11 research outputs found
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Safety and efficacy of endoscopic submucosal dissection for rectal neoplasia: a multicenter North American experience.
Background and aims  Rectal lesions traditionally represent the first lesions approached during endoscopic submucosal dissection (ESD) training in the West. We evaluated the safety and efficacy of rectal ESD in North America. Methods  This is a multicenter retrospective analysis of rectal ESD between January 2010 and September 2018 in 15 centers. End points included: rates of en bloc resection, R0 resection, adverse events, comparison of pre- and post-ESD histology, and factors associated with failed resection. Results  In total, 171 patients (median age 63 years; 56 % men) underwent rectal ESD (median size 43 mm). En bloc resection was achieved in 141 cases (82.5 %; 95 %CI 76.8-88.2), including 24 of 27 (88.9 %) with prior failed endoscopic mucosal resection (EMR). R0 resection rate was 74.9 % (95 %CI 68.4-81.4). Post-ESD bleeding and perforation occurred in 4 (2.3 %) and 7 (4.1 %), respectively. Covert submucosal invasive cancer (SMIC) was identified in 8.6 % of post-ESD specimens. There was one case (1/120; 0.8 %) of recurrence at a median follow-up of 31 weeks; IQR: 19-76 weeks). Older age and higher body mass index (BMI) were predictors of failed R0 resection, whereas submucosal fibrosis was associated with a higher likelihood of both failed en bloc and R0 resection. Conclusion  Rectal ESD in North America is safe and is associated with high en bloc and R0 resection rates. The presence of submucosal fibrosis was the main predictor of failed en bloc and R0 resection. ESD can be considered for select rectal lesions, and serves not only to establish a definitive tissue diagnosis but also to provide curative resection for lesions with covert advanced disease
Per-Oral Endoscopic Myotomy for Esophagogastric Junction Outflow Obstruction: A Multicenter Pilot Study
Efficacy of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasia in a Large Cohort in North America
Background & Aims
Endoscopic submucosal dissection (ESD) is a widely accepted treatment option for superficial gastric neoplasia in Asia, but there are few data on outcomes of gastric ESD from North America. We aimed to evaluate the safety and efficacy of gastric ESD in North America.
Methods
We analyzed data from 347 patients who underwent gastric ESD at 25 centers, from 2010 through 2019. We collected data on patient demographics, lesion characteristics, procedure details and related adverse events, treatment outcomes, local recurrence, and vital status at the last follow up. For the 277 patients with available follow-up data, the median interval between initial ESD and last clinical or endoscopic evaluation was 364 days. The primary endpoint was the rate of en bloc and R0 resection. Secondary outcomes included curative resection, rates of adverse events and recurrence, and gastric cancer-related death.
Results
Ninety patients (26%) had low-grade adenomas or dysplasia, 82 patients (24%) had high-grade dysplasia, 139 patients (40%) had early gastric cancer, and 36 patients (10%) had neuroendocrine tumors. Proportions of en bloc and R0 resection for all lesions were 92%/82%, for early gastric cancers were 94%/75%, for adenomas and low-grade dysplasia were 93%/ 92%, for high-grade dysplasia were 89%/ 87%, and for neuroendocrine tumors were 92%/75%. Intraprocedural perforation occurred in 6.6% of patients; 82% of these were treated successfully with endoscopic therapy. Delayed bleeding occurred in 2.6% of patients. No delayed perforation or procedure-related deaths were observed. There were local recurrences in 3.9% of cases; all occurred after non-curative ESD resection. Metachronous lesions were identified in 14 patients (6.9%). One of 277 patients with clinical follow up died of metachronous gastric cancer that occurred 2.5 years after the initial ESD.
Conclusions
ESD is a highly effective treatment for superficial gastric neoplasia and should be considered as a viable option for patients in North America. The risk of local recurrence is low and occurs exclusively after non-curative resection. Careful endoscopic surveillance is necessary to identify and treat metachronous lesions
Endoscopic management of an esophagomediastinal fistula arising from a cervical esophageal diverticulum after blunt chest trauma
679 – Discrepancy Between Self-Reported Preferences on Polypectomy Techniques and Actual Practice Patterns During Colonoscopy Among Endoscopists At a Tertiary Care Center (Poster Presentation)
Su1436 LUMEN-APPOSING METAL STENTS (LAMS) FOR PANCREATIC FLUID COLLECTIONS ARE SAFE AND ASSOCIATED WITH A LOW RATE OF DELAYED ADVERSE EVENTS AT THE TIME OF CLINICAL FOLLOW-UP: A MULTICENTER RETROSPECTIVE ANALYSIS
870 Comprehensive Analysis of Adverse Events Associated With PerOral Endoscopic Myotomy (POEM) in 1826 Patients: An International Multicenter Study:2016 DDW ASGE Program and AbstractsDDW 2016 ASGE Program and Abstracts
874 Comparative Evaluation of PerOral Endoscopic Myotomy (POEM) for the Treatment of Achalasia in Patients With Failed Heller Myotomy vs Patients Without a History of Surgical Myotomy: A Multicenter Retrospective Cohort Study:2016 DDW ASGE Program and AbstractsDDW 2016 ASGE Program and Abstracts
Sa1907 CLASSIFICATION AND GRADING OF ADVERSE EVENTS RELATED TO PERORAL ENDOSCOPIC MYOTOMY (POEM): A COMPARISON BETWEEN THE AMERICAN SOCIETY OF GASTROINTESTINAL ENDOSCOPY LEXICON AND THE CLAVIEN-DINDO CLASSIFICATION:DDW 2018 ASGE Program and AbstractsDDW 2018 ASGE Program and Abstracts
Efficacy and Safety of Peroral Endoscopic Myotomy for Treatment of Achalasia After Failed Heller Myotomy
In patients with persistent symptoms after Heller myotomy (HM), treatment options include repeat HM, pneumatic dilation, or peroral endoscopic myotomy (POEM). We evaluated the efficacy and safety of POEM in patients with achalasia with prior HM vs without prior HM