Indications For Endoscopic Treatment Research Articles

Endoscopic treatment of chronic pancreatitis in children: a retrospective study

Background. Chronic pancreatitis (CP) in children is a relatively rare polyetiological disease of the pancreas, accompanied by progressive inflammation of the parenchyma with gradual loss of its function and/or the occurrence of specific complications. Indications for a particular treatment method for a specific patient with a specific etiology and stage of CP are not clearly defined and largely depend on the experience and technical capabilities of a specific clinic. In recent years, individual centers have accumulated experience in using endoscopic methods for the treatment of CP in children, which seems very promising. Aim. To analyze the results of our experience in endoscopic treatment of CP in children. Materials and methods. From 2018 to June 2023, endoscopic treatment methods were used in 31 children with CP. Indications for endoscopic treatment were frequent episodes of exacerbation of pancreatitis in combination with signs of ductal hypertension with or without Wirsungolithiasis. According to etiology, patients were divided into groups: pancreatic duct anomalies, abnormal pancreaticobiliary junction (APBJ), hereditary CP, acquired duct strictures and idiopathic pancreatitis. The results were assessed by the frequency of episodes of exacerbation of pancreatitis. Results. Endoscopic treatment failed in two patients due to: impossibility of cannulation of the main pancreatic duct in a child operated on for annular pancreas and impossibility of recanalization of posttraumatic duct stricture in the isthmus area. Early complications included post-manipulation pancreatitis (n=2; 6.4%), asymptomatic hyperenzymemia (n=5; 16.1%), stent loss (n=2; 6.4%), stent obstruction with pancreatic precipitates (n=2; 6.4%). The average follow-up period was 2.31±1.32 years. In all groups except APBJ, there was a significant decrease in exacerbation episodes with their complete absence in most patients. Ineffectiveness of endoscopic treatment was noted in one case of a combination of the complete type of divided pancreas and a pathogenic mutation of the gene SPINK1. Thus, endoscopic treatment was effective in 28 (90.3%) children in the early period and in 22 (71%) in the late period due to the return of symptoms in the APBJ group. Conclusion. Endoscopic treatment of chronic pancreatitis in children is effective and can be recommended as first-line therapy. Endoscopic treatment of symptomatic APBJ has a temporary clinical effect.

791. ONLY HALF OF THE PATIENTS TREATED ENDOSCOPICALLY FOR EARLY BARRETT RELATED NEOPLASIA IS DETECTED DURING BARRETT SURVEILLANCE

Abstract Background Barrett’s esophagus (BE) with early neoplasia is an indication for endoscopic treatment. Patients with non-dysplastic BE are typically enrolled in an endoscopic surveillance program to enable early detection, and treatment, of BE related neoplasia. In contrast, a subset of patients with early BE neoplasia is concurrently diagnosed with BE and early neoplasia. Our goal was to distinguish cases detected through endoscopic surveillance programs (i.e. initial detection of non-dysplastic BE with progression to neoplasia later in time (metachronous neoplasia)) from cases where BE and neoplasia were diagnosed simultaneously (synchronous neoplasia). Methods We obtained data from the Dutch Barrett Expert Center Registry, a comprehensive nationwide registry encompassing data from all BE patients who underwent endoscopic treatment in Barrett expert Centers in the Netherlands. To enhance data completeness, we supplemented the registry with pathology reports sourced from the national pathology registry (PALGA). Primary endpoint was the proportion of patients diagnosed with BE and neoplasia simultaneously (synchronous neoplasia). Enrollment in an endoscopic surveillance program was defined as the presence of at least one endoscopy with non-dysplastic BE ≥12 months prior to endoscopic treatment initiation. Results A total of 2,091 patients were identified from the registry with a mean age of 66 years (SD±10) and 81% of the cohort being male. Median BE length was C2M5 (IQR 0-6; 3-8) and treatment indication encompassed low-grade dysplasia (LGD; 23%), high-grade dysplasia (HGD; 25%), or cancer (52%). Overall, 1149/2,091 patients (55%) underwent an endoscopy that revealed a new diagnosis of BE with synchronous neoplasia. Conversely, the remaining 942/2,091 patients (45%) were enrolled in endoscopic surveillance programs at the moment neoplasia was diagnosed, with a median duration of endoscopic surveillance prior to neoplasia detection of 8 years (IQR 4-13). The proportion of patients with new BE and synchronous neoplasia increased along with more severe histology at the moment of neoplasia detection. Specifically, the proportion of patients with synchronous neoplasia was 42% (198/475) for a treatment indication of LGD, 50% (260/520) for HGD and 63% (690/1096) for cancer (P <0.01). There was no significant difference observed concerning varying lengths of BE. Conclusions Remarkably, less than half of the patients with early Barrett’s neoplasia and neoplasia, receive a neoplasia diagnosis following enrollment in endoscopic surveillance programs, while the remaining patients present with de novo diagnosis of BE containing synchronous neoplasia. Notably, for patients with more severe histologic changes at the moment of neoplasia detection, the proportion of de novo BE with synchronous neoplasia is even higher. These findings support further critical view regarding the benefits of BE surveillance.

Methods of endoscopic treatment of chronic radiation proctitis

Aim. To compare the clinical effectiveness of argon plasma coagulation (APC) and radiofrequency ablation (RFA) for the treatment of patients with chronic radiation proctitis (CRP) complicated by recurrent rectal bleeding.Methods. A prospective, randomized, single-center study conducted in the State Medical University of the Loginov Moscow State Medical Scientifi Centre. The study included 73 patients with 1—2 degrees of CLP on the RTOG/EORTC scale. The indication for endoscopic treatment was recurrent rectal bleeding. Endoscopic treatment was performed: APC (36 patients) and RF (37 patients), depending on randomization.Results. In 44 patients (60.2 %), of which 18 (50 %) patients in the APC group and 26 (70.2 %) patients in the RF group, a complete regression of the disease was revealed. Telangiectasia was detected in 18 patients (50 %) in the APC group and in 11 patients (29.7 %) in the RF group, which were a continuing source of bleeding. After regression of inflmmatory changes, the patients underwent the second stage of surgery corresponding to the randomization group. After the second stage of surgery in the APC group in 17 patients (94.4 %) and in the RF group in 11 patients (100 %), a complete regression of the disease was revealed. Postoperative pain syndrome occurs in two groups; however, the RF group experiences higher intensity and longer duration of pain.Conclusion: Radiofrequency ablation and argon plasma coagulation are effective and safe treatments for rectal bleeding in chronic radiation proctitis without erosive or ulcerative lesions.

468. THE EFFECT OF ROUTINE ENDOSCOPIC SCREENING FOR SYNCHRONOUS ESOPHAGEAL NEOPLASIA IN PATIENTS WITH HEAD AND NECK SQUAMOUS CELL CARCINOMA

Abstract Esophageal squamous cell carcinoma (ESCC) and head and neck (H&N) cancer coincide in high frequency and early detection of synchronous cancer is inevitable for these patients. The aim of this study is to analyze the effect of routine endoscopic screening for synchronous esophageal cancer in patients with H&N cancer. From April 2020 to March 2022, 35 patients with newly-diagnosed H&N cancer had routine screening endoscopy for synchronous esophageal cancer. All patients with H&N cancer were referred to our department prior to the treatment for H&N cancer. The locations of H&N cancers were oral/oropharyngeal/hypopharyngeal/laryngeal/other H&N cancer; 9/6/9/9/2 respectively. Image-enhanced endoscopy using BLI (blue laser imaging) was performed in all patients. Lugol staining was used in 20 patients and multiple Lugol voiding lesions were detected in 9 patients. Among all patients, abnormal endoscopic findings in esophagus were detected in 15 patients (43%), and biopsy was performed in 11 patients (31%). Biopsy revealed SCC in 5 patients and atypical epithelium in 2 patients. Esophageal lesions were all found in early stage within indication of endoscopic treatment. 3 patients underwent endoscopic treatment after treatment of H&N cancer. Routine endoscopic screening for patients with H&N cancer is effective in early detection of synchronous esophageal cancer with minimally invasive treatment for esophageal neoplasm. The treatment of chemotherapy for H&N cancer may be effective for esophageal lesions, therefore, careful surveillance is required during the treatment of H&N cancer. Routine endoscopy should be continued further for these patients for screening of metachronous cancer.

Downregulated Expression of hsa_circ_0005556 in Gastric Cancer and Its Clinical Significance.

Background Gastric cancer (GC) has a poor prognosis due to the lack of ideal tumor markers. Circular RNAs (circRNAs) are a novel type of noncoding RNA related to the occurrence of GC. Among our research, we investigated the role of hsa_circ_0005556 in GC. Materials and Methods The expression of hsa_circ_0005556 of 100 paired GC tissues and adjacent normal tissues was detected using quantitative reverse transcription-polymerase chain reaction (qRT-PCR). A receiver operating characteristic (ROC) curve was established to evaluate the diagnostic value of hsa_circ_0005556. The correlation between the expression of hsa_circ_0005556 and corresponding clinicopathological characteristic was explored. Results hsa_circ_0005556 was significantly downregulated in GC tissues contrasted with adjacent normal tissues (n = 100, p < 0.001). The areas under the ROC curve (AUC) of hsa_circ_0005556 were up to 0.773, while 64% sensitivity and 82% specificity, respectively. Moreover, its expression levels were significantly associated with differentiation (p = 0.001), TNM stage (p = 0.013), and lymphatic metastasis (p = 0.039). GC patients of high hsa_circ_0005556 levels had a longer overall survival (OS) than those of the low group (p = 0.047). Conclusion hsa_circ_0005556 is a potential biomarker for GC, which may guide judgment of the indication of endoscopic treatment for early gastric cancer (EGC).

Interpretation of the Chinese Consensus on Endoscopic Diagnosis and Management of Gastrointestinal Submucosal Tumors (version 2018)

In August 2018, The Chinese Consensus on Endoscopic Diagnosis and Management of Gastrointestinal Submucosal Tumors, which was formulated by the Surgical Group of Chinese Society of Digestive Endoscopology, the Chinese Physicians Association Endoscopy Branch Digestive Endoscopy Professional Committee, the Gastrointestinal Surgery Group of Chinese Society of Surgery, was published in Chinese Journal of Gastrointestinal Surgery. This consensus is the first guideline in the area of gastrointestinal submucosal tumors (SMTs) in China, and it proposed the diagnosis and management procedure of SMTs from the endoscopists' viewpoint. This consensus presents case selection principles and technical principles of endoscopic treatment of SMTs. For and the indication and contraindication of endoscopic treatment of SMTs, it is suggested that clinician choose optimal procedure according to disease's characteristics and techniques of the clinician. In this review, the key contents of consensus are interpreted in detail. The application of endoscopic snare resection, endoscopic submucosal excavation, endoscopic full-thickness resection and submucosal tunneling endoscopic resection at different SMTs was summarized. At the same time, the controversies in endoscopic diagnosis and management of the SMTs, such as biopsy, indication of endoscopic treatment and new techniques of endoscopic therapy, were analyzed.

Indication of endoscopic treatment

Indication of endoscopic treatment

Research status of indication of endoscopic treatment of early gastric cancer

Early gastric cancer(EGC) that has a better prognosis is superficial in the depth and low in the rate of lymph node metastasis. A standard treatment of gastrectomy and lymph node resection can radically remove EGC, however, it inflicts a greater trauma on patients, and has a greater impact on postoperative quality of life. Compared with surgery, endoscopic resection(ER) approaches a similar outcome and thus becomes a new research hotspot. However, accurate assessment of lymph node metastasis before procedure and indication of ER is crucial to the safety of treatment. This article will give an overview of current research status of indication of endoscopic treatment. Key words: Stomach neoplasms; Lymph nodes; Review; Endoscopic submucosal dissection; Indication

Can the depth of invasion of early esophageal cancer be predicted based on endoscopic evidence?

Esophageal cancer is one of the leading causes of cancer-related death worldwide. Its poor prognosis is related to an often late diagnosis. An earlier diagnosis and treatment however, is related to a better outcome. Early stage esophageal cancer can be diagnosed and treated endoscopically with minimally invasive techniques, which is associated with lower mortality and morbidity than surgery. Whether esophageal carcinoma can be treated endoscopically depends mainly on the risk of lymph node metastasis, which itself correlates to the invasion depth of the tumor. The question is whether endoscopy can accurately determine the invasion depth and thus the treatment modality. Articles used for this review were identified by searches of PubMed and references of relevant articles. Lesion morphology has some predictive value for the depth of invasion for squamous cell carcinoma (SCC) and esophageal adenocarcinoma (EAC). An intramucosal cancer generally has a flat appearance (Paris 0-IIa, 0-IIb,). By contrast, a submucosally invasive cancer often has an excavated (0-IIc, 0-III) and sometimes a polypoid morphology (0-I). In SCC, classification of surface vessels and intrapapillary capillary loops (IPCLs) allows accurate assessment of invasion depth. Generally, mucosal lesions are an indication for endoscopic treatment. However recent studies have shown that tumors with submucosal infiltration and low risk profile for metastasis can also be treated safely by endoscopic resection. Endoscopic assessment allows a rather accurate estimation of invasion depth of early esophageal cancer. To determine the final treatment modality however the final histological staging obtained by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is crucial.

A retrospective study of endoscopic treatment on early gastric cancer in a single center for 10 years

Objective To evaluate the efficacy, safety and risk factors of endoscopic treatment for patients with early gastric cancer. Methods A retrospective study was conducted in a single center and data was collected from 186 early gastric cancers in 168 pathologically confirmed patients who received endoscopic treatment in Peking Union Medical College Hospital from January 2006 to December 2015. The cases were divided into different groups according to indications of endoscopic treatment. The curative resection rate and complication rate were analyzed. Post-resection outcomes were evaluated by long-term surveillance. Results The curative resection rate was 86.9%(73/84)in the group with absolute indications, 61.7%(50/81)in the group with expanded indications, and 33.3%(7/21) in the group beyond indications (P<0.01). Multivariate analysis revealed that the significant independent predictors for curative resection included lower third location of stomach, no ulceration, ≤2 cm at diameter, no adhesion, and well-differentiation in histopathology. In the expanded indications group, discordance of differentiation type and deeper invasion mainly resulted in non-curative resection in en bloc lesions. The rate of bleeding and perforation was 4.8% (9/186) and 3.8% (7/186), respectively. The perforation rate was significantly lower in the lesions located in the lower third of stomach, without adhesion or performed by en bloc resection. During a median follow-up period of 22.3 months, 154 patients were followed successfully. The incidence of synchronous and metachronous gastric cancers in curative resected lesions was 7.5% (8/106) and 0.9% (1/106), respectively. Conclusion Endoscopic resection is an optimal treatment with high curative resection rate for early gastric cancer patients with absolute indications. Patients with expanded indications should take precise preoperative evaluation to avoid higher risk of non-curative resection endoscopically. Close follow-up is necessary for synchronous and metachronous gastric cancers after endoscopic resection. Key words: Stomach neoplasms; Endoscopic mucosal resection; Endoscopic submucosal dissection; Indication; Curative resection

Results of Endoscopic and Surgical Fistula Treatment in Esophagointestinal Anastomosis After Gastrectomy.

Intestinal fistulas occur in 4% to 8% of cases of upper gastrointestinal tract surgery. Until now, this type of surgery has been the standard for treating fistulas in esophagointestinal anastomosis. The use of stents and hemoclips is still controversial, but an increasing number of publications have been presenting good results with this type of treatment. The objective of the study was to investigate the outcome of endoscopic and surgical treatment of fistulas in esophagointestinal anastomosis after gastrectomy. Fistulas in esophagointestinal anastomoses were observed in 23 patients (4.8%) over an 18-year period. The indications for endoscopic treatment were small (<50 mL/d) and large (>50 mL/d) fistulas in patients with no symptoms of peritonitis or abscess, who were treated with implantation of a covered stent.Surgical intervention was carried out for large fistulas that resulted in peritonitis and complicated gangrene of margins and/or abscesses. Four subjects were treated endoscopically with hemoclips, resulting in 50% technical and clinical success. We implanted stents in 12 patients. Technical success was achieved in all patients; yet, permanent closure of the fistula was reported in 8 subjects (66%). Thirty-three percent of patients were operated upon for fistulas. We reported 4 deaths in this group. The use of hemoclips in the treatment of small fistulas and of self-expandable covered stents in the treatment of medium and large fistulas is an effective method that shortens the hospitalization period and accelerates the introduction of oral nutrition while reducing the number of fatal complications.

Results of endoscopic and surgical fistula treatment in oesophagointestinal anastomosis after gastrectomy.

IntroductionIntestinal fistulas occur in 4–8% of cases of upper gastrointestinal tract surgery. Until now, surgery has been the standard of treating fistulas in oesophagointestinal anastomosis. The use of stents and haemoclips still causes much controversy, but more and more publications present good results with this type of treatment.AimTo present results of endoscopic and surgical treatment of fistulas in oesophagointestinal anastomosis after gastrectomy.Material and methodsA fistula in the oesophagointestinal anastomosis was observed in 23 (4.8%) patients within an 18-year period. The indications for endoscopic treatment were small fistulas (< 50 ml/day), and large (> 50 ml/day) fistulas in subjects with no symptoms of peritonitis or abscess were treated with implantation a of covered stent. Surgical treatment was performed with a large fistula leading to peritonitis and complicated gangrene of margins and/or the presence of abscess.ResultsFour subjects were treated endoscopically with the use of haemoclips, resulting in 50% technical and clinical success. We implanted stents in 12 patients. Technical success was achieved in all the patients, yet permanent closure of the fistula was reported for 8 (66%) subjects. The percentage of patients operated on for fistula was 33%. We recorded 4 deaths in this group.ConclusionsThe use of haemoclips in treatment of small fistulas, and self-expandable, covered stents in treatment of medium and large fistulas, is an effective method that shortens the hospitalisation period and accelerates introduction of oral nutrition while reducing the number of fatal complications.

The effectiveness of radiofrequency ablation on eradicating widespread early 0-IIb esophageal squamous cell carcinoma and precancerous lesions

Objective To evaluate the effectiveness of radiofrequency ablation (RFA) on eradicating widespread early 0-Ⅱb esophageal squamous cell carcinoma (ESCC) and precancerous lesions. Methods Retrospective analysis was performed on 33 patients with early 0-Ⅱb ESCC, high and middle-grade dysplasis (HGD, MGD) between October 2008 and June 2011 at Cancer Institute and Hospital, Chinese Academy of Medical Sciences for the proportion of patients with histological complete response (CR) and adverse events after 12 months. Results In 33 patients, of whom 26 were male, 7 were female, mean age being 61years old with MGD (10), HGD (17), EESCC (6). USL length was 3-12(mean 7.9)cm.Treatment area(TA)length was 5-14(mean 9.9)cm, and the esophagus was involved 11/12 circumference. Primary RFA treatment time was 11-57(mean 30)min and average hospitalization day was 3 days. CR was 69.7%(23/33) after one RFA session in 3 months, and was 93.9% (31/33) after 12 months. There were 4(12%)severe strictures, who received dilation 3-12 (mean 7) times, and symptoms were relieved. There was no other complication. Conclusion RFA is effective, safe and less technique-demanding in treating patients with widespread 0-Ⅱb esophageal squamous cell neoplasia and precancerous lesions, extending the indications of endoscopic treatment. Key words: Radiofrequency ablation; Esophageal neoplasms; Early esophageal squamous cell carcinoma; Precancerous lesions

Major predictors and management of small-bowel angioectasia.

BackgroundSmall-bowel angioectasias are frequently diagnosed with capsule endoscopy (CE) or balloon endoscopy however, major predictors have not been defined and the indications for endoscopic treatment have not been standardized. The aim of this study was to evaluate the predictors and management of small-bowel angioectasia.MethodsAmong patients with obscure gastrointestinal bleeding (OGIB) who underwent both CE and double-balloon endoscopy at our institution, we enrolled 64 patients with small-bowel angioectasia (angioectasia group) and 97 patients without small-bowel angioectasia (non-angioectasia group). The angioectasia group was subdivided into patients with type 1a angioectasia (35 cases) and type 1b angioectasia (29 cases) according to the Yano-Yamamoto classification. Patient characteristics, treatment, and outcomes were evaluated.ResultsAge (P = 0.001), cardiovascular disease (P = 0.002), and liver cirrhosis (P = 0.003) were identified as significant predictors of small-bowel angioectasia. Multivariate logistic regression analysis identified cardiovascular disease (odds ratio 2.86; 95 % confidence interval, 1.35–6.18) and liver cirrhosis (odds ratio 4.81; 95 % confidence interval, 1.79–14.5) as independent predictors of small-bowel angioectasia. Eleven type 1a cases without oozing were treated conservatively, and 24 type 1a cases with oozing were treated with polidocanol injection (PDI). Re-bleeding occurred in two type 1a cases (6 %). Seventeen type 1b cases were treated with PDI and 12 type 1b cases were treated with PDI combined with argon plasma coagulation (APC) or clipping. Re-bleeding occurred in five type 1b cases (17 %) that resolved after additional endoscopic hemostasis in all cases. There was one adverse event from endoscopic treatment (1.6 %).ConclusionsCardiovascular disease and liver cirrhosis were significant independent major predictors of small-bowel angioectasia. Type 1a angioectasias with oozing are indicated for PDI and type 1b angioectasias are indicated for PDI with APC or clipping.

WITHDRAWN: Indication for endoscopic treatment based on the risk of lymph node metastasis in patients with ulcerative-type early gastric cancer

WITHDRAWN: Indication for endoscopic treatment based on the risk of lymph node metastasis in patients with ulcerative-type early gastric cancer

Redefining early gastric cancer.

The problem is that current definitions of early gastric cancer allow the inclusion of regional lymph node metastases. The increasing use of endoscopic submucosal dissection to treat early gastric cancer is a concern because regional lymph nodes are not addressed. The aim of the study was thus to critically evaluate current evidence with regard to tumour-specific factors associated with lymph node metastases in "early gastric cancer" to develop a more precise definition and improve clinical management. A systematic and comprehensive search of major reference databases (MEDLINE, EMBASE, PubMed and the Cochrane Library) was undertaken using a combination of text words "early gastric cancer", "lymph node metastasis", "factors", "endoscopy", "surgery", "lymphadenectomy" "mucosa", "submucosa", "lymphovascular invasion", "differentiated", "undifferentiated" and "ulcer". All available publications that described tumour-related factors associated with lymph node metastases in early gastric cancer were included. The initial search yielded 1494 studies, of which 42 studies were included in the final analysis. Over time, the definition of early gastric cancer has broadened and the indications for endoscopic treatment have widened. The mean frequency of lymph node metastases increased on the basis of depth of infiltration (mucosa 6% vs. submucosa 28%), presence of lymphovascular invasion (absence 9% vs. presence 53%), tumour differentiation (differentiated 13% vs. undifferentiated 34%) and macroscopic type (elevated 13% vs. flat 26%) and tumour diameter (≤2 cm 8% vs. >2 cm 25%). There is a need to re-examine the diagnosis and staging of early gastric cancer to ensure that patients with one or more identifiable risk factor for lymph node metastases are not denied appropriate chemotherapy and surgical resection.

Tu1471 Pathological Characteristics of "Skirt" Spreading on the Margin of Rectal Laterally Spreading Tumors

of SMI are absent, the finding of SMF or IPB in a lesion O30mm should prompt re-evaluation. Tu1470 Clinicopathological Features of Laterally Spreading Tumor of the Colorectum : References Among Subtypes and Submucosal Invasion Tomoyuki Ishigaki*, Shin-Ei Kudo, Takemasa Hayashi, Yusuke Yagawa, Katsuro Ichimasa, Naoya Toyoshima, Hiromasa Oikawa, Yuichi Mori, Masashi Misawa, Toyoki Kudo, Tomokazu Hisayuki, Kunihiko Wakamura, Hideyuki Miyachi, Eiji Hidaka, Fumio Ishida Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama-SHI, Japan Background / aims: Laterally spreading tumors (LSTs) are usually good indication for endoscopic treatment because they are rather benign in spite of their large diameter. There are four subtypes in LSTs; granular type (homogeneous type (H) / nodular mixed type (M)), and non-granular type (flat-elevated type (F) / pseudodepressed type (PD)). Their pathological features are different among subtypes. The aim of this study is to evaluate the clinicopathologial features of LSTs focusing on their subtypes and submucosal(SM) invasion. Methods: In a retrospective review of the colonoscopy database (Apr 2001 to Mar 2013) at our institution, we selected cases of colorectal neoplasms based on the following criteria; endoscopically diagnosed cases of LSTs that underwent subsequent endoscopic or surgical resection. We evaluated clinicopathological features (gender, age, size, rate of SM invasion) according to LSTs subtypes. Furthermore, we examined the LSTs with SM invasion which treated from Apr 2010 to Mar 2013 focusing on their locus of SM invasion. For analysis, we used chi-square test and one way ANOVA post hoc test for statistical analysis. Results: A total of 2035 LSTs were eligible for inclusion. The main results are shown in the table.0As the three types of LST(G(M)/NG(F)/NG(PD)) became larger, the ratio of submucosal invasion became higher. But LST-G(H) showed low rate of that even when they were large in diameter. 0LST-NG(PD) had higher ratio of submucosal invasion (44.8%; 90/201) than the other types (P!0.01).BLSTs with SM invasion which treated from Apr 2010 to Mar 2013 were 85 lesions.0The locus of SM invasion at LST-G(M) was almost(77.8%; 21/27) under nodule.0In LST-NG(PD), SM invasion was tend to occur multifocally(41.7%; 10/24) compared with the other type(11.5%; 7/61) (P! 0.01). Conclusions: Clinicopathological features of LSTs are different among subtypes, therefore we have to select the treatment method carefully according to LST subtypes.

Endoscopic resection therapies for rectal neuroendocrine tumors: A systematic review and meta‐analysis

Among various endoscopic resection therapies, including conventional endoscopic mucosal resection (EMR) only with a snare after submucosal injection, modified EMR (m-EMR) with other assistant devices such as a ligation band or a suction cap, and endoscopic submucosal dissection (ESD), we aimed to study which is the best choice for rectal neuroendocrine tumors. A broad literature research was performed, and a systematic review and meta-analysis were conducted. Ten retrospective studies with 650 patients were included. Complete resection rates were significantly higher in the ESD group compared with the EMR group (relative risk [RR] 0.89, 95% confidence interval [CI] [0.79, 0.99]), in the m-EMR group compared with the conventional EMR group (RR 0.72, 95% CI [0.60, 0.86]), and was comparable between the ESD group and the m-EMR group (RR 1.03, 95% CI [0.95, 1.11]). Procedure time was significantly longer in the ESD group than in the EMR group (standard mean differences -1.37, 95% CI [-1.99, -0.75]), but there was no significant difference between that of the m-EMR group and ESD group (standard mean differences -1.50, 95% CI [-3.14, 0.14]). Local recurrence occurred in five cases in the EMR group (5/328) and did not occur in the ESD group (0/209). ESD or m-EMR techniques could be applied to rectal neuroendocrine tumors with indications for endoscopic treatment. m-EMR procedures appear to be comparable with ESD in the treatment of rectal neuroendocrine tumors. However, the findings have to be carefully interpreted due to the lower level of evidence.

Endoscopic Management of Upper Urinary Tract Urothelial Carcinoma

Upper urinary tract urothelial carcinoma (UTUC) is relatively uncommon. Radical nephroureterectomy with an ipsilateral bladder cuff excision has been the gold standard treatment for UTUC. However, recent advances in technology have made possible the increased use of endoscopic management for the treatment of UTUC. The definitive goal of endoscopic management of UTUC is cancer control while maintaining renal function and the integrity of the urinary tract. Endoscopic management includes both the retrograde ureteroscopic and antegrade percutaneous approaches. The endoscopic management of UTUC is a reasonable alternative for patients with renal insufficiency or a solitary functional kidney, bilateral disease, or a significant comorbidity that precludes radical surgery. Select patients with a functional contralateral kidney who have low-grade, low-stage tumors may also be candidates for endoscopic management. The careful selection of patients is the most important point for the successful endoscopic management of UTUC. It is crucial that patients are compliant and motivated, because a lifetime protocol of strict surveillance is necessary. Adjuvant topical therapy with Bacillus Calmette-Guerin or mitomycin C can be used after endoscopic management of UTUC in an attempt to reduce recurrence. In this article, we review current endoscopic techniques, indications for endoscopic treatment, clinical outcomes of endoscopic management, adjuvant topical therapy, and surveillance in patients with UTUC.

Endoscopic mucosal resection with a ligation device or endoscopic submucosal dissection for rectal carcinoid tumors: An analysis of 24 consecutive cases

Endoscopic submucosal dissection (ESD) has several advantages over conventional endoscopic mucosal resection, including a higher en bloc resection rate and more accurate pathological estimation. However, ESD is a complex procedure that requires advanced endoscopic skills. The aim of our study is to evaluate the efficacy of endoscopic mucosal resection with a ligation device (EMR-L) compared to ESD for rectal carcinoid tumors. Between September 2003 and April 2011, 24 rectal carcinoid tumors in 24 patients treated by ESD or EMR-L were retrospectively analyzed. The indications for endoscopic treatment were node-negative rectal carcinoid tumors. We compared the therapeutic outcomes of the ESD group (n = 13) and the EMR-L group (n = 11). Both groups had similar mean tumor sizes (ESD: 5.5 ± 2.1 mm; EMR-L: 4.4 ± 2.2 mm). The rates of en bloc and complete resection were, respectively, 100% and 92.3% for ESD, and 100% and 100% for EMR-L. Perforations did not occur in either group. Postoperative bleeding occurred in one EMR-L case, and it was endoscopically managed. However, there were no differences in therapeutic outcomes between the two groups. The mean procedure time was longer in the ESD group (28.8 ± 16.2 min) than in the EMR-L group (17.4 ± 4.4 min), without a significant difference. The mean hospitalization period was significantly shorter in the EMR-L group (1.8 ± 3.1 day) than in the ESD group (6.2 ± 2.1 day), and eight EMR-L cases were treated in an outpatient setting. EMR-L is a simple and effective procedure that compares favorably to ESD for small rectal carcinoid tumors.