scholarly journals Improved endoscopic resection of large flat lesions and early cancers using an external additional working channel (AWC): a case series

2019 ◽  
Vol 07 (02) ◽  
pp. E298-E301 ◽  
Author(s):  
Benjamin Walter ◽  
Simone Schmidbaur ◽  
Yannick Krieger ◽  
Alexander Meining
Keyword(s):  
Gastrointestinal Tract ◽  
Endoscopic Resection ◽  
Case Series ◽  
En Bloc Resection ◽  
Lower Gastrointestinal Tract ◽  
En Bloc ◽  
Dual Channel ◽  
Arterial Bleeding ◽  
Flat Lesions ◽  
Bimanual Tasks

Abstract Background En-bloc resection of large, flat lesions or early stages of cancer is challenging. No bimanual tasks are possible using standard endoscopes. Dual-channel endoscopes are not available everywhere and have a small distance between the channels. Patients and methods A new external additional working channel (AWC) (Ovesco, Tuebingen, Germany) was designed and developed potentially enabling bimanual tasks. Fixed to the tip of a standard gastroscope or pediatric colonoscope, a second endoscopic tool can be inserted through the AWC and used for tissue retraction during endoscopic resection. Results In the upper and lower gastrointestinal tract, endoscopic mucosal resection (EMR) with a modified grasp-and-snare technique and endoscopic submucosal dissection (ESD) were performed successfully using the AWC in eight patients. Complications were acute arterial bleeding post-EMR in two cases treated by endoscopic clipping. Conclusions We conclude that a newly developed external additional working channel (AWC) enables endoscopic resection of large lesions in the upper and lower gastrointestinal tract. Potential benefits are its suitability for EMR and ESD, no need for a dual-channel endoscope and an adjustable distance of working channels.

scholarly journals Endoscopic management of superficial nonampullary duodenal tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Endoscopy ◽  
2021 ◽  
Author(s):  
Geoffroy Vanbiervliet ◽  
Alan Moss ◽  
Marianna Arvanitakis ◽  
Urban Arnelo ◽  
Torsten Beyna ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
En Bloc Resection ◽  
Endoscopic Management ◽  
Duodenal Adenoma ◽  
En Bloc ◽  
Strong Recommendation ◽  
Delayed Bleeding ◽  
Duodenal Adenomas ◽  
Moderate Quality ◽  
Quality Evidence

Main recommendations 1 ESGE recommends that all duodenal adenomas should be considered for endoscopic resection as progression to invasive carcinoma is highly likely.Strong recommendation, low quality evidence. 2 ESGE recommends performance of a colonoscopy, if that has not yet been done, in cases of duodenal adenoma.Strong recommendation, low quality evidence. 3 ESGE recommends the use of the cap-assisted method when the location of the minor and/or major papilla and their relationship to a duodenal adenoma is not clearly established during forward-viewing endoscopy.Strong recommendation, moderate quality evidence. 4 ESGE recommends the routine use of a side-viewing endoscope when a laterally spreading adenoma with extension to the minor and/or major papilla is suspected.Strong recommendation, low quality evidence. 5 ESGE suggests cold snare polypectomy for small (< 6 mm in size) nonmalignant duodenal adenomas.Weak recommendation, low quality evidence. 6 ESGE recommends endoscopic mucosal resection (EMR) as the first-line endoscopic resection technique for nonmalignant large nonampullary duodenal adenomas.Strong recommendation, moderate quality evidence. 7 ESGE recommends that endoscopic submucosal dissection (ESD) for duodenal adenomas is an effective resection technique only in expert hands.Strong recommendation, low quality evidence. 8 ESGE recommends using techniques that minimize adverse events such as immediate or delayed bleeding or perforation. These may include piecemeal resection, defect closure techniques, noncontact hemostasis, and other emerging techniques, and these should be considered on a case-by-case basis.Strong recommendation, low quality evidence. 9 ESGE recommends endoscopic surveillance 3 months after the index treatment. In cases of no recurrence, a further follow-up endoscopy should be done 1 year later. Thereafter, surveillance intervals should be adapted to the lesion site, en bloc resection status, and initial histological result. Strong recommendation, low quality evidence.

scholarly journals Long-term follow-up after colorectal endoscopic submucosal dissection in 182 cases

2021 ◽  
Vol 09 (02) ◽  
pp. E258-E262
Author(s):  
Christian Suchy ◽  
Moritz Berger ◽  
Ingo Steinbrück ◽  
Tsuneo Oyama ◽  
Naohisa Yahagi ◽  
...  
Keyword(s):  
Case Series ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Published Data ◽  
Low Grade ◽  
Recurrence Rates ◽  
En Bloc ◽  
Long Term Follow Up

Abstract Background and study aims We previously reported a case series of our first 182 colorectal endoscopic submucosal dissections (ESDs). In the initial series, 155 ESDs had been technically feasible, with 137 en bloc resections and 97 en bloc resections with free margins (R0). Here, we present long-term follow-up data, with particular emphasis on cases where either en bloc resection was not achieved or en bloc resection resulted in positive margins (R1). Patients and methods Between September 2012 and October 2015, we performed 182 consecutive ESD procedures in 178 patients (median size 41.0 ± 17.4 mm; localization rectum vs. proximal rectum 63 vs. 119). Data on follow-up were obtained from our endoscopy database and from referring physicians. Results Of the initial cohort, 11 patients underwent surgery; follow-up data were available for 141 of the remaining 171 cases (82,5 %) with a median follow-up of 2.43 years (range 0.15–6.53). Recurrent adenoma was observed in 8 patients (n = 2 after margin positive en bloc ESD; n = 6 after fragmented resection). Recurrence rates were lower after en bloc resection, irrespective of involved margins (1.8 vs. 18,2 %; P < 0.01). All recurrences were low-grade adenomas and could be managed endoscopically. Conclusions The rate of recurrence is low after en bloc ESD, in particular if a one-piece resection can be achieved. Recurrence after fragmented resection is comparable to published data on piecemeal mucosal resection.

scholarly journals Prevention and Management of Complications and Education in Endoscopic Submucosal Dissection

2021 ◽  
Vol 10 (11) ◽  
pp. 2511
Author(s):  
Yoshitsugu Misumi ◽  
Kouichi Nonaka
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Endoscopic Mucosal Resection ◽  
Endoscopic Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resection Rate ◽  
En Bloc ◽  
Educational Methods ◽  
Submucosal Dissection ◽  
Management Of Complications

Endoscopic submucosal dissection (ESD) is considered superior to endoscopic mucosal resection as an endoscopic resection because of its higher en bloc resection rate, but it is more difficult to perform. As ESD techniques have become more common, and the range of treatment by ESD has expanded, the number of possible complications has also increased, and endoscopists need to manage them. In this report, we will review the management of critical complications, such as hemorrhage, perforation, and stenosis, and we will also discuss educational methods for acquiring and improving ESD skills.

scholarly journals Clinical Overview of GIST and Its Latest Management by Endoscopic Resection in Upper GI: A Literature Review

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Cicilia Marcella ◽  
Rui Hua Shi ◽  
Shakeel Sarwar
Keyword(s):  
Endoscopic Resection ◽  
Gastrointestinal Stromal Tumors ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Endoscopic Techniques ◽  
Stromal Tumors ◽  
Upper Gi ◽  
Risk Of Malignancy

Aims. To review the clinical presentation, diagnosis, assessment of risk of malignancy, and recent advances in management (mainly focusing on the role of endoscopic resection) of gastrointestinal stromal tumors (GISTs) in upper GI.Method. We searched Embase, Web of science, and PubMed databases from 1993 to 2018 by using the following keywords: “gastrointestinal stromal tumors,” “GIST,” “treatment,” and “diagnosis.” Additional papers were searched manually from references of the related articles.Findings. The improvement of endoscopic techniques in treating upper gastrointestinal subepithelial tumors especially gastrointestinal tumors has reduced the need for invasive surgery in patients unfit for surgery. Many studies have concluded that modified endoscopic treatments are effective and safe. These treatments permit minimal tissue resection, better dissection control, and high rates of en bloc resection with an acceptable rate of complications.

scholarly journals Endoscopic mucosal resection with an additional working channel (EMR+) in a porcine ex vivo model: a novel technique to improve en bloc resection rate of snare polypectomy

2020 ◽  
Vol 08 (02) ◽  
pp. E99-E104 ◽  
Author(s):  
Richard F. Knoop ◽  
Edris Wedi ◽  
Golo Petzold ◽  
Sebastian C.B. Bremer ◽  
Ahmad Amanzada ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Ex Vivo ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resection Rate ◽  
Ex Vivo Model ◽  
En Bloc ◽  
Novel Technique ◽  
Mucosal Resection ◽  
Flat Lesions

Abstract Background and study aims Recently, a new external additional working channel (AWC) was introduced by which conventional endoscopic mucosal resection (EMR) can be improved to a technique termed “EMR+”. We first evaluated this novel technique in comparison to classical EMR in flat lesions. Methods The trial was prospectively conducted in an ex vivo animal model with porcine stomachs placed into the EASIE-R simulator. Prior to intervention, standardized lesions were set by coagulation dots, measuring 1, 2, 3 or 4 cm. Results Overall, 152 procedures were performed. EMR and EMR+ were both very reliable in 1-cm lesions, each showing en bloc resection rates of 100 %. EMR+ en bloc resection rate was significantly higher in 2-cm lesions (95.44 % vs. 54.55 %, P = 0.02), in 3-cm lesions (86.36 % vs. 18.18 %, P < 0.01) and also in 4-cm lesions (60.00 % vs. 0 %, P < 0.01). Perforations occurred only in EMR+ procedures in 4-cm lesions (3 of 20; 15 %). Conclusions With its grasp-and-snare technique, EMR+ facilitates en bloc resection of larger lesions compared to conventional EMR. In lesions 2 cm and larger, EMR+ has demonstrated advantages, especially concerning en bloc resection rate. At 3 cm, EMR+ reaches its best discriminatory power whereas EMR+ has inherent limits at 4 cm and in lesions of that size, other techniques such as ESD or surgery should be considered.

scholarly journals High proficiency of colonic endoscopic submucosal dissection in Europe thanks to countertraction strategy using a double clip and rubber band

2019 ◽  
Vol 07 (09) ◽  
pp. E1166-E1174 ◽  
Author(s):  
Jérémie Jacques ◽  
Aurélie Charissoux ◽  
Pierre Bordillon ◽  
Romain Legros ◽  
Jérôme Rivory ◽  
...  
Keyword(s):  
Case Series ◽  
Rubber Band ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Point Of View ◽  
University Hospital ◽  
Control Group ◽  
R0 Resection ◽  
Resection Rate ◽  
En Bloc

Abstract Background and study aims ESD in the colon is more challenging technically than in other locations. Here, we report the first comparative case series of colon ESD using a systematic countertraction strategy using two clips and a rubber band. Patients and methods Retrospective comparative study of classic versus countertraction colon ESD performed in colon ESD cases collected prospectively at Lyon Edouard Herriot Hospital and Limoges University Hospital from January 2016 until December 2017. Results The study included 192 cases (control = 76, countertraction = 116). Countertraction using the double clip and rubber band technique versus the control group resulted in a significant decrease in the procedure time (94.7 vs. 117 min; P = 0.004) and significant increases in procedure speed (28.2 vs. 16.7 mm2/min; P < 0.0001), en bloc resection rate (95.7 % vs. 76.3 %, P < 0.0001), and R0 resection rate (78.5 % vs. 64.5 %, P = 0.04).At an individual operator point of view, results varied between operators but the double clip countertraction strategy significantly increased the en bloc resection rate, R0 resection rate, and speed of dissection for each of the 4 operators. Conclusion Systematic countertraction using a double clip and rubber band facilitates colon ESD. This strategy should become the standard for colon ESD.

Endoscopic resection of low grade, subglottic chondrosarcoma

2009 ◽  
Vol 123 (12) ◽  
pp. 1364-1366 ◽  
Author(s):  
Y Oestreicher-Kedem ◽  
T G Dray ◽  
E J Damrose
Keyword(s):  
Endoscopic Resection ◽  
Cricoid Cartilage ◽  
Voice Quality ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Low Grade ◽  
Retrospective Case ◽  
En Bloc ◽  
Extensive Resection ◽  
Airway Patency

AbstractIntroduction:This paper evaluates the feasibility of transoral, endoscopic resection of macroscopically localised, low grade, subglottic chondrosarcoma.Method:Retrospective case study including patients diagnosed with low grade, subglottic laryngeal chondrosarcoma. Tumours were resected endoscopically via direct laryngoscopy with microlaryngeal technique, under jet ventilation. The post-operative course, vocal fold function, airway patency and oncological results were evaluated.Results:Two male patients aged 49 and 60 years underwent endoscopic, translaryngeal, en bloc resection of low grade chondrosarcoma of the cricoid cartilage. Extubation was performed immediately after surgery. Neither patient required tracheostomy or developed subglottic stenosis. No tumour recurrence was noted after an average follow up of 10.5 months. Voice quality was stable and dyspnoea improved.Summary:Transoral, endoscopic resection of low grade, subglottic chondrosarcoma is a viable technique with good functional outcomes. Extensive resection of subglottic disease is possible, which may afford patients an alternative to total laryngectomy.

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