scholarly journals Burn the Base to Get the Polyp Erased: A Novel Technique to Reduce Post-EMR Recurrence

2021 ◽  
Author(s):  
John Maynard Levenick ◽  
Adnrew J Groff ◽  
Carl Manzo ◽  
Courtney Lester ◽  
Jennifer L Maranki
Keyword(s):  
Local Recurrence ◽  
Endoscopic Mucosal Resection ◽  
Recurrence Rate ◽  
Focal Therapy ◽  
Standard Group ◽  
Colon Polyps ◽  
Recurrence Rates ◽  
Novel Technique ◽  
Standard Techniques

Abstract Background and Aims: Endoscopic mucosal resection (EMR) has become the standard for removing large colon polyps but has a 10-30% recurrence rate using standard techniques. Data shows improved recurrence rates with focal therapy of the edge of the resection base using cautery. We examine a novel technique, hybrid APC assisted EMR, which treats both the edge and the base with cautery to assess its effect on local recurrence. Methods: We reviewed all EMRs of polyps >2cm by a single endoscopist with six month follow-up from May 2018-November 2019 using both standard EMR as well as hybrid APC assisted EMR to assess local recurrence as well complications. Results: 48 patients with 59 polyps removed by EMR had full six month follow up with a mean age of 66.1 years of age, 45% were female. 30 polyps were removed by hybrid APC assisted EMR and 29 removed with standard EMR. Overall, 0 (0%) polyps in the h-APC arm had local recurrence while 6 (20.7%) in the standard group had histological proven local recurrence (p=0.01). Post-resection bleeding occurred in 6 patients, 2 in the hAPC arm and 4 in the standard arm (p=0.41). Conclusions: Hybrid APC assisted EMR was superior to conventional EMR for local recurrence after removal of large colon polyps and trended towards a less post-EMR bleeds.

scholarly journals Hybrid argon plasma coagulation-assisted endoscopic mucosal resection for large sessile colon polyps to reduce local recurrence: a prospective pilot study

Endoscopy ◽  
2021 ◽  
Author(s):  
Victoria L. Motz ◽  
Courtney Lester ◽  
Matthew T. Moyer ◽  
Jennifer L. Maranki ◽  
John M. Levenick
Keyword(s):  
Pilot Study ◽  
Local Recurrence ◽  
Endoscopic Mucosal Resection ◽  
Recurrence Rate ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Colon Polyps ◽  
Plasma Coagulation ◽  
Prospective Pilot Study

Abstract Background Endoscopic mucosal resection (EMR) of large, sessile colon polyps often results in incomplete resection with subsequent recurrence. The aim of this prospective pilot study was to evaluate the efficacy and safety of a novel technique, hybrid argon plasma coagulation-assisted EMR (hAPC-EMR), to remove large, sessile polyps. Methods 40 eligible patients underwent hAPC-EMR for the removal of one or more nonpedunculated colon polyps ≥ 20 mm. Participants were contacted 30 days post-procedure to assess for adverse events and were recommended to return for a surveillance colonoscopy at 6 months to assess for local recurrence. Results At the time writing, 32 patients with 35 polyps (median size 27 mm; interquartile range 14.5 mm) resected by hAPC-EMR had undergone the 6-month follow-up colonoscopy. Recurrence rate was 0 % (95 % confidence interval [CI] 0–0) at follow-up. Post-polypectomy bleeding was experienced by three patients (7.5 %; 95 %CI 0.00–0.15), and no patients developed post-polypectomy syndrome. Conclusion These preliminary results showed 0 % local recurrence rate at 6 months and demonstrated the safety profile of hAPC-EMR. A large, randomized, controlled trial is required to confirm these results.

Recurrence Rate in Vulvar Carcinoma in Relation to Pathological Margin Distance

2010 ◽  
Vol 20 (5) ◽  
pp. 869-873 ◽  
Author(s):  
Saskia M.A. Groenen ◽  
Petra J. Timmers ◽  
Curt W. Burger
Keyword(s):  
Local Recurrence ◽  
Recurrence Rate ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Surgical Approaches ◽  
Stromal Invasion ◽  
Recurrence Rates ◽  
Potential Risk Factors ◽  
Radical Vulvectomy

Objectives:This paper describes the results of a retrospective study of surgical approaches and recurrence rates relating to patients with squamous cell carcinoma (SCC) of the vulva. The aim of this study was to analyze the histological margins in relation to recurrence rate and survival.Methods:A retrospective chart review of 93 cases of vulvar cancer. The data collected included clinicopathological and surgical characteristics and the following potential risk factors: pathological margin distance, less than 8 mm; stromal invasion depth, more than 2.5 mm; tumor size; and presence of benign or premalignant epithelial disorders.Results:Ninety-three patients (median age, 74 years) underwent modified radical vulvectomy, hemi-vulvectomy, or local wide excision for SCC of the vulva from 2000 to 2005. The tumor was radically removed in 80 patients (86%), although the histopathological margin was less than 8 mm in 50 patients (54%). Eighteen patients (23%) developed a local recurrence. The recurrence rate did not differ between patients in whom the margin distance was 8 mm or more and those in whom the margin distance was less than 8 mm, (23% and 22%, respectively). The median follow-up was 31 months (range, 2-90 months).Conclusions:Several studies showed that pathological margin distance of more than 8 mm is an important predictor for local recurrence. This finding was not confirmed in the present study.

scholarly journals First thousand rectal cancer cases: Local recurrence and survival

2004 ◽  
Vol 51 (2) ◽  
pp. 133-137 ◽  
Author(s):  
Zoran Krivokapic ◽  
Goran Barisic ◽  
V. Markovic ◽  
Milos Popovic ◽  
Sladjan Antic ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Anal Verge ◽  
Preoperative Staging ◽  
Recurrence Rates ◽  
Hartmann Procedure ◽  
Cumulative Survival ◽  
Colorectal Anastomoses ◽  
Significant Difference ◽  
Dukes C

In the period 1990 - 2002, 1674 patients with colorectal carcinoma were operated in the First Surgical Clinic, Third Department for Colorectal Surgery. In 1264 cases (75,5%) rectal carcinoma was the indication for surgical treatment. Sphincter saving procedures (SSP) were performed in 824 (65,2%), abdominoperineal resections (APR) in 340 (26,9%) and resections of rectum with definitive stoma (Hartmann procedure) in 100 (7,9%) patients. We analyzed 1095 cases where curative SSP or APR were performed. All cases where curative resection was not possible because of liver metastases or inability to excise all macroscopic disease were excluded. In the group of patients where SSP was performed (767 cases), there were 26,6% high colorectal anastomoses (8cm from anal verge), 65,4% with low (4-8cm from anal verge) and 8,0% with intersphincteric coloanal anastomosis (cm from anal verge). Patohistological exam showed 5,3% Dukes A, 53,1% Dukes B, 36,5% Dukes C and 4,9% Dukes D. In the APR group (328 cases) there were 1,5% Dukes A, 32,4% Dukes B, 62,1% Dukes C and 3,5% Dukes D. In this study we analyzed local recurrence and five-year survival in both groups. Recurrence of the disease was registered in 325 (29,6%) out of 1095 patients. Local recurrence was found in 81 (7,4%) patients. In the SSP group recurrence occured in 215 (28,0%) out of 767 curative resections. Local recurrence alone was found in 53 patients (6,9%). SSP group was also divided into two subgroups; in the first group TME was performed and in second transection of mesorectum was carried out. Analyzing local recurrence in these two groups, in the TME group it was 7,6% and in the transection group 5,6%. In the APR group recurrence was registered in 110 (33,5%) out of 328 patients while local recurrence alone was found in 28 (8,5%) cases. Analyzing mortality we found that 234 (21,4%) out of 1095 patients died during follow-up. In the SSP group 154 out of 767 patients (20,1%) died. In the TME group mortality was 21,7% and in the transection group 16,9%. Mortality in the APR group showed that 80 out of 328 (24,4%) patients died during follow-up. Analysis by the Kaplan-Meier?s test shows cumulative survival of 0,69 for all cases. In the SSP group cumulative survival is 0,72 and in the APR group 0,64 with statistically significant difference (p,001). In the TME group cumulative survival is 0,75 and in the transection group 0,72 with statistically significant difference (p,05). We believe that performing SSP should be encouraged whenever it is possible because there is no difference in local recurrence rates and survival compared to APR. Transection of mesorectum can safely be performed in most cases with tumors located more than 8 cm form anal verge. We believe that exact preoperative staging and preoperative radiotherapy could improve results.

scholarly journals Outcome of endoscopic vs microsurgical transsphenoidal resection for Cushing’s disease

2018 ◽  
Vol 7 (1) ◽  
pp. R26-R37 ◽  
Author(s):  
Nidan Qiao
Keyword(s):  
Recurrence Rate ◽  
Cushing’S Disease ◽  
Meta Analysis ◽  
Cushing's Disease ◽  
Recurrence Rates ◽  
Microscopic Surgery ◽  
Significant Difference ◽  
Comprehensive Search ◽  
Definition Of

Introduction It is unclear whether the proportions of remission and the recurrence rates differ between endoscopic transsphenoidal surgery (TS) and microscopic TS in Cushing’s disease (CD); thus, we conducted a systematic review and meta-analysis to evaluate studies of endoscopic TS and microscopic TS. Methods We conducted a comprehensive search of PubMed to identify relevant studies. Remission and recurrence were used as outcome measures following surgical treatment of CD. Results A total of 24 cohort studies involving 1670 adult patients were included in the comparison. Among these studies, 702 patients across 9 studies underwent endoscopic TS, and 968 patients across 15 studies underwent microscopic TS. Similar baseline characteristics were observed in both groups. There was no significant difference in remission between the two groups: 79.7% (95% CI: 73.1–85.0%) in the endoscopic group and 76.9% (95% CI: 71.3–81.6%) in the microscopic group (P = 0.485). It appears that patients who underwent endoscopic surgery experience recurrence less often than patients who underwent microscopic surgery, with recurrence proportions of 11.0% and 15.9%, respectively (P = 0.134). However, if follow-up time is taken into account, both groups had a recurrence rate of approximately 4% per person per year (95% CI: 3.1–5.4% and 3.6–5.1%, P = 0.651). Conclusions We found that remission proportion and recurrence rate were the same in patients who underwent endoscopic TS as in patients who underwent microscopic TS. The definition of diagnosis, remission and recurrence should always be considered in the studies assessing therapeutic efficacy in CD.

Local recurrence of diminutive colorectal polyps after cold forceps polypectomy with jumbo forceps followed by magnified narrow-band imaging: a multicenter prospective study

Endoscopy ◽  
2019 ◽  
Vol 51 (03) ◽  
pp. 253-260 ◽  
Author(s):  
Toshio Kuwai ◽  
Takuya Yamada ◽  
Tatsuya Toyokawa ◽  
Hiroaki Iwase ◽  
Tomohiro Kudo ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Recurrence Rate ◽  
Local Recurrence Rate ◽  
Narrow Band ◽  
Narrow Band Imaging ◽  
Therapeutic Option ◽  
Colorectal Polyps ◽  
Delayed Bleeding ◽  
Immediate Bleeding

Background Cold polypectomy has been increasingly used to remove diminutive colorectal polyps. We evaluated the local recurrence rate of diminutive polyps at the 1-year follow-up after cold forceps polypectomy (CFP). Methods In a prospective, multicenter, observational cohort study, patients with diminutive colorectal polyps ( ≤ 5 mm) were treated by CFP using jumbo forceps followed by magnified narrow-band imaging (NBI). Patients were assessed for local recurrence at 1-year follow-up. Risk factors associated with local recurrence were analyzed using logistic regression analysis. Results Overall, 955 lesions were resected in 471 patients who completed the 1-year follow-up. The endoscopic complete resection rate was 99.4 %. Immediate and delayed bleeding occurred in 0.8 % and 0.2 % of cases, respectively, with no perforations observed. Local recurrence occurred in 2.1 % of cases at the 1-year follow-up. Univariable analyses indicated that polyps > 3 mm (P < 0.01) and immediate bleeding (P = 0.04) were significantly associated with local recurrence. A trend was observed for patients ≥ 65 years (P = 0.06) and fractional resection (P = 0.09). Multivariable analyses confirmed that lesions > 3 mm were significantly associated with local recurrence (odds ratio 3.4, P = 0.02). Conclusions CFP with jumbo forceps followed by NBI-magnified observation had a low local recurrence rate and is an acceptable therapeutic option for diminutive colorectal polyps. Although we recommend limiting the use of CFP with jumbo forceps to polyps ≤ 3 mm in size, future comparative studies are needed to make recommendations on cold polypectomy using either forceps or snares as the preferred approach for diminutive polyp resection.

GIANT CELL TUMOURS OF TENDON SHEATH OF HAND: CAUSES AND STRATEGIES TO PREVENT RECURRENCE

Hand Surgery ◽  
2011 ◽  
Vol 16 (02) ◽  
pp. 149-154 ◽  
Author(s):  
Azal Jalgaonkar ◽  
Baljinder Dhinsa ◽  
Howard Cottam ◽  
Ganapathyraman Mani
Keyword(s):  
Risk Factors ◽  
Local Recurrence ◽  
Giant Cell ◽  
Recurrence Rate ◽  
Case Series ◽  
Tendon Sheath ◽  
Giant Cell Tumours ◽  
High Incidence ◽  
The Mean

Giant cell tumours of tendon sheath of hand present a surgical dilemma due to their high incidence of local recurrence. We present a case series of 46 patients with 47 histologically confirmed giant cell tumours of tendon sheath over a ten-year period from 1998 to 2008. The mean follow-up was 47 months (range 25–124 months). We identified tumours with bony erosions and piecemeal resections as predictors of recurrence. Our recurrence rate of 9% was at the lower end of spectrum of previously published reports (range 7%–44%). We recommend "en-masse" excision of these tumours. All the patients with suspicion of these tumours should have preoperative radiographs to identify erosions. A thorough curettage of the bone should be done in cases with osseous erosion to prevent recurrence. Patients with these risk factors should be followed up annually for five years and be warned about recurrence.

Hemangiopericytoma of the Nasal Cavity: A Review of 15 Cases over a 40-Year Period

1992 ◽  
Vol 6 (6) ◽  
pp. 203-209 ◽  
Author(s):  
Kenneth V. Hughes ◽  
Michael C. Bard ◽  
Jean E. Lewis ◽  
Jan L. Kasperbauer ◽  
George W. Facer
Keyword(s):  
Local Recurrence ◽  
Nasal Cavity ◽  
Paranasal Sinuses ◽  
Clinical Course ◽  
Recurrence Rates ◽  
Long Term Follow Up ◽  
Vascular Origin ◽  
The Mean

Hemangiopericytomas are rare tumors of vascular origin most commonly found in the extremities or retroperitoneal area. When they originate from the nasal cavity and paranasal sinuses, they tend to be less aggressive and generally do not metastasize. The term “hemangiopericytoma-like lesion” has been coined for sinonasal hemangiopericytomas that display more benign histologic and growth characteristics than do those located elsewhere. Fifteen cases of hemangiopericytoma of the nasal cavity and paranasal sinuses were reviewed over the period 1951 to 1990; included are follow-up data on cases reported earlier from this institution. The clinical course, management, and outcome was evaluated and correlated with the histologic characteristics of the tumors. The recurrence rate in our series was 13.3%; the mean follow-up was 11 years. No patients died of their disease or had evidence of metastatic disease. This clinicopathologic review suggests that sinonasal hemangiopericytomas should not be classified as “hemangiopericytoma-like” lesions; rather, they should be expected to have significant local recurrence rates with low rates of distant metastasis and mortality. Long-term follow-up is essential as there can be local recurrence after many years.

scholarly journals Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review

2021 ◽  
Vol 10 (19) ◽  
pp. 4372
Author(s):  
Ioanna Sfakianaki ◽  
Paris Binos ◽  
Petros Karkos ◽  
Grigorios G. Dimas ◽  
George Psillas
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Recurrence Rate ◽  
Benign Paroxysmal Positional Vertigo ◽  
Female Gender ◽  
Recurrence Rates ◽  
Positional Vertigo ◽  
Risk Factors For Recurrence ◽  
Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular dysfunctions encountered in clinical practice. Although the treatment of BPPV is relatively successful, many patients develop recurrence after treatment. Our purpose is to evaluate the mean recurrence rate and risk factors of BPPV after treatment. A review of the literature on the risk factors of BPPV recurrence was performed. A thorough search was conducted using electronic databases, namely Pubmed, CINAHL, Academic Search Complete and Scopus for studies published from 2000 to 2020. Thirty studies were included in this review with 13,358 participants. The recurrence rate of BPPV ranged from 13.7% to 48% for studies with follow-up <1 year, and from 13.3% to 65% for studies with follow-up ≥2 years. Pathophysiologic mechanisms and implication of each of the following risk factors in the recurrence of BPPV were described: advanced age, female gender, Meniere’s disease, trauma, osteopenia or osteoporosis, vitamin D deficiency, diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, migraine, bilateral/multicanal BPPV, cervical osteoarthrosis and sleep disorders. Patients with hyperlipidemia and hypertension had the highest recurrence rates of BPPV, 67.80% and 55.89%, respectively, indicating that vascular comorbidities increase the risk of BPPV recurrence. In addition, more than half of patients (53.48%) with diabetes mellitus and BPPV experienced recurrence of BPPV. Knowledge and awareness of risk factors for recurrence of BPPV are essential for the assessment and long-term prognosis of patients. Identification of these relapse risk factors may enhance the ability of clinicians to accurately counsel patients regarding BPPV and associated comorbidities.

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