Multiband mucosectomy for the treatment of challenging non-pedunculated colorectal polyps

Abstract Background and study aims Endoscopic mucosal resection is the gold standard treatment for non-pedunculated colorectal polyps; however, some specific situations (location behind folds, scarred or flat morphology) can make this technique challenging. We aimed to assess the efficacy and safety of multiband mucosectomy (MBM) for resection of non-pedunculated colorectal polyps. Patients and methods This was a retrospective study of patients in whom MBM was performed to resect large non-pedunculated colorectal polyps. All procedures were carried out using the Shooter multiband ligator kit (Cook Medical, Limerick, Ireland). A 3-month follow-up colonoscopy was performed in all patients. Results 10 patients underwent MBM for resection of 10 large (median 33.5 mm) non-pedunculated polyps. A total of 45 MBM sessions were carried out to resect all of the lesions using on average one rubber band per 1.5 cm2 of resected tissue. Complete resection was possible in 9 out of 10 lesions, although en bloc resection was only feasible in one lesion. Follow-up colonoscopy revealed residual adenoma in just one patient. No major complications were registered. Conclusions In this small series of patients, MBM proved to be a safe and effective endoscopic resection technique for challenging non-pedunculated colorectal polyps.

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ID: 3518501 EN-BLOC RESECTION RATE OF COLORECTAL POLYPS ≤ 20 MM IS LOW AMONG ADVANCED ENDOSCOPY TRAINEES

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2021.03.192 ◽

2021 ◽

Vol 93 (6) ◽

pp. AB70

Author(s):

William W. King ◽

Peter V. Draganov ◽

Andrew Y. Wang ◽

Dushant Uppal ◽

Nikhil A. Kumta ◽

...

Keyword(s):

En Bloc Resection ◽

Bloc Resection ◽

Colorectal Polyps ◽

Resection Rate ◽

En Bloc

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

Endoscopy International Open ◽

10.1055/a-1321-1271 ◽

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.

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Endoscopic resection outcomes and predictors of failed en bloc endoscopic mucosal resection of colorectal polyps ≤ 20 mm among advanced endoscopy trainees

Endoscopy International Open ◽

10.1055/a-1578-1965 ◽

2021 ◽

Vol 09 (11) ◽

pp. E1820-E1826

Author(s):

William W. King ◽

Peter V. Draganov ◽

Andrew Y. Wang ◽

Dushant Uppal ◽

Amir Rumman ◽

...

Keyword(s):

Multivariate Analysis ◽

Endoscopic Mucosal Resection ◽

En Bloc Resection ◽

Lesion Size ◽

Bloc Resection ◽

Colorectal Polyps ◽

Polyp Size ◽

En Bloc ◽

Mucosal Resection ◽

Piecemeal Resection

Abstract Background and study aims En bloc endoscopic mucosal resection (EMR) is preferred over piecemeal resection for polyps ≤ 20 mm. Data on colorectal EMR training are limited. We aimed to evaluate the en bloc EMR rate of polyps ≤ 20 mm among advanced endoscopy trainees and to identify predictors of failed en bloc EMR. Methods This was a multicenter prospective study evaluating trainee performance in EMR during advanced endoscopy fellowship. A logistic regression model was used to identify the number of procedures and lesion cut-off size associated with an en bloc EMR rate of ≥ 80 %. Multivariate analysis was performed to identify predictors of failed en bloc EMR. Results Six trainees from six centers performed 189 colorectal EMRs, of which 104 (55 %) were for polyps ≤ 20 mm. Of these, 57.7 % (60/104) were resected en bloc. Trainees with ≥ 30 EMRs (OR 6.80; 95 % CI: 2.80–16.50; P = 0.00001) and lesions ≤ 17 mm (OR 4.56;95 CI:1.23–16.88; P = 0.02) were more likely to be associated with an en bloc EMR rate of ≥ 80 %. Independent predictors of failed en bloc EMR on multivariate analysis included: larger polyp size (OR:6.83;95 % CI:2.55–18.4; P = 0.0001), right colon location (OR:7.15; 95 % CI:1.31–38.9; P = 0.02), increased procedural difficulty (OR 2.99; 95 % CI:1.13–7.91; P = 0.03), and having performed < 30 EMRs (OR: 4.87; 95 %CI: 1.05–22.61; P = 0.04). Conclusions In this pilot study, we demonstrated that a relatively low proportion of trainees achieved en bloc EMR for polyps ≤ 20 mm and identified procedure volume and lesion size thresholds for successful en bloc EMR and independent predictors for failed en bloc resection. These preliminary results support the need for future efforts to define EMR procedure competence thresholds during training.

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Parathyroid carcinoma

Vojnosanitetski pregled ◽

10.2298/vsp0608765f ◽

2006 ◽

Vol 63 (8) ◽

pp. 765-769

Author(s):

Aleksandar Filipovic ◽

Ivan Paunovic ◽

Dragutin Savjak ◽

Tamara Zivkovic

Keyword(s):

Primary Hyperparathyroidism ◽

Parathyroid Carcinoma ◽

Disease Recurrence ◽

En Bloc Resection ◽

Bloc Resection ◽

Endocrine Tumors ◽

En Bloc ◽

Histologic Diagnosis ◽

Serum Pth

Background. Parathyroid carcinoma is the least frequent malignancy among endocrine tumors. In the most reported series of patients with primary hyperparathyroidism the incidence of carcinoma is less than 1%. Recognition by a surgeon that the parathyroid tumor is malignant, and the performance of an adequate en bloc removal of primary lesion, with histologic diagnosis offer the best treatment of a patient with this unusual malignancy. Case report. We reported a 30-year-old patient with parathyroid carcinoma, primary hyperparathyroidism, and recurrent nephrocalcinosis. Marked hypercalcemia, low serum phosphorus, and substantial elevation of serum parathyroid hormone indicated a diagnosis of primary hiperparathyroidism. General symptoms were anorexia, muscle weakness, back pain and depression. Ultrasonography done before the surgery revealed a 2 cm upper left parathyroid gland with solid and cystic areas. The neck exploration was done with en block resection of the tumor. A histopathological evaluation confirmed the diagnosis of parathyroid carcinoma. Over more than a three-year-follow-up, the patient had no evidence of the disease recurrence and his serum PTH and calcium levels remained within the normal. Conclusion. Parathyroid carcinoma is a rare cause of primary hyperparathyroidism. Preoperative diagnosis remains a challenge. Radical en bloc resection of the tumor is the treatment of choice for this malignancy.

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En Bloc Resection of the Duodenum for Locally Advanced Right Colon Adenocarcinoma

The American Surgeon ◽

10.1177/000313480707301031 ◽

2007 ◽

Vol 73 (10) ◽

pp. 1063-1066 ◽

Cited By ~ 3

Author(s):

Ahmad N. Hakimi ◽

David K. Rosing ◽

Bruce E. Stabile ◽

Beverley A. Petrie

Keyword(s):

Colon Cancer ◽

Locally Advanced ◽

En Bloc Resection ◽

Bloc Resection ◽

Morbidity And Mortality ◽

Right Colon ◽

En Bloc ◽

Adjacent Structures ◽

Duodenal Invasion

Direct invasion of colorectal adenocarcinoma into adjacent structures occurs frequently, but only rarely is the duodenum involved. This study was undertaken to assess the safety and efficacy of en bloc resection of locally advanced right colon carcinoma invading the duodenum. A retrospective review of 49 patients with locally advanced colon cancer, surgically managed between 2000 and 2005, was performed. Forty-six patients underwent en bloc resection of colon and adjacent organs not involving the duodenum. Three patients with duodenal invasion underwent en bloc partial duodenectomy. The mean operative blood loss, length of stay, postoperative morbidity, and mortality compare favorably between these two groups of patients. Of the 46 patients with en bloc resection of other organs, 27 are alive at 12 to 60 months follow up. Two patients with duodenal invasion are alive without recurrence at 15 and 20 months follow up. En bloc resection of colon cancer invading the duodenum can be performed safely because morbidity and mortality rates are comparable to those attending extended resections of other locally advanced colon carcinomas. Overall survival in patients who underwent surgery with curative intent justifies en bloc duodenal resection in selected patients.

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

Endoscopy International Open ◽

10.1055/a-0965-8531 ◽

2019 ◽

Vol 07 (09) ◽

pp. E1166-E1174 ◽

Cited By ~ 9

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.

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Endoscopic submucosal dissection using countertraction with clips and rubber band allows safe en bloc resection of recurrent duodenal superficial lesions with intense fibrosis

Endoscopy ◽

10.1055/a-1144-2611 ◽

2020 ◽

Vol 52 (11) ◽

pp. E398-E399

Author(s):

Alexandru Lupu ◽

Julien Faller ◽

Borathchakra Oung ◽

Timothée Wallenhorst ◽

Jérémie Jacques ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Rubber Band ◽

En Bloc Resection ◽

Bloc Resection ◽

En Bloc ◽

Submucosal Dissection

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Mandibular periosteal (juxtacortical) chondrosarcoma

Brazilian Dental Journal ◽

10.1590/s0103-64402009000500013 ◽

2009 ◽

Vol 20 (5) ◽

pp. 428-433 ◽

Cited By ~ 3

Author(s):

Elisângela Maria Cunha Costa ◽

Bárbara Lima Lucas ◽

Mariana Reis Silva ◽

Renata Hinhug Vilarinho ◽

Paulo Rogério de Faria ◽

...

Keyword(s):

Final Diagnosis ◽

En Bloc Resection ◽

Bloc Resection ◽

Bone Surface ◽

En Bloc ◽

Grade Ii ◽

Well Differentiated ◽

Slow Growing ◽

Tomography Scan

Periosteal (juxtacortical) chondrosarcoma (PC) is a well-differentiated malignant cartilage-forming tumor arising from the external bone surface, especially in long bones. The therapy of choice is en-bloc resection and, in general, its prognosis is good. This paper reports a rare case of PC affecting the mandible of a 41-year-old man. The lesion presented as a slow-growing-painless swelling that lasted 2 months. Computed tomography scan showed a tumoral mass arising from the external bone surface, extending into the adjacent soft tissue presenting patchy regions of popcorn-like calcifications. A final diagnosis of PC (grade II) was rendered after biopsy. Hemimandibulectomy was undertaken followed by complementary radiotherapy with 70 Gy. Although no episodes of recurrence or metastasis had been noticed after 18 months of follow-up, the patient died and causa mortis could not be established.

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Underwater versus conventional endoscopic mucosal resection for small size non-pedunculated colorectal polyps: a randomized controlled trial

BMC Gastroenterology ◽

10.1186/s12876-020-01457-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Zhixin Zhang ◽

Yonghong Xia ◽

Hongyao Cui ◽

Xin Yuan ◽

Chunnian Wang ◽

...

Keyword(s):

Endoscopic Mucosal Resection ◽

En Bloc Resection ◽

Bloc Resection ◽

Colorectal Polyps ◽

Efficacy And Safety ◽

Resection Rate ◽

En Bloc ◽

Randomized Controlled ◽

Mucosal Resection ◽

Group 1

Abstract Background Underwater endoscopic mucosal resection (UEMR) is a recently developed technique and can be performed during water-aided or ordinary colonoscopy for the treatment of colorectal polyps. The objective of this clinical trial was to evaluate the efficacy and safety of UEMR in comparison with conventional endoscopic mucosal resection (CEMR) of small non-pedunculated colorectal polyps. Methods Patients with small size, non-pedunculated colorectal polyps (4–9 mm in size) who underwent colonoscopic polypectomy were enrolled in this multicenter randomized controlled clinical trial. The patients were randomly allocated to two groups, an UEMR group and a CEMR group. Efficacy and safety were compared between groups. Results In the intention-to-treat (ITT) analysis, the complete resection rate was 83.1% (59/71) in the UEMR group and 87.3% (62/71) in the CEMR group. The en-bloc resection rate was 94.4% (67/71) in the UEMR group and 91.5% (65/71) in the CEMR group (difference 2.9%; 90% CI − 4.2 to 9.9%), showed noninferiority (noninferiority margin − 5.7% < − 4.2%). No significant difference in procedure time (81 s vs. 72 s, P = 0.183) was observed. Early bleeding was observed in 1.4% of patients in the CEMR group (1/71) and 1.4% of patients in the UEMR group (1/71). None of the patients in the UEMR group complained of postprocedural bloody stool, whereas two patients in the CEMR group (2/64) reported this adverse event. Conclusion Our results indicate that UEMR is safer and just as effective as CEMR in En-bloc resection for the treatment of small colorectal polyps as such, UEMR is recommended as an alternative approach to excising small and non-pedunculated colorectal adenomatous polyps. Trial registration Clinical Trials.gov, NCT03833492. Retrospectively registered on February 7, 2019.

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Therapeutic strategy involving endoscopic resection for cN0 superficial carcinoma of the esophagus.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.1 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 1-1

Author(s):

T. Iizuka ◽

D. Kikuchi ◽

S. Hoteya

Keyword(s):

Endoscopic Resection ◽

En Bloc Resection ◽

Bloc Resection ◽

Additional Treatment ◽

En Bloc ◽

Carcinoma Of The Esophagus ◽

Secondary Hemorrhage ◽

Long Term Follow Up

1 Background: With the progress in endoscopic submucosal dissection (ESD) which enables en bloc resection irrespective of the size of lesion, a therapeutic strategy has become feasible whereby ESD is undertaken first, followed by considering additional treatment based on the results of histologic exploration. In this study, we attempted to clarify the clinical results in patients who had undergone additional treatment after endoscopic resection (ER) for cN0 superficial carcinoma. Methods: Of 140 patients diagnosed as having T1a-MM-SM2 lesions of squamous cell carcinoma of the esophagus who had undergone ER between January 1998 and March 2010, 83 patients who received additional treatment after ER (surgery, 27 pts; chemoradiotherapy [CRT], 56 pts.) were the subjects of this study. The mean duration of observation was 45.1 months. Results: The en bloc resection rate was 86%. There were 5 patients (6%) who had complications associated with ER, including perforation in 2 patients, secondary hemorrhage in a patient and pneumonia in 2 patients. Complications associated with additional treatment were noted in 13 patients (15.6%), including secondary hemorrhage, recurrent laryngeal nerve paralysis and pulmonary infarction in one patient each, pneumonia in 3, grade ≥ 3 myelosuppression in 5, and syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and radiation pneumonitis in one patient each. Long-term follow-up revealed no local recurrence and no patients who experienced late toxicity due to CRT. The tumor recurred in 4 patients, the site of recurrent lesion being the mediastinum in 3 patients and the cervical lymph node in one patient, of whom 2 patients died of the primary disease. The 5-year survival rate was 88.4%. Conclusions: Endoscopic resection plus additional treatment for superficial carcinoma of the esophagus did not entail the development of any serious complications; thus, such combined treatment was safe and feasible. The long-term follow-up results were fairly gratifying, and ER with subsequent additional treatment is considered to be valid for patients with cN0 superficial carcinoma of the esophagus. No significant financial relationships to disclose.

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