Wide Field Endoscopic Mucosal Resection Research Articles

Cap Polyposis: An Elusive Diagnosis in a Pediatric Patient Successfully Managed With Endoscopic Treatment

Cap polyposis is a rare condition of the rectum or sigmoid colon manifested by inflammatory polyps covered by a thick layer of fibrinopurulent mucus. This condition typically presents as mucoid diarrhea and rectal bleeding, and patients are often prescribed antibiotics (such as those for Helicobacter pylori), steroids, infliximab, or aminosalicylates. Surgical management is an option for unresponsive disease, but endoscopic management has been rarely reported. For cases of cap polyposis in which conservative medical management fails, wide-field endoscopic mucosal resection is a viable option.

S1987 Cap Polyposis: A Rare Condition in a Pediatric Patient Successfully Treated With Endoscopic Treatment

Introduction: Cap polyposis is a rare condition of the rectum or sigmoid colon manifested by inflammatory polyps covered by a thick layer of fibrinopurulent mucus. This condition typically presents as mucoid diarrhea and rectal bleeding, and patients are often prescribed antibiotics (such as those for Helicobacter pylori), steroids, infliximab, or aminosalicylates. Surgical management is an option for unresponsive disease, but endoscopic management has been rarely reported. Case Description/Methods: A 16-year-old boy had a 10-year history of mucoid diarrhea and occasional rectal bleeding and incontinence. Previous endoscopy revealed pseudopolyps in the rectum that appeared inflammatory with granulation tissue. Initial laboratory evaluation revealed mild iron deficiency, anemia, and hypoalbuminemia. The patient was treated with limited polypectomy, topical steroids, and diphenoxylate-atropine, which did not resolve his symptoms. A full workup for inflammatory bowel disease with an upper endoscopy, colonoscopy, and magnetic resonance enterography showed indications of marked polyposis in the rectum that was suggestive of “cap polyposis”. Tests for H. pylori were negative. There was no improvement with metronidazole or with treatments to reduce straining during bowel movements. Repeat sigmoidoscopy showed diffuse 1–4-cm multilobulated polypoid lesions in the rectum. Initially ESD was considered but deemed unsuitable due to poor lifting of the lesions. Thus, wide field endoscopic mucosal resection (WEMR) was performed, Approximately 40 band ligations with snare endoscopic submucosal resection were performed with near complete removal of all of the lesions. There was no post-procedure bleeding, pain, or other adverse effects. The resected tissue specimen had signs of high-grade dysplasia away from the resection margins. The patient’s symptoms resolved, and a second-look procedure 3.5 months later revealed only a slightly nodular area with no signs of dysplasia or cap polyposis. Discussion: Patients with cap polyposis typically report mucoid stools and rectal bleeding, and evaluations reveal a characteristic pattern on colonoscopy and pathology. For cases of cap polyposis in which conservative medical management fails, wide-field endoscopic mucosal resection is a viable option.

Wide-field endoscopic mucosal resection of laterally spreading rectaltumors using a multiband ligation endoscopic mucosal resection technique.

Video 1Tools and techniques video introducing and demonstrating the multiband ligation-assisted EMR technique to achieve wide-field endoscopic mucosal resection of large rectal laterally spreading tumors.

Wide-field endoscopic mucosal resection versus endoscopic submucosal dissection for laterally spreading colorectal lesions: a cost-effectiveness analysis

ObjectiveTo compare the cost-effectiveness of endoscopic submucosal dissection (ESD) and wide-field endoscopic mucosal resection (WF-EMR) for removing large sessile and laterally spreading colorectal lesions (LSLs) >20 mm.DesignAn incremental cost-effectiveness analysis...

Wide-field endoscopic mucosal resection in the small bowel: Management of a rare cause of jejunal intussusception by double-balloon enteroscopy

Wide-field endoscopic mucosal resection in the small bowel: Management of a rare cause of jejunal intussusception by double-balloon enteroscopy

Endoscopy Lower.

Endoscopy Lower.

大型腫瘍に対する広範囲EMR（WF-EMR）の長期成績で腺腫再発は稀である：1,000例のACE Studyからの結果と危険因子

大型腫瘍に対する広範囲EMR（WF-EMR）の長期成績で腺腫再発は稀である：1,000例のACE Studyからの結果と危険因子

Prediction of Clinically Significant Bleeding Following Wide-Field Endoscopic Resection of Large Sessile and Laterally Spreading Colorectal Lesions: A Clinical Risk Score.

Clinically significant bleeding (CSPEB) is the most frequent adverse event following wide-field endoscopic mucosal resection (WF-EMR) of large sessile and laterally spreading colorectal lesions (LSL). There is limited knowledge regarding accurate prediction of CSPEB. We aimed to derive a score to predict the risk of CSPEB. Data on patient and lesion characteristics and outcomes from WF-EMRs of LSL ≥20 mm at 8 referral hospitals were analyzed. The cohort was divided at random into equal sized training and test groups. Independent predictors of CSPEB in the training cohort were identified by multiple logistic regression analysis and used to develop a risk score. The performance of this score was assessed in the independent test cohort. Over 80 months to June 2015, 2,128 patients with 2,424 LSL were referred for WF-EMR. Two thousand and twelve patients were eligible for analysis. There were 135 cases of CSPEB (6.7%). In the training cohort of 1,006 patients, the independent predictors of CSPEB were lesion size >30 mm (odds ratio (OR) 2.5), proximal colonic location (OR 2.3), presence of a major comorbidity (OR 1.5), and epinephrine in injection solution (OR 0.57). The derived risk score comprised lesion size >30 mm (2 points), proximal colon (2 points), presence of major comorbidity (1 point), and absence of epinephrine use (1 point). The probabilities of CSPEB for scores of 0, 1, 2, 3, 4, and ≥5 in the training cohort were 1.5, 2.0, 5.6, 7.8, 9.1, and 17.5% and were 0.9, 6.7, 4.9, 6.2, 9.0, and 15.7% in the test cohort. The probabilities of CSPEB in those with low (score 0-1), medium (score 2-4), and elevated (score 5-6) risk levels were 1.7, 7.1, and 17.5% in the training cohort and 3.4, 6.2, and 15.7% in the test cohort. Patients at elevated risk of CSPEB can be identified using four readily available variables. This knowledge may improve the management of those undergoing WF-EMR and assist in designing studies evaluating CSPEB.

Prophylactic clipping for the prevention of bleeding following wide-field endoscopic mucosal resection of laterally spreading colorectal lesions: an economic modeling study.

Clinically significant bleeding (CSPEB) is the most common adverse event following endoscopic mucosal resection (EMR) of large sessile and laterally spreading colorectal lesions (LSLs), and is associated with morbidity and resource utilization. CSPEB occurs more frequently with proximal LSLs. Prophylactic clipping of the post-EMR defect may be beneficial in CSPEB prevention. The aim of this study was to determine the cost-effectiveness of a prophylactic clipping strategy. We hypothesized that prophylactic clipping in the proximal colon was cost-effective. An economic model was applied to outcomes from the Australian Colonic Endoscopic Mucosal Resection (ACE) Study. Clip distances of 3, 5, 8, and 10 mm were analyzed. The cost of treating CSPEB was determined from an independent costing agency. The funds needed to spend (FNS) was the cost incurred in order to prevent one episode of CSPEB. A break-even analysis was performed to determine cost equivalence of the costs of clipping and CSPEB. Outcomes of 1717 LSLs (mean size 35.8mm; 52.6 % proximal colon) that underwent EMR were analyzed. The overall rate of CSPEB was 6.4 % (proximal 8.9 %; distal 3.7 %). Endoscopic management was required in 45 % of CSPEB episodes. With a clip distance of 3 mm, the expected cost of prophylactic clipping was € 1106 per lesion compared with € 157 per lesion for the expected cost of CSPEB without clipping. At 100 % clipping efficacy, the FNS was € 14 826 (proximal and distal lesions € 9309 and € 29 540, respectively). A clip price of € 10.35 was required for the cost of clipping to offset the cost of CSPEB. A prophylactic clipping strategy is not cost-effective and at present cannot be justified for all lesions or selectively for lesions in the proximal colon. ClinicalTrials.gov (NCT01368289).

Tu1603 Risk Factors for Stricture Formation After Wide Field Endoscopic Mucosal Resection (Wfemr) in Barrett's Esophagus (Be) Patients Undergoing Endoscopic Eradiation Therapy: Results From a Large Tertiary Care Center

Tu1603 Risk Factors for Stricture Formation After Wide Field Endoscopic Mucosal Resection (Wfemr) in Barrett's Esophagus (Be) Patients Undergoing Endoscopic Eradiation Therapy: Results From a Large Tertiary Care Center

Tu1565 Efficacy, Durability and Safety of Wide Field Endoscopic Mucosal Resection (wfEMR) in the Treatment of High Grade Dysplasia (HGD) and Intramucosal Adenocarcinoma (IMC) in Patients With Barrett's Esophagus (Be): Results From a Tertiary Care Referral Center

HGD and IMC can be effectively treated with EMR. wfEMR of all visible BE in one EGD has the potential to increase the success rate of complete eradication (CE) and decrease recurrence (R) rates. However, data is limited on outcomes of wfEMR.

723 Extended Wide Field Endoscopic Mucosal Resection Does Not Reduce Recurrence Compared to Standard Endoscopic Mucosal Resection of Large Colonic Laterally Spreading Lesions

723 Extended Wide Field Endoscopic Mucosal Resection Does Not Reduce Recurrence Compared to Standard Endoscopic Mucosal Resection of Large Colonic Laterally Spreading Lesions

330 A Prophylactic Clip Strategy Is Not Cost Effective for the Prevention of Clinically Significant Bleeding Following Wide-Field Endoscopic Mucosal Resection of Large Colorectal Sessile and Laterally Spreading Lesions

330 A Prophylactic Clip Strategy Is Not Cost Effective for the Prevention of Clinically Significant Bleeding Following Wide-Field Endoscopic Mucosal Resection of Large Colorectal Sessile and Laterally Spreading Lesions

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

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

Wide Field Endoscopic Mucosal Resection (EMR) for Barrett’s Esophagus With High-Grade Dysplasia

Wide Field Endoscopic Mucosal Resection (EMR) for Barrett’s Esophagus With High-Grade Dysplasia

Prophylactic Endoscopic Coagulation to Prevent Bleeding After Wide-Field Endoscopic Mucosal Resection of Large Sessile Colon Polyps

Clinically significant postendoscopic mucosal resection bleeding (CSPEB) is the most frequent significant complication of wide-field endoscopic mucosal resection (WF-EMR) of advanced mucosal neoplasia (sessile or laterally spreading colorectal lesions > 20 mm). CSPEB requires resource-intensive management and there is no strategy for preventing it. We investigated whether prophylactic endoscopic coagulation (PEC) reduces the incidence of CSPEB. We performed a prospective randomized controlled trial of 347 patients (mean age, 67.1 y; 55.3% with proximal colonic lesions) undergoing WF-EMR for advanced mucosal neoplasia at 3 Australian tertiary referral centers. Patients were assigned randomly (1:1) to groups receiving PEC (n = 172) or no additional therapy (n = 175, controls). PEC was performed with coagulating forceps, applying low-power coagulation to nonbleeding vessels in the resection defect. CSPEB was defined as bleeding requiring admission to the hospital. The primary end point was the proportion of CSPEB. Patients in each group were similar at baseline. CSPEB occurred in 9 patients receiving PEC (5.2%) and 14 controls (8.0%; P = .30). CSPEB was associated significantly with proximal colonic location on multivariate analysis (odds ratio, 3.08; P = .03). Compared with the proximal colon, there was a significantly greater number (3.8 vs 2.1; P = .002) and mean size (0.5-1 vs 0.3-0.5 mm; P = .04) of visible vessels in the distal colon. PEC does not significantly decrease the incidence of CSPEB after WF-EMR. There were significantly more and larger vessels in the WF-EMR mucosal defect of distal colonic lesions, yet CSPEB was more frequent with proximal colonic lesions. ClinicalTrials.gov NCT01368731.

Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study

ObjectiveWide-field endoscopic mucosal resection (WF-EMR) is an alternative to surgery for treatment of advanced colonic mucosal neoplasia up to 120 mm in size, but has been criticised for its potentially...

501 Incidence and Risk Factors for Sedation-Associated Complications in Gastrointestinal Endoscopy — Initial Data From the German Prosed Registry a Prospective, Multicenter Study by Members of the Working Group of Leading Hospital Gastroenterologists (Algk) in Germany

501 Incidence and Risk Factors for Sedation-Associated Complications in Gastrointestinal Endoscopy — Initial Data From the German Prosed Registry a Prospective, Multicenter Study by Members of the Working Group of Leading Hospital Gastroenterologists (Algk) in Germany

502 Perforation and Deep Mural Injury After Colonic Endoscopic Mucosal Resection: Classification, Risk Factors, Management and Outcomes

Introduction: Perforation is the most serious complication associated with Wide Field Endoscopic Mucosal Resection (WF-EMR) of large colonic lesions. The target sign has been shown to identify muscularis propria (MP) injury, however a range of deep mural injury (DMI) syndromes exist. As yet an endoscopic classification system has not been described. The different endoscopic correlates likely confer differing clinical sequelae and require different management approaches. Aims: To describe the spectrum of DMI following WF-EMR and propose a classification system.

Tu1405 Clinical and Endoscopic Predictors of Cytological Dysplasia in Large Sessile Serrated Adenomas Resected by Wide Field Endoscopic Mucosal Resection From a Multicentre Prospective Cohort

Tu1405 Clinical and Endoscopic Predictors of Cytological Dysplasia in Large Sessile Serrated Adenomas Resected by Wide Field Endoscopic Mucosal Resection From a Multicentre Prospective Cohort