Endoscopic Resection Research Articles

Effect of adjuvant radiotherapy after endoscopic resection of early esophagus cancer to prevent new intraluminal mucosal recurrence.

381 Background: Endoscopic resection (ER) is effective for treating T1a early esophageal squamous cell carcinoma (ESCC). Occasional distant metastasis and recurrence are inevitable invasion in depth of muscularis mucosa(MM). Additional surgical resection is an effective means for cure and prevent recurrence, but it imposes a heavy physical burden. Chemoradiation therapy (CRT) is a comparable alternative to surgery. Not all patients will want those additional treatment. Another problem is the occurrence of new esophagus intraluminal mucosal recurrence. After endoscopic treatment, there is an increased risk of scarring and deformity. But there are few reports of the effectiveness of additional RT in suppressing new lesions. This study was designed to verify the efficacy of not only curability but also suppressive effect the occurrence of new lesions additional treatment of T1a(MM) ESCC. Methods: This study was a retrospective study. We reviewed 71 consecutive patients who underwent ER followed by clinical stage I (T1a: MM) ESCC. We compared patients in the radiotherapy group or non-radiotherapy group after ER. Patients of radiotherapy group received radiation within 3 months after ER. All patients underwent regular follow-up. Recurrence, recurrence-free survival, cancer-specific survival, overall survival, and complications were evaluated. Results: There were 34 cases of radiotherapy group and 37 cases of non-radiotherapy group. 3 patients (8.9 %) in the radiotherapy group experienced intraluminal mucosal recurrence, and 2 patients (6.6 %) experienced local recurrence. On the other hand, in the non-radiotherapy group, 9 patients (24.3 %) experienced intraluminal mucosal recurrence, and 7 patients (18.9 %) experienced local recurrence (intraluminal mucosal recurrence: p< 0.05, local recurrence p=0.14). The recurrent group received chemotherapy. The 3-year cumulative recurrence-free survival was 97 % in the radiotherapy group and 83.7 % in the non-radiotherapy group (p< 0.05). No severe radiation toxicities were recorded. Conclusions: The radiotherapy after ESD reduced the risk of lymph nodes recurrence not only local lymph node recurrence but also new intraluminal mucosal recurrence, and safe and effective therapeutic strategy.

Is naso-axial line a better predictor in endoscopic endonasal resection of the odontoid and pannus removal? Technical nuances of maximizing corridor and maintaining occipital cervical joint stability.

The transoral transpharyngeal odontoidectomy, followed by occipitocervical fixation, have traditionally been a recognized method for ameliorating ventral compression at the craniovertebral junction (CVJ), despite its associated comorbidities. As an alternative, the endoscopic endonasal odontoid resection is a viable approach for various CVJ abnromalities that preserve the oropharynx and leads to fewer procedure-related complications(1-4). We present our case to detail the technical nuances of the procedure and its advantages over other techniques. In this video, we describe our experience of a novel modified endoscopic endonasal odontoidectomy (EEO) for the removal of a large retro-odontoid pannus, compressing the spinal cord at the level of CVJ. The patient is a 73-year-old male presenting with progressive bilateral myelopathic symptoms. There was significant clinical improvement postoperatively, and C1-C3 fixation was performed. An MRI at two months later showed an adequate ventral decompression and normal spinal cord shape at the level of CVJ. The endoscopic endonasal approach to the odontoid process offers a less invasive alternative to other methods, which may reduce patient discomfort during and after surgery. By avoiding disruption of the oropharynx, this method can significantly lower the risk of complications such as surgical site infection and poor healing associated with the surgical approach. This technique is advisable for carefully selected patients with favorable sinonasal anatomy. The nasal axial line can more accurately predict the inferior border of the odontoid resection during preoperative planning and intraoperative neuronavigation. It guides the lower extent of odontoidectomy that is affordable by endoscopic endonasal approach.

OP-TNT: Phase II study of total neoadjuvant chemoradiotherapy followed by local resection for early distal rectal carcinoma.

177 Background: Surgery is standard of care for pMMR early distal rectal cancer (RC), which can be partially exempted by totally neoadjuvant chemoradiotherapy (TNT) followed by watch and wait. But long-term data showed that 1/3 patients had local growth( mostly in the rectal wall)in two years. This study investigates the efficacy and safety of TNT followed by local excision( LE) for early distal rectal carcinoma (cT1-3N0M0) in order to preserve organs. Methods: In this single-arm, phase 2 prospective trial, patients were eligible if they were aged 18 years or older, with a performance status of 0-1,newly diagnosed, biopsy proven pMMR/MSS RC which located ≤5cm from the anal verge and staged as cT1-3N0M0. Patients were assigned to receive TNT: 6 courses of CapOx(capecitabine 1000 g/m2 PO BID D1-14, oxaliplatin 130 mg/m2 IV QD D1,Q3W), combined with concurrent long-course radiotherapy (LCRT)(45 Gy/25 Fx to the pelvis with an SIB of 50 Gy/25 Fx to the tumor bed). Evaluation was performed 12 weeks after completion of LCRT. Patients who achieved a clinical complete response (cCR) or near clinical complete response (ncCR)were assigned to LE, whereas those with >ypT1, positive margin, or neurovascular invasion after LE were recommended for total mesorectal excision (TME). The primary endpoint is the 3-year organ-preserving rate. Secondary endpoints include the pathological complete response (pCR)(encompassing response after LE and TME), adverse effects rate, 3y-disease-free survival (DFS)and 3y-overall survival (OS)rate. Results: From October 2022 to August 2024, 52 patients had completed therapy. Median age at evaluation and follow-up duration were 58.3 years and 11 months. Of the patients 78.8% (41/52) were defined as MRI stage T3, and 76.9%(40/52) located ≤3cm from the anal verge. Of 52 evaluable patients ,82.7% (43/52) achieved cCR/ncCR and had LE (6 via endoscopic resection and 37 through trans-anal minimally invasive surgery). Among these patients, 25.6% (11/43) were found to have residual tumors after LE, of which 6 were radical-operated while 5 refused this intervention. Nine patients who did not achieve cCR or ncCR received TME resection, and 6 of them were confirmed as pCR. The total pCR rate was 73.1% (38/52). Of all patients, 3 underwent abdominoperineal resection, and sphincter-preserving rate was 94.2%(49/52). No grade 3 or 4 adverse events were reported, and there were no treatment-related deaths. The main adverse event after local resection was the 1-3 months anterior resection syndrome. Conclusions: The results of interim analysis showed that tumor residue was found in patients with cCR/ncCR after TNT, similar to the regrowth rate previously reported. LE strategy may become prevention. Long-term outcomes are being followed up. Clinical trial information: NCT05563922 .

Clinical outcomes and risk factors of post-polypectomy microperforation in patients with colorectal neoplasia: a case-control study.

Colonoscopic polypectomy significantly reduces the incidence of colorectal cancer, but it carries potential risks, with colonic perforation being the most common and associated with significant morbidity. This study evaluated the clinical outcomes and risk factors of microperforation during colonoscopic polypectomy. A retrospective cohort study. We retrospectively reviewed the patients' records who underwent colonoscopic polypectomy and subsequent plain radiographic examination to monitor perforation. Patients with pneumoperitoneum detected on plain radiography were enrolled. Patients who underwent adverse event-free colonoscopic polypectomies within 1 week of each case and were matched 2:1 by age and sex to the cases were selected as controls. Microperforations occurred in 12 patients (8 males; age: median 64.5 years). Polyps with microperforations were more frequent in the right colon (83.3% vs 33.3%). Endoscopic mucosal resection with precutting (EMR-P; 16.7% vs 0.0%) or hot-snare polypectomy (8.3% vs 0.0%) was more frequently performed in the microperforation group. Muscle fibers at the polypectomy site were more frequently visible in the microperforation group (58.3% vs 8.3%). By multivariate analysis, right colon location and visible muscle fibers were independent risk factors for microperforation. All patients with microperforation received intravenous antibiotics and were advised to fast. Patients responded well to these conservative treatments and were discharged after a median of 3 (2-6.75) days of hospital stay. Our data suggest that conservative treatment is feasible and could be the primary management option for selected patients with microperforations postcolonoscopic polypectomy. Right-sided colonic polyps and visible muscle fibers predispose to microperforations.

Adjuvant therapy with somatostatin analogs for recurrent gastric neuroendocrine tumors type 1.

665 Background: Neuroendocrine gastric tumors (gNETs) type 1 are associated with chronic autoimmune atrophic gastritis, hypergastrinemia and usually have multifocal lesions and high frequency of recurrence (up to 70% for 2 years). Somatostatin analogs (SA) showed promising data in neoadjuvant setting with 84% of complete responses in a small retrospective trial. The aim of this study was to evaluate the efficacy of adjuvant treatment with SA for recurrent gNETs type 1. Methods: This retrospective, single-center study included patients (pts) with recurrent gNETs who received adjuvant treatment with SA. Recruitment of pts was carried out from 2012 to February 2024. Results: The study included 35 pts, 33 females and 2 males. Endoscopic mucosal resection (EMR) was performed in 34 cases (97.1%), gastric resection in 1 (2.9%). The median of previous EMR was 2 (1-6) procedures. Most of the pts have multifocal lesions – 28 (80%), the median of lesions is 5. The median tumor size – 6 mm, tumor size >10 mm was observed in 2 cases (5.7%), one of them had N+. The median of ki67 was 3,5% (1-10%), grade 1 (G) - 14 (40%) and G2 - 21 (60%). All pts received adjuvant therapy with SA, 33 (94.3%)long-active releasing octreotide30 mg and 2 (5.7%) lanreotide 120 mg every 4 weeks. The time of SA therapy was <12 months in 23 cases (65.7%) and ≥12 months in 12 (34.3%). The median of follow-up was 30.5 months. The median disease-free survival (DFS) was not reached (95% CI, 67-NR). We compared median DFS after previous EMR (DFS1) without adjuvant SA and DFS after EMR with adjuvant SA (DFS2). The DFS2 was significantly higher – median of DFS1 was 8.8 months (95% CI, 2.7-14.9) not reached (95% CI, 67-NR, p<0.01) . Adjuvant treatment with SA ≥12 months was associated with improved DFS compared to <12 months – not reached (95% CI, 58.1-NR) versus 61 months (95% CI, 26.2-96.2, p=0.05). Adjuvant SA reduced gastrin levels after a year of therapy by ≥50% from baseline in 13 cases (37.1%). Conclusions: Adjuvant treatment with SA significantly improved DFS and should be considered for recurrent and multifocal gNETs type 1. Duration of therapy ≥12 months was significantly associated with improvement in DFS compared with shorter duration of therapy.

Optical coherence tomography and elastography for the visualization of architecture and stiffness differences in gastric cancer and dysplasia.

382 Background: Individuals at high risk for gastric cancer may be recommended to undergo risk-reducing gastrectomy, which leads to life-long morbidity. Surveillance with endoscopy can be an appropriate and effective option for avoiding unnecessary surgery. Gastric cancer is commonly characterized by changes in tissue architecture and increased tissue stiffness, but visualization of these alterations is challenging for white light endoscopy methods. We utilized optical coherence tomography (OCT), a non-destructive imaging modality that uses reflected near-infrared light to generate cross-sectional images of tissue, to visualize microstructure and relative tissue stiffness. Methods: We utilized two modes of OCT for visualization of ex vivo tissue samples collected from patients undergoing gastrectomy for gastric cancer, endoscopic mucosal resection, or endoscopic biopsy. Images were collected with a benchtop OCT system (Thorlabs Telesto TEL221). Structural OCT was used to visualize changes in tissue architecture including thickened mucosa and irregular put structure of the mucosa. Optical coherence elastography (OCE) was used to extract relative measures of tissue stiffness using an optical palpation method. A phantom of known mechanical properties was placed on the tissue and an axial force was applied. The resulting deformation (strain) of the phantom provided relative measurements of tissue stiffness. Classification of normal and cancerous tissue was confirmed by histology. Results: Structural OCT imaged architectural features of tissue with high resolution (<10 um) and depth of imaging up to 1.5 mm. Strain maps generated with OCE data showed that normal gastric tissue had relatively consistent stiffness, whereas stomach cancer and dysplasia exhibited increased tissue stiffness compared to normal. Conclusions: Structural OCT and OCE captured changes in tissue architecture and increased stiffness in patient samples of gastric cancer and dysplasia. These tissue features are classic characteristics of cancer, making this technique a useful screening tool for several cancer types. Future work aims to implement endoscopic OCT and OCE to detect cancer at early stages in vivo .

Procedural outcomes of a novel underwater injection endoscopic mucosal resection technique for colorectal polyps ≥10 mm.

It is uncertain whether underwater endoscopic mucosal resection (UEMR) enables resection of the submucosal tissue with sufficient margins for T1 colorectal cancer (CRC) because UEMR forgoes submucosal injection. Therefore, we developed a novel "underwater injection EMR" (UIEMR) method that combines submucosal injection with UEMR to obtain an adequate vertical margin.We retrospectively analyzed procedure-related outcomes of 135 consecutive lesions from patients who underwent UIEMR for ≥10-mm nonpedunculated colorectal polyps (median size 15 mm). The outcomes included the en bloc, R0, RX, and R1 resection rates, and adverse events. Additionally, the vertical margin distance of seven T1 CRCs was evaluated.En bloc resection was achieved in 127 lesions (94.1%). R0 and RX resections were observed in 92 (68.1%) and 42 lesions (31.1%), respectively, while R1 resection was seen in only one lesion (0.7%). There were two cases with adverse events (1.5%), both delayed bleeding. In T1 CRCs, all seven cases had free vertical margins, and the median vertical margin distance was 1140 µm (range 731-1570 µm).UIEMR safely demonstrated high success rates for en bloc resection, and potentially ensures a sufficient vertical margin. This technique might be an option, particularly for relatively small lesions concerning for T1 CRC, and deserves further study.

Clinical characteristics and esophageal motility in patients with gastric cardia submucosal tumors and associated changes after endoscopic resection.

This study aimed to investigate the clinical characteristics and esophageal motility of patients with gastric cardia submucosal tumors (SMTs) and the associated changes after endoscopic resection based on high-resolution impedance manometry (HRIM). From our electronic database, we identified patients who underwent pre-operative evaluation of gastric cardia SMTs between 2015 and 2023. All patients completed standardized symptom questionnaires and underwent endoscopic ultrasonography and HRIM. Endoscopic resection via submucosal dissection or submucosal tunnel endoscopic resection was performed, followed by esophagogastroduodenoscopy and HRIM three months later. Esophageal motility on HRIM was compared based on the updated Chicago Classification v4.0. Thirty patients (mean age, 47.4 ± 12.8years; male, 50%) were analyzed. Most patients were asymptomatic (43.3%), while others presented with epigastralgia, regurgitation, chest pain, or dysphagia. On endoscopic ultrasonography, the average tumor size was 16.7 ± 4.5mm (range, 10.0-30.0mm), and most tumors originated from the fourth layer (80%). On HRIM, eight patients (26.7%) had abnormal esophageal motility, including five with ineffective esophageal motility (IEM) and three with esophagogastric junction outflow obstruction. Complete resection was achieved in 25 of the 27 patients (92.6%) who underwent endoscopic treatment. Pathology revealed leiomyomas (96%) and gastrointestinal stromal tumors (4%). No significant differences in symptom profiles or HRIM parameters were observed after tumor resection. Three patients with pre-operative IEM exhibited normal motility at the follow-up HRIM. Up to 26.7% of patients with gastric cardia SMTs had abnormal esophageal motility on HRIM. Endoscopic resection of these SMTs was effective and safe and appeared to improve esophageal motility in patients with IEM.

Neurocognitive Safety of Endoscopic Colloid Cyst Resection: Paired Pre- and Post-Operative Cognitive Function from an Exploratory Cohort

Objective: Resection of colloid cysts, a rare third ventricle pathology, is accepted clinical practice. Owing to their location proximal to deep gray nuclei and forniceal columns, colloid cysts have been theorized to contribute to cognitive decline. Comprehensive pre- and post-operative cognitive testing, however, has rarely been implemented. Methods: We analyzed formal neuropsychological testing performed in 20 patients undergoing endoscopic cyst resection. Pre- and post-operative performance was compared either for each individual patient or according to aggregated neuropsychological factor scores grouped via expert census. A change in performance was deemed significant if (i) it reached statistical significance and (ii) was greater than 1.5 pre-operative standard deviations. Results: Twenty patients with colloid cysts (average diameter 13.3 ± 1.3 mm) underwent matched pre- and post-operative testing. No patient had a significant change in cognitive performance. Neurocognitive metrics assessing cognitive functions typically subsumed by the temporal (p = 0.35), extratemporal (p = 0.20), occipitoparietal (p = 0.31), or frontal lobes (p = 0.11) did not change post-operatively. Similarly, no differences emerged when factor scores were generated according to composite scores of different neurocognitive domains: attention (p = 0.32), executive function (p = 0.14), language (p = 0.98), and visuospatial function (p = 0.42). Conclusions: Neuropsychological testing allows for the careful monitoring of cognitive status before and after surgery and for the identification of patients who may benefit from pre- and post-operative cognitive rehabilitation. It should also be used as a valuable surgical psychometric marker and adjuvant. No significant cognitive decline was observed in this cohort.

Effect of artificial intelligence-aided differentiation of adenomatous and non-adenomatous colorectal polyps at CT colonography on radiologists' therapy management.

Adenomatous colorectal polyps require endoscopic resection, as opposed to non-adenomatous hyperplastic colorectal polyps. This study aims to evaluate the effect of artificial intelligence (AI)-assisted differentiation of adenomatous and non-adenomatous colorectal polyps at CT colonography on radiologists' therapy management. Five board-certified radiologists evaluated CT colonography images with colorectal polyps of all sizes and morphologies retrospectively and decided whether the depicted polyps required endoscopic resection. After a primary unassisted reading based on current guidelines, a second reading with access to the classification of a radiomics-based random-forest AI-model labelling each polyp as "non-adenomatous" or "adenomatous" was performed. Performance was evaluated using polyp histopathology as the reference standard. 77 polyps in 59 patients comprising 118 polyp image series (47% supine position, 53% prone position) were evaluated unassisted and AI-assisted by five independent board-certified radiologists, resulting in a total of 1180 readings (subsequent polypectomy: yes or no). AI-assisted readings had higher accuracy (76% +/- 1% vs. 84% +/- 1%), sensitivity (78% +/- 6% vs. 85% +/- 1%), and specificity (73% +/- 8% vs. 82% +/- 2%) in selecting polyps eligible for polypectomy (p < 0.001). Inter-reader agreement was improved in the AI-assisted readings (Fleiss' kappa 0.69 vs. 0.92). AI-based characterisation of colorectal polyps at CT colonography as a second reader might enable a more precise selection of polyps eligible for subsequent endoscopic resection. However, further studies are needed to confirm this finding and histopathologic polyp evaluation is still mandatory. Question This is the first study evaluating the impact of AI-based polyp classification in CT colonography on radiologists' therapy management. Findings Compared with unassisted reading, AI-assisted reading had higher accuracy, sensitivity, and specificity in selecting polyps eligible for polypectomy. Clinical relevance Integrating an AI tool for colorectal polyp classification in CT colonography could further improve radiologists' therapy recommendations.

Prevention of bleeding after endoscopic resection of early esophageal neoplasia in patients with esophageal varices: a systematic review.

Background Although endoscopic resection (ER) is recommended as first-choice treatment for early esophageal neoplasia, patients with esophageal varices are considered a high-risk group due to an increased bleeding risk. This systematic review aimed to evaluate the effectiveness and safety of ER in this specific patient category. Methods We searched for studies reporting on clinical outcomes of ER in presence of esophageal varices, irrespective of study design or follow-up time. Endpoints included the incidence of prophylactic measures to reduce the risk of variceal hemorrhage, radical and curative resection rates, and adverse events. Results After screening a total of 2,371 studies, 42 studies with a total sum of 186 subjects were included in this systematic review. Endoscopic band ligation (72/186; 39%) and endoscopic injection sclerotherapy (22/186; 12%) were reported as most widely adopted prophylactic measures to eradicate varices prior to ER. Other frequently described prophylactic measures included direct varix coagulation during ER (18/186; 10%) and the placement of a transjugular intrahepatic portosystemic shunt prior to ER (9/186; 5%). While the radical and curative resection rates were high (86% and 72%, respectively), the periprocedural and delayed bleeding risk were reported to be relatively low (6% and 3%, respectively). In all studies, no procedure-related mortality was observed. Conclusions ER appears to be a safe and effective treatment option in selected patients with concurrent early esophageal neoplasia and esophageal varices, provided that a tailored approach of adequate prophylactic measures is applied to prevent bleeding.

Prevention strategies of esophageal stenosis after endoscopic resection for superficial esophageal cancer: a Bayesian network meta-analysis.

What interventions effectively prevent postoperative stenosis following endoscopic resection (ER) of superficial esophageal cancer? This study aimed to identify effective interventions or combinations through a systematic review and network meta-analysis. Six databases were systematically searched for eligible studies up to 30 April 2023, on interventions to prevent esophageal stenosis post-ER. Odds ratios (ORs) evaluated stenosis rate (primary outcome) and complications (secondary outcome), while mean differences (MD) evaluated endoscopic balloon dilatation (EBD) sessions post-stenosis. Twenty-three studies involving 1271 patients and 11 different interventions were included. Eight interventions were effective in preventing post-ER stenosis: oral hydrocortisone sodium succinate and aluminum phosphate gel (OHA) (OR: 0.02, 95% credible interval [CrI]: 0.00-0.11), polyglycolic acid (PGA)+ST (OR: 0.02, 95% CrI: 0.00-0.23), oral tranilast (OT)+preemptive endoscopic balloon dilatation (PEBD) (OR: 0.08, 95% CrI: 0.01-0.77), botulinum toxin (BT) (OR: 0.10, 95% CrI: 0.03-0.32), ST (OR: 0.08, 95% CrI: 0.01-0.67), oral steroid (OS) (OR: 0.11, 95% CrI: 0.05-0.28), endoscopic triamcinolone injection (ETI)+OS (OR: 0.17, 95% CrI: 0.07-0.42), and ETI (OR: 0.18, 95% CrI: 0.11-0.30). Five interventions significantly reduced EBD sessions: PGA+ST (MD: -5.78, 95% CrI: -11.04 to -1.21), ETI+OS (MD: -3.27, 95% CrI: -5.37 to -0.72), OS (MD: -6.18, 95% CrI: -9.43 to -3.38), ETI (MD: -3.81, 95% CrI: -5.74 to -1.99), and BT (MD: -2.16, 95% CrI: -4.12 to -0.40). None of the interventions significantly increased complications. This study confirmed the efficacy of OS, ETI, and ETI+OS and verified five other interventions (OHA, PGA+ST, OT+PEBD, BT, and ST) in preventing stenosis. Notably, PGA+ST and BT also reduced the number of EBD sessions.

Development and validation of a radiomics-visual evoked potential nomogram for preoperative prediction of visual outcome after endoscopic craniopharyngioma resection.

Craniopharyngiomas are rare, benign brain tumors that are primarily treated with surgery. Although the extended endoscopic endonasal approach (EEEA) has evolved as a more reliable surgical alternative and yields better visual outcomes than traditional craniotomy, postoperative visual deterioration remains one of the most common complications, and relevant risk factors are still poorly defined. Hence, identifying risk factors and developing a predictive model for postoperative visual deterioration is indeed necessary. However, there is still a lack of research on these topics. Therefore, the authors used the largest known case series of EEEA for craniopharyngioma to determine pertinent risk factors and develop a nomogram for the noninvasive preoperative prediction of visual outcome. A total of 483 cases of craniopharyngioma (338 in the training cohort, 145 in the validation cohort) between January 2019 and March 2023 were retrospectively reviewed, and related risk factors were identified. In total, 851 radiomic features from the MR images of each case were extracted. The least absolute shrinkage and selection operator algorithm was used to select features and construct the radiomic score (Rad-score). A support vector machine (SVM) classifier was adopted to construct a radiomic model. Moreover, a clinical-radiomic nomogram was built by multivariable logistic regression. The performance of the nomogram was assessed by its discrimination, calibration, and clinical utility. The overall incidence of postoperative visual deterioration was 9.1%. A lack of intraoperative visual evoked potential (VEP) monitoring (OR 0.221, p = 0.001), larger maximum tumor diameter (OR 1.052, p = 0.014), and tight adherence (OR 2.963, p = 0.044) were demonstrated as independent risk factors for postoperative visual deterioration. The radiomic model using the SVM based on 8 selected features exhibited good discrimination in predicting adhesion strength in the training and validation cohorts (area under the receiver operating characteristic curve [AUC] 0.85 vs 0.80). Moreover, the nomogram incorporating the Rad-score and clinical factors showed AUCs of 0.827 and 0.808 in the training and validation sets, respectively, fitting well in calibration curves. Decision curve analysis further confirmed the clinical usefulness of the nomogram. Intraoperative VEP monitoring was proven to help reduce postoperative visual deterioration, while tight adherence and larger maximum tumor diameter were confirmed as independent risk factors. The radiomic model allowed a noninvasive prediction of the adherence strength between the optic nerves and craniopharyngioma. The nomogram showed a promising performance for noninvasively predicting postoperative visual deterioration and may serve as a useful tool for clinical decision-making and patient counseling.

Eight patients with inflammatory myofibroblastic tumor treated with rigid bronchoscopy

BackgroundPulmonary inflammatory myofibroblastic tumor (IMT) accounts for 0.04–0.7% of all lung tumors, and endobronchial IMT accounts for only 10% of all pulmonary IMTs. Little is known about the therapeutic outcomes of rigid bronchoscopy for endobronchial IMT. Here, we report a case series of eight patients with endobronchial IMT underwent rigid bronchoscopy.MethodsWe retrospectively analyzed eight patients with endobronchial IMT between January 2004 and December 2023.ResultsThe median age of our patients was 36 years, and 62.5% were male. Dyspnea was the predominant symptom in cases where the tumor was centrally located (n = 6), whereas hemoptysis was the predominant symptom in peripherally located tumors (n = 2). Most cases had high contrast enhancement and a tumor stalk without bronchial wall invasion on computed tomography (CT) and bronchoscopy. Complete endoscopic resection and laser cauterization via rigid bronchoscopy were possible in five patients. There were only two cases in which tumors remained after the procedure, requiring additional treatment (chemotherapy and surgical resection, respectively). In one patient, surgical resection was performed three weeks after the procedure, and the surgical specimen was free of residual tumor. There was no mortality during the median follow-up duration of 18.8 months.ConclusionsEndoscopic resection and laser cauterization using rigid bronchoscopy may serve as a safe and effective alternative treatment modality to surgery for patients with endobronchial IMT.

Therapeutic rigid bronchoscopy for endobronchial glomus tumors: a case series

BackgroundGlomus tumors (GTs) are rare, comprising only 2% of all soft tissue tumors. Pulmonary GTs are exceptionally rare, with fewer than 80 cases reported to date. Little is known about the therapeutic outcomes of rigid bronchoscopy for endobronchial GT.MethodsThis is a case series of four patients with endobronchial GT who underwent therapeutic rigid bronchoscopy between February 2021 and June 2024.ResultsThe ages of the patients in our series ranged from 32 to 75 years, and all patients were male. Cough and blood-tinged sputum were present in all patients with endobronchial GT. The tumor sizes ranged from 1 to 3 cm. Complete endoscopic resection and laser cauterization via rigid bronchoscopy were achieved in two patients. One patient had incomplete resection of a 3-cm tumor in the segmental bronchus that showed radiological evidence of bronchial wall invasion. This patient subsequently underwent lobectomy seven months after bronchoscopic resection. The fourth patient was lost to follow-up. There was no mortality throughout the follow-up periods that ranged from 2.8 to 42.5 months. Factors favoring successful rigid bronchoscopy resection for endobronchial GT include a benign tumor in the central airways without bronchial wall invasion.ConclusionEndoscopic resection and laser cauterization using rigid bronchoscopy may be a viable option for patients with endobronchial GT when surgery is not practical.Clinical trial numberNot applicable.

Outcomes of Endoscopic Submucosal Dissection for High-Risk Colorectal Colitis-Associated Neoplasia in Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) patients have an increased risk of developing colorectal cancer. High-risk colorectal colitis-associated neoplasia (HR-CAN) can be difficult to treat using traditional endoscopic resection methods. Aim of the study is to evaluate the outcomes of endoscopic submucosal dissection (ESD) on IBD patients with HR-CANs. In this retrospective multicenter study, we consecutively included IBD patients referred to expert Italian endoscopy centers who underwent ESD or hybrid-ESD (hESD) for HR-CANs. Main outcomes were the rate of en-bloc, R0, curative resections, adverse events (AEs), the rate of local recurrence, metachronous lesions, and post-resection surgery. Kaplan-Meier method was used to analyze survival curves. Risk factors associated to main outcomes were investigated by univariable analysis. Ninety-one colonic IBD patients (83.4% ulcerative colitis, disease duration of 15.3 ± 8.7 years) with 96 HR-CANs (53.1% high-grade dysplasia/adenocarcinoma, size 34.8 mm ± 16.2 mm) were included. ESD and hESD were performed in 82.3% and 17.7% of cases. En-bloc, R0, and curative resections were achieved in 95.9% (95% CI 0.958; 0.896-0.988), 85.4% (95% CI 0.854; 0.767-0.917), and 83.3% (95% CI 0.833; 0.743-0.901) of cases. AEs occurred in 12.5% (95% CI 0.125; 0.066-0.208) of cases, which were all conservatively managed. After a mean follow-up of 23.4 ± 16.1 months, local recurrence and metachronous lesions occurred each in 3.1% (95% CI 0.031; 0.006-0.088) of cases. Post-resection surgery was required in 11.5% (95%CI 0.114; 0.058-0.195) of cases. ESD of HR-CANs shows favorable outcomes on the medium and long-term course in IBD patients.

Free-Hand Endoscopic Full-Thickness Resection for Duodenal Subepithelial Lesions.

This work aims to evaluate the efficacy and safety of free-hand endoscopic full-thickness resection (EFTR) for duodenal subepithelial lesions (SELs). We performed a retrospective review of 105 patients with duodenal SELs who underwent free-hand EFTR. Free-hand EFTR means no other devices (over-the-scope clip or full-thickness resection device) are required. The preoperative baseline data, procedure-related characteristics, and postoperative outcomes were analyzed. The technical success rate was 99.0%, and the en bloc resection rate was 94.2%. A total of nine (8.7%) patients experienced major postoperative adverse events (AEs). The incidence of major AEs was significantly higher for lesions with a maximum diameter ≥ 2 cm (30.4%) than for lesions with a maximum diameter < 2 cm (2.6%) (p < 0.001). There were also significant differences in the incidence of major AEs for peri-ampullary lesions (37.5%), bulb lesions (4.8%), bulb-descending junction lesions (6.7%), and descending part lesions (12.5%) (p = 0.032). Multivariable regression analyses revealed that the maximum diameter ≥ 2 cm (OR = 18.108; 95% CI = 1.881-174.281; p = 0.012) and lesions located in peri-ampullary (OR = 18.950; 95% CI = 1.219-294.648; p = 0.036) were independent risk factors for major AEs. The mean duration of the follow-up period was 36.6 ± 21.3 months, and only one patient with gastrointestinal stromal tumors recurred. Free-hand EFTR is a safe and effective technique for nonampullary duodenal SELs with a maximum diameter of < 2 cm. Given the complexity of the duodenal anatomy, this procedure should be performed by experienced endoscopists.

P0617 Feasibility and safety of endoscopic submucosal dissection in inflammatory bowel disease (ESDEUR-IBD): an interim analysis of European retrospective study

Abstract Background Colectomy is the primary treatment for dysplastic lesions in inflammatory bowel disease (IBD). Since the development of advanced endoscopic techniques, the management of dysplasia is evolving. Endoscopic submucosal resection (ESD) could be used in selected cases at referral centres as an alternative to colectomy. However, the feasibility and safety in IBD remains limited. Main aim: To evaluate en-bloc resection rate and the need of colectomy due to ESD failure in IBD. Secondary aims: to assess the complications of ESD, the local recurrence of dysplastic lesions, the presence of synchronous and metachronous lesions and the risk of IBD relapse following the procedure. Methods Multicentre, retrospective study of IBD patients who underwent ESD for suspected colonic dysplastic lesions at least one month before the inclusion date. Patients with total colectomy before ESD, invisible dysplasia at the time of ESD, or pregnancy were excluded. En-bloc resection rate and colectomy due to ESD failure at the short term were evaluated by logistic regression analysis. The risk of IBD relapse was evaluated by Cox regression analysis. Results Forty-eight patients from 16 centres were included: 36 with ulcerative colitis, 9 with Crohn’s disease and 2 with IBD-unclassified. The mean age at ESD was 63 years (SD 13). The majority of the lesions (n=28, 60%) were located in rectum. Forty lesions (87%) were located in areas previously inflamed. En-bloc and R0 were achieved in 45 (94%) and 37 patients (77%), respectively. Colectomy due to ESD failure was required in 4 patients (8.3%) (Figure 1A). No risk factors were associated with colectomy in multivariable analysis, including inflammatory activity, IBD treatments or characteristics of the lesions. Complications occurred in 16 patients (33%): 6 required pharmacologic therapy, 5 needed endoscopic or radiologic intervention, and 2 underwent surgery (Table 1). No deaths were reported. At least one surveillance colonoscopy after ESD was performed in 35 patients (73%). Local recurrence was observed in 2 patients while other dysplastic lesions were detected in 9 (29%) during the follow-up (median 2.5 years, IQR 0.5-4). All of these lesions were removed endoscopically. Synchronous and metachronous lesions were identified in 4 (25%) and 7 patients (26%), respectively. IBD relapse occurred in 8 patients during the follow-up, with an incidence rate of 7% person-year (CI 95%:3-15) (Figure 1B). Conclusion ESD avoids colectomy in 80% of IBD patients with dysplastic lesions. One-third of the patients experienced complications, all of them resolved with no sequelae. Given the risk of new dysplastic lesions, ongoing monitoring with surveillance colonoscopies is recommended.

Does Cerebrospinal Fluid Leak in Pituitary Surgery Affect Patient Reported Quality of Life?

Endoscopic techniques allow for improved visualization and tumor debulking of pituitary adenomas. More thorough tumor resection, however, can be associated with higher rates of CSF leaks. We set out to determine if CSF leaks influenced patient perceived quality of life outcomes. This retrospective study included 152 patients who underwent endoscopic pituitary tumor resection over a 10-year period. QoL was assessed using the SF-36 questionnaire and completed before surgery, 6 weeks and 6 months post-operatively. Statistical analysis was conducted using a equivalence test and a two-way mixed model ANOVA to assess intraoperative CSF leak, postoperative CSF leak, redo surgery, and the use of a lumbar drain. Of the 152 patients, 98 had a potential intraoperative CSF leak. Intra- and postoperative CSF leaks did not significantly impact patient reported QoL outcomes at 6 months following surgery. There was clinical equivalence in mental scores as early as 6 weeks and 6 months for physical scores. There was no statistically significant difference in physical (p-value = 0.975) and mental (p = 0.204) scores for patients who experienced a postoperative CSF leak. There was no statistically significant difference in QoL in the mental and physical scores for patients that received a lumbar drain (physical score p = 0.832; mental score p = 0.915) or redo surgery (physical score p = 0.830; mental score p = 0.204). This article demonstrates that CSF leaks do not impact patient-reported QoL outcomes at 6 months post-surgery. This will allow surgeons to better provide insight and counsel patients regarding the relevance of CSF leaks in the setting of pituitary procedures. III Laryngoscope, 2025.

Long-term outcomes and lymph node metastasis following endoscopic resection with additional surgery or primary surgery for T1 colorectal cancer

Optimal management of T1 colorectal cancer (CRC) remains controversial. This study compared the long-term outcomes of endoscopic resection with additional surgical resection (ER + ASR) versus primary surgical resection (PS) in patients with T1 CRC and identified risk factors for lymph node metastasis (LNM). This retrospective cohort study included 373 patients with T1 CRC who underwent ER + ASR or PS between January 2010 and December 2020 at a tertiary center in Taiwan. Surgical and oncological outcomes, including recurrence rates, LNM, 5-year overall survival (OS), and 5-year recurrence-free survival (RFS) were compared. Univariate and multivariate analyses identified risk factors for LNM. No significant differences were observed between the ER + ASR and PS groups in surgical outcomes, recurrence rates, LNM, 5-year OS (93% vs. 89%, P = 0.18), or 5-year RFS (89% vs. 88%, P = 0.47). Patients with ≥ 2 high-risk factors had significantly lower 5-year OS and RFS compared to those with ≤ 1 risk factor (p < 0.01). Poor histology grade and lymphovascular invasion were independent risk factors for LNM. ER + ASR and PS had comparable long-term outcomes in patients with T1 CRC. A multidisciplinary approach and standardized protocols are required for optimal management of early-stage CRC.