Minimally Invasive Approaches for the Management of “Difficult” Colonic Polyps

Traditionally, patients with colonic polyps not amenable to endoscopic removal require open colectomy for management. We evaluated our experience with minimally invasive approaches including endoscopic mucosal resection (EMR), laparoscopic-assisted endoscopic polypectomy (LAEP), and laparoscopic-assisted colectomy (LAC). Patients referred for surgery for colonic polyps were selected for one of three minimally invasive modalities. A total of 123 patients were referred for resection of “difficult” polyps. Thirty underwent EMR, 25 underwent LAEP, and 68 underwent LAC. Of those selected to undergo EMR or LAEP, 76.4% were successfully managed without colon resection. The remaining 23.6% underwent LAC. Nine complications were encountered, including two requiring reoperative intervention. Of the 123 patients, three were found to have malignant disease on final pathology. Surgical resection can be avoided in a significant number of patients with “difficult” polyps referred for surgery by performing EMR and LAEP. In those who require surgery, minimally invasive resection can be achieved.

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Clinical and financial impacts of introducing an endoscopic mucosal resection service for treatment of patients with large colonic polyps into a regional tertiary hospital

Endoscopy International Open ◽

10.1055/a-0970-8828 ◽

2019 ◽

Vol 07 (11) ◽

pp. E1386-E1392

Author(s):

Thomas Worland ◽

Oliver Cronin ◽

Benjamin Harrison ◽

Linda Alexander ◽

Nik Ding ◽

...

Keyword(s):

Endoscopic Mucosal Resection ◽

Surgical Procedures ◽

Colonic Polyps ◽

Tertiary Hospital ◽

Safe Alternative ◽

Intention To Treat ◽

Mucosal Resection ◽

Regional Center ◽

Financial Benefits ◽

Number Of Patients

Abstract Background and study aims Endoscopic mucosal resection (EMR) of large sessile or laterally spreading colonic lesions is a safe alternative to surgery. We assessed reductions in Surgical Resection (SR) rates and associated clinical and financial benefits following the introduction of an EMR service to a large regional center. Patients and methods Ongoing prospective intention-to-treat analysis of EMR was undertaken from time of service inception in 2009 to 2017. Retrospective data for SR of large sessile/laterally spreading colonic lesions were collected for the period 4 years before commencement of the EMR service (2005 – 2008) and 9 years after its introduction (2009 – 2017). Results From 2005 to 2008, 32 surgical procedures were performed for non-malignant colonic neoplasia (50 % male, median age 68 years, median Length of Stay (LoS) 10 days). Following the introduction of the EMR service, there was a 56 % reduction in the number of patients referred for surgery (32 surgical procedures, 47 % male, median age 70 years, median LoS 8.5 days). During this period, EMR was successfully performed in 183 patients with 216 lesions resected (60 % male, median age 68 years, median LoS 1 day). Compared to the SR group, the EMR cohort had a lower peri-procedural complication rate (7.7 % vs 54.7 %, P < 0.0001), and shorter average LoS (1 vs 9 days, P < 0.0001). A cost saving of AUD $ 19 543.5 was seen per lesion removed with EMR compared to SR. Conclusions The introduction of a dedicated EMR service into a large regional center as an alternative to SR can lead to a substantial decrease in unnecessary surgery with subsequent clinical and financial benefits.

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P58 Laparoscopic assisted endoscopic mucosal resection reduces the need for bowel resection for complex colonic polyps

10.1136/gutjnl-2020-bsgcampus.133 ◽

2021 ◽

Author(s):

Jody Parker ◽

Michael Davies ◽

Sunil Dolwani

Keyword(s):

Endoscopic Mucosal Resection ◽

Bowel Resection ◽

Colonic Polyps ◽

Mucosal Resection ◽

Laparoscopic Assisted

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ENDOSCOPIC MUCOSAL RESECTION

JMS SKIMS ◽

10.33883/jms.v23i2.758 ◽

2020 ◽

Vol 23 (2) ◽

Author(s):

Altaf Shah ◽

Nadeem Ahmad

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Minimally Invasive ◽

Endoscopic Mucosal Resection ◽

Therapeutic Option ◽

Endoscopic Removal ◽

Gi Tract ◽

Mucosal Resection ◽

Gastrointestinal Lesions ◽

Malignant Lesions

EMR was developed for minimally invasive, organ-sparing endoscopic removal of benign and early malignant lesions in the GI tract. Endoscopic mucosal resection was pioneered in Japan [Soetikno et al. 2003] for the management of early gastric cancer. This has gained wider acceptance as a therapeutic option for various gastrointestinal lesions around the globe 1.

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COLD SNARE PIECEMEAL ENDOSCOPIC MUCOSAL RESECTION (CSP-EMR) OF LARGE SESSILE COLONIC POLYPS ≥20 MM IS FEASIBLE, SAFE AND EFFECTIVE

10.1055/s-0039-1681596 ◽

2019 ◽

Author(s):

D Mangira ◽

K Cameron ◽

JH Koo ◽

A Moss

Keyword(s):

Endoscopic Mucosal Resection ◽

Colonic Polyps ◽

Mucosal Resection

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Crohn’s disease: a population-based study of surgery in the age of biological therapy

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03930-w ◽

2021 ◽

Author(s):

Christian Stöss ◽

Maximilian Berlet ◽

Stefan Reischl ◽

Ulrich Nitsche ◽

Marie-Christin Weber ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Minimally Invasive ◽

Biological Therapy ◽

Hospital Admissions ◽

Diagnosis Related Groups ◽

Age Distribution ◽

Considerable Proportion ◽

Discharge Data ◽

Number Of Patients

Abstract Purpose Despite primary conservative therapy for Crohn’s disease, a considerable proportion of patients ultimately needs to undergo surgery. Presumably, due to the increased use of biologics, the number of surgeries might have decreased. This study aimed to delineate current case numbers and trends in surgery in the era of biological therapy for Crohn’s disease. Methods Nationwide standardized hospital discharge data (diagnosis-related groups statistics) from 2010 to 2017 were used. All patients who were admitted as inpatient Crohn’s disease cases in Germany were included. Time-related development of admission numbers, rate of surgery, morbidity, and mortality of inpatient Crohn’s disease cases were analyzed. Results A total number of 201,165 Crohn’s disease cases were included. Within the analyzed time period, the total number of hospital admissions increased by 10.6% (n = 23,301 vs. 26,069). While gender and age distribution remained comparable, patients with comorbidities such as stenosis formation (2010: 10.1%, 2017: 13.4%) or malnutrition (2010: 0.8%, 2017: 3.2%) were increasingly admitted. The total number of all analyzed operations for Crohn’s disease increased by 7.5% (2010: n = 1567; 2017: n = 1694). On average, 6.8 ± 0.2% of all inpatient patients received ileocolonic resections. Procedures have increasingly been performed minimally invasive (2010: n = 353; 2017: n = 687). The number of postoperative complications remained low. Conclusion Despite the development of novel immunotherapeutics, the number of patients requiring surgery for Crohn’s disease remains stable. Interestingly, patients have been increasingly hospitalized with stenosis and malnutrition. The trend towards more minimally invasive operations has not relevantly changed the rate of overall complications.

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P57 Laparoscopic assisted endoscopic mucosal resection of a complex caecal polyp

10.1136/gutjnl-2020-bsgcampus.132 ◽

2021 ◽

Author(s):

Jody Parker ◽

Sunil Dolwanit ◽

Michael Davies

Keyword(s):

Endoscopic Mucosal Resection ◽

Mucosal Resection ◽

Laparoscopic Assisted

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ID: 3524319 USE OF ADJUNCTIVE REMOVAL TECHNIQUES FOR ENDOSCOPIC MUCOSAL RESECTION OF LARGE NON-PEDUNCULATED COLONIC POLYPS IS PREDICTIVE OF POLYP RECURRENCE

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2021.03.273 ◽

2021 ◽

Vol 93 (6) ◽

pp. AB109-AB110

Author(s):

Suqing Li ◽

Jeffrey D. Mosko ◽

Gary R. May ◽

Gabor Kandel ◽

Paul Kortan ◽

...

Keyword(s):

Endoscopic Mucosal Resection ◽

Colonic Polyps ◽

Mucosal Resection ◽

Polyp Recurrence

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Endoscopic Mucosal Resection (Emr) of Colonic Polyps in the Older Patient – is it Safe?

10.1055/s-0041-1724502 ◽

2021 ◽

Author(s):

T Garvey ◽

A Hadjinicolaou ◽

M Frank ◽

V Nadesalingam ◽

E McDermott

Keyword(s):

Endoscopic Mucosal Resection ◽

Colonic Polyps ◽

Older Patient ◽

Mucosal Resection

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Minimally Invasive versus Open Thoracolumbar Surgery for Lumbar Spinal Stenosis in Patients with Diabetes: A CSORN Study

Journal of Spine Practice (JSP) ◽

10.18502/jsp.v1i1.9773 ◽

2021 ◽

pp. 13

Author(s):

Kalpesh Hathi

Keyword(s):

Back Pain ◽

Minimally Invasive ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Research Network ◽

Leg Pain ◽

Number Of Patients ◽

Patients With Diabetes ◽

One Year ◽

Lumbar Spinal

Introduction: This study was aimed at comparing outcomes of minimally invasive (MIS) versus OPEN surgery for lumbar spinal stenosis (LSS) in patients with diabetes. Methodology: This retrospective cohort study included patients with diabetes who underwent spinal decompression alone or with fusion for LSS within the Canadian Spine Outcomes and Research Network (CSORN) database. Outcomes of MIS and OPEN approaches were compared for two cohorts: (i) patients with diabetes who underwent decompression alone (N = 116; MIS, n = 58, OPEN, n = 58) and (ii) patients with diabetes who underwent decompression with fusion (N = 108; MIS, n = 54, OPEN, n = 54). Mixed measures analyses of covariance compared modified Oswestry Disability Index (mODI) and back and leg pain at one-year post operation. The number of patients meeting minimum clinically important difference (MCID) or minimum pain/disability at one year were compared. Result: MIS approaches had less blood loss (decompression alone difference 99.66 mL, p = 0.002; with fusion difference 244.23, p < 0.001) and shorter LOS (decompression alone difference 1.15 days, p = 0.008; with fusion difference 1.23 days, p = 0.026). MIS compared to OPEN decompression with fusion had less patients experience an adverse event (difference, 13 patients, p = 0.007). The MIS decompression with fusion group had lower one-year mODI (difference, 14.25, p < 0.001) and back pain (difference, 1.64, p = 0.002) compared to OPEN. More patients in the MIS decompression with fusion group exceeded MCID at one year for mODI (MIS 75.9% vs OPEN 53.7%, p = 0.028) and back pain (MIS 85.2% vs OPEN 70.4%, p = 0.017). Conclusion: MIS approaches were associated with more favorable outcomes for patients with diabetes undergoing decompression with fusion for LSS.

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