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英文中文

Expanding the boundaries of EUS: EUS-guided fiducial placement and fine-needle biopsy in oligometastatic disease of the adrenal gland

iGIE

Pub Date : 2024-12-01 DOI: 10.1016/j.igie.2024.08.002

Ricardo Marrero Torres MD , Hari Gopakumar MD , Dushyant Singh Dahiya MD , Aqsa Khan MD , Uday Patel DO , Sahib Singh MD , Talia Malik MD , Marzena Muller MD , Mariajose Rojas de Leon MD , Neil R. Sharma MD

Background

Radiation therapy, including Intensity Modulated Radiation Therapy (IMRT) and Stereotactic Body Radiation Therapy (SBRT), is a crucial treatment for various malignancies, though side effects often arise from radiation exposure to healthy tissues. Fiducial markers are used in SBRT to optimize tumor targeting and minimize damage to surrounding tissues. Traditionally, fiducials are placed surgically or percutaneously, but EUS offers a safer, less invasive, and potentially cost-effective alternative. While fiducial placement within the pancreas has been well-studied, there are limited data on EUS-guided fiducial marker placement in non-GI organs, particularly the adrenal glands.

Methods

This retrospective case series evaluated EUS-guided fiducial marker placement in the left adrenal gland in 6 patients from 2020 to 2023. Patients were selected following multidisciplinary tumor board discussions, and all procedures were performed using a 22-gauge Menghini-tip needle under EUS guidance. Data were collected on patient demographics, tumor characteristics, technical success, and clinical outcomes following fiducial placement.

Results

The procedure was technically successful in all patients, with no reported adverse events. Four fiducials were placed in each patient, aiding SBRT planning. Five patients proceeded with SBRT, and 80% achieved a complete local response on radiological follow-up. No significant fiducial migration was noted. The findings suggest that EUS-guided fiducial placement for adrenal tumors is safe and effective.

Conclusion

This is the first case series demonstrating the safety and technical success of EUS-guided fiducial placement in the adrenal gland. This technique offers an alternative to more invasive approaches, facilitating precision radiotherapy for adrenal metastases, and highlights the expanding role of interventional endoscopists in oncology care. Further prospective studies are needed to validate these findings and expand their clinical application.

{"title":"Expanding the boundaries of EUS: EUS-guided fiducial placement and fine-needle biopsy in oligometastatic disease of the adrenal gland","authors":"Ricardo Marrero Torres MD , Hari Gopakumar MD , Dushyant Singh Dahiya MD , Aqsa Khan MD , Uday Patel DO , Sahib Singh MD , Talia Malik MD , Marzena Muller MD , Mariajose Rojas de Leon MD , Neil R. Sharma MD","doi":"10.1016/j.igie.2024.08.002","DOIUrl":"10.1016/j.igie.2024.08.002","url":null,"abstract":"<div><h3>Background</h3><div>Radiation therapy, including Intensity Modulated Radiation Therapy (IMRT) and Stereotactic Body Radiation Therapy (SBRT), is a crucial treatment for various malignancies, though side effects often arise from radiation exposure to healthy tissues. Fiducial markers are used in SBRT to optimize tumor targeting and minimize damage to surrounding tissues. Traditionally, fiducials are placed surgically or percutaneously, but EUS offers a safer, less invasive, and potentially cost-effective alternative. While fiducial placement within the pancreas has been well-studied, there are limited data on EUS-guided fiducial marker placement in non-GI organs, particularly the adrenal glands.</div></div><div><h3>Methods</h3><div>This retrospective case series evaluated EUS-guided fiducial marker placement in the left adrenal gland in 6 patients from 2020 to 2023. Patients were selected following multidisciplinary tumor board discussions, and all procedures were performed using a 22-gauge Menghini-tip needle under EUS guidance. Data were collected on patient demographics, tumor characteristics, technical success, and clinical outcomes following fiducial placement.</div></div><div><h3>Results</h3><div>The procedure was technically successful in all patients, with no reported adverse events. Four fiducials were placed in each patient, aiding SBRT planning. Five patients proceeded with SBRT, and 80% achieved a complete local response on radiological follow-up. No significant fiducial migration was noted. The findings suggest that EUS-guided fiducial placement for adrenal tumors is safe and effective.</div></div><div><h3>Conclusion</h3><div>This is the first case series demonstrating the safety and technical success of EUS-guided fiducial placement in the adrenal gland. This technique offers an alternative to more invasive approaches, facilitating precision radiotherapy for adrenal metastases, and highlights the expanding role of interventional endoscopists in oncology care. Further prospective studies are needed to validate these findings and expand their clinical application.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 521-526"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Unsedated transnasal endoscopy experience at a tertiary referral center in India

iGIE

Pub Date : 2024-12-01 DOI: 10.1016/j.igie.2024.09.001

Ravi Teja Pasam MBBS, MPH , Srilekha Chava MBBS , Nagabhushanam Gollapalli MD, DM , Bhaskar Rao Uppala MD, DM , Jagan Mohan Rao Kodali MRCP, FRCP

Background and Aims

Unsedated transnasal endoscopy (uTNE) was developed in the 1990s but has not gained widespread use. We present our experience with uTNE at a tertiary referral center in India.

Methods

A retrospective analysis was conducted with prospectively collected data of patients who underwent uTNE for predominantly diagnostic EGD at our center between January 2014 and September 2017. Patients received 2% lidocaine spray over the back of the throat, xylometazoline, and 10% lidocaine sprays in the nostril 10 minutes before uTNE. Successful completion of TNE without the need for sedation, conversion to peroral EGD (PO-EGD), epistaxis, and tolerance of the procedure compared with prior PO-EGD were the outcomes of interest. Unsedated PO-EGD (uPO-EGD) is the standard of care at our center. Logistic regression was used for analysis.

Results

Successful completion of uTNE (414/440 patients) was significantly associated with male sex (odds ratio [OR], 2.67; 95% confidence interval [CI], 1.16-6.14). Conversion to PO-EGD (4.32%) was significantly associated with age (OR, .96; 95% CI, .94-.99), year of endoscopy (OR, .44; 95% CI, .24-.82), and male sex (OR, .33; 95% CI, .12-.89) in multivariable analysis. Rate of epistaxis was 6.76%, and 93.09% of patients (229/246) tolerated uTNE better than prior PO-EGD. There were no life-threatening or major adverse events requiring prolonged hospitalization.

Conclusions

uTNE should be offered as an alternative to uPO-EGD for diagnostic EGD. Studies comparing tolerance and adverse events of uTNE with those of sedated PO-EGD are required given the costs and potential adverse events associated with sedation.

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引用次数: 0

Historical innovation in education: the development of an endoscopy technician training program and a novel professional pathway for endoscopy assistants

iGIE

Pub Date : 2024-12-01 DOI: 10.1016/j.igie.2024.10.005

Gottumukkala S. Raju MD, FASGE, Phillip S. Ge MD, FASGE

引用次数: 0

Transgastric biliary drainage through a biliodigestive efferent loop using a lumen-apposing metal stent

iGIE

Pub Date : 2024-12-01 DOI: 10.1016/j.igie.2024.08.004

Karsten Büringer Dr med , Stefano Fusco Dr med , Dörte Wichmann PD Dr med , Ulrike Schempf Dr med , Pavlos Missios Dr rer med , Christoph Stein-Thöringer Prof Dr med , Dominik Zinsser Dr med , Nisar P. Malek Prof Dr med , Christoph R. Werner PD Dr med

引用次数: 0

Preliminary validation of the virtual bariatric endoscopic simulator 虚拟减肥内窥镜模拟器的初步验证。

iGIE

Pub Date : 2024-12-01 DOI: 10.1016/j.igie.2024.08.003

Utku Erden BSc , Mark A. Gromski MD , Suvranu De ScD , Doga Demirel PhD

Background and Aims

Obesity is a global health concern. Bariatric surgery offers reliably effective and durable weight loss and improvements of other comorbid conditions. However, the accessibility of bariatric surgery remains limited. Minimally invasive techniques, including endoscopic sleeve gastroplasty (ESG), have emerged to bridge this gap. To effectively complete the ESG procedure, one requires skill in multiple complex interventional endoscopic maneuvers. This requisite expertise poses challenges for training in this burgeoning field.

Methods

We designed the virtual bariatric endoscopic (ViBE) simulator software to mimic the ESG procedure accurately. The ViBE simulator features a detailed simulation of an endoscope equipped with an endoscopic suturing system and a high-resolution stomach, enhancing the visualization of procedural details. Furthermore, the simulator incorporates performance metrics using a reverse scoring system to evaluate users’ proficiency in tasks such as argon plasma coagulation (APC) marking, suturing, and cinching. To validate the simulator, we conducted a study involving experts and novices at the Indiana University School of Medicine, where participants engaged with the simulation environment in a series of training tasks.

Results

Twelve participants, comprising 5 experts and 7 novices, were asked to complete a post-training questionnaire featuring 7 items, rating each on a Likert scale. The APC task realism received the highest score, averaging 3.83. The usefulness of improving endoscopic technical skills averaged 3.08, with the realism of cinching the knot and suturing tasks receiving scores of 3.17 and 3.25, respectively, suggesting a generally positive reception. Automated performance metrics indicated that, on average, experts outperformed novices by 10.83 points.

Conclusions

The ViBE simulation strives to replicate the steps of the ESG within a virtual environment. Our primary objective in developing this simulator was to enhance the learning curve for endoscopic suturing and ESG techniques, thereby safely extending these skills to a broader patient base.

背景和目的：肥胖症是全球关注的健康问题。减肥手术能可靠、有效、持久地减轻体重，并改善其他并发症。然而，减肥手术的可及性仍然有限。包括内镜袖带胃成形术（ESG）在内的微创技术的出现弥补了这一差距。要有效完成 ESG 手术，需要熟练掌握多种复杂的介入性内窥镜操作。这些必要的专业知识给这一新兴领域的培训带来了挑战：方法：我们设计了虚拟减肥内窥镜（ViBE）模拟器软件，以准确模拟 ESG 手术。ViBE 模拟器详细模拟了配备内窥镜缝合系统和高分辨率胃的内窥镜，增强了手术细节的可视化。此外，该模拟器还采用了反向评分系统来评估用户在氩等离子凝固（APC）标记、缝合和夹紧等任务中的熟练程度。为了验证该模拟器，我们在印第安纳大学医学院进行了一项由专家和新手参与的研究，参与者在模拟环境中参与了一系列培训任务：由 5 名专家和 7 名新手组成的 12 名参与者被要求完成一份培训后调查问卷，其中包括 7 个项目，每个项目均采用李克特量表评分。APC任务真实性得分最高，平均为3.83分。提高内窥镜技术技能的实用性平均得分为 3.08 分，而收紧绳结和缝合任务的逼真性分别得分为 3.17 分和 3.25 分，这表明学员们普遍反映良好。自动性能指标显示，专家平均比新手高出 10.83 分：ViBE 模拟器致力于在虚拟环境中复制 ESG 的步骤。我们开发该模拟器的主要目的是提高内窥镜缝合和 ESG 技术的学习曲线，从而将这些技能安全地推广到更广泛的患者群体中。

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引用次数: 0

An unexpected finding after endoscopic management for dysplastic Barrett’s esophagus

iGIE

Pub Date : 2024-12-01 DOI: 10.1016/j.igie.2024.09.006

Rajit Aziz Gilhotra MBBS (Hons), FRACP , Angad Walia BSc , Wei Xiong MD, FRCPC , Roberto Trasolini MD, FRCPC , Neal Shahidi MD, FRCPC, PhD

引用次数: 0

Esophageal varices detection and bleeding risk assessment with artificial intelligence: a systematic review

iGIE

Pub Date : 2024-12-01 DOI: 10.1016/j.igie.2024.10.001

Rahul Ramakrishnan BS , Kevin Kuang BA , Vijay Rajput MD , Mark Benson MD , Sachin Mohan MD, PhD

Background and Aims

Esophageal varices (EVs) result from portal hypertension in decompensated liver disease secondary to liver cirrhosis. Diagnosis and grading is done using EGD and mucosal examination. However, interobserver differences may occur when analyzing EGD results. Recent application of artificial intelligence (AI) algorithms yielded mixed results for varices detection and bleeding risk estimation. The capabilities of AI in the detection and grading of EVs need to be evaluated.

Methods

A systematic review was conducted with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. PubMed, EMBASE, and MEDLINE were searched from January 1956 to July 2023. Data were manually identified and extracted by reviewers, assessing outcomes of AI tools used, EV detection accuracies, and bleeding risk prediction accuracies. Average accuracies were derived from result sections or manual calculations.

Results

Sixteen studies with 26,170 patients and 19 AI systems and algorithms were included after a review of 1670 studies. The most common AI systems were artificial neural network and random forest. The categorical boosting machine learning (ML) algorithm was most accurate for prediction of bleeding (100%), whereas the radiomic model ML tool was the least accurate for EV detection (49%). Overall, AI had an average EV detection accuracy of 78.67% and variceal bleed accuracy of 83.2%.

Conclusions

AI could provide an accessible interface for EV prediction and estimation of bleeding risk. Limitations include the dependence on a single dataset for efficacy, assessment with specific AI tools, and potential overinterpretation of broad geographic variances. Newer algorithms should have larger datasets with reproducible validity to strengthen the predictive value in clinical practice.

{"title":"Esophageal varices detection and bleeding risk assessment with artificial intelligence: a systematic review","authors":"Rahul Ramakrishnan BS , Kevin Kuang BA , Vijay Rajput MD , Mark Benson MD , Sachin Mohan MD, PhD","doi":"10.1016/j.igie.2024.10.001","DOIUrl":"10.1016/j.igie.2024.10.001","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Esophageal varices (EVs) result from portal hypertension in decompensated liver disease secondary to liver cirrhosis. Diagnosis and grading is done using EGD and mucosal examination. However, interobserver differences may occur when analyzing EGD results. Recent application of artificial intelligence (AI) algorithms yielded mixed results for varices detection and bleeding risk estimation. The capabilities of AI in the detection and grading of EVs need to be evaluated.</div></div><div><h3>Methods</h3><div>A systematic review was conducted with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. PubMed, EMBASE, and MEDLINE were searched from January 1956 to July 2023. Data were manually identified and extracted by reviewers, assessing outcomes of AI tools used, EV detection accuracies, and bleeding risk prediction accuracies. Average accuracies were derived from result sections or manual calculations.</div></div><div><h3>Results</h3><div>Sixteen studies with 26,170 patients and 19 AI systems and algorithms were included after a review of 1670 studies. The most common AI systems were artificial neural network and random forest. The categorical boosting machine learning (ML) algorithm was most accurate for prediction of bleeding (100%), whereas the radiomic model ML tool was the least accurate for EV detection (49%). Overall, AI had an average EV detection accuracy of 78.67% and variceal bleed accuracy of 83.2%.</div></div><div><h3>Conclusions</h3><div>AI could provide an accessible interface for EV prediction and estimation of bleeding risk. Limitations include the dependence on a single dataset for efficacy, assessment with specific AI tools, and potential overinterpretation of broad geographic variances. Newer algorithms should have larger datasets with reproducible validity to strengthen the predictive value in clinical practice.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 478-486"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical safety of a novel over-the-scope gastroduodenal full-thickness resection device for the treatment of upper GI tract lesions: a multicenter experience

iGIE

Pub Date : 2024-12-01 DOI: 10.1016/j.igie.2024.09.004

Alyssa Y. Choi MD , Peter H. Nguyen MD , Jaehyun Kim MD , Julie Yang MD , Sherif A. Andrawes MD , Jean Chalhoub MD , Anastasia Chahine MD , Andrew Q. Giap MD , David P. Lee MD , Kenneth H. Park MD , Quin Y. Liu MD , Srinivas Gaddam MD , Kendrick Che DO , Michael Lajin MD , Wasseem Skef MD , Amirali Tavangar MD , John J. Kim MD , Jason B. Samarasena MD, MBA

Background and Aims

A novel gastroduodenal full-thickness resection device system was developed for resection of upper GI tract lesions. In this study, we evaluated the efficacy and safety of the gastroduodenal full-thickness resection device system.

Methods

Consecutive patients who received endoscopic resection of upper GI tract lesions from June 2020 to August 2022 using a gastroduodenal full-thickness resection device were evaluated from 8 U.S. centers. Primary endpoints were technical success and R0 resection. Secondary endpoints were en bloc resection, residual lesions at follow-up endoscopy, and immediate or delayed adverse events.

Results

Forty-four patients (mean age, 60.9 ± 15.8 years) received 45 resections for gastric (35, 80%) and duodenal (9, 20%) lesions. Thirty-four lesions (77%) were subepithelial and 10 (23%) were epithelial lesions. Technical success and en bloc resection were achieved in 43 (96%) and 41 (91%) patients, respectively. Furthermore, R0 resection was achieved in 32 patients (71%), including 24 of 35 (69%) with neoplastic lesions. Pathologic diagnosis included neuroendocrine tumor in 14 patients (32%), GI stromal tumor in 10 (23%), and gastric cancer or high-grade dysplasia in 7 (16%). Minor immediate and delayed bleeding occurred in 17 (38%) and 2 (4%) patients, respectively. One patient had delayed perforation, managed conservatively. On follow-up, 19 of 21 patients (90%) had no residual lesion.

Conclusions

In this multicenter series, the gastroduodenal full-thickness resection device demonstrated high rates of technical success and acceptable rate of R0 resection. Immediate minor bleeding was common, whereas serious adverse events were rare. This gastroduodenal full-thickness resection device should be considered in patients with gastroduodenal subepithelial lesions as an alternative to long-term surveillance.

{"title":"Clinical safety of a novel over-the-scope gastroduodenal full-thickness resection device for the treatment of upper GI tract lesions: a multicenter experience","authors":"Alyssa Y. Choi MD , Peter H. Nguyen MD , Jaehyun Kim MD , Julie Yang MD , Sherif A. Andrawes MD , Jean Chalhoub MD , Anastasia Chahine MD , Andrew Q. Giap MD , David P. Lee MD , Kenneth H. Park MD , Quin Y. Liu MD , Srinivas Gaddam MD , Kendrick Che DO , Michael Lajin MD , Wasseem Skef MD , Amirali Tavangar MD , John J. Kim MD , Jason B. Samarasena MD, MBA","doi":"10.1016/j.igie.2024.09.004","DOIUrl":"10.1016/j.igie.2024.09.004","url":null,"abstract":"<div><h3>Background and Aims</h3><div>A novel gastroduodenal full-thickness resection device system was developed for resection of upper GI tract lesions. In this study, we evaluated the efficacy and safety of the gastroduodenal full-thickness resection device system.</div></div><div><h3>Methods</h3><div>Consecutive patients who received endoscopic resection of upper GI tract lesions from June 2020 to August 2022 using a gastroduodenal full-thickness resection device were evaluated from 8 U.S. centers. Primary endpoints were technical success and R0 resection. Secondary endpoints were en bloc resection, residual lesions at follow-up endoscopy, and immediate or delayed adverse events.</div></div><div><h3>Results</h3><div>Forty-four patients (mean age, 60.9 ± 15.8 years) received 45 resections for gastric (35, 80%) and duodenal (9, 20%) lesions. Thirty-four lesions (77%) were subepithelial and 10 (23%) were epithelial lesions. Technical success and en bloc resection were achieved in 43 (96%) and 41 (91%) patients, respectively. Furthermore, R0 resection was achieved in 32 patients (71%), including 24 of 35 (69%) with neoplastic lesions. Pathologic diagnosis included neuroendocrine tumor in 14 patients (32%), GI stromal tumor in 10 (23%), and gastric cancer or high-grade dysplasia in 7 (16%). Minor immediate and delayed bleeding occurred in 17 (38%) and 2 (4%) patients, respectively. One patient had delayed perforation, managed conservatively. On follow-up, 19 of 21 patients (90%) had no residual lesion.</div></div><div><h3>Conclusions</h3><div>In this multicenter series, the gastroduodenal full-thickness resection device demonstrated high rates of technical success and acceptable rate of R0 resection. Immediate minor bleeding was common, whereas serious adverse events were rare. This gastroduodenal full-thickness resection device should be considered in patients with gastroduodenal subepithelial lesions as an alternative to long-term surveillance.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 490-500"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Novel hemostatic adhesive powder to prevent delayed bleeding after endoscopic submucosal dissection in the GI tract: first U.S. multicenter experience

iGIE

Pub Date : 2024-12-01 DOI: 10.1016/j.igie.2024.10.002

Dennis Yang MD , Amit Bhatt MD , Maham Hayat MD , Muhammad K. Hasan MD , Hiroyuki Aihara MD, PhD

Background and Aims

Delayed bleeding (DB) is a common adverse event after endoscopic submucosal dissection (ESD). We evaluated a novel hemostatic powder (UI-EWD, Nexpowder; Medtronic, Minneapolis, Minn, USA) to prevent DB after ESD.

Methods

This was a multicenter retrospective analysis of ESDs performed between January 2023 and March 2024 in which UI-EWD was applied to prevent DB. Cases in which endoscopic closure of the post-ESD mucosal defect was performed were excluded. DB was defined as a bleeding event requiring hospitalization, blood transfusion, or any intervention within 30 days after the procedure. Technical success of UI-EWD was defined as successful delivery and application of the hemostatic powder over the entire mucosal defect.

Results

Eighty-three patients (median age, 66 years) underwent ESD in the esophagus (n = 18), stomach (n = 15), colon (n = 38), and rectum (n = 12). The median lesion size was 50 mm (interquartile range, 41-70 mm). UI-EWD was successfully applied in all defects, although in 2 cases (2.4%) a second delivery catheter had to be used to complete the procedure. DB occurred in 3 patients (3.6%): 2 after gastric ESD and 1 after colonic ESD within 24 hours of the index procedure. None required intervention on repeat endoscopy. There were no cases of perforation. En bloc and R0 resection rates were 96.2% and 88.7%, respectively.

Conclusions

UI-EWD can be easily applied to mucosal defects after ESD throughout the GI tract. Initial data from this multicenter study demonstrate that the use of UI-EWD was associated with a relatively low rate of DB after ESD. Additional comparative studies are needed to corroborate these preliminary findings.

{"title":"Novel hemostatic adhesive powder to prevent delayed bleeding after endoscopic submucosal dissection in the GI tract: first U.S. multicenter experience","authors":"Dennis Yang MD , Amit Bhatt MD , Maham Hayat MD , Muhammad K. Hasan MD , Hiroyuki Aihara MD, PhD","doi":"10.1016/j.igie.2024.10.002","DOIUrl":"10.1016/j.igie.2024.10.002","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Delayed bleeding (DB) is a common adverse event after endoscopic submucosal dissection (ESD). We evaluated a novel hemostatic powder (UI-EWD, Nexpowder; Medtronic, Minneapolis, Minn, USA) to prevent DB after ESD.</div></div><div><h3>Methods</h3><div>This was a multicenter retrospective analysis of ESDs performed between January 2023 and March 2024 in which UI-EWD was applied to prevent DB. Cases in which endoscopic closure of the post-ESD mucosal defect was performed were excluded. DB was defined as a bleeding event requiring hospitalization, blood transfusion, or any intervention within 30 days after the procedure. Technical success of UI-EWD was defined as successful delivery and application of the hemostatic powder over the entire mucosal defect.</div></div><div><h3>Results</h3><div>Eighty-three patients (median age, 66 years) underwent ESD in the esophagus (n = 18), stomach (n = 15), colon (n = 38), and rectum (n = 12). The median lesion size was 50 mm (interquartile range, 41-70 mm). UI-EWD was successfully applied in all defects, although in 2 cases (2.4%) a second delivery catheter had to be used to complete the procedure. DB occurred in 3 patients (3.6%): 2 after gastric ESD and 1 after colonic ESD within 24 hours of the index procedure. None required intervention on repeat endoscopy. There were no cases of perforation. En bloc and R0 resection rates were 96.2% and 88.7%, respectively.</div></div><div><h3>Conclusions</h3><div>UI-EWD can be easily applied to mucosal defects after ESD throughout the GI tract. Initial data from this multicenter study demonstrate that the use of UI-EWD was associated with a relatively low rate of DB after ESD. Additional comparative studies are needed to corroborate these preliminary findings.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 501-506"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Expert commentary: unveiling a rare adverse event 专家评论：揭开罕见不良事件的面纱

iGIE

Pub Date : 2024-09-01 DOI: 10.1016/j.igie.2024.06.007

Diogo Turiani Hourneaux de Moura MD, MSc, PhD, Post-PhD , Daniel Szvarca MD

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