Dissection-enabled scaffold-assisted resection (DeSCAR): a novel technique for resection of residual or non-lifting gastrointestinal neoplasia of the colon, expanded experience and follow-up

Abstract Background and study aims Colonic lesions may not be amenable to conventional endoscopic mucosal resection (EMR) due to previous manipulation, submucosal invasion, or lesion flatness. In 2018, we described Dissection-enabled Scaffold Assisted Resection (DeSCAR) to be safe for the endoscopic resection of non-lifting or residual colonic lesions 1 In this study, we expand our original cohort to describe our expanded experience with patients undergoing DeSCAR and assess the efficacy, safety, and feasibility of DeSCAR for endoscopic resection of non-lifting or residual colonic lesions. Patients and methods We retrospectively reviewed 57 patients from 2015–2019 who underwent DeSCAR for colonic lesions with incomplete lifting and/or previous manipulation. Cases were reviewed for location, prior manipulation, rates of successful resection, adverse events, and endoscopic follow up to assess for residual lesions. Results Fifty-seven lesions underwent DeSCAR. Of the patients, 51 % were female, and average patient age was 69 years. Lesions were located in the cecum (n = 16), right colon (n = 27), left colon (n = 10), and rectum (n = 4). Average lesion size was 27.7 mm. Previous manipulation occurred in 54 cases (72 % biopsy, 44 % resection attempt, 18 % intralesional tattoo). The technical success rate for resection of non-lifting lesions was 98 %. There were two delayed bleeding episodes (one required endoscopic intervention) and one small perforation (managed by endoscopic hemoclip closure). Endoscopic follow up was available in 31 patients (54 %) with no residual adenoma in 28 patients (90 % of those surveilled). Conclusions Our expanded experience with DeSCAR demonstrates high safety, feasibility, and effectiveness for the endoscopic management of non-lifting or residual colonic lesions.

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Outcomes after endoscopic resection of large laterally spreading lesions of the papilla and conventional ampullary adenomas are equivalent

Endoscopy ◽

10.1055/a-0587-5228 ◽

2018 ◽

Vol 50 (10) ◽

pp. 972-983 ◽

Cited By ~ 18

Author(s):

Amir Klein ◽

Zhengyan Qi ◽

Farzan Bahin ◽

Halim Awadie ◽

Dhruv Nayyar ◽

...

Keyword(s):

Surgical Resection ◽

Endoscopic Resection ◽

Lesion Size ◽

Long Term Outcomes ◽

Index Procedure ◽

Entire Cohort ◽

Delayed Bleeding ◽

Papilla Vateri

Abstract Background Endoscopic resection of ampullary adenomas is a safe and effective alternative to surgical resection. A subgroup of patients have large laterally spreading lesions of the papilla Vateri (LSL-P), which are frequently managed surgically. Data on endoscopic resection of LSL-P are limited and long-term outcomes are unknown. The aim of this study was to compare the outcomes of endoscopic resection of LSL-P with those of standard ampullary adenomas. Methods A retrospective analysis of a prospectively collected and maintained database was conducted. LSL-P was defined as extension of the lesion ≥ 10 mm from the edge of the ampullary mound. Piecemeal endoscopic mucosal resection of the laterally spreading component was followed by resection of the ampulla. Patient, lesion, and procedural data, as well as results of endoscopic follow-up, were collected. Results 125 lesions were resected. Complete endoscopic resection was achieved in 97.6 % at the index procedure (median lesion size 20 mm, interquartile range [IQR] 13 – 30 mm). Compared with ampullary adenomas, LSL-Ps were significantly larger (median 35 mm vs. 15 mm), contained a higher rate of advanced pathology (38.6 % vs. 18.5 %), and had higher rates of intraprocedural bleeding (50 % vs. 24.7 %) and delayed bleeding (25.0 % vs. 12.3 %). Both groups had similar rates of histologically proven recurrence at first surveillance (16.4 % vs. 17.9 %). Median follow-up for the entire cohort was 18.5 months. For patients with at least two surveillance endoscopies (n = 68; median follow-up 29 months, IQR 18 – 48 months), 95.6 % were clear of disease and considered cured. Conclusions LSL-P can be resected endoscopically with comparable outcomes to standard ampullectomy, albeit with a higher risk of bleeding. Endoscopic treatment should be considered as an alternative to surgical resection, even for large LSL-P.

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

Endoscopy ◽

10.1055/a-1442-2395 ◽

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.

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Endoscopic Management of Frontal Sinus Osteomas Revisited

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2009.23.3321 ◽

2009 ◽

Vol 23 (3) ◽

pp. 331-336 ◽

Cited By ~ 48

Author(s):

Kristin Seiberling ◽

Steve Floreani ◽

Simon Robinson ◽

Peter-John Wormald

Keyword(s):

Endoscopic Resection ◽

Frontal Sinus ◽

Ct Scans ◽

Endoscopic Management ◽

Grading System ◽

Tumor Removal ◽

Successful Removal ◽

Grade Iii

Background Recent articles have published guidelines regarding the role of endoscopic surgery in the removal of frontal sinus osteomas. These guidelines recommend the endoscopic approach for small osteomas but recommend an osteoplastic flap for larger tumors. This study presents a series of endoscopically resected tumors both large and small. Methods Retrospective chart reviews were performed. Charts were reviewed of all patients who underwent surgical resection of a frontal sinus osteoma from 1998 to 2008. Sinus CT scans were reviewed and each tumor was staged according to Kennedy's grading system proposed in 2005. Results Twenty-three patients, 8 with a grade IV tumor, 6 with a grade III tumor, and the remaining with a grade I or II tumor, underwent endoscopic resection of a frontal sinus osteoma. In 15 patients a modified Lothrop procedure was performed for tumor removal. In addition, a blepharoplasty incision was used in one patient for removal of a large orbital extension of the tumor and another underwent an enlarged frontal sinus trephine performed via a browline incision. In the remaining patients a frontal sinusotomy with minitrephination provided enough access for tumor removal. Over an average follow-up of 36 months no recurrences were noted. Symptoms improved in all but one patient. There were no postoperative complications. Conclusion Endoscopic resection of both large and small frontal sinus osteomas is feasible. In this article we have shown successful removal of large osteomas that fill the entire frontal sinus with the modified Lothrop procedure.

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Challenges in the Management of Sphenoid Inverted Papilloma

American Journal of Rhinology ◽

10.1177/194589240501900216 ◽

2005 ◽

Vol 19 (2) ◽

pp. 207-213 ◽

Cited By ~ 16

Author(s):

Samer Fakhri ◽

Martin J. Citardi ◽

Stephen Wolfe ◽

Pete S. Batra ◽

Richard A. Prayson ◽

...

Keyword(s):

Endoscopic Resection ◽

Sphenoid Sinus ◽

Inverted Papilloma ◽

Endoscopic Management ◽

Intraoperative Bleeding ◽

Postoperative Surveillance ◽

Skull Base Lesions ◽

Tumor Extent ◽

Sinonasal Symptoms

Background Inverted papilloma (IP) arising in the sphenoid sinus is extremely rare. Management of sphenoid sinus IP is especially challenging because of the paucity of sinonasal symptoms on presentation and the inherent surgical risks associated with the anatomic location of the sphenoid sinus. Methods We performed a retrospective review of medical records of all patients with IP arising within the sphenoid sinus. Results A total of five patients were identified. All patients were managed with endoscopic resection. The most common presenting symptom was headache (three patients). The mean follow-up period was 37.6 months (range, 10–79 months). Two patients with erosive skull base lesions adjacent to the internal carotid artery were managed with a staged endoscopic resection. Only one patient developed a recurrence after 38 months and underwent revision endoscopic resection. Conclusions Endoscopic management of sphenoid IP allows maximal resection with minimal morbidity and facilitates endoscopic postoperative surveillance. Complete preoperative radiological assessment of tumor extent is essential. Preoperative medical therapy can help normalize inflamed mucosa and minimize intraoperative bleeding. For large erosive IP, surgical risks may be minimized by considering a staged resection and using computer-aided surgery.

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Endoscopic resection using an over-the-scope clip for duodenal neuroendocrine tumors

Endoscopy International Open ◽

10.1055/a-1374-6141 ◽

2021 ◽

Vol 09 (05) ◽

pp. E659-E666

Author(s):

Tomoaki Tashima ◽

Shomei Ryozawa ◽

Yuki Tanisaka ◽

Akashi Fujita ◽

Kazuya Miyaguchi ◽

...

Keyword(s):

Neuroendocrine Tumors ◽

Endoscopic Resection ◽

Resected Specimen ◽

R0 Resection ◽

En Bloc ◽

Delayed Bleeding ◽

Over The Scope Clip ◽

Duodenal Neuroendocrine Tumors ◽

Experienced Endoscopist

Abstract Background and study aims Endoscopic resection of duodenal neuroendocrine tumors (DNETs) remains controversial, and its indications are still unclear. This study aimed to evaluate short-term outcomes of a newly developed endoscopic muscularis resection (EMR) method that utilizes an over-the-scope clip (OTSC), termed EMRO, for treating DNETs. Patients and methods In total, 13 consecutive patients with 14 small (≤ 10 mm) DNETs who underwent EMRO from September 2017 to March 2020 were retrospectively enrolled. EMRO was performed by a single experienced endoscopist. Patients’ characteristics and treatment outcomes were assessed. Results The En bloc and R0 resection rates were 100 % (14/14) and 92.9 % (13/14), respectively. The median pathological resected specimen size was 10 mm, with a median pathological resected tumor size of 6 mm. During the EMRO procedure, there was no occurrence of misplacement of the OTSC to the target lesion. With respect to the pathological resection depth, nine cases (64.3 %) and five cases (35.7 %) were categorized as deep submucosal resection and muscularis resection, respectively, whereas no case was categorized as full-thickness resection. There were no intraoperative or delayed perforations. However, delayed bleeding occurred in two cases. At a median follow-up of 12 months (range 7–36) after EMRO, there was no incidence of local recurrence. At the first follow-up endoscopy performed at 6 months after EMRO, the OTSC was retained in place in two of 14 DNETs (14.3 %). Conclusions EMRO can be performed safely, by an experienced endoscopist, for small (≤ 10 mm) DNETs.

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A novel approach with holmium laser ablation for endoscopic management of intrahepatic biliary stricture

BMC Gastroenterology ◽

10.1186/s12876-019-1093-y ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Jianying Lou ◽

Qida Hu ◽

Tao Ma ◽

Wei Chen ◽

Ji Wang ◽

...

Keyword(s):

Laser Ablation ◽

Biliary Stricture ◽

Postoperative Mortality ◽

Holmium Laser ◽

Endoscopic Management ◽

Technical Success Rate ◽

Novel Approach ◽

High Incidence ◽

Perioperative Complication

Abstract Background Hepatolithiasis, featuring high incidence, severe symptoms, and common recurrence, poses a heavy disease burden. Endoscopic management provides an opportunity to cure hepatolithiasis, but fails to properly resolve biliary stricture without additional interventional techniques. An innovative approach towards endoscopic management of biliary stricture is required. Methods Holmium laser ablation was applied to biliary strictures via endoscopic access. Patients’ demographic, operative, and follow-up data after receiving holmium laser ablation were retrospectively collected for analysis. Results A total of 15 patients (4 males and 11 females) underwent stricture ablation by holmium laser via cholangioscopy. All the patients successfully received holmium laser ablation, indicating a technical success rate of 100%. No postoperative mortality or no major perioperative complication was observed. During the follow-up period, the recurrence-free rate was 73% at 2 years and 67% at 5 years. Conclusions We successfully developed a novel technique of biliary stricture removal by cholangioscopic holmium laser ablation with satisfying clinical outcomes.

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Z-POEM as a Treatment Option for Zenker’s Diverticulum: Our Experience at a Tertiary Care Centre in India

Journal of Digestive Endoscopy ◽

10.1055/s-0040-1716584 ◽

2020 ◽

Vol 11 (03) ◽

pp. 209-214

Author(s):

Pankaj N. Desai ◽

Mayank V. Kabrawala ◽

Chintan N. Patel ◽

Rajiv M. Mehta ◽

Subhash K. Nandwani ◽

...

Keyword(s):

Tertiary Care ◽

Endoscopic Management ◽

Zenker’S Diverticulum ◽

Efficacy And Safety ◽

Technical Success Rate ◽

Dysphagia Score ◽

Zenker's Diverticulum ◽

Endoscopic Myotomy ◽

The Mean

Abstract Background This study was aimed to evaluate efficacy and safety of Z–peroral endoscopic myotomy (Z-POEM; submucosal tunneling endoscopic myotomy) for Zenker’s diverticulum (ZD). Methods This is a retrospective study at a single tertiary care center in India. The Z-POEM technique was performed using principles of submucosal tunneling endoscopy with prior experience from POEM technique for achalasia cardia Results Sixteen patients (male, 62.5%; mean age, 73.2 ± 5.2 years) were included with a mean Charleson’s comorbidity index of 4.32. The mean size of ZD was 34.8 ± 10.0 mm. The technical success rate was 100%. Clinical success was achieved in 100% (16/16) with a decrease in mean dysphagia score from 2.9 to 0.2 (p <0.0001). The mean procedure time was 47 ± 7.9 minutes and mean length of septotomy was 31.9 ± 9.4 mm. The mean length of hospital stay was 1.2 ± 0.4 days. No major adverse events were noted. Capnomediastinum was noted in two cases on follow-up Gastrografin study after 24 hours (12.5%). This did not merit any treatment. One patient had intraprocedural bleed which was controlled easily. At the 18-month follow-up, two (12.5%) patients reported dysphagia recurrence (Dakkak and Bennett score 1) but did not require repeat intervention. Conclusion Endoscopic management of ZD using the POEM technique is a promising technique with improved efficacy and safety. However, long-term follow-up is needed to ensure the durability of response.

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A Case of Metastatic Melanoma in the Ureter

Case Reports in Urology ◽

10.1155/2016/1853015 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

James Macneil ◽

Tania Hossack

Keyword(s):

Case Report ◽

Metastatic Melanoma ◽

Endoscopic Resection ◽

Metastatic Disease ◽

Disease Recurrence ◽

Viable Alternative ◽

Endoscopic Management ◽

Left Ureter ◽

Radical Approach

Advances in the treatment of melanoma are resulting in patients living for extended periods after being diagnosed with metastatic disease. Metastases to the ureter are rare, but they have been described in the literature on a number of occasions. In this case report, we describe a patient with established metastatic melanoma who, whilst taking and responding to immunomodulatory therapy, was found to have an obstructive mass in the middle of his left ureter. Rather than performing either a nephroureterectomy or partial resection of the ureter, we opted to perform an endoscopic resection of the melanoma. Follow-up imaging at 12 months shows no evidence of local disease recurrence. We submit that primary endoscopic management of metastatic melanoma in the ureter is a viable alternative to a radical approach.

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Mid-term outcome after endovascular therapy in the superficial femoral and popliteal artery using long stents

VASA ◽

10.1024/0301-1526/a000163 ◽

2012 ◽

Vol 41 (1) ◽

pp. 49-56 ◽

Cited By ~ 10

Author(s):

Schoenefeld ◽

P. Donas ◽

Schönefeld ◽

Osada ◽

Austermann ◽

...

Keyword(s):

Endovascular Treatment ◽

Popliteal Artery ◽

Primary Patency ◽

Stent Fracture ◽

Fracture Rate ◽

Term Outcome ◽

Technical Success Rate ◽

Endovascular Interventions ◽

Artery Disease

Background: Peripheral artery disease (PAD) affecting the femoropopliteal artery is treated by endovascular interventions [2, 5, 13] increasingly. Aim of the study was to evaluate mid-term efficacy and patency of long stents in the superficial femoral and popliteal artery. Patients and methods: Between September 2006 and September 2007 103 patients received 128 stents for endovascular treatment of femoropopliteal vascular stenosis or occlusion. Clinical and hemodynamic parameters were collected. Risk factors, popliteal involvement and TASC classification, were documented and evaluated. Results: Immediate outcome was satisfactory with a technical success rate of 100 %. After a mean follow-up period of 21 months, primary patency was 83.6 %. Potential risk factor analysis for restenosis and fracture demonstrated hypertension to have borderline significance (P = 0.06). In normotensive patients no restenosis occurred. Further pre-conditions, e.g. smoking, metabolic syndrome, age, gender and previous intervention did not show any influence on restenosis or stent fracture. TASC C and D lesion had similar patency rates compared to TASC A and B lesions. Most of the restenoses (13 out of 16) were observed within the first six months of follow-up. Six stent fracture were observed (4.7 %). Conclusions: Long stents had convincing results after endovascular treatment of the femoropopliteal PAD. The used stent was an efficacious endovascular tool for long athersclerotic lesions in the superficial femoral and popliteal artery. Fracture rate was low with an incidence of 4.7 %. Most restenoses occurred within the first six months so that careful follow-up would be necessary.

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Neurological Evaluation of Patients with Newly Diagnosed Coeliac Disease Presenting to Gastroenterologists: A 7-Year Follow-Up Study

Nutrients ◽

10.3390/nu13061846 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1846

Author(s):

Marios Hadjivassiliou ◽

Iain D. Croall ◽

Richard A. Grünewald ◽

Nick Trott ◽

David S. Sanders ◽

...

Keyword(s):

Coeliac Disease ◽

Brain Imaging ◽

Cerebellar Atrophy ◽

Neurological Dysfunction ◽

Close Monitoring ◽

Newly Diagnosed ◽

Positive Serology ◽

Original Cohort ◽

Follow Up Study

We have previously shown that 67% of patients with newly diagnosed coeliac disease (CD) presenting to gastroenterologists have evidence of neurological dysfunction. This manifested with headache and loss of co-ordination. Furthermore 60% of these patients had abnormal brain imaging. In this follow-up study, we re-examined and re-scanned 30 patients from the original cohort of 100, seven years later. There was significant reduction in the prevalence of headaches (47% to 20%) but an increase in the prevalence of incoordination (27% to 47%). Although those patients with coordination problems at baseline reported improvement on the gluten free diet (GFD), there were 7 patients reporting incoordination not present at baseline. All 7 patients had positive serology for one or more gluten-sensitivity related antibodies at follow-up. In total, 50% of the whole follow-up cohort were positive for one or more gluten-related antibodies. A comparison between the baseline and follow-up brain imaging showed a greater rate of cerebellar grey matter atrophy in the antibody positive group compared to the antibody negative group. Patients with CD who do not adhere to a strict GFD and are serological positive are at risk of developing ataxia, and have a significantly higher rate of cerebellar atrophy when compared to patients with negative serology. This highlights the importance of regular review and close monitoring.

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