EMR Group Research Articles

Clinical Value of Clip-and-Snare Assisted Endoscopic Submucosal Resection in Treatment of Rectal Neuroendocrine Tumors

Introduction: The aim of the study was to introduce a new endoscopic technology, clip-and-snare assisted endoscopic submucosal resection (CS-ESMR), for treatment of rectal neuroendocrine tumors (NETs) and then to investigate the therapeutic value of CS-ESMR. Methods: In this retrospective study, 67 patients who underwent endoscopic treatment of rectal NETs from March 2017 to December 2021 were analyzed. According to the endoscopic resection methods (endoscopic mucosal resection [EMR], CS-ESMR, and endoscopic submucosal dissection [ESD]), the cases were divided into CS-ESMR group (27 cases), ESD group (31 cases), and EMR group (9 cases). The pathological R0 resection rate and the incidence of adverse events (bleeding and perforation) were compared among the three groups. Results: There was a significant difference about the pathological R0 resection between the CS-ESMR group and the EMR group and between the CS-ESMR group and the ESD group (both p < 0.05). Compared with ESD group, the procedure time, intraoperative bleeding, and the cost of CS-ESMR group are significantly decreased (p < 0.001, p < 0.05, p < 0.001, respectively). Conclusion: CS-ESMR may be a safe and effective treatment for rectal NETs with a diameter of less than 10 mm, without muscularis propria invasion and metastasis.

Endoscopic submucosal dissection versus endoscopic mucosal resection for early esophageal adenocarcinoma

ObjectivesEndoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) allow endoscopic resection of early esophageal adenocarcinoma. The choice between the two techniques takes into account the morphology of the lesion, and the experience of the endoscopist. The aim of this study was to compare EMR to ESD for the treatment of early esophageal adenocarcinoma. MethodsPatients who underwent an endoscopic resection for esophageal adenocarcinomas between March 2015 and December 2019 were included. ESD was compared to EMR in terms of clinical, procedural, histologic, and oncologic outcomes. Results85 patients were included: 57 ESD and 28 EMR. The median (IQR) diameter of the lesion was 20(15–25) mm in the ESD group, and 15(8–16) mm in the EMR group, p<0.01. ESD allowed en bloc resection in 100% of cases, and EMR in 39% of cases, p<0.001. The R0 and curative resection rate in the ESD group versus the EMR group were 88% and 67%, respectively, versus 21% and 11%, p<0.001. We recorded one severe adverse event, in the EMR group. After a median (IQR) follow-up of 27.5 (14.5–38.7) months, the local recurrence rate was 23% vs. 18% (p = 0.63), and the overall survival 89% vs. 86% (p = 0.72), in the ESD and EMR groups, respectively. ConclusionESD was as safe as EMR and allowed higher en bloc, R0 and curative resection rates. Although these results did not translate into long-term outcomes, these data prompt for a broader adoption of ESD for the resection of esophageal lesions suspected of harboring early esophageal adenocarcinoma.

Effects of mobile phone electromagnetic radiation on thyroid glands and hormones in Rattus norvegicus brain: An analysis of thyroid function, reactive oxygen species, and monocarboxylate transporter 8.

The aim of this study was to investigate the effects of mobile phone electromagnetic radiation (MP-EMR) on the thyroid glands and hormones in Rattus norvegicus brain in term of thyroid function, reactive oxygen species (ROS), and monocarboxylate transporter 8 (MCT8) concentration. Forty rats were divided into different groups: control (without EMR exposure), EMR1 (120-min/day exposure), EMR2 (150-min), and EMR3 (180-min). The levels of serum thyroid stimulating hormone (TSH), thyroxine (T4), and malondialdehyde (MDA) and brain and MCT8 were measured using enzyme-linked immunosorbent assay. One-way analysis of variance followed by the Duncan test was used to analyze the data. Our data indicated that the levels of serum TSH and T4 in all the EMR groups were lower significant postexposure compared to the control with P < 0.01 (EMR1 and EMR2) and P < 0.001 (EMR3), suggesting hypothyroidism due to MP-EMR exposure. Increased MDA and decreased MCT8 levels were also observed following the intervention; however, the changes in both concentrations were notably significant after being subjected to 150-min and 180-min of exposure. In conclusion, a significant reduction in TSH, T4, and MCT8 levels indicated thyroid dysfunction due to MP-EMR exposure.

Effects of 150 kHz intermediate frequency electromagnetic radiation on fertility indicators in male rats

BackgroundThe present study aimed to evaluate the effects of whole-body exposure to 150 kHz Intermediate-frequency electromagnetic radiation (IF EMR) on fertility indicators of male rats since human exposure to this frequency has increased in recent years. Fourteen adult male Sprague-Dawley rats were used in this study. The rats were randomly divided into a control and an EMR group (n = 7/group). The EMR group was continuously irradiated with 150 kHz EMR for 8 weeks. Male fertility indicators, body mass, testicular mass, rectal temperature, testicular histology, histometry, sperm analysis, and serum gonadotrophic hormone levels were evaluated. ResultsThe study showed no negative effect on body mass (grams) (323.78 ± 37.09 to 305.09 ± 26.36; p = 0.72), rectal temperature (Control: 34.5 °C–35.8 °C; EMR: 34.4 °C–36.1 °C; p < 0.05), and testicular histology. There were significant reductions in left and right testicular mass (1.04 ± 0.10 to 0.96 ± 0.32: p = 0.03 and 1.02 ± 0.08 to 0.96 ± 0.35 p = 0.04, respectively), interstitial cell count/1000 μm2 (5.33 ± 0.56 to 4.47 ± 0.48; p = 0.01), sperm motility trajectories (p = 0.05) and sperm distal cytoplasmic droplet (%) (2.27 ± 2.28 to 6.84 ± 5.01; p = 0.05). A significant increase in follicle-stimulating hormone levels was observed (13.44 ± 6.38 IU/ml to 26.96 ± 8.07 IU/ml; p = 0.01). ConclusionsMost male fertility parameters of rats in the present study were not affected by 8 weeks of whole-body exposure to 150 kHz EMR. However, significant decreases in testicular mass, interstitial cell count/1000 μm2, sperm motility trajectories, and distal cytoplasmic droplets were observed, as well as an increase in FSH level.

Tip-in EMR as an alternative to endoscopic submucosal dissection for 20- to 30-mm nonpedunculated colorectal neoplasms

Tip-in EMR, which includes anchoring the snare tip, has recently shown a favorable en-bloc and R0 resection rate for colorectal neoplasms. Thus, Tip-in EMR may be an alternative to endoscopic submucosal dissection (ESD). We aimed to compare clinical outcomes between Tip-in EMR and ESD for large colorectal neoplasms. This retrospective study evaluated consecutive patients who underwent Tip-in EMR or ESD for 20- to 30-mm nonpedunculated colorectal neoplasms at a Japanese tertiary cancer center between January 2014 and December 2019. Baseline characteristics, treatment results, and long-term outcomes were analyzed using 1:1 propensity score matching. Seven hundred nine lesions were evaluated. The Tip-in EMR group included 1 lesion with a nonlifting sign but no lesions with fold convergence. After propensity score matching, each group included 140 lesions. The ESD group showed significantly higher en-bloc resection rates (99.3% vs 85.0%) and R0 resection rates (90.7% vs 62.9%). Procedure time was significantly shorter in the Tip-in EMR group (8 minutes vs 60 minutes). The Tip-in EMR and ESD groups did not differ significantly with respect to local recurrence rate (2.1% vs 0%). Tip-in EMR is comparable with ESD with respect to the local recurrence rate but has a shorter procedure time, despite the lower en-bloc and R0 resection rates for 20- to 30-mm nonpedunculated colorectal neoplasms without fold convergence or nonlifting sign. Thus, Tip-in EMR could be a feasible alternative to ESD in these lesions.

Influence of Withania somnifera(L) Dunal Root Extract on Rat Kidney Exposed to Electromagnetic Waves from Mobile Phone: A Histopathological and Antioxidant Analysis

This study is about to discover the consequences of 4G mobile phone emission on MDA, anti-oxidants, antioxidant marker, and histo-pathological variations in the kidney of rats.144 male rats were separated into four groups. The Group I is considered as the control group, Group II was subjected to mobile radiation 2400 MHz frequency range for 3 hours/day for the period of 6 months, Group III was as same as Group II but treated with 250 mg/kg aqueous extract of Withania somnifera root (Aq-Wsr) orally for 6 months. Group IV was given 250 mg/kg Aq-Wsr alone for 6 months. The animals were euthanized and the kidneys cells have been evaluated for antioxidant and histo-pathological parameters. Results of the study demonstrated that the LPO were significantly raised (p &lt; 0.05) while SOD, CAT, GSH and GPx were significantly lowered (p &lt; 0.05) in the EMR exposed group when compared to the Group I and Group III. In histo-pathological observation, intertubular congestion, haemorrhage, necrotic changes in cortex and medulla, cast formation within the proximal and distal tubules have elevated significantly inside the EMR group compared to the control group (p &lt;.05). Contrarily, the total number of glomeruli in the cortex of EMR group of subjects decreased compared to the Control group (p&lt; 0.05). The defensive effects of Aq-Wsr were witnessed within the kidney of Group III rats. From the study, it is very significant to raise open awareness of promising harmful consequences of cell phone radiofrequency EMR exposure.

Circumferential submucosal incision prior to endoscopic mucosal resection versus conventional endoscopic mucosal resection for colorectal lesions with endoscopic features of sessile serrated lesions.

Sessile serrated lesions (SSLs) are more prone to incomplete resection than conventional adenomas. This study evaluated whether circumferential submucosal incision prior to endoscopic mucosal resection (CSI-EMR) can increase the rate of complete and en bloc resections of colorectal lesions with endoscopic features of SSL. Retrospective analyses and propensity score matching were performed for the resection of colorectal lesions ≥ 10mm with endoscopic features of SSL. After 1:1 ratio matching, 127 lesions in the CSI-EMR group and 127 in the EMR group were selected for analysis. The median size of the lesions was 15mm (IQR 12-16) in both groups. There was no significant difference in either the complete resection rate or en bloc resection rate between CSI-EMR and EMR groups (96.9% vs. 92.9%, P = 0.155; 92.1% vs. 89.0%, P = 0.391). By contrast, the R0 resection rate was significantly higher in the CSI-EMR group than in the EMR group (89.8% vs. 59.8%, P < 0.001). The median procedure time was significantly longer in the CSI-EMR group than in the EMR group (6.28min vs. 2.55min, P < 0.001), whereas there was no significant difference between the two groups in the incidence of adverse events or recurrence rate. Multivariate analysis showed that CSI-EMR was the only factor significantly associated with R0 resection (P < 0.001). For colorectal lesions with endoscopic features of SSL, CSI-EMR does not increase the complete or en bloc resection rate, but does increase the R0 resection rate. The procedure time is longer for CSI-EMR than EMR. The association of CSI-EMR with R0 resection and non-recurrence should be further evaluated.

Clinical Outcomes of Endoscopic Treatment for Type 1 Gastric Neuroendocrine Tumor

BackgroundAlthough the rate of early detection and endoscopic treatment of gastric neuroendocrine tumors (NETs) is steadily increasing, there are insufficient studies on the long-term outcomes of endoscopic treatment. Therefore, we aimed to investigate the clinical features and long-term outcomes of endoscopic treatment for type 1 gastric NETs. MethodsSubjects who underwent endoscopic treatment for gastric NETs between March 1997 and December 2015 were included. Clinical features and endoscopic treatment outcomes were retrospectively investigated by reviewing medical records. ResultsIn total, 125 subjects underwent endoscopic treatment including forceps biopsy (n = 21), argon plasma coagulation (n = 1), endoscopic mucosal resection (EMR, n = 62), and endoscopic submucosal dissection (ESD, n = 41). In total, 103 patients with 114 lesions, who underwent EMR or ESD, were analyzed to evaluate endoscopic and oncologic outcomes. The rates of en bloc resection in the EMR and ESD groups were 91.5% and 97.7%, respectively. Complete resection rates were significantly higher in the ESD group than in the EMR group; it was also higher in < 1-cm small-sized lesions than in 1–2-cm large-sized lesions. Adverse events were similar between the two groups. During a median follow-up period of 63 months, local recurrence rates were 6.5% and 2.4% in the EMR and ESD groups, respectively, and the disease-free survival rate did not differ significantly between the groups. ConclusionEndoscopic treatment for type 1 gastric NETs less than 2 cm in diameter and confined to mucosal and submucosal layers could be an effective and safe treatment strategy based on the favorable long-term outcome.

Outcomes of thermal ablation of the defect margin after duodenal endoscopic mucosal resection (with videos)

Laterally spreading lesions (LSLs) in the duodenum are conventionally treated by EMR. Recurrence is commonly encountered and can be difficult to treat safely due to the unique anatomic characteristics of the duodenum. Auxiliary techniques designed to prevent recurrence have not been described. We sought to evaluate the effectiveness of thermal ablation of the defect margin after EMR (EMR-T) in reducing recurrence at first surveillance endoscopy (SE1, scheduled at 6 months) in a single tertiary referral center. All duodenal LSLs≥10mm referred for EMR were eligible. After successful EMR, thermal ablation was performed using snare-tip soft coagulation around the entire circumference of the resection defect. The primary outcome was the frequency of recurrence at SE1. A previous, well-characterized, prospective cohort of duodenal LSLs≥10mm treated by conventional EMR was the comparator. Over 43 months up to October 2019, 54 LSLs underwent EMR-T. One hundred twenty-five LSLs underwent conventional EMR in the comparator group. Patient and lesion characteristics were similar between the groups. Recurrence was significantly lower in the EMR-T group compared with the conventional EMR group (1 of 49 [2.3%] vs 19 of 108 [17.6%]; P= .01). No difference in technical success, EMR-related adverse outcomes, or referral to surgery were identified between the groups. EMR-T significantly reduces the frequency of recurrence for duodenal LSLs. This technique is safe in the duodenum and has the potential to significantly improve the effectiveness of duodenal EMR. (Clinical trial registration number: NCT02306603.).

The protective effect of melatonin on radiofrequency electromagnetic fields of mobile phone-induced testicular damage in an experimental mouse model.

Radiofrequency electromagnetic radiation (RF-EMR) from mobile devices has undesirable effects on the male reproductive organs. Melatonin with antioxidant potential can help to prevent these damages. Therefore, the aim of this study was to evaluate the protective effect of melatonin on testicular damage induced by RF-EMR of mobile phone. In this experimental study, 32 adult male BALB/c mice were divided randomly into four groups: control, melatonin (2mg/kg, for 30 consecutive days, intraperitoneally), RF-EMR (900MHz, 100 to 300 MT, 54 to 160W/m) (4hr per day, whole body) and melatonin+RF-EMR groups. One day after the last prescription were evaluated oxidative stress parameters, testosterone level and histopathological assays of the testis. EMR of mobile phone led to the induction of oxidative stress, testicular tissue damage and decreased testosterone. Treatment with melatonin improved oxidative stress parameters such as MDA and GSH, and testis injury score, increased the thickness of the germinal epithelial thickness and diameter of the seminiferous tubule, and decreased testosterone hormone in the EMR-exposed mice, and these differences were significant(p<.05). Data showed that melatonin with its antioxidant property can decrease oxidative damage induced by RF-EMR of mobile phones on testis tissue.

Clinical Outcomes following Endoscopic Treatment for Sporadic Nonampullary Duodenal Adenoma

Background and Aims: Endoscopic treatment for duodenal neoplasms is associated with a high risk of perforation. This study aimed to determine the feasibility of endoscopic treatment for sporadic nonampullary duodenal adenoma (SNDA). Methods: Consecutive patients undergoing endoscopic treatment for SNDA between January 2005 and December 2015 were included in the study. Clinical characteristics and endoscopic outcomes were analyzed using medical records. Long-term outcome was assessed in patients whose follow-up period was >12 months >1 year. Results: A total of 95 lesions (92 patients) were treated with argon plasma coagulation (APC) ablation (n = 25), endoscopic mucosal resection (EMR, n = 59), or endoscopic submucosal dissection (ESD, n= 11). The median age was 54.9 years, and 63% were male. In patients who underwent EMR and ESD, the en bloc resection rate was 83.1 and 90.0% (p > 0.99); and the complete resection rate was 81.4 and 80% (p > 0.99), respectively. Perforation occurred in 8 patients (8.7%), 4 of whom required surgery. The ESD group showed a significantly higher perforation rate than APC or EMR group (45.5 vs. 0 and 5.1%; p < 0.001). During the median follow-up period of 19 months (range 12–137 months), one patient in the APC ablation group experienced recurrence; no recurrences were seen among EMR and ESD groups. Conclusions: Favorable long-term outcomes indicate that endoscopic treatment is an effective approach for the treatment of SNDA. Considering the high risk of perforation associated with ESD, APC, or EMR may be an acceptable alternative.

Mo1239 COMPARATIVE OUTCOMES OF CAP ASSISTED ENDOSCOPIC RESECTION AND ENDOSCOPIC SUBMUCOSAL DISSECTION IN PATIENTS WITH DYSPLASTIC BARRETT'S ESOPHAGUS AND INTRAMUCOSAL ADENOCARCINOMA

Endoscopic eradication therapy (EET) is the standard of care for the treatment of Barrett’s Esophagus (BE) with dysplasia and intramucosal esophageal adenocarcinoma (EAC). Cap assisted endoscopic resection (cEMR) leads to piecemeal resection in larger lesions. Endoscopic submucosal dissection (ESD) allows for the en bloc removal of larger lesions. Both approaches are followed by mucosal ablation to achieve complete eradication of dysplasia and intestinal metaplasia. Limited data is available for the efficacy of these two approaches followed by mucosal ablation. We studied the outcomes of patients treated with these modalities at our institution, focusing on rates of complete remission of intestinal metaplasia (CRIM) and dysplasia (CRD). We queried a prospectively maintained database of all patients at our institution undergoing EMR and ESD for dysplastic/neoplastic BE and abstracted relevant demographic and clinical data. Only patients with at least one endoscopic follow up were included. Our primary outcome was the achievement of CRIM, defined as the absence of intestinal metaplasia on at least one follow up EGD at 2 years. Secondary outcomes included rates of complete remission of dysplasia (CRD), defined as the absence of dysplastic BE on at least one follow up EGD and rates of complications. All pathology was read by expert gastrointestinal pathologists. Time dependent analyses were conducted to compare outcomes in the two groups. A total of 633 patients, of whom 447 that underwent cEMR and 89 that underwent ESD were included. 447 (100%) and 59 (66.3%) in the cEMR group and ESD groups underwent ablation (either radiofrequency ablation or cryotherapy) post endoscopic resection. Demographic and clinical variables are displayed in Table 1. The ESD group had a higher proportion of EAC patients (48.3% vs 20.1%, p<0.05) but proportions of HGD+EAC were similar in both groups. More complications were associated with the EMR group, driven mainly by post-procedural bleeding rates. Rates of CRD were lower in the EMR group at 6 months but were comparable at 12 and 24 months (see table 1 and Figure 1). Rates of CRIM were comparable between the two groups at 12 and 24 months. A multivariate model (adjusting for age, gender, BMI, smoking status, length of BE, presence of hiatal hernia, and initial histology) showed that EMR was associated with a lower likelihood of achieving CRD (HR 0.487, 95% CI: 0.337-0.703, p <0.0001), but not CRIM at 2 years (HR 0.895, 95% CI: 0.537-1.491, p=.67). EMR and ESD both appear to be effective in the treatment of BE related neoplasia. ESD is safe when performed by expert endoscopists. While there is a higher likelihood of achieving CRD earlier in patients with ESD, both resection techniques when combined with endoscopic ablation appear equally efficacious in achieving CRIM at 24 months.Comparison of baseline characteristics and outcomes (CRIM, CRD and complications) in the two groups.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Analysis of factors associated with local recurrence after endoscopic resection of gastric epithelial dysplasia: a retrospective study

BackgroundEndoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are widely used techniques for the treatment of gastric epithelial dysplasia. Previous studies have compared the clinical outcome of endoscopic resection for early gastric cancer, but few studies have focused on gastric dysplasia alone. This study aimed to evaluate the long-term prognosis following endoscopic procedures for gastric epithelial dysplasia, investigate differences in local recurrence rates according to the treatment modality, and identify risk factors associated with local recurrence.MethodsIn this retrospective study, local recurrence rates and risk factors associated with local recurrence were compared between 599 patients who underwent EMR and 306 who underwent ESD for gastric epithelial dysplasia from January 2011 to December 2015.ResultsThe en bloc resection rate (32.2% vs. 100%, p < 0.001) and complete resection rate (94.8% vs. 99.0%, p = 0.003) were significantly lower in the EMR group than in the ESD group. The local recurrence rate was significantly lower in the ESD group (1.3%) than in the EMR group (4.2%; p = 0.026). There was a significantly increased risk of local recurrence, regardless of lesion location or histologic grade, in patients with lesions > 2 cm (p = 0.002) or red in color (p = 0.03). The ESD group had a significantly lower local recurrence rate, with a higher complete resection rate, than that in the EMR group (p < 0.05). In the case of recurrence after endoscopic resection, most of the recurred lesions were removed through additional endoscopic procedures; there was no difference between the two groups (p = 0.153).ConclusionsThe complete resection rate was significantly higher, and the local recurrence rate was significantly lower, in patients with gastric epithelial dysplasia treated with ESD. Therefore, ESD should be considered the preferred treatment in patients with lesions > 2 cm or showing redness due to an increased risk of local recurrence and EMR may be possible for low-grade dysplasia that is less than 2 cm without surface changes such as redness, depression and nodularity.

Prophylactic endoscopic coagulation to prevent delayed post-EMR bleeding in the colorectum: a prospective randomized controlled trial (with videos)

Post-EMR bleeding (PEB) is the most common adverse event after EMR. However, there are no established endoscopic methods for the prevention of PEB. This study aimed to investigate whether prophylactic endoscopic coagulation (PEC) using coagulation probes reduces the incidence of overall delayed PEB. We performed a randomized controlled study of patients undergoing EMR for large (≥10mm) sessile lesions and laterally spreading tumors. Patients were randomized 1:1 to the EMR with coagulation group (n=285) or EMR (control) group (n= 285). Immediate bleeding during colon EMR or clean-based ulcer afterEMR was excluded. Clinically significant PEB was defined as bleeding requiring endoscopic hemostasis, hospitalization, or a decrease in the hemoglobin level >2 g/dL. A total of 569 patients were analyzed. The incidence of overall PEB was significantly lower in the EMR with coagulation group than in the control group (12.6% [36/285] vs 18.7% [53/284], P= .048). However, this waslargely because of a reduction in minor bleeding. There was no difference in clinically significant PEB (1.8% [5/285] vs 3.2% [9/284], P= .276). Rectal location was a risk factor associated with overall PEB (odds ratio, 1.256; 95% confidence interval, 1.12-1.41; P< .001). Although this study found reduced PEB with prophylactic cautery of visible vessels, this was largely because of a reduction in minor bleeding with no benefit observed for clinically significant bleeding. Overall, PEB was more frequent with rectal lesions. (Clinical trial registration number: KCT0000779.).

Does Adjunctive Azithromycin Cesarean Bundle Decrease the Risk of Maternal and Neonatal Outcomes? [24H

INTRODUCTION: The goal of preoperative antibiotics is to decrease and prevent postpartum infections. Recent evidence indicates that adding azithromycin (AZI) to Cefazolin as extended antibiotic coverage can decrease the risk of infectious co-morbidities for non-elective Cesarean Deliveries (nCD). November 2017 we started using AZI + cefazolin in nCD. The goal was to determine the institutional compliance to AZI administration. METHODS: An IRB approved retrospective cohort study over 4 months of patients undergoing nCD. ST (1st generation cephalosporin or, clindamycin and gentamycin for cephalosporin allergy). Patients in 2 groups: preEMR bundle (ST) and postEMR bundles (ST + AZI). Maternal and neonatal outcomes collected for 2 months preEMR bundle and 2 months postEMR bundles. Exclusion criteria: women undergoing elective CD, did not receive pre-operative antibiotics, AZI allergy. The primary outcome was overall compliance with AZI administration with the new EMR bundle. The composite outcome-maternal wound infection, endomyometritis, maternal morbidity, neonatal morbidity. Statistical analyses were performed with p value <0.05 significant. RESULTS: There were 100 patients meeting inclusion criteria in study time period. There were no differences in baseline demographics between groups. Only 56% of patients in the post EMR group received AZI in addition to ST. There were no significant differences in the composite outcome between groups. CONCLUSION: Adjunctive AZI at time of nCD does not appear to decrease the risk of maternal and neonatal outcomes; but it was only administered correctly in 56% of the eligible cases. The effect of AZI on outcomes may be improved with better adherence to the EMR bundle.

Long-term outcomes of endoscopic resection and metachronous cancer after endoscopic resection for adenocarcinoma of the esophagogastric junction in Japan

Endoscopic resection (ER) of superficial adenocarcinoma of the esophagogastric junction (AEGJ) has been shown to be safe and effective. However, long-term data in patients undergoing ER for superficial AEGJ in Japan are still limited. The aim of this study was to determine the effect of ER on survival and occurrence of metachronous cancer of patients with superficial AEGJ. A retrospective analysis of patients who underwent or endoscopic submucosal dissection (ESD) for superficial AEJG in 13 centers in Japan was performed. The patients were classified as either low risk or high risk for lymph node metastasis based on histologic features. The incidence of metachronous AEGJ as well as overall survival and disease-specific survival rates were calculated. A total of 372 patients who underwent ER were included, in which 277 patients were low risk and 95 high risk for lymph node metastasis. Five-year cumulative incidences of local recurrence were 13% and .5% in the EMR and ESD groups, respectively (P< .01). Six AEGJ deaths were observed in the high-risk group and none in the low-risk group. The 5-year overall survival rates in the low-risk group without additional treatment, the high-risk group with additional treatment, and the high-risk group without additional treatment were 93.9%, 77.7%, and 81.6%, respectively. The 5-year disease-specific survival rates in the 3 groups were 100%, 94.4%, and 92.8%, respectively. The 5-year cumulative incidence of metachronous AEGJ in 316 patients without additional treatment was 1.1%. Favorable long-term outcomes with ER were observed in patients with AEGJ who met the low-risk criteria for lymph node metastasis. ESD was a reasonable and effective treatment in Japanese patients.

Outcomes of endoscopic resection for superficial duodenal epithelial neoplasia

Pancreaticoduodenectomy is an invasive procedure, and endoscopic resection (ER) is an alternative therapy. However, details regarding the outcomes of ER are unknown, especially for superficial duodenal epithelial neoplasia (SDET). The aim of this study was to elucidate the outcomes of ER for SDET and to compare EMR with endoscopic submucosal dissection (ESD). This was a retrospective observational study. From June 2010 to June 2017, 320 cases of endoscopically resected SDET (146 EMR-treated cases and 174 ESD-treated cases) were included in this study. We analyzed the proportions of en bloc resection, R0 resection, perforation, and bleeding as outcomes of ER and compared outcomes between the EMR and ESD groups. Next, we collected data on the features and clinical course of cases with adverse events. The proportions of en bloc resection and R0 resection among all cases were 96.6% and 83.4%, respectively. In over 95% of cases, ESD achieved en bloc resection, regardless of lesion size. The incidences of perforation and bleeding were 8.8% and 3.4%, respectively, and the former was largely successfully managed by conservative treatment. The mortality rate was 0%, and all patients were discharged with a median hospital stay of 8.5 days (range, 4-52 days). Evaluation of the hospital stay duration according to lesion circumference revealed a significantly longer duration for lesions present on the medial wall than for other lesions (median 41 vs 7 days, P= .0331). The present study revealed that ER achieved secure en bloc resection, with the treatment type (ESD or EMR) selected according to the lesion size. A lesion located on the medial wall was associated with worse outcomes, such as prolonged hospital stay after perforation.

Hot snare polypectomy with or without saline solution/epinephrine lift for the complete resection of small colorectal polyps

The criteria for a standard polypectomy technique for complete removal of small colorectal polyps has not yet been established. This study aimed to compare the complete resection rate of hot snare polypectomy (HSP) with that of EMR for small, sessile, or flat polyps. Patients with 5- to 9-mm non-pedunculated colorectal polyps were prospectively randomized to the HSP or EMR group. The presence of residual polyps was assessed by performing histologic assessment of 4-quadrant forceps biopsy specimens taken from the edges of the polypectomy site. The primary outcome was the complete resection rate after HSP or EMR; the secondary outcomes were the proportion of procedure-related adverse events and specimen-loss rate. Sample size was estimated using a superiority trial design. We assumed that the complete resection rate of the EMR group would be at least 8% higher than that of the HSP group. A total of 382 polyps in 269 patients were assessed and randomly assigned to each method using 4× 4 block randomization. Of these, 353 polyps were finally analyzed based on the pathology results. The mean polypsize was 6.3 ± 1.3mm. The complete resection rate did not differ between the HSP and EMR groups (88.4% [152/172] vs 92.8% [168/181], respectively; P= .2). The intraprocedural bleeding rate, immediately after polypectomy, was significantly higher in the HSP group than in the EMR group (5.2% vs 0.6%, respectively; P=.009). However, clinically significant bleeding and tissue retrieval failure rates did not differ between the groups. In the multivariate logistic regression analysis, sessile serrated adenoma/polyps or hyperplastic polyps were almost 3 times (odds ratio, 2.824; 95% confidence interval, 1.03-7.75; P= .044) more likely to be incompletely resected compared with other conventional adenomatous polyps. Except for pathology, we found no significant independent predictors for incomplete resection. EMR for small non-pedunculated colorectal polyps is not superior to HSP in terms of complete resection or safety. Both methods can be performed according to the endoscopist's preference. (Clinical trial registration number: KCT0001640; cris.nih.go.kr.).

Polypectomy for complete endoscopic resection of small colorectal polyps

Small colorectal polyps are encountered frequently and may be incompletely removed during colonoscopy. The optimal technique for removal of small colorectal polyps is uncertain. The aim of this study was to compare the incomplete resection rate (IRR) by using EMR or cold snare polypectomy (CSP) for the removal of small adenomatous polyps. This was a prospective randomized controlled study from a tertiary-care referral center. A total of 358 patients who satisfied the inclusion criteria (polyp sized 6-9mm) were randomized to the EMR (n=179) and CSP (n=179) groups, and their polyps were treated with conventional EMR or CSP, respectively. After polypectomy, an additional 5 forceps biopsies were performed at the base and margins of polypectomy sites to assess the presence of residual polyp tissue. The EMR and CSP samples were compared to assess the IRR. Among a total of 525 polyps, 415 (79.0%) were adenomatous polyps, and 41 (16.4%) were advanced adenomas. The overall IRR for adenomatous polyps was significantly higher in the CSP group compared with the EMR group (18/212, 8.5% vs 3/203, 1.5%; P= .001). Logistic regression analysis revealed that the CSP procedure was a stronger risk factor for the IRR (odds ratio [OR] 6.924; 95% confidence interval [CI], 2.098-24.393; P= .003). In addition, piecemeal resection was the most important risk factor for the IRR (OR 28.696; 95% CI, 3.620-227.497; P= .001). The mean procedure time for polypectomy was not significantly different between the EMR and CSP groups (5.5 ± 2.7 vs 4.7 ± 3.4 minutes; P= .410). None of these patients presented with delayed bleeding. There were no severe adverse events related to the biopsies. EMR was significantly superior to CSP for achieving complete endoscopic resection of small colorectal polyps. Patients with piecemeal resection of polyps had a higher risk for incomplete resection. (Clinical trial registration number: Hongwei-1102-12.).

OC-011 EMR VS ESD for Barrett’s Neoplasia: Time to Shift the Paradigm?: Abstract OC-011 Table 1

Introduction The risks of ESD in the oesophagus are perceived to be high and consequences potentially disastrous. For this reason, EMR is the most common technique to resect early Barrett’s cancer. However, the drawback of EMR is piecemeal resection with difficulties interpreting resection margins of cancers. The aim of this study was to evaluate feasibility, safety, and outcomes of ESD in the endoscopic treatment of Barrett’s neoplasia and to compare these with EMR. Methods All data was collected prospectively on a predesigned electronic database between 2006 and 2015. The database was interrogated by independent researchers blinded to the endoscopic procedures. Bleeding was defined as significant if patients required transfusion, endoscopic therapy or hospitalisation. Strictures were defined as significant if they were symptomatic or requiring dilatation. SPSS was used for statistical analysis of data Results 81 oesophageal ESDs were performed in 70 patients and 180 EMRs were performed in 112 patients during the study period. Table 1 demonstrates patient and lesion characteristics and outcomes following resection including deep R0 resection margin for cancer and histological outcomes. Lesion morphology and histology was significantly more advanced in the ESD group as compared to EMR. The endoscopic cure rate in the EMR group was 81% with 19% of patients upstaged requiring radical treatment. In the ESD group the endoscopic cure rate was 87% with 13% of patients upstaged requiring radical treatment. Conclusion This is the biggest reported comparison of EMR vs ESD for Barrett’s neoplasia. Proportionately more Is and IIC lesions were resected by ESD than by EMR which is reflected by significantly more cancers identified in the ESD group. Our data shows the safety and efficacy for ESD resection of Barrett’s cancers but EMR still remains a standard therapeutic option for non-cancerous Barrett’s neoplasia. This calls for a prospective RCT comparing ESD vs EMR for Barrett’s cancer. Disclosure of Interest None Declared