREAS COVERED This review provides a practical approach to the initial management of perforation to minimize subsequent complications. The importance of prompt recognition of perforation and early intervention cannot be overstated. This review summarizes indications for closure, anatomic considerations impacting closure, and closure techniques. This article also highlights the do's and don'ts of various closure devices, focusing particularly on advanced closure methods, the-over-the-scope clips (OTSCs) and endoscopic suturing. EXPERT OPINION As ESD offers surgery-sparing alternatives to patients, advanced closure techniques allow endoscopists to effectively and promptly manage associated complications, improving the possibility of the widespread implementation of ESD in the US. With continued improvements in OTSCs and endoscopic suturing, ESD will become a stalwart of endoscopic management of malignant and premalignant gastrointestinal lesions.
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Affiliation(s)
- Shria Kumar
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA, USA
| | - Young Hoon Youn
- Department of Gastroenterology, Yonsei University College of Medicine , Seoul, Korea
| | - Jeffrey H Lee
- Department of Gastroenterology, Hepatology, and Nutrition, MD Anderson Cancer Center , Houston, TX, USA
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15
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Siddiqi S, Schraufnagel DP, Siddiqui HU, Javorski MJ, Mace A, Elnaggar AS, Elgharably H, Vargo PR, Steffen R, Hasan SM, Raja S. Recent advancements in the minimally invasive management of esophageal perforation, leaks, and fistulae. Expert Rev Med Devices 2019; 16:197-209. [PMID: 30767693 DOI: 10.1080/17434440.2019.1582329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Historically, the gold standard management of esophageal perforations, leaks, and fistulae has been traditional open surgery, but it is associated with significant morbidity and mortality. Minimally invasive approaches offer alternatives to surgery in treating hemodynamically stable patients with such defects. In this review article, we will discuss the recent advancements in the minimally invasive management of esophageal perforations, leaks, and fistulas. AREAS COVERED This review includes information from case reports, case series, and clinical trials on minimally invasive management of esophageal perforations, leaks, and fistulas. The focus is on the devices, outcomes, and application of the technology. EXPERT COMMENTARY Minimally invasive treatment represents significant progress in the management of esophageal perforations, leaks, and fistulas. Based on current evidence, it seems safe and effective but it is evolving and more studies are needed to help draw definitive conclusions.
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Affiliation(s)
- Shirin Siddiqi
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Dean P Schraufnagel
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Hafiz Umair Siddiqui
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Michael J Javorski
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Adam Mace
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Abdulrhman S Elnaggar
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Haytham Elgharably
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Patrick R Vargo
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Robert Steffen
- b Department of Cardiovascular Surgery , Minneapolis Heart Institute Foundation , Minneapolis , MN , USA
| | - Saad M Hasan
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Siva Raja
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
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16
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Shahnazarian V, Ramai D, Sarkar A. Endoscopic bariatric therapies for treating obesity: a learning curve for gastroenterologists. Transl Gastroenterol Hepatol 2019; 4:16. [PMID: 30976719 DOI: 10.21037/tgh.2019.03.01] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 12/19/2018] [Accepted: 03/01/2019] [Indexed: 12/16/2022] Open
Abstract
Obesity represents a growing public health threat. Until recently, surgery was the primary means for treating pharmacotherapy resistant obese patients. However, therapeutic endoscopy has evolved as an effective and safe alternative strategy. Particularly, endoscopic bariatric therapy (EBT) can bridge the gap in patients who do not fit the BMI criteria for surgery and fail conservative or medical therapy. Today there are many tools within the realm of EBT available to endoscopists. While there are no formal guidelines for their use, training and use of these tools are limited by the type of institution, preferences of senior endoscopists, cost, and availability. We review different EBT tools available to trainees and gastroenterologist, and the learning curves associated with them.
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Affiliation(s)
- Vahe Shahnazarian
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Brooklyn, NY, 11201 USA
| | - Daryl Ramai
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, NY, 11201 USA
| | - Avik Sarkar
- Division of Gastroenterology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
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17
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Abstract
The endoscopic management armamentarium of gastrointestinal disruptions including perforations, leaks, and fistulas has slowly but steadily broadened in recent years. Previously limited to surgical or conservative medical management, innovations in advanced endoscopic techniques like natural orifice transluminal endoscopic surgery (NOTES) have paved the path towards development of endoscopic closure techniques. Early recognition of a gastrointestinal defect is the most important independent variable in determining successful endoscopic closure and patient outcome. Some devices including through the scope clips and stents have been well studied for other indications and have produced encouraging results in closure of gastrointestinal perforations, leaks and fistulas. Over the scope clips, endoscopic sutures, vacuum therapy, glue, and cardiac device occluders are other alternative techniques that can be employed for successful endoscopic closure.
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Affiliation(s)
- Ritu Raj Singh
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeremy S Nussbaum
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nikhil A Kumta
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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18
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Agnihotri A, Barola S, Hill C, Mishra P, Fayad L, Dunlap M, Moran RA, Singh VK, Kalloo AN, Khashab MA, Kumbhari V. Endoscopic suturing for the management of recurrent dislodgment of percutaneous endoscopic gastrostomy-jejunostomy tube. J Dig Dis 2018; 19:170-176. [PMID: 29389058 DOI: 10.1111/1751-2980.12581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 12/12/2017] [Revised: 01/25/2018] [Accepted: 01/28/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To describe a novel technique for the prevention of recurrent percutaneous endoscopic gastrostomy-jejunostomy (PEG-J) tube dislodgements and assess its feasibility and efficacy. This technique utilizes endoscopic suturing to secure the PEG-J tube to the gastric wall. METHODS This was a retrospective analysis of consecutive cases of recurrent PEG-J tube dislodgements referred to a single endoscopist between June 2016 and June 2017, using an endoscopic suturing system to secure the PEG-J tube directly to the gastric wall. Technical success rates, the procedure time and related adverse events were analyzed. RESULTS There were five patients in total (three females). The procedure was technically successful in all patients. There were no procedure-related adverse events. The mean duration of follow-up was 7.8 ± 5.1 months. Two patients had accidental dislodgement at 8.5 and 12 months, respectively. There were no other unintended dislodgements. CONCLUSION Endoscopic suturing with internal fixation of PEG-J tube is a safe and feasible approach to manage recurrent unintended dislodgements.
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Affiliation(s)
- Abhishek Agnihotri
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sindhu Barola
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christine Hill
- Division of Intramural Population Health Research, National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Priya Mishra
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lea Fayad
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Margo Dunlap
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert A Moran
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vikesh K Singh
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anthony N Kalloo
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mouen A Khashab
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vivek Kumbhari
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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19
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Abstract
Endoscopic submucosal dissection is established as a curative endoscopic method for gastrointestinal epithelial neoplasms with a high possibility of complete en bloc resection; however, postoperative adverse events of bleeding and delayed perforation remain. To prevent or minimize them, several techniques for endoscopic mucosal closure have been introduced, such as using endoscopic clips, combined use of hemoclips and supplement devices, and specially designed endoscopic suturing devices. Furthermore, endoscopic full-thickness suturing technique for gastrointestinal wall defect has been developed based on the concept in natural orifice transluminal endoscopic surgery and endoscopic full-thickness resection. Several closure techniques, including over-the-scope clip, threaded bars inserted in a hollow needle, stitches or staplers, and a curved needle and thread are reported. Secure closure of the iatrogenic defect may further expand the range of therapeutic endoscopy. Accumulation of evidence for the efficacy of endoscopic closure and establishment of these techniques are desired.
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Affiliation(s)
- Teppei Akimoto
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, School of Medicine, Keio University, Tokyo, Japan
| | - Osamu Goto
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, School of Medicine, Keio University, Tokyo, Japan
| | - Toshihiro Nishizawa
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, School of Medicine, Keio University, Tokyo, Japan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, School of Medicine, Keio University, Tokyo, Japan
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20
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Kumar N, Larsen MC, Thompson CC. Endoscopic Management of Gastrointestinal Fistulae. Gastroenterol Hepatol (N Y) 2014; 10:495-452. [PMID: 28845140 PMCID: PMC5566192] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A gastrointestinal fistula is a common occurrence, especially after surgery. Patients who develop a fistula may have an infection, surgically altered anatomy, nutritional deficiency, or organ failure, making surgical revision more difficult. With advancements in flexible endoscopic devices and technology, new endoscopic options are available for the management of gastrointestinal fistulae. Endoscopically deployable stents, endoscopic suturing devices, through-the-scope and over-the-scope clips, sealants, and fistula plugs can be used to treat fistulae. These therapies are even more effective in combination. Despite the inherent challenges in patients with fistulae, endoscopic therapies for treatment of fistulae have demonstrated safety and efficacy, allowing many patients to avoid surgical fistula repair. In this paper, we review the emerging role of endoscopy in the management of gastrointestinal fistulae.
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Affiliation(s)
- Nitin Kumar
- Dr Kumar is an advanced endoscopy fellow in the Division of Gastroenterology and Dr Thompson is the director of therapeutic endoscopy at Brigham and Women's Hospital in Boston, Massachusetts. Dr Larsen is an associate physician in the Digestive Disease Institute at Virginia Mason Medical Center in Seattle, Washington
| | - Michael C Larsen
- Dr Kumar is an advanced endoscopy fellow in the Division of Gastroenterology and Dr Thompson is the director of therapeutic endoscopy at Brigham and Women's Hospital in Boston, Massachusetts. Dr Larsen is an associate physician in the Digestive Disease Institute at Virginia Mason Medical Center in Seattle, Washington
| | - Christopher C Thompson
- Dr Kumar is an advanced endoscopy fellow in the Division of Gastroenterology and Dr Thompson is the director of therapeutic endoscopy at Brigham and Women's Hospital in Boston, Massachusetts. Dr Larsen is an associate physician in the Digestive Disease Institute at Virginia Mason Medical Center in Seattle, Washington
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21
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Pauli EM, Delaney CP, Champagne B, Stein S, Marks JM. Safety and effectiveness of an endoscopic suturing device in a human colonic treat-and-resect model. Surg Innov 2013; 20:594-9. [PMID: 23445712 DOI: 10.1177/1553350613479204] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite advances in many areas of therapeutic endoscopy, the development of an effective endoscopic suturing device has been elusive. The purpose of this trial was to evaluate the safety and effectiveness of a suturing device to place and secure sutures within normal, in vivo human colonic tissue prior to surgical resection. METHODS Patients undergoing elective colectomy were enrolled in this treat-and-resect model. The Overstitch endoscopic suturing device (Apollo Endosurgery, Austin, TX) was used to place sutures in healthy colonic tissue during a 15-minute, time-limited period. Following colectomy, the explanted tissue was evaluated to determine the depth of suture penetration and the effectiveness of the suture/cinch element. Clinical and operative data were recorded. RESULTS Four patients (50% female) were enrolled. Seven sutures were successfully placed, incorporating a total of 10 tissue bites in a mean of 13.5 minutes. On inspection of the explanted tissue, all sutures were found to be located subserosal (no full thickness bites were taken). The suture and cinch elements were judged to be effective in the majority of cases. One device-related issue did not inhibit the ability to oppose tissue or place the cinch. There were no intraoperative or postoperative complications. CONCLUSIONS The Overstitch permitted safe and effective suturing in an in vivo human colon model. The sutures were placed at a consistent subserosal depth and at no point risked iatrogenic injury to adjacent structures. Technical issues with the device were infrequent and did not inhibit the ability to place sutures effectively.
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Affiliation(s)
- Eric M Pauli
- 1University Hospitals Case Medical Center, Cleveland, OH
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22
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Abu Dayyeh BK, Jirapinyo P, Weitzner Z, Barker C, Flicker MS, Lautz DB, Thompson CC. Endoscopic sclerotherapy for the treatment of weight regain after Roux-en-Y gastric bypass: outcomes, complications, and predictors of response in 575 procedures. Gastrointest Endosc 2012; 76:275-82. [PMID: 22817783 PMCID: PMC4428559 DOI: 10.1016/j.gie.2012.03.1407] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [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: 09/02/2011] [Accepted: 03/29/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Weight regain after Roux-en-Y gastric bypass (RYGB) is common. Endoscopic sclerotherapy is increasingly used to treat this weight regain. OBJECTIVES To report safety, outcomes, durability, and predictors of response to sclerotherapy in a large prospective cohort. DESIGN Retrospective analysis of a prospective cohort study of patients with weight regain after RYGB. PATIENTS A total of 231 consecutive patients undergoing 575 sclerotherapy procedures between September 2008 and March 2011. INTERVENTIONS Single or multiple sclerotherapy procedures to inject sodium morrhuate into the rim of the gastrojejunal anastomosis. MAIN OUTCOME MEASUREMENTS We report weight loss, complications, and predictors of response. We also used Kaplan-Meier survival analysis and log-rank test to compare time to continuation of weight regain after sclerotherapy in patients undergoing a single versus multiple sclerotherapy procedures. RESULTS At 6 and 12 months from the last sclerotherapy procedure, weight regain stabilized in 92% and 78% of the cohort, respectively. Those who underwent 2 or 3 sclerotherapy sessions had significantly higher rates of weight regain stabilization than those who underwent a single session (90% vs 60% at 12 months; P = .003). The average weight loss at 6 months from the last sclerotherapy session for the entire cohort was 10 lb (standard deviation 16), representing 18% of the weight regained after RYGB. A subset of 73 patients (32% of the cohort) had greater weight loss at 6 months (26 lb, standard deviation 12), representing 61% of the weight regained. Predictors of a favorable outcome included greater weight regain and the number of sclerotherapy procedures. Bleeding was reported in 2.4% of procedures and transient diastolic blood pressure increases in 15%, without adverse health outcomes. No GI perforations were reported. CONCLUSIONS Endoscopic sclerotherapy appears to be a safe and effective tool for the management of weight regain after RYGB.
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Affiliation(s)
- Barham K. Abu Dayyeh
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts,Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA,Gastroenterology Division, Brigham and Women’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - Pichamol Jirapinyo
- Gastroenterology Division, Brigham and Women’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - Zachary Weitzner
- Gastroenterology Division, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Charlotte Barker
- Gastroenterology Division, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Michael S. Flicker
- Gastroenterology Division, Brigham and Women’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - David B. Lautz
- Harvard Medical School, Boston, Massachusetts,Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Christopher C. Thompson
- Gastroenterology Division, Brigham and Women’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
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23
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Abstract
Endoscopic bariatric procedures are gaining traction as possible minimally invasive treatment modalities for obesity. This article focuses on the various endoscopic devices and procedures that pertain to primary and revisional treatments. Additionally, the article discusses the potential for applying these various devices and procedures to other points of intervention, including early intervention, bridge to surgery, and primary metabolic treatment (eg, diabetes management). Devices that are currently in human use are preferentially discussed, followed by references to devices that may see clinical use in the near future.
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Affiliation(s)
- Marvin Ryou
- Advanced Endoscopy Fellow, Partners Combined Program, Division of Gastroenterology, Brigham & Women’s Hospital and Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School
| | - Christopher C. Thompson
- Director of Developmental & Therapeutic Endoscopy, Assistant Professor of Medicine, Division of Gastroenterology, Brigham & Women’s Hospital, Harvard Medical School
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