Z-line suturing for a colorectal mucosal defect after endoscopic submucosal dissection
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ABSTRACT:
DISEASE(S): Superficial Colorectal Tumor
PROVIDER: 2653862 | ecrin-mdr-crc |
REPOSITORIES: ECRIN MDR
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Project description:IntroductionClosure of mucosal defects after duodenal endoscopic submucosal dissection (ESD) is important to prevent postoperative adverse events. Previously, we devised an underwater reopenable-clip closure method for effective closure of mucosal defects under endoscopic guidance within the field of view. Recently, the usefulness of a method using a clip with a line passing through an accessory channel to close a mucosal defect has been reported. We also described a reopenable-clip over the line method (ROLM) to completely close margin and the muscular layers of mucosal defects using a clip line.Case reportOur patient was a 70-year-old woman with a 40-mm duodenal tumor in the descending portion of the duodenum. The lesion was completely resected using ESD . In the result, the mucosal defect size was approximately 50 mm, representing about 3/4 of the duodenal circumference. A clip-line closure was performed using ROLM to close the mucosal defect's margins completely. An additional clip was applied to close the mucosal defect after ESD completely. Subsequently, the line was fixed with a modified locking-clip technique, closed, and cut with endoscopic scissors. The patient was discharged without any adverse events 9 days after the duodenal ESD.DiscussionMucosal defect closure after duodenal ESD using ROLM is a novel method that can reliably close mucosal defects.
| S-EPMC8264231 | biostudies-literature
Project description:Video 1Clip with line-pulley securing technique with plastic detachable snare for endoscopic submucosal dissection defect closure.
| S-EPMC10928135 | biostudies-literature
Project description:Video 1Hybrid endoscopic submucosal dissection with novel helix tacking system for defect closure.
| S-EPMC8503940 | biostudies-literature
Project description: Not available
| S-EPMC7651752 | biostudies-literature
Project description:Endoscopic resection of superficial colorectal neoplasms decrease risk of colorectal cancer. En bloc resection is necessary for large superficial lesions with risk of superficial submucosal cancer and is advised if feasible for all lesions. Endoscopic submucosal dissection (ESD) allows en bloc resection of large superficial colorectal neoplasms, increasing curative resection rate and decreasing local recurrence risk. However, the risk of perprocedural or delayed perforation is higher compared to wild field piece meal endoscopic mucosal resection. Endoscoping clipping and closing methods mostly allow conservative treatment, but some case still necessitate surgery. The aim of our study is to describe and ananalyse outcomes after perprocedural or delayed perforation in all patients undergoing ESD and analyse the need for surgical intervention.
| 8389 | ecrin-mdr-crc
Project description:ObjectivesTo investigate the treatment effects of endoscopic submucosal dissection (ESD) versus endoscopic mucosal resection (EMR) for early gastric cancer (EGC).DesignMeta-analysis.MethodsWe systematically searched three electronic databases, including PubMed, EmBase and the Cochrane library for studies published with inception to January 2018. The eligible studies should be evaluated for the efficacy and safety of ESD versus EMR for patients with EGC. The summary ORs and standard mean differences (SMDs) with 95% CIs were employed as effect estimates. Sensitivity analyses were conducted to evaluate the impact of single study on overall analysis. Subgroup analyses were performed for investigated outcomes to evaluate the treatment effects of ESD versus EMR for patients with EGC with specific subsets.ResultsEighteen studies, with a total of 6723 patients with EGC, were included in final analysis. The summary ORs indicated that patients with EGC who received ESD were associated with an increased incidence of en bloc resection (OR: 9.00; 95% CI: 6.66 to 12.17; p<0.001), complete resection (OR: 8.43; 95% CI: 5.04 to 14.09; p<0.001) and curative resection (OR: 2.92; 95% CI: 1.85 to 4.61; p<0.001) when compared with EMR. Furthermore, ESD was associated with lower risk of local recurrence (OR: 0.18; 95% CI: 0.09 to 0.34; p<0.001). In addition, there was no significant difference between ESD and EMR for the risk of bleeding (OR: 1.26; 95% CI: 0.88 to 1.80; p=0.203). Though, ESD was correlated with greater risk of perforation (OR: 2.55; 95% CI: 1.48 to 4.39; p=0.001), and longer operation time (SMD: 1.12; 95% CI: 0.13 to 2.10; p=0.026) as compared with EMR. Additionally, several different features observed in included studies and patients could bias the effectiveness of ESD versus EMR in patients with EGC.ConclusionsESD is superior than EMR for en bloc resection, complete resection, curative resection and local recurrence, while it increased perforation risk and longer operation time.
| S-EPMC7008428 | biostudies-literature
Project description: Not available
| S-EPMC5989134 | biostudies-literature
Project description:Background and aimsThere is a significant bleeding risk after gastric endoscopic submucosal dissection (ESD) and EMR cases. This case series describes the use of an endoscopic hemostasis spray, which is not typically used to treat this type of bleeding, after multiple attempts with other modalities failed.MethodsWe present 2 patient cases of ESD and EMR used to treat a gastric adenoma (case 1) and 2 gastric hyperplastic masses (case 2) with refractory bleeding after use of multiple other treatment modalities. Both patients were not surgical candidates because of their medical comorbidities.ResultsBleeding was eventually controlled with the use of endoscopic hemostasis spray after attempts were made using SB Knife Jr tip, Coagrasper Hemostatic Forceps, Argon Photocoagulation, and scope tamponade.ConclusionsIn very specific cases, endoscopic hemostasis spray may have some utility for refractory bleeding after dissection of gastric lesions. After using this spray, it became technically challenging to suture endoscopically because of the mud-like quality of the hemostasis material.
| S-EPMC8503932 | biostudies-literature
Project description:Background and study aims Evidence from recent trials comparing conventional endoscopic mucosal resection (EMR) to underwater EMR (UEMR) have matured. However, studies comparing UEMR to endoscopic submucosal dissection (ESD) are lacking. Hence, we sought to conduct a comprehensive network meta-analysis to compare the efficacy of UEMR, ESD, and EMR. Methods Embase and Medline databases were searched from inception to December 2020 for articles comparing UEMR with EMR and ESD. Outcomes of interest included rates of en bloc and complete polyp resection, risk of perforation and bleeding, and local recurrence. A network meta-analysis comparing all three approaches was conducted. In addition, a conventional comparative meta-analysis comparing UEMR to EMR was performed. Analysis was stratified according to polyp sizes (< 10 mm, ≥ 10 mm, and ≥ 20 mm). Results Twenty-two articles were included in this study. For polyps ≥ 10 mm, UEMR was inferior to ESD in achieving en bloc resection ( P = 0.02). However, UEMR had shorter operating time for polyps ≥ 10 mm ( P < 0.001), and ≥20 mm ( P = 0.019) with reduced perforation risk for polyps ≥ 10 mm ( P = 0.05) compared to ESD. In addition, en bloc resection rates were similar between UEMR and EMR, although UEMR had reduced recurrence for polyps ≥ 10 mm ( P = 0.013) and ≥ 20 mm ( P = 0.014). UEMR also had shorter mean operating than EMR for polyps ≥ 10 mm ( P < 0.001) and ≥ 20 mm ( P < 0.001). Risk of bleeding and perforation with UEMR and EMR were similar for polyp of all sizes. Conclusions UEMR has demonstrated technical and oncological outcomes comparable to ESD and EMR, along with a desirable safety profile. UEMR appears to be a safe and effective alternative to conventional methods for resection of polyps ≥ 10 mm.
| S-EPMC8759939 | biostudies-literature
Project description:AimsThis study aimed to evaluate the safety, efficacy, and long-term outcomes of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for treating colorectal adenomas and tumors.MethodsA systematic literature review was conducted using databases including PubMed, Web of Science, and Embase. Parameters such as number of patients or lesions, histological diagnosis, lesion size, surgery time, en-bloc resection, R0 resection, severe postoperative complications, and local recurrence were extracted and pooled for analysis.ResultsA total of 12 retrospective studies involving 1289 patients and 1850 lesions were included in the analysis. EMR was found to have a shorter operation time by 53.6 minutes (95% CI: 51.3, 55.9, P<0.001) and fewer incidences of severe postoperative complications such as perforation and delayed bleeding (OR = 0.40, 95%CI: 0.23, 0.71, P<0.001). On the other hand, ESD had higher rates of en-bloc resection (OR = 0.15, 95%CI: 0.07, 0.30, P<0.001) and R0 resection (OR = 0.32, 95%CI: 0.16, 0.65, P<0.001). Recurrence after EMR was found to be significantly higher than that after ESD surgery (OR = 5.88, 95%CI: 2.15, 16.07, P = 0.037).ConclusionsThe study suggests that the choice of surgical method may have a greater impact on recurrence compared to the pathological type, and that ESD may be more suitable for the treatment of malignant lesions despite its higher rates of severe postoperative complications and longer operation time.
| S-EPMC10538725 | biostudies-literature