Mo1427 Interrogation of the Mucosal Defect After Advanced Endoscopic Resection: Predicting Post-Procedural Outcomes

Abstract Background Although endoscopic resection is safe and effective for gastric epithelial neoplasms, information is limited on its efficacy and safety in extremely elderly patients who have various comorbidities. Further, the relationship between comorbidities and complications of endoscopic resection is not well established. Therefore, we aimed to evaluate the efficacy and safety of endoscopic resection of gastric epithelial neoplasms in extremely elderly patients. Methods From October 2008 to December 2017, 4475 consecutive patients underwent endoscopic resection of gastric epithelial neoplasms. Among them, 242 were 75 years or older. We assessed Charlson comorbidity index (CCI) scores, procedural outcomes, and procedure- and sedation-related complications related to endoscopic resection. Results Mean patient age was 78 (range, 75–88) years. Of the 242 patients, 124 (51.2%) had low-grade dysplasia and 112 (46.3%) had high-grade dysplasia or adenocarcinoma. The most common comorbidity was hypertension (55.4%), followed by diabetes (23.1%). The mean CCI score was 5.0 ± 1.5. Eighty patients (33.1%) had a CCI score ≥ 6. During the procedure, 10 (4.1%) patients had desaturation that recovered by flumazenil use with mask (n=2) or Ambu bag (n=3) ventilation. During subsequent admission, in addition to abdominal pain (35.1%), atelectasis and pneumonia occurred in 45 (18.6%) patients, hypotension in 27 (11.2%), and post-procedural bleeding in 12 (5.0%). Respiratory complications were more common in patients with a CCI score ≥ 6 (23/80, 28.7%) than in those with a CCI score < 6 (22/162, 13.6%, P=0.001). Conclusions CCI score is related to respiratory complications of endoscopic resection in elderly patients. Endoscopic resection must be performed cautiously, particularly in elderly patients with a high CCI score, to prevent respiratory complications.

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Endoscopic resection combined with the Cryoballoon focal ablation system in the porcine normal esophagus: a preclinical study

BMC Gastroenterology ◽

10.1186/s12876-021-01819-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hironori Sunakawa ◽

Yusuke Yoda ◽

Nobuyoshi Takeshita ◽

Hiro Hasegawa ◽

Kenji Takashima ◽

...

Keyword(s):

Combination Therapy ◽

Endoscopic Resection ◽

Tissue Damage ◽

Preclinical Study ◽

Rapid Weight Loss ◽

Time Saving ◽

Mucosal Defect ◽

Normal Esophagus ◽

Initial Procedure ◽

Focal Ablation

Abstract Background The Cryoballoon focal ablation system (CbFAS) for dysplastic Barrett’s esophagus is simple, time-saving and has high therapeutic efficacy. This study aimed to evaluate the technical feasibility and tissue damage with combination therapy of endoscopic resection (ER) and CbFAS in porcine models. Methods Three pigs (A, B, and C) were included, and all ER procedures were performed by endoscopic mucosal resection using the Cap method (EMR). Combination therapy for each pig was performed as follows: (a) CbFAS was performed for a post-EMR mucosal defect for Pig A; (b) CbFAS for post-EMR scar for Pig B, and (c) EMR for post-CbFAS scar for Pig C. All pigs were euthanized at 32 days after the initial procedure, and the tissue damage was evaluated. Results All endoscopic procedures were followed as scheduled. None of the subjects experienced anorexia, rapid weight loss, bleeding, and perforation during the observation period. They were euthanized at 32 days after the initial endoscopic procedure. On histological assessment, there was little difference between the tissue that was treated with CbFAS alone and that treated with CbFAS in combination with ER. Conclusion Combination therapy with ER and CbFAS can be technically feasible, and its outcome was not significantly different from CbFAS alone in terms of tissue damage.

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Endoscopic Resection Combined with the Cryoballoon Focal Ablation system in the Porcine Normal Esophagus: A Preclinical Study

10.21203/rs.3.rs-196161/v1 ◽

2021 ◽

Author(s):

Hironori Sunakawa ◽

Yusuke Yoda ◽

Nobuyoshi Takeshita ◽

Hiro Hasegawa ◽

Kenji Takashima ◽

...

Keyword(s):

Combination Therapy ◽

Endoscopic Resection ◽

Tissue Damage ◽

Preclinical Study ◽

Rapid Weight Loss ◽

Time Saving ◽

Mucosal Defect ◽

Normal Esophagus ◽

Initial Procedure ◽

Focal Ablation

Abstract Background: The Cryoballoon focal ablation system (CbFAS) for dysplastic Barrett’s esophagus is simple, time-saving and has high therapeutic efficacy. This study aimed to evaluate the technical feasibility and tissue damage with combination therapy of endoscopic resection (ER) and CbFAS in porcine models.Methods: Three pigs (A, B, and C) were included, and all ER procedures were performed by endoscopic mucosal resection using the Cap method (EMR). Combination therapy for each pig was performed as follows: (a) CbFAS was performed for a post-EMR mucosal defect for Pig A; (b) CbFAS for post-EMR scar for Pig B, and (c) EMR for post-CbFAS scar for Pig C. All pigs were euthanized at 32 days after the initial procedure, and the tissue damage was evaluated.Results: All endoscopic procedures were followed as scheduled. None of the subjects experienced anorexia, rapid weight loss, bleeding, and perforation during the observation period. They were euthanized at 32 days after the initial endoscopic procedure. On histological assessment, there was little difference between the tissue that was treated with CbFAS alone and that treated with CbFAS in combination with ER.Conclusion: Combination therapy with ER and CbFAS can be technically feasible, and its outcome was not significantly different from CbFAS alone in terms of tissue damage.

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Effectiveness of topical budesonide in preventing esophageal strictures after endoscopic resection of esophageal cancer

Endoscopy International Open ◽

10.1055/a-1266-3423 ◽

2020 ◽

Vol 08 (12) ◽

pp. E1795-E1803

Author(s):

Steffi Elisabeth Maria van de Ven ◽

Manon J.B.L. Snijders ◽

Marco J. Bruno ◽

Arjun Dave Koch

Keyword(s):

Esophageal Cancer ◽

Endoscopic Resection ◽

Esophageal Stricture ◽

Oral Treatment ◽

Preventive Treatment ◽

Control Groups ◽

Early Esophageal Cancer ◽

Mucosal Defect ◽

Stricture Rate ◽

Esophageal Strictures

Abstract Background and study aims A disadvantage of endoscopic resection (ER) of early esophageal cancer (EC) is the high stricture rate after resection. A risk factor for stricture development is a mucosal defect after ER of ≥ 75 % of the esophageal circumference. Stricture rates up to 94 % have been reported in these patients. The aim of this study was to investigate the effectiveness of oral treatment with topical budesonide for stricture prevention after ER of early EC. Patients and methods We performed a retrospective analysis of a prospective cohort study of patients who received topical budesonide after ER of EC between March 2015 and April 2020. The primary endpoint was the esophageal stricture rate after ER. Stricture rates of our cohort were compared with stricture rates of control groups in the literature. Results In total, 42 patients were treated with ER and topical budesonide. A total of 18 of 42 patients (44.9 %) developed a stricture. The pooled stricture rate of control groups in the literature was 75.3 % (95 % CI 68.8 %-81.9 %). Control groups consisted of patients with esophageal squamous cell carcinoma with a mucosal defect after ER of ≥ 75 % of the esophageal circumference. Comparable patients of our cohort had a lower stricture rate (47.8 % vs. 75.3 %, P = 0.007). Conclusions Topical budesonide therapy after ER for EC seems to be a safe and effective method in preventing strictures. The stricture rate after budesonide treatment is lower compared to the stricture rate of patients who did not receive a preventive treatment after ER reported in the literature.

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Association Between Charlson Comorbidity Index and Complications of Endoscopic Resection of Gastric Neoplasms in Elderly Patients

10.21203/rs.2.16786/v2 ◽

2020 ◽

Author(s):

Sunmin Kim ◽

Dong Hyun Kim ◽

Seon-Young Park ◽

Chang Hwan Park ◽

Hyun Soo Kim ◽

...

Keyword(s):

Elderly Patients ◽

Endoscopic Resection ◽

Charlson Comorbidity Index ◽

Gastric Neoplasms ◽

Low Grade ◽

Efficacy And Safety ◽

Respiratory Complications ◽

Comorbidity Index ◽

Epithelial Neoplasms ◽

Procedural Outcomes

Abstract Background: Although endoscopic resection is safe and effective for gastric epithelial neoplasms, information is limited on its efficacy and safety in extremely elderly patients who have various comorbidities. Further, the relationship between comorbidities and complications of endoscopic resection is not well established. Therefore, we aimed to evaluate the efficacy and safety of endoscopic resection of gastric epithelial neoplasms in extremely elderly patients. Methods: From October 2008 to December 2017, 4475 consecutive patients underwent endoscopic resection of gastric epithelial neoplasms. Among them, 242 were 75 years or older. We assessed Charlson comorbidity index (CCI) scores, procedural outcomes, and procedure- and sedation-related complications related to endoscopic resection. Results: Mean patient age was 78.7 ± 3.2 years. Of the 242 patients, 124 (51.2%) had low-grade dysplasia and 112 (46.3%) had adenocarcinoma. The most common comorbidity was hypertension (55.4%), followed by diabetes (23.1%). The mean CCI score was 1.67 ± 1.43. Sixty patients (24.8%) had a CCI score ≥ 3. During the procedure, 10 (4.1%) patients had desaturation that recovered by flumazenil use with mask (n=2) or Ambu bag (n=3) ventilation. During subsequent admission, atelectasis or pneumonia occurred in 45 (18.6%) patients, post-procedural bleeding in 12 (5.0%), and perforation in 3 (1.2%). Respiratory complications were more common in patients with a CCI score ≥ 3 (20/60, 33.3%) than in those with a CCI score < 3 (25/182, 13.7%, P=0.002). Conclusions: CCI score is related to respiratory complications of endoscopic resection in extremely elderly patients. Endoscopic resection must be performed cautiously, particularly in elderly patients with a high CCI score, to prevent respiratory complications.

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1142 The Impact of Carbon Dioxide Insufflation on Post-Procedural Outcomes After Endoscopic Resection of Large Colonic Lesions: A Prospective Cohort Study

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2012.04.157 ◽

2012 ◽

Vol 75 (4) ◽

pp. AB176 ◽

Cited By ~ 1

Author(s):

Milan S. Bassan ◽

Michael J. Bourke ◽

Bronte A. Holt ◽

Alan Moss ◽

Stephen J. Williams ◽

...

Keyword(s):

Carbon Dioxide ◽

Cohort Study ◽

Endoscopic Resection ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Carbon Dioxide Insufflation ◽

Procedural Outcomes ◽

The Impact

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Endoscopic Resection of the Olecranon and Pre-Patellar Bursa

Swiss Surgery ◽

10.1024/1023-9332.7.3.121 ◽

2001 ◽

Vol 7 (3) ◽

pp. 121-125 ◽

Cited By ~ 9

Author(s):

Nussbaumer ◽

Candrian ◽

Hollinger

Keyword(s):

Endoscopic Resection ◽

Postoperative Komplikationen

Fragestellung: Gemäss Literatur treten nach chirurgischer Behandlung entzündlich veränderter Bursae präpatellar oder am Olecranon in rund 20% der Fälle Narbenbeschwerden auf. Die Frage ist, ob durch ein endoskopisches Vorgehen, welches erstmals 1990 beschrieben wurde, die Häufigkeit dieser Komplikationen reduziert werden kann. Methode: Im Rahmen einer prospektiven Studie wurde bei 13 Patienten mit einer Bursitis ein endoskopisches Bursa-shaving durchgeführt. Alle Patienten wurden drei Wochen und sechs Monate postoperativ klinisch nachkontrolliert. Resultate: Bei neun Patienten wurde eine Bursa olecrani entfernt, viermal eine Bursa präpatellaris. In 11 Fällen handelte es sich um eine akute, infizierte Bursitis. Die Eingriffe wurden je zur Hälfte in Vollnarkose bzw. Regionalanästhesie durchgeführt. Intra- sowie postoperative Komplikationen wurden keine beobachtet. Bei den Nachkontrollen waren sämtliche Patienten beschwerdefrei und zeigten eine volle Funktion des betroffenen Gelenks. Schlussfolgerung: In unseren Händen hat sich das endoskopische Bursashaving zur chirurgischen Therapie der Bursitis bewährt. Im Vergleich zur konventionellen Bursektomie können insbesondere Wundheilungsstörungen und chronische Narbenbeschwerden reduziert werden.

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