The safety and efficacy of radiofrequency ablation following endoscopic submucosal dissection for Barrett's neoplasia

2017 ◽  
Vol 31 (3) ◽  
Author(s):  
S Subramaniam ◽  
K Kandiah ◽  
F Chedgy ◽  
P Meredith ◽  
G Longcroft-Wheaton ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Endoscopic Submucosal Dissection ◽  
Endoscopic Resection ◽  
Stricture Formation ◽  
Complication Rates ◽  
Safety And Efficacy ◽  
Submucosal Dissection ◽  
Increased Risk ◽  
Tertiary Center ◽  
Significant Difference

SUMMARY The current standard of treating early Barrett's neoplasia is resection of visible lesions using endoscopic mucosal resection (EMR) followed by ablative therapy to the Barrett's segment. There is increasing evidence to support the use of endoscopic submucosal dissection (ESD) where en-bloc resection and lower recurrence rates may be achieved. However, ESD is associated with deep submucosal dissection when compared to EMR. This may increase the risk of complications including stricture formation with subsequent radiofrequency ablation (RFA) therapy. The aim of this study is to compare the safety and efficacy of RFA following EMR and ESD as well as when RFA was used without prior endoscopic resection. The primary outcome measure was complication rates. Clearance of dysplasia (CRD) and clearance of intestinal metaplasia (CRIM) were secondary outcomes. A retrospective analysis of a cohort of 91 patients referred for RFA from a single academic tertiary center was performed. The choice of endoscopic resection method was tailored according to the lesion type and morphology. Focal and circumferential ablation was performed after initial follow up endoscopy postresection. Patients proceeded straight to RFA in the absence of any visible lesions. In this study, the ESD group had a higher proportion of cancers compared to the EMR cohort (74.1% vs. 30.2%, P < 0.01) prior to RFA. All complications post RFA occurred in the groups with previous endoscopic resection. There was no significant difference in the total complication rate (7.4% vs. 9.3%, P = 0.78) and stricture formation rate (3.7% vs. 9.3%, P = 0.38) between the ESD and EMR groups. CRD was achieved in 96.3% in the ESD group, 88.4% in the EMR group, and all patients in the RFA alone group. CRIM rates were similar in the EMR and ESD groups (81.4% vs. 85.2%) but higher in the RFA alone group (90.5%). In conclusion, RFA following ESD is very effective and not associated with an increased risk of complications compared to EMR. This supports the application of RFA in the treatment algorithm of patients undergoing ESD for Barrett's neoplasia.

scholarly journals Safety and Efficacy of Nonanesthesiologist-Administrated Propofol during Endoscopic Submucosal Dissection of Gastric Epithelial Tumors

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Keiichiro Abe ◽  
Keiichi Tominaga ◽  
Akira Kanamori ◽  
Tsunehiro Suzuki ◽  
Hitoshi Kino ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Submucosal Dissection ◽  
University Hospital ◽  
Physical Status ◽  
Safety And Efficacy ◽  
Submucosal Dissection ◽  
Epithelial Tumors ◽  
Physical Status Classification ◽  
Significant Difference ◽  
Status Classification

Objective. There is no consensus regarding administration of propofol for performing endoscopic submucosal dissection (ESD) in patients with comorbidities. The aim of this study was to evaluate the safety and efficacy of propofol-induced sedation administered by nonanesthesiologists during ESD of gastric cancer in patients with comorbidities classified according to the American Society of Anesthesiologists (ASA) physical status. Methods. Five hundred and twenty-two patients who underwent ESD for gastric epithelial tumors under sedation by nonanesthesiologist-administrated propofol between April 2011 and October 2017 at Dokkyo Medical University Hospital were enrolled in this study. The patients were divided into 3 groups according to the ASA physical status classification. Hypotension, desaturation, and bradycardia were evaluated as the adverse events associated with propofol. The safety of sedation by nonanesthesiologist-administrated propofol was measured as the primary outcome. Results. The patients were classified according to the ASA physical status classification: 182 with no comorbidity (ASA 1), 273 with mild comorbidity (ASA 2), and 67 with severe comorbidity (ASA 3). The median age of the patients with ASA physical status of 2/3 was higher than the median age of those with ASA physical status of 1. There was no significant difference in tumor characteristics, total amount of propofol used, or ESD procedure time, among the 3 groups. Adverse events related to propofol in the 522 patients were as follows: hypotension (systolic blood pressure<90 mmHg) in 113 patients (21.6%), respiratory depression (SpO2<90%) in 265 patients (50.8%), and bradycardia (pulse rate<50 bpm) in 39 patients (7.47%). There was no significant difference in the incidences of adverse events among the 3 groups during induction, maintenance, or recovery. No severe adverse event was reported. ASA 3 patients had a significantly longer mean length of hospital stay (8 days for ASA 1, 9 days for ASA 2, and 9 days for ASA 3, P=0.003). However, the difference did not appear to be clinically significant. Conclusions. Sedation by nonanesthesiologist-administrated propofol during ESD is safe and effective, even for at-risk patients according to the ASA physical status classification.

scholarly journals Continuous use of low-dose warfarin for gastric endoscopic submucosal dissection: a prospective study

2017 ◽  
Vol 05 (05) ◽  
pp. E348-E353 ◽  
Author(s):  
Hideaki Harada ◽  
Satoshi Suehiro ◽  
Daisuke Murakami ◽  
Takanori Shimizu ◽  
Ryotaro Nakahara ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Low Dose ◽  
Postoperative Bleeding ◽  
Warfarin Dose ◽  
International Normalized Ratio ◽  
Safety And Efficacy ◽  
Submucosal Dissection ◽  
Day Range ◽  
Dose Warfarin ◽  
Significant Difference

Abstract Background and study aims Patients who receive warfarin usually require heparin bridge therapy (HBT) to prevent thromboembolic events during endoscopic submucosal dissection (ESD); however, clinical evidence demonstrating the safety and efficacy of HBT during gastric ESD is limited. Conversely, warfarin can be continuously used as a substitute for HBT to endoscopic procedures which have a low risk of bleeding. This study aimed to clarify the safety and efficacy of continuous low-dose warfarin (LDW) for gastric ESD. Patients and methods This was a prospective observational study at a single institution. A total of 22 patients who received warfarin between December 2014 and January 2016 were enrolled. The patients were treated with gastric ESD with a low dose of warfarin ( ≤ 4 mg) at approximately 1.6 – 2.6 of the international normalized ratio (INR) levels. Furthermore, we analyzed a total of 23 patients with HBT who underwent gastric ESD between January 2011 and November 2014. Results The average of warfarin dose and the INR level on the day of gastric ESD in the continuous LDW group were 2.3 mg/day (range 0.5 – 4.0) and 1.87 (range 1.41 – 2.75), respectively. Two of the 22 patients (9.1 %) in the continuous LDW group and 5 of the 23 patients (21.7 %) in the HBT group had postoperative bleeding after gastric ESD. Although the postoperative bleeding rate in the continuous LDW group was lower than that in the HBT group, no significant difference was observed between the 2 groups (P = 0.414). Conclusions Gastric ESD with continuous LDW as a substitute for HBT was feasible and may be acceptable.

scholarly journals Evaluating the effect of injecting triamcinolone acetonide in two sessions for preventing esophageal stricture after endoscopic submucosal dissection

2019 ◽  
Vol 07 (06) ◽  
pp. E764-E770 ◽  
Author(s):  
Satoru Hashimoto ◽  
Ken-ichi Mizuno ◽  
Kazuya Takahashi ◽  
Hiroki Sato ◽  
Junji Yokoyama ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Triamcinolone Acetonide ◽  
Esophageal Stricture ◽  
Control Group ◽  
Study Group ◽  
Stricture Formation ◽  
Endoscopic Injection ◽  
Submucosal Dissection ◽  
Stricture Rate ◽  
Significant Difference

Abstract Background and study aims Several previous reports indicate that endoscopic injection of triamcinolone acetonide (TA) after widespread endoscopic submucosal dissection (ESD) is effective for preventing esophageal stricture. We investigated the efficacy of injecting TA in two sessions for preventing stricture formation post-ESD. Patients and methods Sixty-six consecutive patients with widespread mucosal defects that affected more than three-fourths of the circumference of the esophagus were included. The study group (n = 40) received TA injections over two sessions: immediately after and 14 days after ESD. The control group (n = 26) did not receive a TA injection. This study was performed retrospectively against historical controls. The primary endpoint of this study was frequency of stricture after TA injection. The secondary endpoint was number of required endoscopic balloon dilations (EBDs) after TA injection. Results The post-ESD stricture rate among patients who had subcircumferential mucosal defects was 45.7 % in the study group (16/35 patients), which was significantly lower than the rate of 73.9 % in the control group (17/23 patients; P = 0.031). The number of EBD procedures required was significantly lower in the study group (median 0, range 0 – 7) than in the control group (median 4, range 0 – 20; P < 0.001). There was no significant difference between the study and control groups among the patients who had full circumferential mucosal defects. Conclusion This study showed that performing two sessions of TA injection is an effective and safe treatment for prevention of esophageal stricture following subcircumferential ESD.

scholarly journals Salvage endoscopic submucosal dissection for recurrent invasive Barrett neoplasia after endoscopic resection and radiofrequency ablation

Endoscopy ◽  
2020 ◽  
Vol 53 (01) ◽  
pp. E5-E6
Author(s):  
Borathchakra Oung ◽  
Julien Faller ◽  
Florence Juget Pietu ◽  
Marco Petronio ◽  
Mathieu Pioche
Keyword(s):  
Radiofrequency Ablation ◽  
Endoscopic Submucosal Dissection ◽  
Endoscopic Resection ◽  
Submucosal Dissection

scholarly journals Real-World Experience of Endoscopic Submucosal Dissection for Ulcerative Colitis-Associated Neoplasia

2021 ◽  
pp. 1-8
Author(s):  
Akira Matsui ◽  
Shu Hoteya ◽  
Junnosuke Hayasaka ◽  
Satoshi Yamashita ◽  
Yorinari Ochiai ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Endoscopic Submucosal Dissection ◽  
Endoscopic Resection ◽  
Univariate Analysis ◽  
R0 Resection ◽  
Submucosal Dissection ◽  
Toranomon Hospital ◽  
Increased Risk ◽  
Epithelial Lesions ◽  
Horizontal Margin

Introduction: Patients with ulcerative colitis (UC) have an increased risk of colorectal cancer. Some studies have recently investigated endoscopic resection of UC-associated neoplasia (UCAN), but the indications for endoscopic resection of UCAN remain controversial. This study sought to clarify the problems encountered in endoscopic submucosal dissection (ESD) for UCAN. Methods: Seventeen lesions in 12 patients with UCAN (UCAN group) and 913 epithelial lesions in 824 control patients without UC (non-UC group) were evaluated. Both groups underwent ESD between January 2010 and December 2017 at Toranomon Hospital, Tokyo, Japan. Treatment outcomes of the 2 groups were compared retrospectively. Results: Univariate analysis showed that the mean tumor size was significantly smaller in the UCAN group than in the non-UC group (25.1 ± 26.7 mm vs. 31.9 ± 19.0; p = 0.0023); however, the R0 resection rate was significantly lower in the UCAN group (70.6 vs. 92.9%; p = 0.001). Multivariate analysis showed a significantly lower negative horizontal margin rate in the UCAN group (odds ratio 11.3, 95% confidence interval 3.588–34.525; p = 0.000). Discussion/Conclusion: ESD for UCAN is associated with a low-negative horizontal margin rate. When performing ESD for UCAN, it is important to evaluate the accuracy of the UCAN demarcation line, especially for flat lesions, using white-light imaging and chromoendoscopy as well as other modalities, including biopsy of surrounding tissues.

scholarly journals A Propensity Score Matching Study Between Microwave Ablation and Radiofrequency Ablation in Terms of Safety and Efficacy for Benign Thyroid Nodules Treatment

2021 ◽  
Vol 12 ◽  
Author(s):  
Hao Jin ◽  
Jinrui Fan ◽  
Ligong Lu ◽  
Min Cui
Keyword(s):  
Radiofrequency Ablation ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Microwave Ablation ◽  
Thyroid Nodules ◽  
Complication Rates ◽  
Safety And Efficacy ◽  
Significant Difference ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid

BackgroundLarge benign thyroid nodules often lead to cosmetic problems and compression on trachea. Thermal ablation is an effective method for benign thyroid nodules treatment. Among all the thermal ablation techniques, microwave and radiofrequency are frequently used energy sources. However, treatment outcomes of the two ablation types have not been compared in detail. Therefore, we conducted this study aiming for comparing the safety and efficacy of the two ablation techniques in benign thyroid nodules treatment.MethodsInformation was retrospectively collected from patients with benign thyroid nodules, who received radiofrequency ablation or microwave ablation between January 1, 2018, and December 31, 2019, in a main hospital in South China. Patients were divided into microwave ablation group and radiofrequency ablation group according to the techniques applied. A propensity score matching was performed to balance the baseline indexes between the two groups. We also recorded and analyzed the operative variables including operative duration, intraoperative blood loss, hospitalization time, and overall costs. Postoperative quality of life, volume reduction rates, and complication rates were routinely evaluated during the follow-up by asking patients to fulfil questionnaires at the 1st, 3rd, 6th, 12th, and 18th postoperative month.ResultsA total of 943 patients receiving microwave ablation or radiofrequency ablation in the years of 2018 and 2019 met our inclusion criteria. After 1:1 propensity score matching, 289 pairs of patients were matched. There was no significant difference between the two groups in operative duration, intraoperative blood loss, hospitalization time, overall cost, quality of life scores, complication rates or volume reduction rates.ConclusionThere was no significant difference between microwave and radiofrequency ablation in terms of safety and efficacy. Both of the two techniques` are ideal therapeutic methods in benign thyroid nodules treatment.Registration numberChiCTR2000034764.

Current Endoscopic Resection Techniques for Gastrointestinal Lesions: Endoscopic Mucosal Resection, Submucosal Dissection, and Full-Thickness Resection

2021 ◽  
pp. 1-14
Author(s):  
Arthur Hoffman ◽  
Raja Atreya ◽  
Timo Rath ◽  
Markus Ferdinand Neurath
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Endoscopic Resection ◽  
Complication Rates ◽  
Full Thickness ◽  
National Guidelines ◽  
En Bloc ◽  
Early Stages ◽  
Mucosal Resection ◽  
Submucosal Dissection ◽  
Gastrointestinal Lesions

<b><i>Background:</i></b> Endoscopic resection of dysplastic lesions in early stages of cancer reduces mortality rates and is recommended by many national guidelines throughout the world. Snare polypectomy and endoscopic mucosal resection (EMR) are established techniques of polyp removal. The advantages of these methods are their relatively short procedure times and acceptable complication rates. The latter include delayed bleeding in 0.9% and a perforation risk of 0.4–1.3%, depending on the size and location of the resected lesion. EMR is a recent modification of endoscopic resection. A limited number of studies suggest that larger lesions can be removed en bloc with low complication rates and short procedure times. Novel techniques such as endoscopic submucosal dissection (ESD) are used to enhance en bloc resection rates for larger, flat, or sessile lesions. Endoscopic full-thickness resection (EFTR) is employed for non-lifting lesions or those not easily amenable to resection. Procedures such as ESD or EFTR are emerging standards for lesions inaccessible to EMR techniques. <b><i>Summary:</i></b> Endoscopic treatment is now regarded as first-line therapy for benign lesions. <b><i>Key Message:</i></b> Endoscopic resection of dysplastic lesions or early stages of cancer is recommended. A plethora of different techniques can be used dependent on the lesions.

scholarly journals Clinical Outcomes of Pulmonary Embolism in Mexican Patients With COVID-19

2021 ◽  
Vol 27 ◽  
pp. 107602962110089
Author(s):  
Luis O. Bobadilla-Rosado ◽  
Santiago Mier y Teran-Ellis ◽  
Gabriel Lopez-Pena ◽  
Javier E. Anaya-Ayala ◽  
Carlos A. Hinojosa
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Outcomes ◽  
Mexico City ◽  
Clinical Characteristics ◽  
Anticoagulation Therapy ◽  
Coagulation Abnormalities ◽  
Survivor Group ◽  
Increased Risk ◽  
Tertiary Center ◽  
Significant Difference

Coagulation abnormalities have been reported in COVID-19 patients, which may lead to an increased risk of Pulmonary Embolism (PE). We aimed to describe the clinical characteristics and outcomes of COVID-19 patients diagnosed with PE during their hospital stay. We analyzed patients with PE and COVID-19 in a tertiary center in Mexico City from April to October of 2020. A total of 26 (100%) patients were diagnosed with Pulmonary Embolism and COVID-19. We observed that 14 (54%) patients were receiving either prophylactic or full anticoagulation therapy, before PE diagnosis. We found a significant difference in mortality between the group with less than 7 days (83%) and the group with more than 7 days (15%) in Intensive Care Unit ( P = .004); as well as a mean of 8 days for the mortality group compared with 20 days of hospitalization in the survivor group ( P = .003). In conclusion, there is an urgent need to review antithrombotic therapy in these patients in order to improve clinical outcomes and decrease hospital overload.

scholarly journals Safety and efficacy of directly acting antivirals (sofosbuvir and daclatasvir) in treatment of chronic HCV in HIV-HCV co-infected Egyptian patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Inas E L-Khedr Mohamed ◽  
Kadry Mohamed EL-Saeed ◽  
Mahmoud Hassan Al-Sadik ◽  
Christina Alphonse Anwar
Keyword(s):  
Complete Blood Count ◽  
Virologic Response ◽  
Safety And Efficacy ◽  
Treatment Regimens ◽  
End Of Treatment ◽  
Increased Risk ◽  
Significant Difference ◽  
Egyptian Patients ◽  
Infected Adult ◽  
Chronic Hcv

Abstract Background Cure of chronic hepatitis C (HCV) in HIV/HCV co-infected patients is a priority due to their increased risk of complications. Daclatasvir and sofosbuvir treatment regimens with or without ribavirin are considered an important chance for better HCV treatment in patients with HIV/HCV co-infection. This study aimed at the assessment of safety and efficacy of sofosbuvir-daclatasvir treatment regimens in HIV/HCV co-infected Egyptian patients. Results Thirty HIV/HCV co-infected adult patients were included. All patients completed the study duration without major problems or drug interactions, HCV PCR was negative for all patients at the end of treatment, yet 12 weeks after ending treatment, only one patient (3.33%) had HCV relapse. Liver enzymes showed a significant decrease by the end of treatment and 12 weeks after end of treatment in comparison with their values before treatment (P-value = 0.0001). CD4 counts as well showed significant increase. There was non-significant change in serum albumin, total bilirubin, alfa fetoprotein, complete blood count (CBC), coagulation profile, random blood sugar, or serum creatinine. Ultrasonographic findings did not show significant difference. Conclusion Combination of daclatasvir and sofosbuvir have showed 96.67% sustained virologic response at 12 weeks after treatment (SVR 12) among HIV/HCV co-infected patients, with a good safety profile. Moreover, the treated patients showed a significant increase in CD4 lymphocytic count.

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