Endoscopic submucosal dissection combined with clip closure is effective to close gastrointestinal fistulas including refractory ones.

ABSTRACT Objective: Gastrointestinal (GI) fistula, a life-threatening condition, represents a therapeutic challenge. Rescue surgery could be hazardous and/or impact quality of life justifying endoscopic con-servative approach including mucosal abrasion, clip closure or stent diversion with moderate success rates in the long term. We assessed whether Fistulas Endoscopic Submucosal Dissection with clip Closure (FESDC) could lead to complete resolution of fistulas even if previous endoscopic therapy failed. Results: 23 patients with GI fistulas were retrospectively included, 57% of those were defined as refractory fistulas since previous endoscopic treatment failed. Tight immediate sealing was obtained for 19 patients (83% [95% CI: 61%, 95%]) who received FESDC. Long term closure (>3 months) was obtained in 14 cases (61% [95% CI: 39%, 80%]) with a median follow-up of 20 months. Ad-verse events occurred in 9% of cases. Previous local malignancy (p=0.077) or radiation therapy (p=0.047) were associated with a higher risk of failure. Conclusion: The new FESDC strategy is safe and allows permanent endoscopic closure of GI fistulas in 61% of the patients, and 54% of those with previous attempt. Further studies are war-ranted to determine the place of this technic in the management of chronic GI fistula.

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Considerations for Continuing Semielective and Emergency Otolaryngological Procedures During the COVID-19 Pandemic

Ear Nose & Throat Journal ◽

10.1177/0145561320952506 ◽

2020 ◽

Vol 100 (1) ◽

pp. 19-25

Author(s):

Sarina K. Mueller ◽

Maximilian Traxdorf ◽

Konstantinos Mantsopoulos ◽

Antoniu-Oreste Gostian ◽

Matti Sievert ◽

...

Keyword(s):

Quality Of Life ◽

Emergency Surgery ◽

Transmission Rate ◽

Medical Personnel ◽

Human Beings ◽

Threatening Condition ◽

Long Time ◽

Life Threatening

Introduction: During the COVID-19 pandemic, worldwide over 600,000 human beings died due to the cause of the disease. In order to deescalate the transmission rate and to avoid crush loading the countries medical health systems social distancing, face masks, and lockdowns have been considered essential by the majority of governments. Whereas some countries have highly reduced or completely stopped otorhinolaryngological procedures, other countries have continued selected surgeries. The objective of this study was to analyze procedures and outcomes of continuing semielective and emergency surgeries during the COVID-19 pandemic. Methods: Retrospective analysis of n = 750 patients who received semi-elective or emergency surgery between March 26 and June 16, 2020, in the Otolaryngology Department of the Friedrich-Alexander-University of Erlangen-Nürnberg. All patients were screened for COVID symptoms and swabbed for SARS-CoV-2 prior to surgery. Results: Of the n = 750 patients, n = 699 patients received semielective surgery and n = 51 emergency surgery. For 27 patients, the swab result could not be awaited due to a life-threatening condition. In these cases, surgery was performed in full protective equipment. No patient was tested positive during or after the surgery (follow-up 45 to 127 days). No member of the medical personnel showed symptoms or was tested positive after contact with patients. Due to the continuation of surgeries, patients’ lives were saved and improvement of long-term quality-of-life and outcomes is anticipated. Conclusions: Continuing selected otorhinolaryngological surgeries is crucial for patients’ health, survival, and long-time quality of life, yet, the protection of the medical personnel has to be granted.

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Aerodynamic, acoustic and functional results of posterior transverse laser cordotomy for bilateral abductor vocal fold paralysis

The Journal of Laryngology & Otology ◽

10.1017/s0022215106000715 ◽

2006 ◽

Vol 120 (4) ◽

pp. 282-288 ◽

Cited By ~ 25

Author(s):

Gürsel Dursun ◽

M Kürşat Gökcan

Keyword(s):

Vocal Fold ◽

Functional Results ◽

Subjective Symptom ◽

Vocal Fold Paralysis ◽

Symptom Scale ◽

Threatening Condition ◽

Life Threatening ◽

Posterior Glottis

Bilateral abductor vocal fold paralysis (BAVFP) is a rare but life-threatening condition which may require an emergency tracheotomy procedure. The ideal surgical technique for this condition should improve quality of life by relieving the airway obstruction while preserving laryngeal functions such as phonation and deglutition. Posterior transverse laser cordotomy (PTLC) was first described by Dennis and Kashima as a technique for providing an airway at the posterior glottis without pre-operative tracheotomy; they reported it as a successful method with satisfactory functional results. The aim of this prospective study was to evaluate long term acoustic, aerodynamic and functional results of the primary bilateral PTLC technique in 22 BAVFP patients. Severity of dyspnoea was evaluated using a five-level subjective symptom scale graded according to the limitation in daily activity and level of respiratory difficulty. Aerodynamic and acoustic analyses were performed pre-operatively and prospective changes in aerodynamic and acoustic parameters were collected after one post-operative year.

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Endoscopic closure of a large gastric mucosal defect after endoscopic submucosal dissection using a novel endoscopic string-with-knotter suture device

Endoscopy ◽

10.1055/a-1348-0645 ◽

2021 ◽

Author(s):

Wei-hui Liu ◽

Zhao-shen Li ◽

Dong Wang

Keyword(s):

Endoscopic Submucosal Dissection ◽

Submucosal Dissection ◽

Mucosal Defect ◽

Endoscopic Closure ◽

Suture Device

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Impact of Comorbidities, Sarcopenia, and Nutritional Status on the Long-Term Outcomes after Endoscopic Submucosal Dissection for Early Gastric Cancer in Elderly Patients Aged ≥ 80 Years

Cancers ◽

10.3390/cancers13143598 ◽

2021 ◽

Vol 13 (14) ◽

pp. 3598

Author(s):

Ga Hee Kim ◽

Kee Don Choi ◽

Yousun Ko ◽

Taeyong Park ◽

Kyung Won Kim ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Early Gastric Cancer ◽

Nutritional Status ◽

Elderly Patients ◽

Endoscopic Submucosal Dissection ◽

Term Survival ◽

Factors Associated ◽

Submucosal Dissection

Background/Aim: We investigated the oncologic outcomes in elderly patients who underwent endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) by focusing on the impact of comorbidities, sarcopenia, and nutritional status. Methods: Between 2005 and 2016, 280 patients aged ≥ 80 years with 289 EGCs underwent ESD at a tertiary care center. The short- and long-term survival outcomes were assessed. Cox regression analysis was used to identify factors associated with survival, including clinicopathologic factors and abdominal muscle area measured by computed tomography. Results: The rates of en bloc, R0, and, curative resection were 99.3%, 90.0%, and 69.2%, respectively. The rates of post-ESD bleeding and perforation rates were 2.1% and 3.1%, respectively, and no cases showed significant life-threatening adverse events. Over a median follow-up period of 70.5 months, the 3- and 5-year overall survival (OS) rates were 89.5% and 77.1%, respectively; of the114 patients who died, only four (3.5%) were due to gastric cancer. A total of 173 (61.8%) had sarcopenia, and they had lower rates of 3-year (88.4% vs. 91.4%) and 5-year (73.1% vs. 84.0%; p = 0.046) OS than did those without sarcopenia. In multivariable analyses, prognostic nutritional index (hazard ratio [HR], 0.93; 95% confidence interval [CI]: 0.90–0.98; p = 0.002) and Charlson comorbidity index (HR 1.19; 95% CI: 1.03–1.37; p = 0.018) were significant factors associated with overall survival. Conclusions: ESD was a feasible and safe therapeutic method to use in elderly patients, whose long-term survival was significantly associated with nutritional status and comorbidities. These results suggest the need for a possible extension of the curative criteria for ESD in elderly patients with EGC.

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Colorectal endoscopic submucosal dissection using the pocket-creation method with single clip traction: a feasibility study

Endoscopy International Open ◽

10.1055/a-1372-3740 ◽

2021 ◽

Vol 09 (05) ◽

pp. E653-E658

Author(s):

Tatsuma Nomura ◽

Yoshikazu Hayashi ◽

Takaaki Morikawa ◽

Masahiro Okada ◽

Hisashi Fukuda ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Major Axis ◽

En Bloc Resection ◽

Bloc Resection ◽

Success Rates ◽

En Bloc ◽

Submucosal Dissection ◽

Mucosal Incision ◽

Axis Length ◽

Colorectal Endoscopic Submucosal Dissection

Abstract Background and study aims The pocket-creation method (PCM) facilitates dissection of the central part of a tumor. We previously developed the PCM with clip traction (PCM-CT) to facilitate opening the mucosal pocket, which otherwise could become cumbersome. In the present study, we aimed to examine the feasibility of PCM-CT for colorectal endoscopic submucosal dissection (ESD). Patients and methods PCM-CT was performed on 30 patients with early colorectal tumors from October 2019 to April 2020. PCM-CT allows efficient opening of the mucosal pocket by using the PCM to dissect the center of the lesion and then apply traction with a single clip after making a circumferential mucosal incision. Results The median specimen major axis length, ESD time, ESD speed, and en bloc resection rate were 48 mm, 84 minutes, 20 mm2/min, and 100 % (30/30), respectively. The success rates for the traction clip and median single-clip-traction time were 100 % (30/30) and 1.5 minutes, respectively. Conclusions Colorectal ESD using PCM-CT is a simple and promising method.

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