Introduction
Many centers have reported excellent short-term efficacy of per-oral endoscopic myotomy (POEM) for the treatment of achalasia. However, long-term data are limited and there are few ...studies comparing the efficacy of POEM versus Heller Myotomy (HM).
Aims
To compare the long-term clinical efficacy of POEM versus HM.
Methods
Using a retrospective, parallel cohort design, all cases of POEM or HM for achalasia between 2010 and 2015 were assessed. Clinical failure was defined as (a) Eckardt Score > 3 for at least 4 weeks, (b) achalasia-related hospitalization, or (c) repeat intervention. All index manometries were classified via Chicago Classification v3. Pre-procedural clinical, manometric, radiographic data, and procedural data were reviewed.
Results
98 patients were identified (55 POEM, 43 Heller) with mean follow-up of 3.94 years, and 5.44 years, respectively. 83.7% of HM patients underwent associated anti-reflux wrap (Toupet or Dor). Baseline clinical, demographic, radiographic, and manometric data were similar between the groups. There was no statistical difference in overall long-term success (POEM 72.7%, HM 65.1%
p
= 0.417, although higher rates of success were seen in Type III Achalasia in POEM vs Heller (53.3% vs 44.4%,
p
< 0.05). Type III Achalasia was the only variable associated with failure on a univariate COX analysis and no covariants were identified on a multivariate Cox regression. There was no statistical difference in GERD symptoms, esophagitis, or major procedural complications.
Conclusion
POEM and HM have similar long-term (4-year) efficacy with similar adverse event and reflux rates. POEM was associated with greater efficacy in Type III Achalasia.
Background & Aims
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have demonstrated similar efficacy in removal of neoplastic esophageal lesions. However, significant ...controversy exists over the preferred resection technique. Our primary aim was to compare the pathologic specimens produced via EMR and ESD and secondarily gauge their effect on clinical decision making and patient outcomes.
Methods
Using a retrospective cohort study design, all esophageal Barrett's‐associated neoplastic lesions resected by a single provider from 2012 to 2017 were reviewed. The pathology was re‐reviewed by two blinded authors for diagnosis, margins, and adverse outcomes and recurrence rates were also collected.
Results
Thirty‐one EMR and 20 ESD cases were identified. Baseline demographics and lesion characteristics were similar. ESD produced more R0 resections and more en bloc resections compared to EMR. EMR produced more equivocal lateral (13/31, 41.9% vs 1/20, 5.0%) and vertical margins (13/31, 41.9% vs. 0/20, 0%, both P < 0.05). This led to an inability to reach a definitive diagnosis in 13/31 EMR vs 0/20 ESD pathology specimens (P = 0.003). Of the 13 EMR specimens with equivocal pathology, 11 were noted to have ‘at least intramucosal adenocarcinoma’. Four of the 11 patients chose to undergo elective esophagectomy with final surgical pathology demonstrating ≤T1a disease in 2, and ≥T1b disease in two.
Conclusion
Compared to ESD, EMR was associated with greater pathologic uncertainty in Barrett's‐associated neoplasia.
Endoscopic mucosal resection (EMR) is the primary treatment for duodenal adenomas; however, it is associated with a high risk of perforation and bleeding, especially with larger lesions. The goal of ...this study was to demonstrate the feasibility and safety of endoscopic suturing (ES) for the closure of mucosal defects after duodenal EMR.
Consecutive adult patients who underwent ES of large mucosal defects after EMR of large (>2 cm) duodenal adenomas were retrospectively enrolled. The OverStitch ES system was employed for closing mucosal defects after EMR. Clinical outcomes and complications, including delayed bleeding and perforation, were documented.
During the study period, ES of mucosal defects was performed in seven patients in eight sessions (six for prophylaxis and two for the treatment of perforation). All ES sessions were technically successful. No early or delayed post-EMR bleeding was recorded. In addition, no clinically obvious duodenal stricture or recurrence was encountered on endoscopic follow-up evaluation, and no patients required subsequent surgical intervention.
ES for the prevention and treatment of duodenal perforation after EMR is technically feasible, safe, and effective. ES should be considered an option for preventing or treating perforations associated with EMR of large duodenal adenomas.
Endoscopic submucosal dissection in the West Podboy, Alexander; Friedland, Shai
International journal of gastrointestinal intervention,
07/2019, Letnik:
8, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Endoscopic resection has emerged as the first line therapy for pre-malignant conditions throughout the gastrointestinal (GI) tract. Resection techniques have evolved from forceps avulsion and snare ...polypectomy to endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). While ESD was originally developed in Japan for resection of early gastric neoplasia, its use in the East has expanded rapidly to all types of superficial neoplasia throughout the GI tract. Despite the widespread use of ESD in the East, Western adoption of the ESD technique has been lukewarm. The hesitancy to adopt ESD is multifactorial, likely secondary to concern about the increased risk of complications, procedure duration and reimbursement, as well as the long learning curve of ESD. Despite this initial hesitancy, preliminary reports of the use of ESD for the resection of superficial neoplastic lesions in the West have been encouraging. The aim of this review is to highlight the current use of ESD for superficial neoplastic lesions throughout the GI tract in the West.
Background
Endoscopic sleeve gastroplasty (ESG) is an emerging bariatric intervention with comparable safety and efficacy to surgical sleeve gastrectomy (SG). As ESG is utilized more commonly, ...postgraduate medical training in bariatric endoscopy has expanded to train physicians in this technically complex procedure. Prior studies have analyzed procedural outcomes of bariatric surgery assisted by medical trainees, but no such analysis has been performed with ESG.
Aims
This study aims to evaluate the short-term safety of ESG in cases assisted by postgraduate medical trainees.
Methods
We retrospectively analyzed over 2000 patients in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database from 2016 to 2020. Cases of ESG performed with the assistance of postgraduate medical trainees (residents and/or fellows) were propensity matched (1:1) to cases of ESG performed without trainee involvement. We compared the occurrences of adverse events (AE), readmissions, re-interventions, and re-operations between these matched cohorts of ESG. Secondary outcomes included procedure time, length of stay (LOS), and total body weight loss (TBWL).
Results
A total of 1204 cases of ESG assisted by postgraduate medical trainees were compared to 1204 matched cases without trainee involvement. Procedures performed by attending physicians alone had fewer AE (0.7% vs 2.0%,
p
= 0.014) and rates of re-operations (0.8% vs 2.4%,
p
= 0.004) compared to procedures assisted by trainees. There were no significant differences in readmissions (4.0% vs 4.4%,
p
= 0.684) or reinterventions (3.8% vs. 4.6%,
p
= 0.416) at 30 days. Cases involving trainees had longer duration (71 vs 51 min,
p
< 0.001) and LOS (1.11 vs. 0.5 days,
p
< 0.001). TBWL at 30 days was greater in procedures performed with trainees (4.1% vs 3.4%,
p
= 0.033).
Conclusion
ESG is a technically complex procedure that can be safely performed with trainee assistance. Academic medical centers may continue supporting the expansion of training in bariatric endoscopy as an advanced endoscopic skill.
Gastroparesis, or symptomatic delayed gastric emptying, has seen a startling increase in prevalence of over last decade. Efficacy of initial dietary and medical therapies remain limited and patients ...that fail these first line remedies represent a significant therapeutic challenge. Recent procedural and technological advancements have led to the development of a promising endoscopic therapy for gastroparesis via an endoscopic pyloromyotomy, also referred to as gastric per-oral endoscopic myotomy (G-POEM) or per-oral endoscopic pyloromyotomy (POP). While initial preliminary reports of G-POEM or POP for the treatment of gastroparesis are encouraging, there is not a consensus standardized procedural approach and published practice patterns at each stage of the G-POEM procedure can vary wildly. The aim of our review is to provide an overview of the technical aspects of the G-POEM procedure framed within our current practice patterns and that of the published literature.
Occurrence of IgG4 in Esophageal Lichen Planus Podboy, Alexander J; Alexander, Jeffrey A; Smyrk, Thomas C ...
Clinical gastroenterology and hepatology,
12/2017, Letnik:
15, Številka:
12
Journal Article
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