Submucosal Saline Injection Research Articles

Submucosal injection of pharyngeal ostium of Eustachian tube for diagnosis of patulous Eustachian tube

Objective:To evaluate the clinical value of submucosal injection of pharyngeal ostium of Eustachian tube in diagnosing patulous Eustachian tube(PET).Method:Twenty-six patients(32 sides),whose the symptoms were consistent with PET,were enrolled from March 2014 to May 2016.The symptoms and signs of all patients were evaluated after submucosal injection of saline into the Eustachian tube.Result:Immediately after submucosal injection of saline into the Eustachian tube,the symptoms and signs disappeared in 24 cases(29 sides),and improved in 2 cases(3 sides).The resolution and/or improvement of symptoms and signs lasted for less than 24 hours in 12 patients,for more than 24 hours in 9 patients,and for more than 48 hours in 4 patients.No adverse reactions were observed.Conclusion:Submucosal injection may be a simple and practical method for auxiliary diagnosis of PET,and may be used in preoperative evaluation of Eustachian tuboplasty.

Efficacy and safety of cold snare resection in preventive screening colonoscopy.

Background and aim Removal of polyps during colonoscopy effectively prevents the development of colorectal cancer. So far, snare resection with high frequency current with or without prior submucosal saline injection is the method of choice. The aim of this study was to evaluate the feasibility, safety, and outcome of cold snare resection during routine endoscopy. Methods In this prospective study, 522 patients undergoing outpatient colonoscopy were included. Cold snare resection for diminutive (< 6 mm), small (6 – 9 mm), and larger polyps (> 9 – 15 mm) was performed using a dedicated cold snare device (Exacto ® ) without prior submucosal injection. Outcome parameters included bleeding rate, perforation rate, procedure time, histologic evaluation of polyp margins, and success rates. The data were compared to a group of patients undergoing hot snare resection. Results Overall, 1233 polyps were removed using cold snare resection with an overall success rate of 99.4 %. All failures of cold snare resection occurred in the cecum (8/82, failure rate 9.8 %). In the remaining colon, the success rate was 100 %. Immediate post-polypectomy bleeding occurred in 0.49 % of all patients and was most frequently seen in polyps larger than 9 mm. The procedure time was significantly shorter using cold snare resection compared with hot snare resection (27.6 min vs. 35.7 min, P < 0.01). Conclusion Cold snare resection can be performed safely in outpatients for removal of small polyps in screening colonoscopy. It does not require prior saline injection and reduces procedure time without an increased risk of bleeding.

Effects of argon plasma coagulation on human stomach tissue: An ex vivo study.

Argon plasma coagulation (APC) is a safe alternative treatment for gastrointestinal neoplasms and precancerous lesions. However, the extent of thermal damage after APC is difficult to predict. We investigated the effects of APC on human stomach tissue. Argon plasma coagulation was performed on 10 freshly resected human stomachs that were obtained after total gastrectomy. The effects on tissue were compared across power settings (40, 60, and 80W), durations (5, 10, 15, 20, and 25s), and between injection (submucosal injection of normal saline) and control (without injection) groups. Success was defined as complete mucosal necrosis without damaging the muscularis propria. Without submucosal injection, the incidence of damaging the muscularis propria increased as the power and duration increased. Tissue damage in the injection group was mostly confined to the submucosa, even when using the high-power setting. In the injection group, ablations at 40W for 20s, 60W for 15s, and 80W for 15 or 20s produced success rates ≥80%. In the control group, ablations at 60W for 10s, and 80W for 5, or 10s produced success rates ≥80%. The optimal energy levels to achieve complete mucosal and submucosal necrosis without damaging the muscularis propria were 800-1600 and 600-800J in the injection and control groups, respectively. Application of APC produces good results with a low risk of perforation.

Periapical Microsurgery: The Effects of Locally Injected Dexamethasone on Pain, Swelling, Bruising, and Wound Healing

IntroductionThe purpose of this prospective, double-blind, randomized clinical trial was to evaluate the postoperative healing of endodontic periapical microsurgery after local administration of dexamethasone. MethodsSixty patients were divided into 2 groups. The dexamethasone group received a single local submucosal injection of 4 mg dexamethasone, and the placebo group received a submucosal injection of saline solution at the conclusion of standardized periapical microsurgery. Acetaminophen and hydrocodone/acetaminophen were prescribed for pain relief. A Likert-like 6-point scale was used for self-evaluation of pain, bruising, swelling, and wound healing at 24, 48, 72, 96 hours and at 1 week. The number of tablets taken was registered. Data were analyzed using the chi-square and Fisher exact tests at a significance level of P < .05. ResultsNo improvements in pain, bruising, and wound healing were registered at any time interval. No difference was found in the number of tablets taken for pain relief. Subjects who received the dexamethasone injection reported less swelling 24 hours after periapical microsurgery (P < .05) but showed no significant benefit for the longer follow-up periods. ConclusionsThis study shows that a 4-mg dose of dexamethasone administered through a local submucosal injection after periapical microsurgery has minimal impact on pain, bruising, and apparent wound healing at any time over a 7-day interval, and the impact on swelling seems limited.

Chemically assisted peroral endoscopic myotomy with submucosal mesna injection in a porcine model

Background: Peroral endoscopic myotomy (POEM) is a less invasive alternative to standard surgery for the treatment of achalasia. Previous studies have demonstrated that submucosal injections of mesna soften tissues and facilitate endoscopic submucosal dissection. Material and methods: We studied the technical feasibility of a chemically assisted POEM procedure with mesna injection (CA-POEM) in ten pigs compared with POEM with saline injection in five pigs. We also compared two dissection techniques in CA-POEM, diathermy needle knife dissection (n = 5) and balloon mechanical dissection (n = 5). A 10 cm esophageal submucosal tunnel was created with a needle knife or with balloon mechanical dissection following mesna or saline submucosal injection. Approximately 5 cm of inner circular muscle was then dissected within the tunnel. The tunnel was closed with endoclip application at the mucosal endoscopic entry point. Pigs were sacrificed one week post procedure. Results: All procedures were successful and all pigs survived for one week. Submucosal tunneling time was significantly shorter in the mesna group (363.8 sec for needle knife dissection and 294.2 sec for balloon dissection) than in the saline group (640 sec), regardless of the dissection method (p < 0.05). Conclusions: Our study demonstrated the technical feasibility of CA-POEM.

Sa1524 Identification of Esophago-Gastric Junction During Per-Oral Endoscopic Myotomy-Benefit of Indocyanine Green Injection

Sa1524 Identification of Esophago-Gastric Junction During Per-Oral Endoscopic Myotomy-Benefit of Indocyanine Green Injection

Endoscopic mucosal resection of large colorectal adenomas: Only for expert centers?

Endoscopic mucosal resection of large colorectal adenomas: Only for expert centers?

Effects of epinephrine–saline submucosal injection of different concentrations on endoscopic submucosal dissection

Objective To evalute and compare the efficacy and safety of epinephrine–saline submucosal injection of different concentrations on endoscopic submucosal dissection (ESD), and to discuss the best concentration of submucosal injection. Methods A total of 128 patients who underwent ESD were randomly assigned to submucosal normal saline injection group (group A, n=32), 0.001% epinephrine–saline injection group(group B, n=32), 0.002% epinephrine–saline injection group(group C, n=32), and 0.004% epinephrine–saline injection group (group D, n=32). The incidence of bleeding during and after ESD were counted, the blood preasure and heart rate of preoperative and intraoperative, the amount of submucosal injection, the time of operation were observed. Results ESD was successfully performed on all patients. There were no difference in highest blood preasure and fastest heart rate between preoperative and intraoperative results of each group. No perforation or intraoperative acute massive bleeding occurred. Intraoperative acute minimal bleeding during ESD occurred in 9 patients in group A and 3 in group B, 2 in group C and 2 in group D (P<0.05), but there were no differences among group B, C and D. The amount of submucosal injection of group A was(39.5±10.8)ml, which was more than that of group B(29.4±9.4)ml, group C(27.3±8.2)ml and group D(20.4±11.8)ml with significant difference. There were no differences among group B, C and D, but there was less in group D than group B. The operation time of group A was(82.3±24.78 minutes), which was longer than that of group B(60.7±25.35minutes), group C (54.7±31.72minutes) and group D(59.2±28.49 minutes), but there was no difference among B, C and D group. Conclusion Epinephrine–saline submucosal injection assiting ESD is safe and effective and reduces the operation time and bleeding than normal saline. The increase of the epinephrine–saline concentrations has not been found to be more beneficial. Key words: Endoscopic submucosal dissection; Injections; Epinephrine; Bleeding

Diminutive colorectal polyp resection comparing hot and cold snare and cold biopsy forceps polypectomy. Results of a pilot randomized, single-center study (with videos).

Background: The optimal method of diminutive polypectomy (< 6 mm) is unknown. Objective: To assess the rates of incomplete resection of diminutive polyps of the colon using three standard polyp resection techniques (hot snare, cold snare, and cold biopsy forceps). Design: Randomized, pilot study. Settings: Single-center endoscopy center. Patients: Patients undergoing routine outpatient colonoscopies. Interventions: Polypectomy was performed using the method to which the patient was randomized. Following retrieval of the polyp, the polypectomy base was lifted by submucosal injection of normal saline and then excised using the cold snare device. If no tissue could be removed, then at least four cold biopsies using forceps of the remaining margin were obtained. Main outcome measures: Adequacy of resection of diminutive polyps, which was defined as no visible adenoma or hyperplastic tissue seen in the base tissue on histology. Results: A total of 60 patients were enrolled (57 % male), the mean age was 60 (range 33 – 82), and 62 polyps were randomized from 37 patients. The mean polyp size was 3.6 mm (range 2 – 5 mm) and 37 polyps (60 %) were adenomatous. Overall incomplete polyp resection rate was 9 % (95 %CI 3 – 19 %), 5 of 37 (14 %) for adenomas. By the study arm, the incomplete resection rates were 1 of 18 (6 %) for hot snare, 2 of 21 (10 %) for cold snare, and 2 of 18 (11 %) for cold biopsy forceps. The majority of polyp bases were removed with cold biopsy forceps since most of the endoscopists did not feel that the saline lift cold snare method was feasible or appropriate. Limitations: Small sample size; endoscopic mucosal resection (EMR) of the polyp base tissue was not routinely performed. Conclusions: Recruiting patients to a pilot study that randomized polyps to one of three common methods of polypectomy for diminutive polyps was feasible, and approximately 1 in 10 diminutive polyps found on colonoscopy were incompletely resected by standard polypectomy methods.

Results of a Standardized Endoscopic Approach to Resection of Polyps >20 mm

Results of a Standardized Endoscopic Approach to Resection of Polyps >20 mm

PD-0012 - The Usefulness of Argon Plasma Coagulation in the Treatment of Gastric Adenoma Known as a Premalignant Lesion of Stomach Cancer : Compare with the Endoscopic Submucosal Dissection Group

Introduction: Argon plasma coagulation (APC) is a method of contact-free electrocoagulation in which energy is transmitted to the tissue through ionized argon gas. APC has been widely used to treat many gastrointestinal diseases. Recently, its application has been broadened into the field of the treatment of gastric adenoma known as a premalignant lesion of stomach cancer. The aim of our study was to assess the usefulness of APC in treating gastric adenoma through comparison with the group Endoscopic submucosal dissection (ESD). Methods: We studied 231 lesions of 210 patients with gastric adenoma, in which patients were treated with APC (108 lesions of 97 patients) and ESD (123 lesions of 113 patients) at Inje University Ilsan Paik Hospital from January 2006 to June 2013. APC group received APC ablation (VIO 300D with APC 2; Erbe Elektromedizin, Germany; pulsed argon plasma coagulation, 40W) after submucosal saline injection to prevent procedure related complications. In ESD group, injection of submucosal saline, circumferential incision and submucosal dissection was performed by flex and/or IT knife. All patients were followed up for more than 3 months of period, and biopsy was performed on post treatment scar lesions. We compared clinical and pathologic characteristics, complications, recurrence rates, admission rate, mean duration of hospital stay, and medical expense between two groups. Results: The mean age of patients was APC 65.8 ±10.03 vs. ESD 64.6 ±11.22 (p = 0.146). The mean adenoma size was 0.9 ± 0.45 cm in the APC group and 1.2 ± 0.72 cm in the ESD group (p < 0.001). The mean duration of hospital stay was significantly shorter in the APC group than the ESD group (APC 1.55 days vs. ESD 5.80 days, p < 0.001). Complication did not occur in the APC group. However, one case of perforation (0.9%) and 6 cases of bleeding (5.3%) occurred in the ESD group. Recurrence rates were 15.3% (15/97 patients) in the APC group and 3.5% (4/113 patients) in the ESD group (p = 0.003). One recurrent case of APC group was diagnosed with adenocarcinoma which was completely treated by surgery. The proportion of hospitalization was less in the APC group (43.3 %, 42/97) than the ESD group (100.0 %, 113/113) (p < 0.001). Medical expense was less in the APC group (377,172 won, 351 dollar) than the ESD group (1,430,610 won, 1,333 dollar) (p < 0.001). No complication was observed in APC treatment group by outpatient department (OPD) basis, medical expense was less in APC group by OPD basis (292,842 won, 272 dollar) than in the APC by admission basis (1,079,698 won, 1,006 dollar) (p < 0.001). Conclusion: In this study, we demonstrated that gastric adenoma can be safely treated by APC without serious complications. APC showed less hospitalization and lower medical expense. Also we showed that APC is an effective and safe treatment modality for gastric adenoma on and OPD basis. However, regular endoscopic follow-up is necessary for detection of residual or recurrent lesions because of the relatively high rate of local recurrence after APC.

Endoscopic Curative Treatment of a Submucosal Invasive Rectal Adenocarcinoma

We report a case of a 45-year-old man with the diagnosis of rectal adenocarcinoma, in which a proctocolectomy was proposed and the patient refrained from surgery. A new colonoscopy was performed, which revealed a 2.5 cm diameter sessile lesion with irregular microvascular mesh work, thick capillaries with heterogeneous distribution and avascular areas, suggesting carcinoma with massive invasion of the sub-mucosa (a C3 lesion in the Hiroshima classification). However, we tried endoscopic resection and the lesion has completely elevated after Sub-mucosal hipertonic saline injection. Then the lesion was removed “en block” with a polypectomy snare. Histopathological study evidenced a moderately differentiated adenocarcinoma in a villous adenoma with high grade dysplasia with sub-mucosal invasion of 655 μm; there was no angiolymphatic invasion and the lateral and lower margins were lesion-free.

Endoscopic ultrasound combined with submucosal saline injection for differentiation of T1a and T1b esophageal squamous cell carcinoma: a novel technique

Endoscopic ultrasound (EUS) is the optimum method for investigation of early esophageal squamous cell carcinoma (ESCC). However, it is difficult to substage early ESCC as T1a or T1b. The aim of this study was to improve the staging accuracy of early ESCC by using EUS combined with submucosal saline injection (SSI). The study enrolled 15 patients with suspected early ESCC who were examined by EUS and subsequently by SSI combined with EUS. The patients then underwent endoscopic or surgical resection within 10 days. The accuracy of EUS staging (alone or following SSI) was evaluated and compared with the pathological results postoperatively. No severe complications of the SSI arose. EUS plus SSI easily distinguished the mucosa from the lesion and the submucosa because of the low-echoic saline-filled cushion in the submucosa. The accuracy of SSI combined with EUS for staging T1a or T1b was 86.7 %, which was better than that using EUS alone (60.0 %).

Clinical outcomes of argon plasma coagulation for the treatment of gastric neoplasm

There are insufficient reports on the outcomes and local recurrence rates for gastric neoplasms treated using argon plasma coagulation (APC). The purpose of this study was to analyze the clinical outcomes in early gastric cancer or gastric adenoma patients following APC treatment. Seventy-one patients were enrolled and all underwent APC at the Asan Medical Center between July 2007 and August 2011. Clinical and oncological outcomes were analyzed. The median follow-up period was 20 months (interquartile range 13-29 months). Among the 71 patients we evaluated, nonlifting after submucosal saline injection was found in 35 patients and 15 patients (21.2%) experienced local recurrence with a median period of 10 months (IQR 5-13 months). The rate of local recurrence was higher in the nonlifting group and the 40-W group than in the lifting group and the 60- or 80-W groups (31.4 vs. 11.1%, p = 0.045 and 31.7 vs. 6.7%, p = 0.017, respectively). Multivariate analysis showed that the power setting with the 40-W and nonlifting groups after submucosal injection was associated with local recurrence. APC therapy after submucosal saline injection using high power (60 or 80 W) appears to be an effective alternative in the management of gastric neoplasm.

Endoscopic closure of an iatrogenic duodenal perforation: a novel technique using endoclips, endoloop, and fibrin glue

An 80-year-old woman with a flat duodenal tubulovillous adenoma presented for endoscopic mucosal resection (EMR). This lesion had received treatment with EMR and Nd:YAG laser in the past. The lesion was located in the proximal second portion of duodenum (D2), measured approximately 2cm, andwas half-circumferential from the 12-o’clock to the 6-o’clock position. The lesion was lifted with submucosal injection of methylene blue and saline. A multibanding cap was used to place ligation bands around two areas for EMR. One area was targeted with a hexagonal snare, and after resection a 1-cm perforation became obvious at the lateral aspect of D2 (● Fig.1). Endoscopic clipping of the defect was attempted but, due to the large size of the defect and the wall being taut, the edges were not able to be approximated. A “clutching rose stems” technique was used to close the defect (● Fig.2), as follows. A total of eight endoclips (Resolution clip; Boston Scientific, Natick, Massachusetts, USA) were placed circumferentially around the perimeter of the wound edge. This was followed by placing a detachable endoloop (Polyloop; Olympus America Inc., Melville, New York, USA) around the perimeter base of the clips. The snare was tightened, which successfully brought all the edges of the wound together, and was then detached. In order to ensure a complete seal, a total of 8ml of fibrin glue (Tisseel; Baxter, Deerfield, Illinois, USA) was injected at the center of the “rose stems”. A large, transparent glue “clot” formed over the entire wound. The total time for endoscopic closure was 45 minutes. Post procedure, the patient was noted to be asymptomatic despite the presence of free air on abdominal computed tomography (CT). An upper gastrointestinal contrast study failed to show any extravasation of contrast out of the bowel. The patient received nasogastric tube decompression with bowel rest and broad spectrum antibiotic coverage, and had an uneventful hospital course. Multiple case reports have been published on iatrogenic duodenal perforations closed using endoclips [1–5]. To our knowledge, this is the first case of a duodenal perforation closed using a “clutching rose stems” technique using endoclips, an endoloop, and fibrin glue. In this case, the fibrin glue was essential in sealing the center hole after the endoclips and endoloop had brought the edges of the defect together. In the advent of newer resection techniques, further progress needs to be made in the area of endoscopic closure, such that perforations can easily be managed by the endoscopist. Endoscopy_UCTN_Code_TTT_1AR_2AI

Full-thickness endoscopic resection of gastrointestinal cancer: from animal lab to humans

Background: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are currently used for resection of early gastrointestinal (GI) tract cancer, limited to superficial layers of the gastric and colonic wall. These techniques are technically difficult, labor intensive and cannot be used when tumor cannot be lifted with submucosal injection and/or involves deeper layers of GI tract wall. Aim: To study technical feasibility and safety of full-thickness colonic resection in a live porcine model and the first clinical experience in humans. Methods: We performed endoscopic full-thickness resections of gastric and colonic wall in nine 50-kg domestic pigs. After resection the defects in GI tract wall were sutured with Overstitch® endoscopic suturing device Apollo Endosurgery Inc, Austin, TX). Three animals were sacrificed post procedure. Six animals were survived for 14 days and subsequently sacrificed for postmortem examination. Then endoscopic full-thickness resection of the colonic wall was performed in a patient with actively bleeding colon cancer, who was not a surgical candidate due to severe concomitant medical problems. Results: Large (3–5 cm) full-thickness endoscopic resections of gastric (3 animals) and colonic (4 animals) wall were easily achieved using hook knife, IT-knife and polypectomy snare (all made by Olympus, Tokyo, Japan). Suturing with the Overstitch® endoscopic suturing device was technically easy and achieved airtight closure of the GI tract in all animals. Postmortem examination reveal good full-thickness healing of the GI tract wall at the sites of resection. After gaining significant experience in endoscopic suturing we performed full-thickness endoscopic resection on a 64-year old man with actively bleeding colon cancer located at hepatic flexure. The patient required anticoagulation and was not able to tolerate even laparoscopic resection due to severe heart problems. The cancer was 2 × 4 cm and could not be lifted with submucosal injection of normal saline. After endoscopic resection, 4 × 6 cm full-thickness defect in colonic wall was completely closed with continuous suture line. The patient had no pain post procedure and was discharged home in 3 days. Follow-up endoscopy in 3 and 6 months revealed good healing of colonic wall without any residual cancer or strictures. Conclusion: This is the first reported purely endoscopic, full-thickness resection of GI tract cancer in humans. This procedure can be used even when EMR and ESD are not possible and can potentially become another valuable alternative to laparoscopy and open surgery.

Endoscopic submucosal dissection of early gastric neoplasia with a water jet–assisted knife: a Western, single-center experience

Endoscopic submucosal dissection (ESD) of early gastric neoplasia has not yet been established in Western countries because of a lack of data and the difficult, time-consuming, and hazardous nature of the method. Some of the technical limitations may be overcome by use of a water jet-assisted knife, which allows a combination of a high-pressure water jet and electrosurgical interventions. To evaluate the efficacy and safety of water jet-assisted ESD (WESD) with a water jet-assisted knife in selected patients with early gastric neoplasia. Single-center, prospective study. This study involved 29 consecutive patients (13 female; median age 61 years; age range 35-93 years) with early gastric neoplasia that met the expanded criteria of the Japanese Gastric Cancer Association. Histology of biopsies had shown gastric adenocarcinoma in 21 cases, adenoma in 8 case, and suspicion of a GI stromal tumor in 1 case. The median maximal diameter of the lesions was 20 mm (range 10-40 mm). All procedures were done with patients under sedation with propofol. The water jet-assisted knife was used for setting coagulation markers around the neoplastic lesions, then for circumferential incision and dissection in combination with repeated submucosal injection of saline solution with a water jet system. Bleeding was treated with diathermia by use of the water jet-assisted knife or hemostatic forceps in case of failure or larger vessels. Clips were used for closure of perforations. Complete resection of neoplasia, procedure time, complication and recurrence rates. According to endoscopic criteria, complete resection of the targeted area could be achieved in all cases, with an en bloc resection rate of 90%. The median procedure duration was 74 minutes (range 15-402 minutes). Exchange of the device was needed in only 10 cases because of severe bleeding from larger vessels, which could be managed by use of hemostatic forceps. The 30-day morbidity rate was 4 of 30 (13.8%) because of postprocedure pain in 3 cases and delayed bleeding in 1 case. A 93-year-old patient died the night after WESD without evidence of a procedure-related complication. Histology of the resected specimens showed adenocarcinoma in 20 cases, adenoma in 7, no neoplasia in 2, and a plasmacytoma in 1. Complete resection (R0) was histologically confirmed in 18 of 28 patients (64.3%) with resected neoplastic specimens. A horizontal or vertical neoplasia-free margin could not be confirmed in 9 cases and 1 case, respectively. Complete local remission of neoplasia was achieved in 25 of 28 patients (89.3%) who were followed over a median period of 22 months (range 6-44 months). In 1 patient, a metachronous gastric adenocarcinoma was identified 54 weeks after initial WESD. Noncontrolled study with a limited number of patients. The use of a water jet-assisted knife simplifies ESD because exchange of devices is rarely needed. WESD promises to be effective and safe. The study demonstrates that the high rates of en bloc resection of early gastric neoplasia reported in Asia can be reproduced in Western referral centers. However, histology may not always confirm complete resection of horizontal tumor margins. In spite of the unfavorable histology results, the high rate of complete local remission of neoplasia promises that surgical treatment of early gastric neoplasia can be avoided in the majority of cases.

Botulinum toxin type A for the treatment of trigeminal neuralgia: results from a randomized, double-blind, placebo-controlled trial

To investigate the efficacy, safety and tolerability of intradermal and/or submucosal administration of botulinum toxin type A (BTX-A) for patients with trigeminal neuralgia (TN). In this randomized, double-blind, placebo-controlled study, 42 TN patients were randomly allocated into two groups, namely, intradermal and/or submucosal injection of BTX-A (75 U/1.5 mL; n = 22) or saline (1.5 mL; n = 20) in the skin and/or mucosa where pain was experienced. The primary endpoints were pain severity (assessed by the visual analogue scale) and pain attack frequency per day. The secondary endpoint was the patient's overall response to treatment, assessed using the Patient Global Impression of Change scale. Patients with ≥ 50% reduction in mean pain score at week 12 were defined as responders. A total of 40 patients completed the study. BTX-A significantly reduced pain intensity at week 2 and pain attack frequency at week 1. The efficacy was maintained throughout the course of the study. More BTX-A treated patients reported that pain had improved by the end of the study. Significantly more responders were present in the BTX-A group (68.18%) than in the placebo group (15.00%). BTX-A was well tolerated, with few treatment-related adverse events. BTX-A may be an efficient, safe and novel strategy for TN treatment.

Kolorektale Adenome: Pro konventionelle/laparoskopische Resektion

The knowledge that due to the adenoma-cancer sequence polyps will develop sooner or later into invasive cancer demands the complete removal of colorectal polyps. The majority of polyps can be endoscopically removed. The indications for surgical removal of polyps are a previous incomplete endoscopic resection, location not amenable to endoscopic removal and lesions which are macroscopically highly suspicious for malignancy and cannot be detached by submucosal saline injection. If a surgical approach is indicated minimally invasive surgery in the hands of an experienced laparoscopic surgeon is a suitable option. Adenomas suspicious for malignancy in the lower two thirds of the rectum should not be treated by time-consuming endoscopic submucosal dissection (ESD) and can be quickly and safely removed transanally, conventionally or by transanal endoscopic microsurgery (TEM) by a full thickness én bloc resection. This allows the pathologist to determine the depth of invasion and the completeness of resection in terms of the circumferential margin and a definitive radical surgical approach is only necessary in high risk situations.

Quality of Pathology Specimens From Sessile Colon Polyps Obtained With and Without Submucosal Saline Injection

Quality of Pathology Specimens From Sessile Colon Polyps Obtained With and Without Submucosal Saline Injection