ID: 3524590 EXPLORING THE ROLE OF ENDOSCOPIC FULL THICKNESS RESECTION AT AN ACADEMIC TERTIARY CARE CANCER CENTER SETTING

Abstract Background and study aims Endoscopic full-thickness resection allows resection of early gastrointestinal neoplasms not amenable to conventional endoscopic resection techniques, due to their location, presence of submucosal fibrosis, or suspected deep mural invasion. It is typically achieved using a dedicated over-the-scope device (full-thickness resection device or FTRD). The aim of our study was to evaluate the feasibility, safety, and clinical outcomes of endoscopic full-thickness resection using an endoscopic submucosal dissection (ESD) knife. Patients and methods Consecutive patients who underwent full-thickness endoscopic resection at six tertiary care centers from August 2010 to June 2017 were retrospectively included. We conducted a comparative analysis of patient characteristics, technical success, adverse events, and time to discharge between patients treated by a full-thickness resection using an ESD knife. Results Twenty-one procedures were performed using an ESD knife. En-bloc resection and R0 resection rates were 95.2 % and 65 %, respectively. Clinical symptoms of perforation occurred in 66.7 %. There was no need for surgery or additional endoscopic procedures. Conclusion Endoscopic full-thickness resection of early colorectal neoplasms using an ESD knife might be feasible and safe. It allows complete resection of lesions with no limitation in size. The technique may be preferable to an other-the-scope resection device in lesions larger than 20 mm, and to surgery in selected cases of low-risk T1 colorectal carcinomas, non-lifting adenomas, submucosal tumors, or technically challenging lesion locations.

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Transmission of Clostridium difficile During Hospitalization for Allogeneic Stem Cell Transplant

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.237 ◽

2015 ◽

Vol 37 (1) ◽

pp. 8-15 ◽

Cited By ~ 18

Author(s):

Mini Kamboj ◽

Anna Sheahan ◽

Janet Sun ◽

Ying Taur ◽

Elizabeth Robilotti ◽

...

Keyword(s):

Stem Cell ◽

Clostridium Difficile ◽

Stem Cell Transplant ◽

Tertiary Care ◽

Cancer Center ◽

Cell Transplant ◽

Allogeneic Stem Cell Transplant ◽

Time Space ◽

Donor Source

OBJECTIVETo determine the role of unit-based transmission that accounts for cases of early Clostridium difficile infection (CDI) during hospitalization for allogeneic stem cell transplant.SETTINGStem cell transplant unit at a tertiary care cancer center.METHODSSerially collected stool from patients admitted for transplant was screened for toxigenic C. difficile through the hospital stay and genotyping was performed by multilocus sequence typing. In addition, isolates retrieved from cases of CDI that occurred in other patients hospitalized on the same unit were similarly characterized. Transmission links were established by time-space clustering of cases and carriers of shared toxigenic C. difficile strains.RESULTSDuring the 27-month period, 1,099 samples from 264 patients were screened, 69 of which had evidence of toxigenic C. difficile; 52 patients developed CDI and 17 were nonsymptomatic carriers. For the 52 cases, 41 had evidence of toxigenic C. difficile on the first study sample obtained within a week of admission, among which 22 were positive within the first 48 hours. A total of 24 sequence types were isolated from this group; 1 patient had infection with the NAP1 strain. A total of 11 patients had microbiologic evidence of acquisition; donor source could be established in half of these cases.CONCLUSIONSMost cases of CDI after stem cell transplant represent delayed onset disease in nonsymptomatic carriers. Transmission on stem cell transplant unit was confirmed in 19% of early CDI cases in our cohort with a probable donor source established in half of the cases.Infect. Control Hosp. Epidemiol. 2015;37(1):8–15

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Full-thickness resection of neuroendocrine tumors in the rectum

Endoscopy ◽

10.1055/a-1008-9077 ◽

2019 ◽

Vol 52 (01) ◽

pp. 68-72 ◽

Cited By ~ 4

Author(s):

Benjamin Meier ◽

Heinz Albrecht ◽

Thomas Wiedbrauck ◽

Arthur Schmidt ◽

Karel Caca

Keyword(s):

Neuroendocrine Tumors ◽

Lesion Size ◽

Tumor Characteristics ◽

Full Thickness ◽

Post Market ◽

Endoscopic Full Thickness Resection ◽

Major Adverse Events ◽

Comparative Trials

Abstract Background Rectal neuroendocrine tumors (NETs) are subepithelial tumors with potential for malignancy. Depending on tumor characteristics, endoscopic or surgical resection is recommended. However, the optimal endoscopic approach is not defined. This is the first larger study evaluating endoscopic full-thickness resection (EFTR) of rectal NETs. Methods For resection, the full-thickness resection device (FTRD) was used. A registry was created as part of post-market clinical follow-up. All cases of rectal NETs in the registry were analyzed retrospectively. Results 31 German centers entered data of 501 FTRD procedures and 40 cases of rectal NETs were identified. The median lesion size was 8 mm. All lesions could be resected using FTRD. The median procedure time was 18.5 minutes. Resection was macroscopically and histologically complete in all cases. Full-thickness resection was achieved in 95 %. No major adverse events occurred. Endoscopic follow-up showed no evidence of residual or recurrent tumor. Conclusion EFTR is safe and effective for resection of smaller rectal NETs. Prospective comparative trials are needed to define the role of EFTR of rectal NETs.

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P086 EFFECTIVENESS OF VEDOLIZUMAB IN PATIENTS WITH REFRACTORY IMMUNOTHERAPY-RELATED COLITIS: A CASE SERIES

Inflammatory Bowel Diseases ◽

10.1093/ibd/zaa010.184 ◽

2020 ◽

Vol 26 (Supplement_1) ◽

pp. S73-S73

Author(s):

Jessica Harris ◽

David Faleck

Keyword(s):

Clinical Response ◽

Fecal Microbiota Transplantation ◽

Checkpoint Inhibitors ◽

Tertiary Care ◽

Case Series ◽

Fecal Microbiota ◽

Cancer Center ◽

Sustained Remission ◽

Tnf Inhibitor

Abstract Intro Immune checkpoint inhibitors (ICIs) have become a new standard of care in several cancers but often lead to undesirable immune-related adverse effects, including GI toxicity in up to 1/3 of patients. ICI-related colitis (irColitis) is generally treated with immunosuppressive medications such as steroids, but may be refractory in up to 50% of cases and require further treatments such as infliximab. The role of vedolizumab (VDZ), a newer gut-selective agent approved for inflammatory bowel disease (IBD), remains unclear. Methods We describe a retrospective study of all patients treated with VDZ for irColitis at a tertiary care cancer center in New York City between 2018–2019. Clinical response was defined as initial improvement in diarrhea to CTCAE Grade ≤1. Sustained remission was defined as resolution of diarrhea with no further flares within 30 days. Results Eleven patients were treated with VDZ during this time period. Patients were followed for a median of 11.6 months from the time of ICI initiation. Two patients with pre-existing IBD (ulcerative colitis n=1, lymphocytic colitis n=1) with prior severe irColitis were started on VDZ as a steroid-sparing agent (n=1) and prophylaxis during ICI re-challenge (n=1). Both patients’ colitis remained in remission without further flares. Nine patients were treated with VDZ for steroid-refractory irColitis, seven (78%) of whom had already failed at least one TNF inhibitor. VDZ was started a median of 76 (IQR 72–124) days after onset of colitis and patients were treated with a median of 2 (IQR 2–5) doses. The median time to initial clinical response after starting VDZ was 7 (IQR 5–14) days. Six (67%) achieved sustained remission with VDZ after a median of 15 (IQR 5–43) days. Two (22%) of patients were refractory to both infliximab and VDZ therapy and required further salvage with fecal microbiota transplantation and/or surgery. Median total steroid duration was 80 (IQR 52–108) days, and median duration from onset until final resolution of colitis was 126 (IQR 51–133) days. Conclusion In this series of patients with refractory irColitis, VDZ treatment led to successful resolution of colitis in the majority of patients, with sustained remission achieved generally after 1–2 doses. Prospective studies are needed to further elucidate the role of VDZ in the treatment of irColitis. Patient Demographics Immune-Related Colitis Treatment

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