Underwater endoscopic mucosal resection for superficial nonampullary duodenal adenomas

Abstract Background and study aim Underwater endoscopic mucosal resection (UEMR) was recently developed in a Western country. A prospective cohort study to investigate the effectiveness of UEMR was conducted in patients with small superficial nonampullary duodenal adenomas. Patients and methods Patients with duodenal adenomas ≤ 20 mm were enrolled. After the duodenal lumen had been filled with physiological saline, UEMR was performed without submucosal injection. Endoclip closure was attempted for all mucosal defects after UEMR. Follow-up endoscopy with biopsy was performed 3 months later. The primary end point was the complete resection rate, defined as neither endoscopic nor histological residue of adenoma at the follow-up endoscopy. Results 30 patients with 31 lesions were enrolled. The mean (SD) tumor size was 12.0 mm (7.3). The complete resection rate was 97 % (90 % confidence interval, 87 % – 99 %). The en bloc resection rate was 87 %. All mucosal defects were successfully closed by endoclips. No adverse events occurred except for one case of mild aspiration pneumonia. Conclusions UEMR is efficacious for the treatment of small duodenal adenomas, but further large-scale trials are warranted to confirm these results. Trial registered at University Hospital Medical Network Clinical Trials Registry (UMIN 000018710).

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Ligation-assisted endoscopic mucosal resection has high complete resection rate in rectal carcinoid tumor

BMC Gastroenterology ◽

10.1186/s12876-021-02061-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ming-Yao Su ◽

Cheng-Tang Chiu

Keyword(s):

Endoscopic Mucosal Resection ◽

Surgical Resection ◽

Complete Resection ◽

Carcinoid Tumors ◽

Rectal Carcinoid ◽

Resection Rate ◽

Therapeutic Modalities ◽

Mucosal Resection ◽

Complete Resection Rate ◽

The Mean

Abstract Aim We aimed to compare the outcomes of different therapeutic modalities in rectal carcinoid tumors. Method We retrospectively collected 145 patients with rectal carcinoid tumors which were pathologically diagnosed from 2005/01/01 to 2016/12/31. We compared tumor size, complete resection rate and recurrent rate between different therapeutic modalities. Then, prospectively compared the treatment outcomes of 28 patients treated with ligation assisted endoscopic mucosal resection (LEMR) and 25 patients treated with endoscopic mucosal resection with cap (EMRC). Result The mean size of tumors was 6.5 mm (1–25 mm), and the mean follow-up duration was 26 months (6–118 months). The therapeutic modalities included ligation-assisted endoscopic mucosal resection (LEMR) (25 tumors, 17%), endoscopic mucosal resection (EMR) (31 tumors, 21%), snare polypectomy (30 tumors, 21%), biopsy forceps removal (46 tumors, 32%) and surgical resection (13 tumors, 11%), including 6 tumors treated with transanal endoscopic microsurgery (TEM) method. In view of pathologically complete resection rate, LEMR was highest (100%), followed by surgical resection (85%). However, EMR only had 42% pathologically complete resection rate. Besides, LEMR and surgical resection had no local recurrence and significantly higher clinically complete resection rate, compared to other treatments. For the further prospective study, complete resection was noted in 28 (100%) patients in LEMR group and 13 (52%) patients in EMRC group. Conclusion In the treatment of rectal carcinoid tumors, LEMR is safe and effective compared with traditional endoscopic treatments.

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Ligation-Assisted Endoscopic Mucosal Resection Has High Complete Resection Rate in Rectal Carcinoid Tumor

10.21203/rs.3.rs-774264/v1 ◽

2021 ◽

Author(s):

Ming-Yao Su ◽

Cheng-Tang Chiu

Keyword(s):

Endoscopic Mucosal Resection ◽

Surgical Resection ◽

Complete Resection ◽

Carcinoid Tumors ◽

Rectal Carcinoid ◽

Resection Rate ◽

Therapeutic Modalities ◽

Mucosal Resection ◽

Complete Resection Rate ◽

The Mean

Abstract Aim: We aimed to compare the outcomes of different therapeutic modalities in rectal carcinoid tumors. Method: We retrospectively collected 145 patients with rectal carcinoid tumors which were pathologically diagnosed from 2005/01/01 to 2016/12/31. We compared tumor size, complete resection rate and recurrent rate between different therapeutic modalities. Then, prospectively compared the treatment outcmes of 28 patients treated with ligation assisted endoscopic mucosal resection (LEMR) and 25 patients treated with endoscopic mucosal resection with cap (EMRC). Result: The mean size of tumors was 6.5mm (1-25mm), and the mean follow-up duration was 26 months (6-118 months). The therapeutic modalities included ligation-assisted endoscopic mucosal resection (LEMR) (25 tumors, 17%), endoscopic mucosal resection (EMR) (31 tumors, 21%), snare polypectomy (30 tumors, 21%), biopsy forceps removal (46 tumors, 32%) and surgical resection (13 tumors, 11%), including 6 tumors treated with transanal endoscopic microsurgery (TEM) method. In view of pathologically complete resection rate, LEMR was highest (100%), followed by surgical resection (85%). However, EMR only had 42% pathologically complete resection rate. Besides, LEMR and surgical resection had no local recurrence and significantly higher clinically complete resection rate, compared to other treatments. For the further prospective study, complete resection were noted in 28 (100%) patients in LEMR group and 13 (52%) patients in EMRC group. Conclusion: In the treatment of rectal carcinoid tumors, LEMR is safe and effective compared with traditional endoscopic treatments.

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Efficacy of precutting endoscopic mucosal resection with full or partial circumferential incision using a snare tip for difficult colorectal lesions

Endoscopy ◽

10.1055/a-0956-6879 ◽

2019 ◽

Vol 51 (09) ◽

pp. 871-876 ◽

Cited By ~ 4

Author(s):

Naohisa Yoshida ◽

Ken Inoue ◽

Osamu Dohi ◽

Ritsu Yasuda ◽

Ryohei Hirose ◽

...

Keyword(s):

Endoscopic Mucosal Resection ◽

En Bloc Resection ◽

Bloc Resection ◽

Complete Resection ◽

Benign Lesions ◽

Resection Rate ◽

En Bloc ◽

Mucosal Resection ◽

Therapeutic Outcomes ◽

Mucosal Incision

Abstract Background We analyzed the efficacy of precutting endoscopic mucosal resection (EMR), which is a method of making a full or partial circumferential mucosal incision around a tumor with a snare tip for en bloc resection. Methods We reviewed cases from 2011 to 2018 in which precutting EMR (n = 167) and standard EMR (n = 557) were performed for lesions of 10 – 30 mm. Precutting EMR was indicated for benign lesions of 20 – 30 mm or lesions of < 20 mm for which standard EMR was difficult. Through propensity score matching of the two groups, the therapeutic outcomes for 35 lesions of ≥ 20 mm and 98 lesions of < 20 mm in each group were analyzed. Results In the two sizes of lesion, there were significant differences between the precutting and standard groups in the en bloc resection rate (≥ 20 mm 88.6 % vs. 48.5 %, P < 0.001; < 20 mm 98.0 % vs. 85.7 %, P = 0.004) and the histological complete resection rate (≥ 20 mm 71.4 % vs. 42.9 %, P = 0.02; < 20 mm 87.8 % vs. 67.3 %, P < 0.001). Conclusion Precutting EMR enabled high en bloc resection rates in cases involving difficult lesions.

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The efficacy and safety of underwater endoscopic mucosal resection for ≥10-mm colorectal polyps: systematic review and meta-analysis

Endoscopy ◽

10.1055/a-1234-8918 ◽

2020 ◽

Author(s):

De-feng Li ◽

Ming-Guang Lai ◽

Mei-feng Yang ◽

Zhi-yuan Zou ◽

Jing Xu ◽

...

Keyword(s):

Endoscopic Mucosal Resection ◽

En Bloc Resection ◽

Bloc Resection ◽

Colorectal Polyps ◽

Complete Resection ◽

R0 Resection ◽

Efficacy And Safety ◽

Resection Rate ◽

En Bloc ◽

Mucosal Resection

Abstract Background Underwater endoscopic mucosal resection (UEMR) is a promising strategy for nonpedunculated colorectal polyp removal. However, the efficacy and safety of the technique for the treatment of ≥ 10-mm colorectal polyps remain unclear. We aimed to comprehensively assess the efficacy and safety of UEMR for polyps sized 10–19 mm and ≥ 20 mm. Methods PubMed, EMBASE, and the Cochrane Library databases were searched for relevant articles from January 2012 to November 2019. Primary outcomes were the rates of adverse events and residual polyps. Secondary outcomes were the complete resection, en bloc resection, and R0 resection rates. Results 18 articles including 1142 polyps from 1093 patients met our inclusion criteria. The overall adverse event and residual polyp rates were slightly lower for UEMR when removing colorectal polyps of 10–19 mm vs. ≥ 20 mm (3.5 % vs. 4.3 % and 1.2 % vs. 2.6 %, respectively). The UEMR-related complete resection rate was slightly higher for colorectal polyps of 10–19 mm vs. ≥ 20 mm (97.9 % vs. 92.0 %). However, the en bloc and R0 resection rates were dramatically higher for UEMR removal of polyps of 10–19 mm vs. ≥ 20 mm (83.4 % vs. 36.1 % and 73.0 % vs. 40.0 %, respectively). In addition, univariate meta-regression revealed that polyp size was an independent predictor for complete resection rate (P = 0.03) and en bloc resection (P = 0.01). Conclusions UEMR was an effective and safe technique for the removal of ≥ 10-mm nonpedunculated colorectal polyps. However, UEMR exhibited low en bloc and R0 resection rates for the treatment of ≥ 20-mm polyps.

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Endoscopic mucosal resection of non-ampullary sporadic duodenal adenomas: a retrospective analysis with long-term follow-up

Scandinavian Journal of Gastroenterology ◽

10.1080/00365521.2018.1438508 ◽

2018 ◽

Vol 53 (4) ◽

pp. 490-494 ◽

Cited By ~ 2

Author(s):

Giorgio Valerii ◽

Andrea Tringali ◽

Rosario Landi ◽

Ivo Boškoski ◽

Pietro Familiari ◽

...

Keyword(s):

Retrospective Analysis ◽

Endoscopic Mucosal Resection ◽

Mucosal Resection ◽

Duodenal Adenomas ◽

Long Term Follow Up

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ANCHORING THE SNARE TIP USING A SMALL INCISION IN THE SUBMUCOSA FACILITATES EN BLOC ENDOSCOPIC MUCOSAL RESECTION FOR SPORADIC DUODENAL ADENOMAS

10.1055/s-0038-1637145 ◽

2018 ◽

Author(s):

J Rivory ◽

M Pioche ◽

T Ponchon

Keyword(s):

Endoscopic Mucosal Resection ◽

En Bloc ◽

Small Incision ◽

Mucosal Resection ◽

Duodenal Adenomas

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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

Endoscopy International Open ◽

10.1055/a-0996-8050 ◽

2020 ◽

Vol 08 (02) ◽

pp. E99-E104 ◽

Cited By ~ 3

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.

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Endoscopic Mucosal Resection: Early Experience in British Columbia

Canadian Journal of Gastroenterology ◽

10.1155/2010/897473 ◽

2010 ◽

Vol 24 (4) ◽

pp. 239-244 ◽

Cited By ~ 6

Author(s):

Mayur Brahmania ◽

Eric Lam ◽

Jennifer Telford ◽

Robert Enns

Keyword(s):

British Columbia ◽

Barrett’S Esophagus ◽

Endoscopic Mucosal Resection ◽

Barrett's Esophagus ◽

Low Grade ◽

Complication Rates ◽

The Third ◽

Mucosal Resection ◽

The Mean

BACKGROUND: Endoscopic mucosal resection (EMR) has been proposed as a primary method of managing patients with dysplasia- or mucosal-based cancers of the esophagus.OBJECTIVES: To evaluate the use of EMR for the treatment of Barrett’s esophagus with dysplasia or early adenocarcinoma, assessing efficacy, complication rates and long-term outcomes.METHODS: All patients who underwent EMR at St Paul’s Hospital (Vancouver, British Columbia) were reviewed. Eligible patients were assessed with aggressive biopsy protocols. Detected cancers were staged with both endoscopic ultrasound imaging and computed tomography. Appropriate patients were offered EMR using a commercially available mucosectomy device. EMR was repeated at six- to eight-week intervals until complete. Patients with less than one year of follow-up or who were undergoing other ablative methods were excluded.RESULTS: Twenty-two patients (all men) with a mean (± SD) age of 67±10.6 years were identified. The mean duration of gastroesophageal reflux disease was 17 years (range four to 40 years) and all were receiving proton pump inhibitor therapy. The mean length of Barrett’s esophagus was 5.5±3.5 cm. One patient had no dysplasia (isolated nodule), three had low-grade dysplasia, 15 had high-grade dysplasia (HGD) and three had adenocarcinoma. A mean of 1.7±0.83 endoscopic sessions were performed, with a mean of 6±5.4 sections removed. Following EMR, three patients developed strictures; two of these patients had pre-existing strictures and the third required two dilations, which resolved his symptoms. There were no other complications. Three patients underwent esophagectomy. Two had adenocarcinoma or HGD in a pre-existing stricture. The third patient had an adenocarcinoma not amenable to EMR. One patient with a long segment of Barrett’s esophagus underwent radiofrequency ablation. At a median follow-up of two years (range one to three years), the remaining 18 patients (82%) had no evidence of HGD or cancer.CONCLUSION: Most patients with esophageal dysplasia can be managed with EMR. Individuals with pre-existing strictures require other endoscopic and/or surgical methods to manage their dysplasia or adenocarcinoma.

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