Mucosal Endoscopic Dissection Research Articles

Injectable temperature-sensitive hydrogel facilitating endoscopic submucosal dissection.

Purpose: Early gastrointestinal tumors can be removed by endoscopic procedures. Endoscopic mucosal dissection (ESD) requires submucosal fluid injection to provide mucosal elevation and prevent intraoperative perforation. However, the clinically applied normal saline mucosal elevation height is low for a short time, which often requires multiple intraoperative injections that increase the inconvenience and procedure time. In addition, recently researched submucosal injection materials (SIM) suffer from complex preparation, poor economy, and poor biocompatibility. Therefore, there is an urgent need for a new type of SIM that can provide long, safe and effective mucosal elevation in support of the endoscopic procedures. Methods: The FS hydrogel is based on polyethylene-polypropylene glycol (F-127) mixed with sodium alginate (SA). The different physicochemical properties of FS hydrogels were characterized through various experiments. Afterward, various biosafety assessments were carried out. Finally, the performance of FS hydrogels was evaluated by in vitro submucosal injection and in vivo swine ESD. Results: The experimental results show that the FS hydrogel is liquid at room temperature, making it easy to inject, and when injected under the mucosa, it undergoes temperature-induced cross-linking, transforming from a liquid to a solid state to provide long-lasting mucosal augmentation. At the same time, the FS hydrogel exhibits controllable gelation, stability, and biocompatibility. The results of in vitro submucosal injections and in vivo ESD procedures showed that FS achieves high mucosal augmentation and provides good submucosal cushioning in the long term. Conclusion: In summary, the F-127/SA hydrogel is simple to synthesize, cost-effective, safe, easy to store, and able to assist ESD well from the perspective of practical clinical problems, indicating that the FS hydrogel can be an ideal potent submucosal injection substitution.

A first-in-human clinical study of laparoscopic autologous myoblast sheet transplantation to prevent delayed perforation after duodenal endoscopic mucosal dissection

BackgroundThe detection rate of superficial non-ampullary duodenal epithelial tumors (SNADETs) has recently been increasing. Large tumors may contain malignant lesions and early therapeutic intervention is recommended. Endoscopic mucosal dissection (ESD) is considered a feasible treatment modality, however, the anatomical and physiological characteristics of the duodenum create a risk of postoperative perforation after ESD.MethodsTo explore whether myoblast sheet transplantation could prevent delayed perforation after ESD, a first-in-human (FIH) clinical trial of laparoscopic autologous myoblast sheet transplantation after duodenal ESD was launched. Autologous myoblast sheets fabricated from muscle tissue obtained seven weeks before ESD were transplanted laparoscopically onto the serous side of the ESD. The primary endpoints were the onset of peritonitis due to delayed perforation within three days after surgery and all adverse events during the follow-up period.ResultsThree patients with SNADETs ≥ 20 mm in size underwent transplantation of a myoblast sheet onto the serous side of the duodenum after ESD. In case 1, The patient’s postoperative course was uneventful. Endoscopy and abdominal computed tomography revealed no signs of delayed perforation. Despite incomplete mucosal closure in case 2, and multiple micro perforations during ESD in case 3, cell sheet transplantation could prevent the postoperative massive perforation after ESD, and endoscopy on day 49 after transplantation revealed no stenosis.ConclusionsThis clinical trial showed the safety, efficacy, and procedural operability of this novel regenerative medicine approach involving transplanting an autologous myoblast sheet laparoscopically onto the serosa after ESD in cases with a high risk of delayed perforation. This result indicates the potential application of cell sheet medicine in treating various abdominal organs and conditions with minimal invasiveness in the future.Trial registrationjRCT, jRCT2073210094. Registered November 8 2021,https://jrct.niph.go.jp/latest-detail/jRCT2073210094.

Using a novel hemostatic peptide solution to prevent bleeding after endoscopic submucosal dissection of a gastric tumor.

Endoscopic mucosal dissection has become the standard treatment for early gastric cancer. However, post-endoscopic submucosal dissection (ESD) ulcer occurs in 4.4% of patients. This study hypothesized whether applying PuraStat, a novel hemostatic peptide solution, prevents post-ESD bleeding. To investigate the preventive potential of PuraStat, a hemostatic formulation, against bleeding in post-ESD gastric ulcers. Between May 2022 and March 2023, 101 patients (Group P) underwent ESD for gastric diseases at our hospital and received PuraStat (2 mL) for post-ESD ulcers. We retrospectively compared this group with a control group (Group C) comprising 297 patients who underwent ESD for gastric diseases at our hospital between April 2017 and March 2021. P values < 0.05 on two-sided tests indicated significance. Post-ESD bleeding occurred in 6 (5.9%) (95%CI: 2.8-12.4) and 20 (6.7%) (95%CI: 4.4-10.2) patients in Groups P and C, respectively, with no significant between-group difference. The relative risk was 1.01 (95%CI: 0.95-1.07). The lesser curvature or anterior wall was the bleeding site in all 6 patients who experienced postoperative bleeding in Group P. In multivariate analysis, the odds ratios for resection diameter ≥ 50 mm and oral anticoagulant use were 6.63 (95%CI: 2.52-14.47; P = 0.0001) and 4.04 (1.26-0.69; P = 0.0164), respectively. The adjusted odds ratio of post-ESD bleeding and PuraStat was 1.28 (95%CI: 0.28-2.15). PuraStat application is not associated with post-ESD bleeding. However, the study suggests that gravitational forces may affect the effectiveness of applied PuraStat.

The role of advanced endoscopy in appendiceal polyp management and outcomes

BackgroundAppendiceal orifice lesions are often managed operatively with limited or oncologic resections. The aim is to report the management of appendiceal orifice mucosal neoplasms using advanced endoscopic interventions.MethodsPatients with appendiceal orifice mucosal neoplasms who underwent advanced endoscopic resections between 2011 and 2021 with either endoscopic mucosal resection (EMR), endoscopic mucosal dissection (ESD), hybrid ESD, or combined endoscopic laparoscopic surgery (CELS) were included from a prospectively collected dataset. Patient and lesion details and procedure outcomes are reported.ResultsOut of 1005 lesions resected with advanced endoscopic techniques, 41 patients (4%) underwent appendiceal orifice mucosal neoplasm resection, including 39% by hybrid ESD, 34% by ESD, 15% by EMR, and 12% by CELS. The median age was 65, and 54% were male. The median lesion size was 20 mm. The dissection was completed piecemeal in 49% of patients. Post-procedure, one patient had a complication within 30 days and was admitted with post-polypectomy abdominal pain treated with observation for 2 days with no intervention. Pathology revealed 49% sessile-serrated lesions, 24% tubular adenomas, and 15% tubulovillous adenomas. Patients were followed up for a median of 8 (0–48) months. One patient with a sessile-serrated lesion experienced a recurrence after EMR which was re-resected with EMR.ConclusionAdvanced endoscopic interventions for appendiceal orifice mucosal neoplasms can be performed with a low rate of complications and early recurrence. While conventionally lesions at the appendiceal orifice are often treated with surgical resection, advanced endoscopic interventions are an alternative approach with promising results which allow for cecal preservation.

Comparative analysis of early versus late feeding after an EGD-based intervention: meta-analysis

Background & AimsThe right time to re-start feeding after esophagogastroduodenoscopic (EGD interventions is not well established. However, impaired nutrition from prolonged fasting may lead to unfavorable clinical outcomes. Herein, we performed a systematic review and meta-analysis to study the impact of early feeding (within 24 hours) vs. late feeding (more than 24 hours) in patients undergoing acute therapeutic EGD interventions. MethodsMultiple databases, including Medline, Scopus, and Embase, were searched (in May 2022) using specific terms for studies evaluating the outcomes of early vs. late feeding after EGD interventions. Outcomes of interest were early rebleed (< 7 days), late rebleed (> 7 days), mortality rates, length of hospital stay, and rate of blood transfusion. Standard meta-analysis methods were employed using the random-effects model. I2% heterogeneity was used to assess the heterogeneity. The GRADE working group approach was used to assess the certainty of evidence. ResultsEight studies (813 patients) were included in the final analysis. The ‘Early feeding’ cohort included 411 patients, 31% females, with a mean age of 58 years, and the ‘late feeding’ cohort included 402 patients, 26.4% females, with a mean age of 57 years. Four studies (283 patients) evaluated patients with band ligation/sclerotherapy in acute variceal bleeding (224 patients), two studies (309 patients) with endoscopic treatment of peptic ulcer bleeding, and two studies in endoscopic mucosal dissection for gastric mucosal epithelial neoplasia. The pooled risk ratio (RR) of early rebleed in ‘early feeding’ vs. ‘late feeding’ was 1.6 (95% confidence interval (CI) [0.7-3.7; I2=0%, p=0.2]. Similarly, the RR of late rebleed was 0.9 [0.4-2.3; I2=0%, p= 0.9]. The pooled RR of total rebleed was 1.2 [0.7-2.2; I2=0%, p=0.3]. The pooled RR of mortality between the ‘early feeding’ and ‘late feeding’ groups was 0.6 [0.3-1.2; I2=0%, p=0.16]. The Pooled rate of standard difference of mean length of hospital stay was -1.184 (-1.5 - -0.81, I2 = 92%, p=0.00) between early and late feeding groups. The Pooled rate of mean difference in blood transfusion between early and late feeding groups was 0.1 [-0.4 - 0.41; I2= 77.6%, p=0.96]. ConclusionOur meta-analysis demonstrates early enteral feeding within 24 hours does not appear to have a higher risk of rebleeding and mortality than delayed enteral feeding in patients undergoing EGD therapeutic interventions. However, early feeding is associated with a shorter length of hospital stay compared to late feeding.

A novel miniature flexible robotic system for endoscopic mucosal dissection: an animal experimental study.

Endoscopic submucosal dissection (ESD) is a standard treatment for early gastrointestinal cancer due to its higher rate of en-bloc resection and lower recurrence rate. However, the technical challenges lead to long learning curve and high risks of adverse events. A gastrointestinal flexible robotic-tool system (GIFTS) was proposed to reduce the difficulty and shorten the learning curve of novices. This is an animal study to evaluate the feasibility of GIFTS in ESD. The GIFTS provides a total of 13 degrees of freedom within 10 mm in diameter and variable stiffness function to achieve endoscopic intervention and submucosal dissection with the cooperation of two flexible robotic instruments. One esophageal and four colorectal ESDs in five porcine models were performed. In all five ESD procedures, the GIFTS was successfully intubated and submucosal dissection was completed without perforation or significant bleeding, and there was no system fault. The mean operative time was 99min, and the mean size of the specimen was 151 mm2. The fifth experiment showed significantly better results than the first one. In vivo animal experiments confirmed the feasibility of GIFTS in performing ESD. The control of GIFTS is friendly to inexperienced beginners, which will help reduce the technical challenges of ESD and shorten the learning curve of endoscopists.

New hope for esophageal stricture prevention: A prospective single-center trial on acellular dermal matrix.

Given the high incidence of esophageal cancer in China, an increasing number of patients there are undergoing endoscopic mucosal dissection (ESD). Although the 5-year survival rate after ESD can exceed 95%, esophageal stricture, the most common and serious postoperative complication, affects the long-term prognosis of patients and the quality of life. Autologous mucosal grafts have proven to be successful in preventing stricture after ESD for early esophageal cancer. To examine the viability of acellular dermal matrix (ADM) as an alternative to autologous mucosa for the prevention of stricture after ESD. This is a prospective, single-center, controlled study. Consecutive patients who underwent ESD surgery and were willing to undergo autologous mucosal transplantation were recruited between January 1 and December 31, 2017. Consecutive patients who underwent ESD surgery and were willing to undergo ADM transplantation were recruited between January 1 to December 31, 2019. A final three-year follow-up of patients who received transplants was conducted. Based on the current incidence of esophageal stricture, the sample size required for both the autologous mucosal graft group and the ADM group was calculated to be 160 cases. Due to various factors, a total of 20 patients with autologous mucosal grafts and 25 with ADM grafts were recruited. Based on the inclusion exclusion and withdrawal criteria, 9 patients ultimately received autologous mucosal grafts and completed the follow-up, while 11 patients received ADM grafts and completed the follow-up. Finally, there were 2 cases of stenosis in the autologous mucosal transplantation group with a stenosis rate of 22.22% and 2 cases of stenosis in the ADM transplantation group with a stenosis rate of 18.18%, with no significant difference noted between the groups (P = 0.94). In this prospective, single-center, controlled trial, we compared the effectiveness of autologous mucosa transplantation and ADM for the prevention of esophageal stricture. Due to certain condition limitations, we were unable to recruit sufficient subjects meeting our target requirements. However, we implemented strict inclusion, exclusion, and withdrawal criteria and successfully completed three years of follow-up, resulting in valuable clinical insights. Based on our findings, we hypothesize that ADM may be similarly effective to autologous mucosal transplantation in the prevention of esophageal stricture, offering a comparable and alternative approach. This study provides a new therapeutic idea and direction for the prevention of esophageal stricture.

The efficacy and safety of endoscopic mucosal dissection for early gastrointestinal cancer and precancerous lesions.

The efficacy and safety of endoscopic mucosal dissection for early gastrointestinal cancer and precancerous lesions.

Therapeutic Challenges for Gastric Neuroendocrine Neoplasms: Take It or Leave It?

Background and Objectives: Gastric neuroendocrine neoplasms (gNENs) represent rare but increasingly recognized tumors. They are distinguished into three main clinical types (type-1, type-2, and type-3) according to gastrin level and at histological evaluation in well-differentiated G1, G2, or G3 lesions, as well as poorly-differentiated lesions. Small type-1 and type-2 neoplasms with low proliferation indices demonstrated excellent survival without progression during an extended follow-up period, and for these reasons, active endoscopic observation or endoscopic resection are feasible options. On the other hand, surgery is the treatment of choice for more aggressive type-3, G3, or infiltrating neoplasms. The present study aims to comprehensively review and compare the available therapeutic strategies for gNENs. Materials and Methods: A computerized literature search was performed using relevant keywords to identify all of the pertinent articles with particular attention to gNEN endoscopic treatment. Results: In recent years, different endoscopic resective techniques (such as endoscopic mucosal dissection, modified endoscopic mucosal resection, and endoscopic full-thickness resection) have been developed, showing a high rate of complete resection for advanced and more aggressive lesions. Conclusions: Overall, gNENs represent a heterogeneous group of lesions with varying behavior which require personalized management. The non-operative approach for small type-1 gNENs seems to be feasible and should be promoted. A step-up approach with minimally invasive endoscopic therapies might be proposed, particularly for type-1 gNEN. On the other hand, it is important to recognize the negative prognostic factors in order to identify those rare cases requiring more aggressive approaches. A possible therapeutic algorithm for localized gNEN management is provided.

Factors associated with heterochronic gastric cancer development post-endoscopic mucosal dissection in early gastric cancer patients.

Endoscopic mucosal resection is an innovative method for treating early gastric cancer and has been widely used in clinical practice. To analyze the factors associated with the development of heterochronic gastric cancer in patients with early gastric cancer who had undergone endoscopic mucosal dissection (EMD). A cohort of patients with early gastric cancer treated using EMD was retrospectively analyzed, and patients who developed heterochronic gastric cancer after the surgery were compared with those who did not. The effects of patient age, sex, tumor size, pathological type, and surgical technique on the development of heterochronic gastric cancer were assessed using statistical analysis. Of the 300 patients with early gastric cancer, 150 patients developed heterochronic gastric cancer after EMD. Statistical analysis revealed that patient age (P value = XX), sex (P value = XX), tumor size (P value = XX), pathological type (P value = XX), and surgical technique (P value = XX) were significantly associated with the occurrence of heterochronic gastric cancer. Age, sex, tumor size, pathological type, and surgical technique are key factors influencing the occurrence of heterochronic gastric cancer after EMD in patients with early gastric cancer. To address these factors, postoperative follow-up and management should be strengthened to improve the prognosis and survival rate of patients.

Analysis of Programmed Nursing Cooperation During Gastrointestinal Endoscopic Mucosal Dissection

Objective: To analyze the application value of programmed nursing combined with digestive endoscopic mucosal dissection. Methods: A total of 200 patients undergoing endoscopic mucosal dissection from February 2021 to February 2023 were included as samples. Randomized grouping was conducted, with Group A receiving programmed nursing cooperation and Group B receiving routine nursing. Nursing values were then compared. Result: Group A exhibited shorter operation and hospitalization times compared to Group B, with less intraoperative blood loss (P &lt; 0.05). The SF-36 score for Group A was higher than that for Group B, and the postoperative complication rate in Group A was lower than in Group B (P &lt; 0.05). Conclusion: The implementation of a programmed nursing coordination plan in gastrointestinal endoscopic submucosal dissection nursing proved effective in reducing endoscopic surgery bleeding volume, shortening the patient’s disease course, and enhancing the patient’s quality of life. This approach is efficient and feasible.

Primary Esophageal Mucosa-associated Lymphoid Tissue Lymphoma: A Rare Case Report and Review of Other Published Data

The gastrointestinal tract is the most common extranodal site for lymphomas, and mucosa-associated lymphoid tissue lymphoma is the second most common histological lymphoma subtype. However, primary esophageal mucosa-associated lymphoid tissue lymphomas are extremely rare. Few such cases are documented, and the reports demonstrate inconsistent diagnostic and therapeutic strategies. Herein, a 54-year-old man was referred to our hospital for treatment of dysphagia. Esophagogastroduodenoscopy revealed a large, horseshoe-shaped subepithelial mass in the upper esophagus. Endoscopic ultrasonography and computed tomography revealed that the mass was well-demarcated and confined to the muscularis mucosa, with no abnormalities in other organs or lymph nodes. The mass was presumptively diagnosed as benign, and the patient underwent endoscopic mucosal dissection for pathological confirmation and symptom relief. Pathological examination of the dissection specimen revealed that it was a primary esophageal mucosa-associated lymphoid tissue lymphoma. As the patient had an elevated immunoglobulin G level and &lt;i&gt;Helicobacter pylori&lt;/i&gt; infection, we administered adjuvant eradication therapy. The patient remains under surveillance and is free of lymphoma recurrence 36 months postoperatively. This case report demonstrates that endoscopic resection and &lt;i&gt;H. pylori&lt;/i&gt; eradication are effective treatment strategies for early-stage esophageal mucosa-associated lymphoid tissue lymphoma.

The risk of osteoporotic fracture in gastric cancer survivors: total gastrectomy versus subtotal gastrectomy versus endoscopic treatment.

Previous studies have suggested that there is an increased risk of osteoporotic fracture in gastric cancer survivors. However, the data was not classified according to surgery type. This study investigated the cumulative incidence osteoporotic fracture (OF) in gastric cancer survivors according to treatment modality. A total of 85,124 gastric cancer survivors during 2008-2016 were included. The type of surgery was classified as total gastrectomy (TG, n = 14,428)/subtotal gastrectomy (SG, n = 52,572)/endoscopic mucosal dissection and endoscopic mucosal resection (ESD/EMR, n = 18,125). The site of osteoporotic fractures included the spine, hip, wrist, and humerus. We examined cumulative incidence using Kaplan-Meier survivor analysis and cox proportional hazards regression analysis to determine the risk factor of OF. The incidence of OF per 100,000 patient year was 2.6, 2.1, 1.8 in TG, SG, ESD/EMR group. The cumulative incidence rate was 2.3% at 3years, 4.0% at 5years, and 5.8% at 7years in gastrectomy group, and 1.8% at 3years, 3.3% at 5years in the SG group, and 4.9% at 7years postoperatively in ESD/EMR group. TG increased the risk of OF compared to patients who underwent SG (HR 1.75, 95% confidence interval [CI] 1.57-1.94), and ESD/EMR (hazard ratio [HR] 2.23, 95% CI 2.14-2.32). Gastric cancer survivors who underwent TG had an increased osteoporotic fracture risk than did SG or ESD/EMR in these patients. The amount of gastric resection and accompanying metabolic changes seemed to mediate such risk. Additional research is needed to establish an optimal strategy for each type of surgery.

Cell Sheet Transplantation to Prevent Delayed Perforation after Endoscopic Mucosal Dissection in Animal Model

Kanetaka, Kengo MD, FACS; Maruya, Yasuhiro MD, PhD; Higashi, Miki MD; Kobayashi, Shinichiro MD, PhD; Eguchi, Susumu MD, PhD, FACS Author Information

Preservation of remnant esophagus during total pharyngolaryngectomy in a patient with previous subtotal esophagectomy: a case report

BackgroundWith the improved survival rate of patients with esophageal cancer, secondary cancers, including pharyngolaryngeal cancer, have become a problem. Phanryngolaryngeal cancer surgery often requires esophagogastric anastomosis resection in patients with a previous history of subtotal esophagectomy. Owing to adhesions, especially surrounding the esophagogastric anastomosis, caused by the initial surgery, the second surgery might cause postoperative complications.Case presentationA 65-year-old man was diagnosed with early stage esophageal squamous cell carcinoma and underwent endoscopic mucosal dissection. However, the histopathological depth of the tumor was pT1b, and additional treatment was required. After administration of the neoadjuvant chemotherapy, he underwent thoracoscopic esophagectomy and retrosternum reconstruction via a gastric tube (pT1N3M0 stage III). Eight months after the first surgery, tumor recurrences were observed at the anastomosis and left cervical lymph node. Definitive chemoradiotherapy was performed for the recurrences, and complete response was achieved. Seven months after chemoradiotherapy, he was diagnosed with hypopharyngeal squamous cell carcinoma in the right piriform fossa (cT2N2bM0 stage IVA), and salvage surgery was chosen as treatment. The surgical findings revealed strong adhesion around the remnant esophagus, which was difficult to dissect from surrounding tissue and was associated with a risk of breaking of the anastomosis. However, indocyanine green fluorescence imaging findings indicated sufficient blood flow to preserve the remnant esophagus, including the anastomosis, even after the interruption of blood flow from the proximal side of the esophagus by total pharyngolaryngectomy. Finally, approximately 4 cm of the remnant esophagus was preserved, and the free jejunum reconstruction with cervical vascular anastomosis was performed. Moreover, the patient was discharged without complications on postoperative day 38. After 10 months of the second surgery, a metastatic lymph node was observed in the right neck. Immune checkpoint inhibitors and chemotherapy were administered, and the patient is alive and under treatment 1.5 years after the second surgery.ConclusionsBlood supply to the remnant cervical esophagus was thought to be from the gastric conduit over the anastomosis and surrounding capillaries. Thus, the preservation of the remnant esophagus can be considered in total pharyngolaryngectomy even after < 2 years of esophagectomy by blood flow evaluation using indocyanine green fluorescence.

A137 TRANSANAL ENDOSCOPIC COOPERATIVE SURGERY (TECS): COMBINED APPROACH FOR A LARGE POST-TRANSANAL RESECTION RECURRENCE. A CASE REPORT

Abstract Background Advancements in endoscopy and minimally invasive surgery have led to the development of organ-preserving resection techniques to manage rectal lesions. According to JGES, ESGE, and AGA, endoscopic mucosal dissection (ESD) is typically recommended for Kudo V/JNET 2b pit pattern, LST-NG/Paris Is/IIc/IIa+Is morphology, presence of submucosal fibrosis, and local residual/recurrent adenomas. ESD is not without its limitations including depth of resection, technical difficulty and time. In some instances, a transanal minimally invasive surgery (TAMIS) approach can overcome some of these limitations while also avoiding the morbidity of proctectomy. The ESD-TAMIS approach has been described by two groups in the USA and Germany demonstrating initial safety and feasibility for management of distal rectal adenomas. Purpose We present the first Canadian case to demonstrate the use of a combined ESD-TAMIS for the management of a large post-TAMIS recurrent rectal adenoma, involving the dentate line, not amenable to endoscopic resection or TAMIS alone. Method N/A Result(s) A healthy 78-yr-old woman was referred for consideration of ESD of a large recurrent low rectal adenomatous lesion which had undergone multiple prior endoscopic mucosal and TAMIS resections. Pathology from prior excisions never showed high grade dysplasia (HGD) or intramucosal cancer. The lesion was 4-5cm long and occupied 90% of the circumference of the lumen including the dentate line. It had Paris IIa+Is+IIb components with submucosal fibrosis. The pit pattern was JNET 2a/2b (Fig 1). Given the size and dramatic submucosal scarring, ESD was deemed extremely challenging, time consuming and would likely involve a full thickness resection. Similarly, given that the lesion involved the dentate line and the borders were difficult to delineate, a TAMIS would not be feasible. In collaboration with our surgical colleagues, we proceeded with the ESD-TAMIS. The borders of the lesion were first demarcated and marked endoscopically. Using standard ESD technique, a mucosal incision was performed on the anal side of the lesion, followed by submucosal dissection until sufficient space was created for the TAMIS platform. Then, using TAMIS technique, a full thickness resection was performed. The lesion was successfully removed en-bloc and pinned for pathology. The large size of the defect and proximity to the dentate line prevented surgical closure. Post-op course was complicated by fever successfully managed with antibiotics. Overall, the procedure was well tolerated. The final pathology revealed a tubulovillous adenoma with HGD and extensive submucosal fibrosis. Image Conclusion(s) A transanal endoscopic cooperative surgery combining ESD and TAMIS was safe and effective, combining the advantages of each procedural technique, in providing curative en-bloc resection of a recurrent large near-circumferential low rectal tubulovillous adenoma with HGD involving the dentate line. Here, we present the first reported Canadian case using this novel technique. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Comparison of efficacy and safety between endoscopic mucosal dissection and resection in the treatment of early gastrointestinal cancer and precancerous lesions: a systematic review and meta-analysis.

Endoscopic mucosal dissection (EMD) is a new treatment method. Whether its clinical efficacy and safety are superior to surgical resection is still controversial. The sample size of previous studies on EMD for the treatment of early cancer of digestive tract is small, and there is no reliable evidence at present. Therefore, it is necessary to evaluate the efficacy and safety of EMD based on the evidence of evidence-based medicine. The PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang, cqvip.com (VIP), websites and citation searching were searched to obtain relevant literature on EMD for early cancer and precancerous lesions of digestive tract. The retrieval time was from the establishment of the database to November 29th, 2022. Literature was screened according to inclusion and exclusion criteria and data and data were extracted. The final included literature was assessed by Cochrane risk of bias tool, and publication bias was assessed by Egger's test. A total of 10 articles were included, with a total of 1,165 patients. Among these, 585 cases were treated with EMD and 580 cases were in the control group. The literature quality evaluation found that 5 articles had low risk of bias and 5 articles had unclear risk of bias. The results showed that the complete resection rate in the observation group was higher than that in the control group [risk ratio (RR) =1.25, 95% confidence interval (CI): 1.15-1.35, P<0.01]. Cumulative intraoperative blood loss (P<0.01), operation time (P<0.01), postoperative complications (P<0.01), hospital stay (P<0.01), and hospitalization expenses (P<0.01) in the observation group were lower than those in the control group. EMD for early gastrointestinal cancer and precancerous lesions can improve the complete resection rate of tumors; reduce intraoperative blood loss, complications, operation time, and hospitalization time and cost. However, due to the small number of literatures included in this paper, the quality of literatures is not high, and some results have heterogeneous interference, the conclusion needs to include more high-treatment studies for further study.

Application effect of a Donabedian three-dimensional quality evaluation model in perioperative nursing of early gastric cancer male patients undergoing endoscopic mucosal dissection

The effect of Donabedian three-dimensional quality evaluation model is explored for the high-quality nursing during perioperative period of endoscopic mucosal dissection in early gastric cancer male patients. Seventy-eight early gastric cancer male patients were randomly grouped as 39 cases in control having received routine care, while 39 in the intervention group having received routine care combined with the three-dimensional quality evaluation model. Clinical recovery indicators including anxiety, depression, pain, life quality and complications were compared for the two groups. The intervention group’s clinical nursing recovery indicator scored higher than that of the control. The scores of each the short-form 36 item health survey questionnaire (SF-36) dimension were better than those of control, and the differences were statistically significant (p &lt; 0.05). The incidence of complications in intervention group was 5.12%, and that in the control was 20.5%. The intervention group experienced less complications than the control, and the difference was statistically significant (p &lt; 0.05). Treating early gastric cancer male patients with endoscopic mucosal dissection using three-dimensional quality evaluation model can improve clinical recovery and life quality, and reduce anxiety, depression, pain and complications.

Endoscopic mucosal dissection for multiple rectal carcinoids: A case report

Endoscopic mucosal dissection for multiple rectal carcinoids: A case report

The effective analysis of refractory esophageal stricture after endoscopic mucosal dissection of early esophageal cancer treated by endoscopic radiotomy combined with local injection of triamcinolone acetonide

Refractor esophageal stenosis after endoscopic submucosal dissection of early esophageal carcinoma is a difficult clinical problem. To verify the effect of endoscopic radial incision combined local triamcinolone injection to treat refractory esophageal stenosis, we retrospectively analyzed 7 patients diagnosed with refractory esophageal stricture after endoscopic mucosal dissection of early esophageal cancer in this study, of whom 4 male and 3 female patients, aged 50-76 years, with the mean age of 63 years. We performed the endoscopic radial incision in the thickness point of the scar stricture and injected the triamcinolone locally. The results showed it was safe and effective. The follow-up showed no esophageal stenosis occured and no adverse reaction such as hemorrhage, perforation, tumor-recurrence and triamcinolone-allergy occured.