scholarly journals Effectiveness and risk factors of endoscopic submucosal dissection for right colon neoplasms

2020 ◽  
Vol 179 (4) ◽  
pp. 29-35
Author(s):  
E. A. Khomyakov ◽  
D. A. Mtvralashvili ◽  
Yu. E. Vaganov ◽  
S. V. Chernyshov ◽  
O. M. Iugai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Risk Factor ◽  
Postoperative Complications ◽  
Endoscopic Submucosal Dissection ◽  
Local Excision ◽  
Lateral Spreading ◽  
Right Colon ◽  
Colon Neoplasms ◽  
Submucosal Dissection

Introduction. Endoscopic submucosal dissection (ESD) is a standard method of local excision of benign colon tumors. Nevertheless, it is not widely used because of its technical difficulty and risk of complication especially in right colon. The OBJECTIVE was to improve the results of treatment of patients with right colon neoplasms.Methods and materials. The results of 152 consecutive patients (median age 66 years, 88 female) with lateral spreading tumors (LST) were analyzed. Logistic regression was performed to evaluate risk factors of conversion and complications.Results. ESD as planned performed in 133 out of 152 patients. Conversion to bowel resection occurred in 19 cases. In the logistic regression model, lifting less than 3 mm (p=0.034) was independent risk factor of the conversion. Postoperative complications up to 30 days occurred in 5 out of 133 (3.8 %) of patients underwent ESD. There was no mortality after ESD. Severe fibrosis the base of the neoplasm was the only risk factor of postoperative complications (95 % CI=1.0—1.2; p=0.007). Final pathology revealed that 127 out of 133 patients (95.5 %) had adenomas and 6 out of 133 (4.5 %) patients had early adenocarcinomas. R0 resections was performed in 94/133 (70.7 %) cases.Conclusions. ESD is the safe and efficient method of local excision of benign right colon neoplasms. Unfavorable lifting (p=0.05) and submucosal fibrosis (p=0.007) are risk factors of ESD failure.

scholarly journals DOES LESION SITE AFFECTS OUTCOMES OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR COLON NEOPLASIA?

2019 ◽  
Vol 18 (2) ◽  
pp. 33-48 ◽  
Author(s):  
D. A. Mtvralashvili ◽  
A. A. Likutov ◽  
V. V. Veselov ◽  
O. A. Maynovskaya ◽  
V. N. Kashnikov ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Endoscopic Submucosal Dissection ◽  
Intraoperative Complications ◽  
Lesion Size ◽  
Lesion Site ◽  
En Bloc ◽  
Colon Neoplasms ◽  
Submucosal Dissection ◽  
One Year ◽  
Complications Rate

AIM: to assess results of endoscopic submucosal dissection (ESD) for colon neoplasms due to lesion site.PATIENTS AND METHODS: One-hundred thirteen patients (66 females, aged 65,7±11,0 years) with colon neoplasms which underwent ESD for one year (January 2017 – January 2018) were included in the study. All patients were divided in two groups depending on lesion site. The first group included patients with lesions in caecum, ascending colon and proximal third of tranverse colon, the second group – other colon parts and intraperitoneal part of the rectum. All patients underwent preoperative tests including colonoscopy, gastroscopy and transabdominal ultrasound. ESD included lesion marking, injection, circular incision and dissection. The results obtained were analyzed statistically using Graph Pad 7 for Mac. RESULTS: the 1st group included 61 (54.0%) patients and the 2nd – 52 (46.0%). Laterally spreading tumors (LST) were detected more often in the 1st group (56 patients of the 1st group vs 38 – in the 2nd, p=0.03). The lesion size in the 1st group was 31±13 (7-80) mm and 29±11 (8-76) in the 2nd one (p=0.3). Conversion from ESD to resection occurred in 9 (8.0%) patients, in 5 patients of the 1st group and in 4 – the 2nd one (p=1.0). The only reason for conversion was unfavorable lesion lifting (≤2 mm).Most of the lesions were removed en bloc, specimen fragmentation after ESD occurred in 10 (9.6%) patients: in 5 (9.0%) in the 1st group and in 5 (10.4%) in the 2nd (р=1.0). Intraoperative complications during ESD in the 1st group occurred in 2 (3.5%) cases and in 2 (4.1%) – in the 2nd (р=1.0). Postoperative complications were detected in 2 (1.9%) patients. Histopathology showed adenocarcinoma in 9 (8.0%) patients. Two (1.7%) patients produced local recurrence. CONCLUSION: ESD is a safe method removal of colon ademonas. The intra- and postoperative complications rate is 3.5% and 1.9% for the 1st and the 2nd group. Local recurrences occurred in 2,04%. Unfavorable lesion lifting (≤2 mm) in right colon is a risk factor for specimen fragmentation or conversion.

scholarly journals Risk factor-based optimal endoscopic surveillance intervals after endoscopic submucosal dissection for gastric adenoma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Choong-Kyun Noh ◽  
Eunyoung Lee ◽  
Gil Ho Lee ◽  
Sun Gyo Lim ◽  
Kee Myung Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Endoscopic Submucosal Dissection ◽  
Risk Groups ◽  
Recurrence Risk ◽  
Endoscopic Surveillance ◽  
Gastric Adenoma ◽  
Submucosal Dissection ◽  
Risk Patients ◽  
Surveillance Interval

AbstractTo date, there exists no established endoscopic surveillance interval strategy after endoscopic submucosal dissection (ESD) for gastric adenoma. In this study, we suggest a risk factor-based statistical model for optimal surveillance intervals for gastric adenoma after ESD with curative resection. A cox proportional hazard model was applied to identify risk factors for recurrence after ESD. Patients (n = 698) were categorized into groups based on the identified risk factors. The cumulative density of recurrence over time was computed using a cubic splined baseline hazard function, and the customized surveillance interval was modeled for each risk group. The overall cumulative incidence of recurrence was 7.3% (n = 51). Risk factors associated with recurrence were male (hazard ratio [HR], 2.60, P = 0.030), protruded scar (HR, 3.18, P < 0.001), and age ≥ 59 years (HR, 1.05, P < 0.001). The surveillance interval for each group was developed by using the recurrence limit for the generated risk groups. According to the developed schedule, high-risk patients would have a maximum of seven surveillance visits for 5 years, whereas low-risk patients would have biennial surveillance for cancer screening. We proposed a simple and promising strategy for determining a better endoscopic surveillance interval by parameterizing diverse and group-specific recurrence risk factors into a well-known survival model.

scholarly journals Prevalence and outcome of young stroke patients with middle cerebral artery stenosis

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wenjuan Xu ◽  
Xiaoyu Zhang ◽  
Huan Chen ◽  
Zhangning Zhao ◽  
Meijia Zhu
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Risk Factor ◽  
Factor Score ◽  
Unfavorable Outcome ◽  
Stroke Patients ◽  
Young Stroke ◽  
Stroke In Young Adults ◽  
Risk Factor Score ◽  
Stroke In Young

Abstract Background Etiologies of acute ischemic stroke in young adults are heterogeneous. Middle cerebral artery (MCA) stenosis is a common finding in Asians which may be an important cause of stroke in young adults. However, studies of stroke in young Asian populations are rare. Our study was to investigate the prevalence and outcome of young stroke patients with MCA stenosis in Chinese populations. Methods Young patients with MCA territory infarction between January 2013 and September 2018 were retrospectively recruited. Subjects were defined as stenosis group (MCA stenosis ≥50%) and no-stenosis group (MCA stenosis<50% or no stenosis) by their MCA stenosis. For patients in stenosis group, they were categorized as uni-MCA stenosis subgroup and multiple stenosis subgroup. Demographic data, risk factors, imaging feature and complications were compared between groups. Prevalence of MCA stenosis and risk factor score (score ≥ 2 or 3) in different age groups were investigated. Modified Rankin Scale (mRS) was used for evaluating functional outcome at discharge (unfavorable outcome: 3–6). Binary logistic regression was performed to determine independent risk factors of unfavorable outcome. Results Two hundred forty-nine young stroke patients were included in our study and 110 (44.2%) patients were defined as stenosis group. 55 (50%) patients were categorized as uni-MCA stenosis subgroup and 55 (50%) were multiple stenosis subgroup. The most common traditional vascular risk factors included hypertension, hyperlipemia, smoking, hyperhomocysteinemia and alcohol consumption. Prevalence of risk factor score ≥ 2 or 3 increased with age, but not incidence of MCA stenosis. By TOAST classification, the most common etiologies were large-artery atherosclerosis (41.0%) and small vessel disease (33.7%). Compared with no-stenosis group, patients in stenosis group were more likely to have large territorial infarct, develop complications and have unfavorable outcome. No significant difference was found between patients in uni-MCA stenosis and multiple stenosis subgroups except history of stroke/TIA, risk factor score ≥ 3 and silent infarct. By logistic regression, hypertension (OR = 3.561; 95%CI, 1.494 to 8.492; p = 0.004), NIHSS scores at admission (OR = 1.438; 95%CI, 1.276 to 1.620; p = 0,000) and infarct size (p = 0.015) independently predicted unfavorable outcome. Conclusions Forty-four point two percent young Chinese adults with MCA territory infarction had MCA stenosis. Prevalence of MCA stenosis did not increase with age. Patients with MCA stenosis had worse clinical outcome, however, only hypertension, NIHSS scores at admission and infarct size were independent predictors.

Sa1162 Management and Risk Factor of Stenosis After Endoscopic Submucosal Dissection for Colorectal

2016 ◽  
Vol 83 (5) ◽  
pp. AB237 ◽  
Author(s):  
Takemasa Hayashi ◽  
Shin-ei Kudo ◽  
Yusuke Yagawa ◽  
Tomoyuki Ishigaki ◽  
Naoya Toyoshima ◽  
...  
Keyword(s):  
Risk Factor ◽  
Endoscopic Submucosal Dissection ◽  
Submucosal Dissection

Risk factors and outcomes of postoperative emergency response team activation: a matched case-control study

2020 ◽  
Vol 22 (1) ◽  
pp. 6-14
Author(s):  
Matthew I Hardman ◽  
◽  
S Chandralekha Kruthiventi ◽  
Michelle R Schmugge ◽  
Alexandre N Cavalcante ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Postoperative Complications ◽  
Emergency Response ◽  
Case Control Study ◽  
Case Control ◽  
Multiple Logistic Regression ◽  
Increased Risk ◽  
Response Team ◽  
Control Study

OBJECTIVE: To determine patient and perioperative characteristics associated with unexpected postoperative clinical deterioration as determined for the need of a postoperative emergency response team (ERT) activation. DESIGN: Retrospective case–control study. SETTING: Tertiary academic hospital. PARTICIPANTS: Patients who underwent general anaesthesia discharged to regular wards between 1 January 2013 and 31 December 2015 and required ERT activation within 48 postoperative hours. Controls were matched based on age, sex and procedure. MAIN OUTCOME MEASURES: Baseline patient and perioperative characteristics were abstracted to develop a multiple logistic regression model to assess for potential associations for increased risk for postoperative ERT. RESULTS: Among 105 345 patients, 797 had ERT calls, with a rate of 7.6 (95% CI, 7.1–8.1) calls per 1000 anaesthetics (0.76%). Multiple logistic regression analysis showed the following risk factors for postoperative ERT: cardiovascular disease (odds ratio [OR], 1.61; 95% CI, 1.18–2.18), neurological disease (OR, 1.57; 95% CI, 1.11–2.22), preoperative gabapentin (OR, 1.60; 95% CI, 1.17–2.20), longer surgical duration (OR, 1.06; 95% CI, 1.02–1.11, per 30 min), emergency procedure (OR, 1.54; 95% CI, 1.09–2.18), and intraoperative use of colloids (OR, 1.50; 95% CI, 1.17–1.92). Compared with control participants, ERT patients had a longer hospital stay, a higher rate of admissions to critical care (55.5%), increased postoperative complications, and a higher 30-day mortality rate (OR, 3.36; 95% CI, 1.73–6.54). CONCLUSION: We identified several patient and procedural characteristics associated with increased likelihood of postoperative ERT activation. ERT intervention is a marker for increased rates of postoperative complications and death.

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