Traditional Endoscopic Resection Research Articles

Outcomes of endoscopic submucosal dissection in cirrhotic patients: First American cohort.

Among patients with cirrhosis and pre-malignant or early malignant mucosal lesions, surgical intervention carries a much higher bleeding risk. When such lesions are discovered, endoscopic submucosal dissection (ESD) may offer curative therapy with lower risks than surgery and improved outcomes compared to traditional endoscopic resection. To evaluate the outcomes of ESD in patients with cirrhosis. Patients with cirrhosis undergoing ESD between July 2015 and August 2022 were retrospectively matched in 1:2 fashion to controls based on lesion location, size, and anticoagulation use. Procedural outcomes were compared between groups. A total of 64 Lesions from 59 patients were included (16 cirrhosis, 43 control). There were no differences in patient or lesion characteristics between groups. En bloc and curative resection was achieved in 84.21%, 78.94% of the cirrhosis group and 88.89%, 68.89% of controls, respectively, with no significant differences. Cirrhotic patients had significantly higher rates of intra-procedural coagulation grasper use for control of bleeding (47.37% vs 20%; P = 0.02). There were otherwise no significant differences in adverse event rates. In the 29 patients with follow up, we found higher rates of recurrence in the cirrhosis group compared to controls (40% vs 5.26%; P = 0.019), however this effect did not persist on multivariable analysis controlling for known confounders. ESD may be safe and effective in patients with cirrhosis. Most procedure related outcomes were not significantly different between groups. Intra-procedural bleeding requiring use of the coagulation grasper use was expectedly higher in the cirrhosis group given the known effects of liver disease on hemostasis.

Endoscopic esophageal submucosal tunnel resection of gastric fundus-cardiac tumors originating from muscularis propria

Objective To investigate the clinical value of endoscopic esophageal submucosal tunnel resection of gastric fundus-cardiac tumors originating from muscularis propria. Methods Clinical date of 18 patients with gastric fundus-cardiac submucosal tumors originating from muscularis propria who underwent endoscopic esophageal submucosal tunnel resection from January 2011 to December 2011 were retrospectively collected and analyzed. Results All lesions were successfully and completely resected in 18 patients, with sizes ranging from 0. 7 cm to 7. 2 cm, mean （2. 43 ± 1.91 ） em. Pneumoretroperitoneum, pneumomediastinum and pneumohypoderma occured during the procedure in 2 cases, but spontaneously resolved in 3 days. Fever with increased WBC within 24 h after the procedure occurred in one patient, and was cured in two days with antibiotics. There were no severe complications including bleeding, perforation or death. All patients could have liquid diet 3 days later after the operation. Follow-up endoscopy at 1 week after the operation showed a healing of esophageal incision. Conclusion Endoscopic esophageal submucosal tunnel resection is a safe and effective method for gastric fundus-cardiac submucosal tumors originating from the muscularis propria, lessening the difficuhy of traditional endoscopic resection. Key words: Gastric fundus-cardiac part; Tumors originated from the muscularis propria; Endoscopic esophageal submucosal tunnel technique

Laparoscopic-Assisted Endoluminal Hybrid Surgery: A Stepping Stone To NOTES

Natural orifice transluminal endoscopic surgery (NOTES) is the anticipated progression of minimally invasive surgery. As it approaches, surgeons will need to develop the fundamental skills and spatial orientation needed to perform safely in this new field. The Natural Orifice Surgery Consortium for Assessment and Research has established several fundamental challenges to the safe introduction of NOTES. Our institutional experience with laparoscopic-assisted endoluminal surgery is reviewed to display the techniques and efficacy of procedures that address many of these challenges and may provide a safe transition for the general surgeon to NOTES or as an alternative to pure NOTES. A retrospective review of all laparoscopic-assisted endoluminal surgeries from 1991 to 2007 was performed. Patients had been referred to the institution and selected after either unsuccessful attempts from traditional endoscopic resection of pathology by a gastroenterologist or being deemed an unfavorable candidate for traditional endoscopic resection. All procedures involved establishment of pneumoperitoneum, placement of trochar ports under laparoscopic visualization, balloon ports in gastric cases combined with endoscopy, intraluminal insufflation, coordinated resection of intraluminal pathology using both the endoscopic and laparoscopic instruments, and closure of the intraluminal port sites with intracorporeal suturing. A total of 175 procedures were performed from 1991 to 2007 using these techniques. These procedures varied and included laparoscopic monitored colonoscopic polypectomy, resection of gastric polyps, intraluminal cystgastrostomy, gastric ulcer resection, and foreign body removal. The average age was 55 years (range 38 to 75 y), length of operation 95 minutes (range 60 to 137 min), hospital stay 3.5 days, and 5 complications (2.8%). Of the total procedures, 18 (10.2%) patients were found to have malignancy on frozen section and preceded with a formal resection. There are no cancer recurrences to date with a mean follow up of 74 months (6 to 196 mo). Our institutional experience with these procedures seems to be a natural transition to developing skills for NOTES procedures and displays a safe and effective approach to a wide range of intraluminal pathology. The general surgeon in practice can use this union of laparoscopy and endoscopy using current instruments and technology for safe transition into the emerging field of NOTES, or even as an alternative to pure NOTES. Mastery of intraoperative endoscopy and intraluminal surgery will be essential to this transition.