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Outcomes of Endoscopic Resection for Colorectal Polyps With High-Grade Dysplasia or Intramucosal Cancer 内镜下切除结直肠息肉伴高级别不典型增生或粘膜内癌的疗效
IF 2.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1016/j.tige.2023.01.003
Sonmoon Mohapatra , Erik Almazan , Paris Charilaou , Luisa Recinos , Mehak Bassi , Arkady Broder , Kevan Salimian , Mouen A. Khashab , Saowanee Ngamruengphong

Background and Aims

Little is known about the outcomes of endoscopic resection (ER) for patients with colorectal adenomas (CRAs) with high-grade dysplasia (HGD) or intramucosal cancer (IMCA). This study aimed to estimate the rate of local/malignant recurrence, identify the predictive factors for local recurrence (LR), and evaluate the treatment outcomes of recurrence after ER for HGD/IMCA.

Methods

A retrospective review was performed to identify patients who underwent ER for HGD/IMCA in 2 academic medical centers. Risk factors for LR were determined by Cox regression analysis.

Results

Overall, 188 lesions with HGD/IMCA were included; 61 lesions were removed by en-bloc ER (e-ER), whereas 127 lesions were removed in a piecemeal ER (p-ER). The mean lesion size was 20.3 mm. Of the 125 patients who underwent follow-up, local adenoma recurrence occurred in 31 (23%), and malignant recurrence occurred in 2 (1.6%) patients at a median follow-up of 16 months. HGD/IMCA ≥ 4 cm removed by p-ER have the greatest hazard ratio (HR = 21.5; 95% CI 2.5-180.5; P = 0.005) for LR, compared with the HGD/IMCA < 4 cm removed by e-ER. Surgery was performed in 3.2% of patients after a complete ER, all after p-ER. Of all patients who had LR, 22.6% (7/31 patients) had recurrent adenomas despite repeat ER attempts after a mean of 1.9 ± 0.79 procedures from the index ER.

Conclusion

Our study demonstrates a high rate of LR (23%) after ER of CRAs with HGD/IMCA with a rate of malignant recurrence of 1.6%, especially after p-ER. Thus, e-ER should be preferred for these lesions whenever technically feasible.

背景和目的对于患有高度发育不良(HGD)或粘膜内癌症(IMCA)的结直肠腺瘤(CRA)患者,内窥镜切除术(ER)的结果知之甚少。本研究旨在估计局部/恶性复发率,确定局部复发(LR)的预测因素,并评估HGD/IMCA急诊后复发的治疗结果。通过Cox回归分析确定LR的危险因素。结果共纳入188个HGD/IMCA病变;整体ER(e-ER)切除61个病灶,而零碎ER(p-ER)切除127个病灶。平均病变大小为20.3 mm。在125名接受随访的患者中,31名(23%)患者出现局部腺瘤复发,2名(1.6%)患者出现恶性复发,中位随访时间为16个月。p-ER去除≥4cm的HGD/IMCA对LR的危险比最大(HR=21.5;95%CI 2.5-180.5;p=0.005),而HGD/IMCA<;通过e-ER移除4cm。3.2%的患者在完全ER后进行了手术,全部在p-ER后进行。在所有患有LR的患者中,22.6%(7/31名患者)有复发性腺瘤,尽管在ER指数平均1.9±0.79次手术后重复进行ER尝试。结论我们的研究表明,患有HGD/IMCA的CRAs在ER后LR发生率很高(23%),恶性复发率为1.6%,尤其是在p-ER后。因此,在技术可行的情况下,e-ER应优先用于这些病变。
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引用次数: 0
Mucosal Impedance Spectroscopy for Objective Real-time Assessment of Mucosal Health 用于客观实时评估粘膜健康的粘膜阻抗谱
IF 2.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1016/j.tige.2023.03.007
Priyanka Arora , Jaspreet Singh , Anuraag Jena , Surinder Kumar , Viren Sardana , Siddhartha Sarkar , Lileswar Kaman , Arunanshu Behera , Divya Dahiya , Ritambhra Nada , Cherring Tandup , H.S. Jatana , Usha Dutta

Background and Aims

There is a need for a real-time objective tool to assess the mucosal health of the gastrointestinal (GI) tract during endoscopy. Our aim was to develop, design, and validate a low-cost mucosal impedance (MI) device and determine its role in differentiating diseased mucosa from normal mucosa.

Methods

A biocompatible catheter was designed and developed after multiple iterations. It was validated with a commercially available catheter and histopathological analysis in a blinded manner. Patients undergoing resection of the GI tract were recruited after consent, and the resected specimens were analyzed ex vivo for MI within 10 minutes of resection. An average of 3 MI readings of the visually diseased segment and adjacent normal segment were analyzed. MI values of diseased and non-diseased mucosa were compared.

Results

The in-house catheter was validated with a commercially available impedance measuring device. It showed a high degree of positive correlation (rho = 0.616; P < 0.001). Two hundred and thirty-two patients (age 46 ± 15 years; 68% females) (180 inflammatory and 52 malignant pathology) who were undergoing abdominal surgery were enrolled. The median impedance value of diseased segments was significantly lower than that of the adjacent normal segments of gut in 130 paired samples [1832(727)Ω vs 2604(1295)Ω; P < 0.001]. The MI value of segments containing malignant tissue (n = 50) and inflamed tissue (n = 80) was significantly lower than the MI value of adjacent normal segments of the GI tract [1880(977)Ω vs 2583(1431)Ω; P < 0.001 and 1787(557)Ω vs 2515(1244)Ω; P < 0.001, respectively]. There was a 24% reduction in visually diseased segments [median reduction 712(661)Ω] from adjacent normal segments. A biocompatible endoscopic catheter (3-mm diameter) has been developed and tested in 3 patients and was found to differentiate diseased from normal mucosa.

Conclusion

Impedance spectroscopy is an effective real-time, simple, objective tool to differentiate diseased gut mucosa from healthy mucosa.

背景和目的需要一种实时客观的工具来评估内窥镜检查期间胃肠道的粘膜健康状况。我们的目的是开发、设计和验证一种低成本的粘膜阻抗(MI)设备,并确定其在区分病变粘膜和正常粘膜中的作用。方法经过多次迭代,设计并开发了一种生物相容性导管。通过市售导管和盲法组织病理学分析对其进行了验证。在同意后招募接受胃肠道切除的患者,并在切除后10分钟内对切除的标本进行MI的离体分析。分析视觉病变节段和邻近正常节段的平均3 MI读数。比较病变和非病变粘膜的MI值。结果使用市售阻抗测量装置对内部导管进行了验证。它显示出高度的正相关(rho=0.616;P<;0.001)。232名正在接受腹部手术的患者(年龄46±15岁;68%的女性)(180名炎症和52名恶性病理)被纳入。在130个配对样本中,病变节段的阻抗中值显著低于相邻正常肠段的阻抗值[1832(727)Ωvs 2604(1295)Ω;P<;0.001]。含有恶性组织(n=50)和炎症组织(n=80)的节段的MI值显着低于相邻正常胃肠道节段的心肌梗死值[1880(977)Ωvs2583(1431)Ω;P<;0.001和1787(557)Ω对2515(1244)Ω;P<;0.001)。视觉病变节段与相邻正常节段相比减少了24%[中值减少712(661)Ω]。开发了一种生物相容性内窥镜导管(直径3毫米),并在3名患者身上进行了测试,发现它可以区分病变粘膜和正常粘膜。结论阻抗谱是一种实时、简便、客观、有效的鉴别病变肠黏膜和健康肠黏膜的方法。
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引用次数: 0
Initial Multicenter Experience of Traction Wire Endoscopic Submucosal Dissection 牵引丝内镜粘膜下剥离术的多中心初步经验
IF 2.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1016/j.tige.2022.10.002
Abel Joseph , Michel Kahaleh , Andrew A. Li , Gregory B. Haber , Prashant Kedia , Mai Ego Makiguchi , Neil R. Sharma , Joo Ha Hwang , Amitabh Chak , Ahmad M. Al-Taee , David Braun , Shaffer Mok , Neal A. Mehta , Emre Gorgun , John Vargo , Seiichiro Abe , Yutaka Saito , Tyler Stevens , Amit Bhatt

Background and Aims

Endoscopic submucosal dissection (ESD) is a technically challenging and time-consuming procedure. A major limitation of ESD is the lack of a “second hand” to provide traction. We have developed a novel retraction device, a traction wire (TW), for ESD. This study was conducted to assess the efficacy, safety, and efficiency of TW-ESD.

Methods

We initially evaluated TW-ESD in a randomized live pig study. After the device was approved for clinical use, we used it in patients undergoing ESD at 8 academic centers in the United States and Japan. Data on demographics, procedural performance, histopathology, and clinical follow-up were collected and analyzed retrospectively.

Results

Porcine study: In total, 12 ESDs were performed in random order in 3 live pigs. ESDs performed with TW had significantly shorter submucosal dissection time (7.0 ± 1.9 minutes vs 18.3 ± 3.4 minutes; P < 0.001) and shorter total ESD time (21.5 ± 4.1 minutes vs 29.5 ± 7.7 minutes; P= 0.049). TW was successfully deployed in all 103 study patients. The median device deployment time was 2 minutes (2, 3.0), and the median procedure time was 100.5 (65.50, 175.75) minutes. En-bloc and R0 resection rates were 98.1% (101/103) and 90.29% (93/103), respectively. The median ease of deployment and retrieval of the device on a 100-mm visual analog scale was 100 (80, 100). The median degree to which the device improved ease of procedure was 90 (77.5, 100). No adverse events related to the TW were seen.

Conclusion

The TW device was safe and efficient to use in ESD.

背景和目的内镜黏膜下剥离术(ESD)是一项技术上具有挑战性且耗时的手术。ESD的一个主要限制是缺乏提供牵引力的“二手车”。我们已经开发了一种新型的回缩装置,牵引线(TW),用于ESD。本研究旨在评估TW-ESD的疗效、安全性和有效性。方法我们在一项随机的生猪研究中初步评估了TW-ESD。在该设备被批准用于临床后,我们在美国和日本的8个学术中心将其用于ESD患者。对人口统计学、手术表现、组织病理学和临床随访的数据进行回顾性收集和分析。结果猪实验:共对3头生猪随机进行了12次ESD。使用TW进行的ESD具有显著更短的粘膜下剥离时间(7.0±1.9分钟vs 18.3±3.4分钟;P<;0.001)和更短的ESD总时间(21.5±4.1分钟vs 29.5±7.7分钟;P=0.049)。在所有103名研究患者中成功部署了TW。装置部署时间中位数为2分钟(2.30),手术时间中位数为100.5分钟(65.50175.75)。整体切除率和R0切除率分别为98.1%(101/103)和90.29%(93/103)。在100毫米视觉模拟量表上,该装置的部署和收回的中位容易程度为100(80100)。该装置改善手术简易性的中位程度为90(77.5100)。未发现与TW相关的不良事件。结论TW装置用于ESD是安全有效的。
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引用次数: 0
Strategies to Curb the Increasing Burden of Early Onset Colorectal Cancer 抑制早发性结直肠癌日益增加的负担的策略
IF 2.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1016/j.tige.2023.01.008
Timothy Yen , Theodore R. Levin , Swati G. Patel

The incidence of early onset colorectal cancer (EoCRC), defined as colorectal cancer (CRC) in patients under age 50, has been increasing in the United States. This is due to a birth cohort effect in which the younger generation has experienced an accelerating rise in EoCRC for reasons currently unknown, although epidemiologic research points to several traditional and emerging generation-specific risk factors. There are several racial/ethnic and geographic differences in the presentation of EoCRC with disparate outcomes. A subset of EoCRC patients have a familial or hereditary cause of EoCRC, although the etiology for most EoCRC remains to be discovered. Our current approach to prevention and early detection includes early screening for familial CRC, germline genetic testing for all cases of EoCRC, triage of alarm symptoms with prompt evaluation of red flag signs and symptoms (such as hematochezia, iron deficiency anemia, and unexplained weight loss), offering a menu of average-risk screening options to those age 45 and older, and performing outreach/navigation to improve opportunistic screening uptake. Unfortunately, full actualization of these approaches remains suboptimal, and the increasing burden of EoCRC demands immediate action. Opportunities to improve prevention and early detection of EoCRC include initiating organized screening approaches through leveraging the electronic health record, centralization of care in medical homes, outreach using blockchain or social media technology, and biotechnological innovations in diagnosis and risk stratification.

早发癌症(EoCRC),即50岁以下患者的癌症(CRC)的发病率在美国一直在增加。这是由于出生队列效应,即年轻一代由于目前未知的原因而经历了EoCRC的加速上升,尽管流行病学研究指出了一些传统的和新兴一代特有的风险因素。EoCRC的表现存在几个种族/民族和地理差异,结果各不相同。尽管大多数EoCRC的病因仍有待发现,但一部分EoCRC患者有家族或遗传原因。我们目前的预防和早期检测方法包括家族性CRC的早期筛查,所有EoCRC病例的种系基因检测,警报症状的分类,并及时评估危险信号和症状(如便血、缺铁性贫血和不明原因的体重减轻),为45岁及以上的人提供平均风险筛查选项菜单,以及进行外联/导航以提高机会筛查的接受率。不幸的是,这些方法的全面实施仍然不理想,EoCRC日益增加的负担需要立即采取行动。改善EoCRC预防和早期检测的机会包括通过利用电子健康记录、医疗院的集中护理、使用区块链或社交媒体技术的外联以及诊断和风险分层方面的生物技术创新,启动有组织的筛查方法。
{"title":"Strategies to Curb the Increasing Burden of Early Onset Colorectal Cancer","authors":"Timothy Yen ,&nbsp;Theodore R. Levin ,&nbsp;Swati G. Patel","doi":"10.1016/j.tige.2023.01.008","DOIUrl":"https://doi.org/10.1016/j.tige.2023.01.008","url":null,"abstract":"<div><p><span>The incidence of early onset colorectal cancer (EoCRC), defined as colorectal cancer (CRC) in patients<span> under age 50, has been increasing in the United States. This is due to a birth </span></span>cohort effect<span><span> in which the younger generation has experienced an accelerating rise in EoCRC for reasons currently unknown, although epidemiologic research points to several traditional and emerging generation-specific risk factors. There are several racial/ethnic and geographic differences in the presentation of EoCRC with disparate outcomes. A subset of EoCRC patients have a familial or hereditary cause of EoCRC, although the etiology for most EoCRC remains to be discovered. Our current approach to prevention and early detection includes early screening for familial CRC<span>, germline genetic testing for all cases of EoCRC, triage of alarm symptoms with prompt evaluation of red flag signs and symptoms (such as hematochezia, </span></span>iron deficiency anemia<span><span>, and unexplained weight loss), offering a menu of average-risk screening options to those age 45 and older, and performing outreach/navigation to improve opportunistic screening uptake. Unfortunately, full actualization of these approaches remains suboptimal, and the increasing burden of EoCRC demands immediate action. Opportunities to improve prevention and early detection of EoCRC include initiating organized screening approaches through leveraging the electronic health record, centralization of care in medical homes, outreach using blockchain or social media technology, and biotechnological innovations in diagnosis and </span>risk stratification.</span></span></p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 3","pages":"Pages 246-258"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49750016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Combined Endoscopic-Percutaneous Rendezvous for Biliary Continuity for Restoration of Completely Transected Common Bile Duct 内镜-经皮联合汇合处用于胆总管全截断修复的胆道连续性
IF 2.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1016/j.tige.2022.11.001
Arunkumar Krishnan, Yousaf Hadi, Aslam Syed, Sardar Momin Shah-Khan, Mohamed Zitun, Shailendra Singh, Shyam Thakkar
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引用次数: 0
Preface: Colorectal Cancer Screening Part II 前言:结直肠癌筛查第二部分
IF 2.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1016/j.tige.2023.07.002
Aasma Shaukat
{"title":"Preface: Colorectal Cancer Screening Part II","authors":"Aasma Shaukat","doi":"10.1016/j.tige.2023.07.002","DOIUrl":"https://doi.org/10.1016/j.tige.2023.07.002","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 4","pages":"Page 301"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49758933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Improving Dysplasia Detection in Barrett's Esophagus 改善Barrett食管异常增生检出率
IF 2.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1016/j.tige.2023.01.002
Erik A. Holzwanger , Alex Y. Liu , Prasad G. Iyer

The incidence of Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) continues to increase in Western countries, and EAC continues to have an overall 5-year survival rate of less than 20%. This is predominantly due to most EAC cases being diagnosed at advanced stages, after the onset of alarm symptoms. The rationale behind endoscopic surveillance of BE follows the paradigm that metaplasia (BE) progresses to EAC via the development of low- (LGD) and then high-grade dysplasia (HGD). Hence, endoscopic surveillance is recommended to enable early detection of dysplasia and EAC. Numerous endoscopic eradication therapy (EET) modalities, such as radiofrequency ablation (RFA), cryotherapy, and endoscopic resection, enable effective treatment of dysplasia and early-stage EAC. Indeed, randomized trials have conclusively shown that endoscopic treatment of BE-HGD and BE-LGD with RFA reduces progression to EAC. Additionally, EET effectively treats early-stage EAC.

Barrett食管(BE)和食管腺癌(EAC)的发病率在西方国家持续增加,EAC的5年生存率仍低于20%。这主要是由于大多数EAC病例是在出现警报症状后的晚期诊断的。BE内镜监测的基本原理遵循这样一种范式,即化生(BE)通过低(LGD)和高级别发育不良(HGD)发展为EAC。因此,建议进行内镜监测,以便早期发现发育不良和EAC。许多内镜根除治疗(EET)方式,如射频消融(RFA)、冷冻治疗和内镜切除,能够有效治疗发育不良和早期EAC。事实上,随机试验已经最终表明,内镜下用RFA治疗BE-HGD和BE-LGD可以减少EAC的进展。此外,EET有效治疗早期EAC。
{"title":"Improving Dysplasia Detection in Barrett's Esophagus","authors":"Erik A. Holzwanger ,&nbsp;Alex Y. Liu ,&nbsp;Prasad G. Iyer","doi":"10.1016/j.tige.2023.01.002","DOIUrl":"https://doi.org/10.1016/j.tige.2023.01.002","url":null,"abstract":"<div><p><span><span>The incidence of Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) continues to increase in Western countries, and </span>EAC<span><span> continues to have an overall 5-year survival rate of less than 20%. This is predominantly due to most EAC cases being diagnosed at advanced stages, after the onset of alarm symptoms. The rationale behind endoscopic surveillance of BE follows the paradigm that metaplasia (BE) progresses to EAC via the development of low- (LGD) and then high-grade </span>dysplasia<span> (HGD). Hence, endoscopic surveillance is recommended to enable early detection of dysplasia and EAC. Numerous endoscopic eradication therapy (EET) modalities, such as </span></span></span>radiofrequency ablation<span> (RFA), cryotherapy<span>, and endoscopic resection<span>, enable effective treatment of dysplasia and early-stage EAC. Indeed, randomized trials have conclusively shown that endoscopic treatment of BE-HGD and BE-LGD with RFA reduces progression to EAC. Additionally, EET effectively treats early-stage EAC.</span></span></span></p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 2","pages":"Pages 157-166"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49765371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Distal Cap-assisted Endoscopic Mucosal Resection for Non-lifting Colorectal Polyps: An International, Multicenter Study 远端帽辅助内镜下粘膜切除术治疗非拔除性结直肠息肉:一项国际多中心研究
IF 2.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1016/j.tige.2023.03.009
Scott R. Douglas , Douglas K. Rex , Alessandro Repici , Melissa Kelly , J. Wes Heinle , Marco Spadaccini , Matthew T. Moyer

Background and Aims

Submucosal fibrosis is a commonly encountered problem associated with complex polyps referred for endoscopic mucosal resection (EMR). Previous biopsies, submucosal tattoo injection, and previous unsuccessful attempts at polyp resection have all been shown to induce submucosal fibrosis, which makes subsequent EMR more difficult and increases the risk of recurrence.

Methods

We conducted a multicenter, international, retrospective study of 61 distal cap-assisted endoscopic mucosal resection (EMR-DC) cases done for the indication of a non-lifting colorectal lesion occurring after a previous biopsy, tattoo, or attempted resection at 3 tertiary referral centers.

Results

EMR-DC was preceded by attempted polypectomy or EMR in 88.5% of cases, submucosal tattoo injection in 2%, previous biopsy in 5%, and both biopsy and tattoo in 5%. Complete macroscopic resection was achieved in 100% of EMR-DC procedures in an average procedure time of 49.5 minutes. The adenoma recurrence rate for these adherent lesions at surveillance (average 6.6 months) was only 9.8%. Two serious adverse events occurred (3.3%) within 30 days of the procedure: one instance of postprocedural bleeding and one episode of post-polypectomy syndrome.

Conclusion

This large, multicenter series demonstrates EMR-DC to be a safe, effective, and efficient approach to a difficult and common clinical problem: adherent and non-lifting polyps. It may offer several advantages over more expensive or invasive endoscopic techniques used for this indication. The use of EMR-DC for larger adherent polyps with adjuvant techniques such as hot avulsion or cold forceps avulsion with adjuvant snare tip soft coagulation for smaller adherent sections may represent an ideal approach.

背景和目的粘膜下纤维化是内镜下黏膜切除术(EMR)中常见的复杂息肉相关问题。以前的活检、粘膜下纹身注射和以前息肉切除失败的尝试都被证明会诱导粘膜下纤维化,这会使随后的EMR更加困难,并增加复发的风险。方法我们对61例远端帽辅助内镜下黏膜切除术(EMR-DC)病例进行了一项多中心、国际性回顾性研究,这些病例是在3个三级转诊中心进行活检、纹身或尝试切除后发生的非提升性结直肠病变的指征。结果88.5%的病例在EMR-DC之前曾尝试过息肉切除术或EMR,2%的病例在粘膜下纹身注射,5%的病例曾进行过活检,5%的患者同时进行了活检和纹身。在100%的EMR-DC手术中,平均手术时间为49.5分钟,实现了完全的宏观切除。在监测时,这些粘连性病变的腺瘤复发率(平均6.6个月)仅为9.8%。在手术后30天内发生了两起严重不良事件(3.3%):一例硬膜后出血和一例息肉切除术后综合征。结论这一大型、多中心的系列研究表明,EMR-DC是一种安全、有效和有效的方法,可以解决一个常见的临床难题:粘连性和非粘连性息肉。与用于该适应症的更昂贵或侵入性内窥镜技术相比,它可以提供几个优点。使用EMR-DC治疗较大的粘连性息肉,并辅以热撕脱术或冷钳撕脱术,同时辅以圈套器尖端软凝固治疗较小的粘连性切片,可能是一种理想的方法。
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引用次数: 0
Prospective Evaluation of a Standardized Approach to Improve Procedure Speed in Esophageal Endoscopic Submucosal Dissection 标准化方法提高食管内镜下黏膜下解剖手术速度的前瞻性评价
IF 2.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1016/j.tige.2023.01.006
Firas Bahdi , Michael M. Mercado , Xiaofan Huang , Kristen A. Staggers , Noor Zabad , Mohamed O. Othman

Background and Aims

Endoscopic submucosal dissection (ESD) of esophageal lesions is limited by the lengthy procedure time, technique's complexity, and need for specialized training. We propose a standardized esophageal ESD technique that takes advantage of specimen self-retraction to improve visualization and procedure speed by starting the margins’ incision at the anal side, followed by the laterals and the proximal.

Methods

This was a prospective clinical trial of all consecutive patients who underwent a standardized esophageal ESD of esophageal lesions at a single tertiary referral center between December 2016 and January 2021. The primary outcome was the entire procedure speed calculated as centimeters squared per hour. Secondary outcomes included the rates of en bloc resection, R0 resection, and adverse events. Linear regression analysis was conducted to test the association between the entire procedure speed and tumor location, number of knives used, year of procedure, and pathology results.

Results

Thirty-two patients prospectively enrolled in our study. The mean patient age was 65 ± 10.9 years. The mean specimen surface area was 17.9 ± 12.7 cm2. The mean entire procedure speed was 11 ± 5.9 cm2/h. The mean total procedure time was 93.5 ± 31 minutes. The entire procedure speed was significantly faster with procedures performed over the last 3 years (+5.86 cm2/h; P = 0.003) or Barrett's esophagus (+7.77 cm2/h; P = 0.001). En-bloc and R0 resection rates were 100% and 68.8%, respectively. There were only 2 early bleeding events (6.3%) and 4 stricture formations (12.5%). All adverse events were successfully managed endoscopically.

Conclusion

Our standardized esophageal ESD technique offered our operator a remarkable entire procedure speed with continuous annual improvement and an acceptable safety profile. Future controlled multicenter studies are warranted to confirm the results’ generalizability and help promote wider adoption of esophageal ESD (ClinicalTrials.gov identifier: NCT04547881).

背景和目的食管病变的内镜黏膜下剥离术(ESD)由于手术时间长、技术复杂以及需要专业培训而受到限制。我们提出了一种标准化的食管ESD技术,该技术利用标本自回缩的优势,通过在肛门侧开始边缘切口,然后在外侧和近端开始切口,来提高可视化和手术速度。方法这是一项前瞻性临床试验,对2016年12月至2021年1月期间在单一三级转诊中心接受标准化食管ESD治疗的所有连续患者进行了研究。主要结果是整个手术速度以厘米每小时的平方计算。次要结果包括整体切除率、R0切除率和不良事件。进行线性回归分析,以测试整个手术速度与肿瘤位置、使用刀具数量、手术年份和病理结果之间的相关性。结果32例患者前瞻性地纳入本研究。患者平均年龄为65±10.9岁。样品的平均表面积为17.9±12.7 cm2。整个过程的平均速度为11±5.9 cm2/h。平均总手术时间为93.5±31分钟。在过去3年中进行的手术(+5.86 cm2/h;P=0.003)或Barrett食管(+7.77 cm2/h,P=0.001)的整个手术速度明显更快。整体切除率和R0切除率分别为100%和68.8%。仅有2例早期出血事件(6.3%)和4例狭窄形成(12.5%)。所有不良事件均通过内镜成功控制。结论我们的标准化食管ESD技术为我们的操作者提供了显著的全过程速度,每年都在不断改进,并且具有可接受的安全性。未来的对照多中心研究有必要证实结果的可推广性,并有助于促进食管ESD的更广泛采用(ClinicalTrials.gov标识符:NCT04547881)。
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引用次数: 0
Initial Experience With a Novel Flexible Endoscopic Robotic Device That Allows Full Resection of Colorectal Lesions and Suturing 一种新型柔性内窥镜机器人设备的初步经验,可以完全切除结直肠病变并进行缝合
IF 2.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1016/j.tige.2022.09.002
Manoel Galvao Neto , Andre Teixeira , Romulo Lind , Eduardo Grecco , Thiago Ferreira Souza , Luis Gustavo Quadros , Fauze Maluf Filho

Conventional endoscopic instruments have intrinsic technical limitations, restraining surgeons’ ability to perform specific colorectal resections with lower complication rates and optimal oncologic results. Robotic transanal surgery has been a recent contribution, considered promising in terms of safety profile, technical learning curve, and oncologic outcomes, an alternative that can ergonomically improve surgeons’ ability to perform more complex procedures. The aim of this study is to report preliminary results regarding the feasibility, safety, and efficacy of ColubrisMX ELS, an endoluminal robotic system for complex polyps and incipient colorectal tumor resection. This was a prospective, single-arm, multicenter study to evaluate the feasibility, safety, and efficacy of an endoluminal robotic system (ColubrisMX ELS) in 8 patients who underwent transanal procedures. All patients were followed up at 7, 30, and 60 days; complication, readmission, and conversion rates, as well as operative time and blood loss, were used to measure safety. Success rates were used to measure efficacy and encompassed the number of procedures performed with a complete tumor resection. Eight patients underwent robotic transanal surgery for local excision of benign or incipient neoplasia over a period of 5.5 months, with a success rate of 100%. Of these, 2 patients (25%) underwent conversions, 1 to manage hemorrhage using endoscopic clips and 1 to complete a polypectomy with the cold snare technique. The mean operative time, from insertion to removal of the transanal flexible tube, was 184 minutes (min 79-max 537), whereas the mean length of hospital stay was 30 hours (min 24-max 144). This approach using a new platform represents a “work in progress” that has the potential to improve not only surgical ergonomics but also surgical outcomes.

传统的内窥镜器械具有内在的技术局限性,限制了外科医生进行特定结直肠切除的能力,从而降低了并发症发生率和最佳的肿瘤学结果。机器人经肛门手术是最近的一项贡献,在安全性、技术学习曲线和肿瘤学结果方面被认为是有前景的,这是一种符合人体工程学的替代方案,可以提高外科医生执行更复杂手术的能力。本研究的目的是报告ColubrisMX ELS的可行性、安全性和有效性的初步结果,ColubrisMXELS是一种用于复杂息肉和早期结直肠癌切除的腔内机器人系统。这是一项前瞻性、单臂、多中心研究,旨在评估腔内机器人系统(ColumbrisMX ELS)在8名接受经肛门手术的患者中的可行性、安全性和有效性。所有患者均在第7、30和60天进行随访;并发症、再入院率、转化率、手术时间和失血量用于衡量安全性。成功率用于衡量疗效,包括完整肿瘤切除的手术次数。8名患者在5.5个月的时间里接受了机器人经肛门手术,对良性或早期肿瘤进行了局部切除,成功率为100%。其中,2名患者(25%)接受了手术,1名使用内窥镜夹治疗出血,1名用冷圈套器技术完成息肉切除术。从插入经肛门软管到取出经肛门软管的平均手术时间为184分钟(最小79分钟,最大537分钟),而平均住院时间为30小时(最小24小时,最大144小时)。这种使用新平台的方法代表了一项“正在进行的工作”,不仅有可能改善手术人体工程学,还有可能改善手术效果。
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Techniques and Innovations in Gastrointestinal Endoscopy
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