Endoscopic Submucosal Dissection of Early Gastric Cancer Using the Insulated Tip Knife

AbstractEndoscopic submucosal dissection (ESD) is an endoscopic technique in which a gastrointestinal mucosal neoplasm can be excised by cutting through the submucosa with an endoscopic knife. It can be used with diagnostic or therapeutic intent and allows en bloc removal of the specimen. ESD usually begins with identification and evaluation of the lesion and assessment of the margin with chromo-endoscopy. The subsequent steps include marking, submucosal injection, and circumferential and submucosal dissection. Complications should be promptly recognized and dealt with immediately if necessary.This video demonstrates the main steps of the technique and management of complications. This article is part of an expert video encyclopedia

Risk Factors for Bleeding After Gastric Endoscopic Submucosal Dissection: a Systematic Review and Meta-Analysis

BACKGROUND AND AIMS: Postprocedural bleeding (PPB) is the most common adverse event associated with endoscopic resection. Several studies have tried to identify risk factors for PPB after gastric EMR and endoscopic submucosal dissection (ESD), with controversial results. This systematic review and meta-analysis aimed to identify significant risk factors for PPB after gastric EMR and ESD. METHODS: Three online databases were searched. Pooled odds ratio (OR) was computed for each risk factor using a random-effects model, and heterogeneity was assessed by Cochran's Q test and I(2). RESULTS: Seventy-four articles were included. Pooled PPB rate was 5.1% (95% confidence interval, 4.5%-5.7%), which did not vary according to different study designs. Male sex (OR, 1.25), cardiopathy (OR, 1.54), antithrombotic drugs (OR, 1.63), cirrhosis (OR, 1.76), chronic kidney disease (OR, 3.38), tumor size > 20 mm (OR, 2.70), resected specimen size > 30 mm (OR, 2.85), localization in the lesser curvature (OR, 1.74), flat/depressed morphology (OR, 1.43), carcinoma histology (OR, 1.46), and ulceration (OR, 1.64) were identified as significant risk factors for PPB, whereas age, hypertension, submucosal invasion, fibrosis, and localization (upper, middle, or lower third) were not. Procedure duration > 60 minutes (OR, 2.05) and the use of histamine-2 receptor antagonists instead of proton pump inhibitors (OR, 2.13) were the procedural factors associated with PPB, whereas endoscopist experience and preprocedural proton pump inhibitors were not. Second-look endoscopy was not associated with decreased PPB (OR, 1.34; 95% confidence interval, .85-2.12). CONCLUSIONS: Risk factors for PPB were identified that can help to guide management after gastric ESD, namely adjusting further management. Second-look endoscopy is not associated with decreased PPB.info:eu-repo/semantics/publishedVersio

Influence of Genetic Polymorphisms in Prostaglandin E2 Pathway (COX-2/HPGD/SLCO2A1/ABCC4) on the Risk for Colorectal Adenoma Development and Recurrence after Polypectomy

OBJECTIVES: Deregulation of prostaglandin E2 (PGE2) levels reported in colorectal carcinogenesis contributes to key steps of cancer development. Our aim was to evaluate the influence of the genetic variability in COX-2/HPGD/SLCO2A1/ABCC4 PGE2 pathway genes on the development and recurrence of colorectal adenomas. METHODS: A case-control study was conducted gathering 480 unscreened individuals and 195 patients with personal history of adenomas. A total of 43 tagSNPs were characterized using the Sequenom platform or real-time PCR. RESULTS: Ten tagSNPs were identified as susceptibility biomarkers for the development of adenomas. The top three most meaningful tagSNPs include the rs689466 in COX-2 (odds ratio (OR)=3.23; 95% confidence interval (CI): 1.52-6.86), rs6439448 in SLCO2A1 (OR=0.38; 95% CI: 0.22-0.65) and rs1751051 in ABCC4 genes (OR=2.75; 95% CI: 1.58-4.80). The best four-locus gene-gene interaction model included the rs1346271, rs1863642 and rs12500316 single nucleotide polymorphisms in HPGD and rs1678405 in ABCC4 genes and was associated with a 13-fold increased susceptibility (95% CI: 3.84-46.3, P<0.0001, cross-validation (CV) accuracy: 0.78 and CV consistency: 8/10). Interesting, in low-risk patients the ABCC4 rs9524821AA genotype was associated not only with a higher hazard ratio (HR=2.93; 95% CI: 1.07-8.03), but half of these patients had adenoma recurrence at 60 months, considerably higher than the 21% noticed in low-risk patients. CONCLUSIONS: Genetic polymorphisms in COX-2/PGE2 pathway appear to contribute to the development of colorectal adenomas and influence the interval time to adenomas recurrence. The definition of risk models through the inclusion of genetic biomarkers might improve the adherence and optimization of current screening and surveillance guidelines for colorectal cancer prevention.Financial support: This study was supported by a research grant from the Instituto Português de Oncologia do Porto— Centro de Investigação. Furthermore, C.P. was a recipient of a PhD grant (SFRH/BD/64805/2009) from FCT— Fundacão para a Ciência e Tecnologia, co-financed by European Social Funds (ESF) under Human Potential Operation Programme (POPH) from National Strategic Reference Framework (NSRF) and Liga Portuguesa Contra o Cancro—Núcleo Regional do Norte. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.info:eu-repo/semantics/publishedVersio

Mechanical joining methods for additive manufactured assembly tools

The use of additive manufacturing (AM) processes is growing in the manufacturing industry. One application with great potential for using these processes is the manufacture of assembly tools for a high-ly competitive markets, such as the automotive industry. A critical aspect of the assembly tool design is its capability to incorporate modifications even at a late stage of its development in very short time. In many cases, these modifications are achieved using metal inserts in the polymeric tool, which allow to add new geometric features. This capability increases the usefulness and versatility of components produced by AM and compensate for potential shortcomings of using additive mate-rials. The purpose of this paper is to evaluate the potential use of accessories in additive manufactured com-ponents. In addition, the effect of different percentages of infill tool material on the joining quality of accesso-ries is evaluated. This is done by performing a screw pull-out test on a ABS ESD-7 part, produced by fused deposition modelling. The following different joining solutions were compared and studied in this work: em-bedded inserts, glue, heating processes, pressure (Tap-in) and creation of threads, such as, printing the thread directly and machining the thread onto the material.Programa Operacional Competitividade e Internacionalização - COMPETE 2020, Projeto nº 002814, Ref. POCI-01-0247-FEDER-002814 entre a Univ. do Minho e a Bosc

Validation of a fluorescence in situ hybridization method using peptide nucleic acid probes for detection of helicobacter pylori clarithromycin resistance in gastric biopsy specimens

Here, we evaluated a previously established peptide nucleic acid-fluorescence in situ hybridization (PNA-FISH) method as a new diagnostic test for Helicobacter pylori clarithromycin resistance detection in paraffin-embedded gastric biopsy specimens. Both a retrospective study and a prospective cohort study were conducted to evaluate the specificity and sensitivity of a PNA-FISH method to determine H. pylori clarithromycin resistance. In the retrospective study (n 30 patients), full agreement between PNA-FISH and PCR-sequencing was observed. Compared to the reference method (culture followed by Etest), the specificity and sensitivity of PNA-FISH were 90.9% (95% confidence interval [CI], 57.1% to 99.5%) and 84.2% (95% CI, 59.5% to 95.8%), respectively. In the prospective cohort (n 93 patients), 21 cases were positive by culture. For the patients harboring clarithromycin- resistant H. pylori, the method showed sensitivity of 80.0% (95% CI, 29.9% to 98.9%) and specificity of 93.8% (95% CI, 67.7% to 99.7%). These values likely represent underestimations, as some of the discrepant results corresponded to patients infected by more than one strain. PNA-FISH appears to be a simple, quick, and accurate method for detecting H. pylori clarithromycin resistance in paraffin-embedded biopsy specimens. It is also the only one of the methods assessed here that allows direct and specific visualization of this microorganism within the biopsy specimens, a characteristic that allowed the observation that cells of different H. pylori strains can subsist in very close proximity in the stomach

Presentation and validation of a new optical sensing concept based in a 3d-printing solution

In high competitive markets, such as the automotive industry, the better quality of products, reduction of manufacturing costs and the fulfilment of all delivery deadlines can only be achieved through continuous improvement of production capabilities. One current strategy is to develop and create smarter and adaptive assembly tools. Automation is a relevant area of development in the current industrial world and the baseline of the fourth industrial revolution (Industry 4.0). Namely, it is very important to use sensing components on jigs for assembly parts in the production line. The arrangement of sensing components on the assembly tools is very dependent of the product, making the project more complex and less flexible. This issue can penalise the productivity heavily, especially if a wide range of products and changeover operations are usual. The use of Additive Manufacturing (AM) is growing in the industry and offers a high potential for research and development in the present stage. The AM is advantageous in many areas, especially in the rapid construction of complex tools (RP). This paper presents a new optical sensing concept based on the 3D printing of internal circuits in the assembly tools. This solution can bring many advantages and increase tools flexibility.Programa Operacional de Competividade e Internacionalização - COMPETE 2020, Projeto nº 002814; Ref. POCI-01-0247-FEDER-002814, entre a Univ. Minho e a Bosc

A multicenter validation of an endoscopic classification with narrow band imaging for gastric precancerous and cancerous lesions

BACKGROUND AND STUDY AIM: The reliability and external validity of narrow band imaging (NBI) in the stomach have not been described consistently. The aim of the current study was to describe and estimate the accuracy and reliability of a simplified classification system for NBI in the diagnosis of gastric lesions. METHODS: Consecutive patients undergoing NBI endoscopy at two reference centers (n=85, 33% with dysplasia) were included in two studies. In total, 224 different areas were biopsied and recorded onto video. In the derivation study, previously described NBI features were analyzed in order to develop a simplified classification. In the validation study the accuracy and reliability of this classification were estimated among three groups of endoscopists with different levels of expertise in NBI. .RESULTS: The reliability/accuracy results from the derivation study allowed the creation of a simplified NBI classification. In the validation study, "regular vessels with circular mucosa" (pattern A) was associated with normal histology (accuracy 83%; 95% confidence interval [CI] 75?%-90%); "tubulo-villous mucosa" (pattern B) was associated with intestinal metaplasia (accuracy 84%; 95CI 77%-91%; positive likelihood ratio [LR+]=4.75); and "irregular vessels and mucosa" (pattern C) was associated with dysplasia (accuracy 95%; 95CI 90%-99%; LR+=44.33). The reproducibility of these patterns was high (k=0.62). "Light-blue crest" was moderately reliable (k=0.49) but specific (87%) for intestinal metaplasia. A variable vascular density (additional pattern+) was the best feature for Helicobacter pylori gastritis (accuracy 70%; 95CI 59%-80%) but showed only fair reliability (k=0.38). Non-experienced endoscopists presented lower agreement (k=0.6 vs. k=0.75) and accuracy (74% vs. 86%) than international experts/experienced endoscopists. CONCLUSION: A simplified NBI classification is accurate and reliable for the diagnosis of intestinal metaplasia and dysplasia. The classification should be further assessed and validated on a per-patient assessment of NBI, and by comparing NBI with other imaging technologies.This study was supported by a grant for medical investigation from the Portuguese Digestive Endoscopy Society (SPED 2009 Investigation Grant)

Metal oxide nanostructures for sensor applications

Electrorheological fluids have been paying a lot of attention due to their potential use in active control of various devices in mechanics, biomedicine or robotics. An electrorheological fluid consisting of polarizable particles dispersed in a non-conducting liquid is considered to be one of the most interesting and important smart fluids. This work presents the effect of the dopant, camphorsulphonic acid or citric acid, on the electrorheological behaviour of suspensions of doped polyaniline nanostructures dispersed in silicone oil, revealing its key role. The influence of carbon nanoparticle concentration has also been studied for these dispersions. All the samples showed an electrorheological effect, which increased with electric field and nanostructure concentration and decreased with silicone oil viscosity. However, the magnitude of this effect was strongly influenced not only by carbon nanoparticle concentration but also by the dopant material. The electrorheological effect was much lower with a higher carbon nanoparticle concentration and doped with citric acid. The latter is probably due to the different acidities of the dopants that lead to a different conductivity of polyaniline nanostructures. Furthermore, the effect of the carbon nanoparticles could be related to its charge trapping mechanism, while the charge transfer through the polymeric backbone occurs by hopping. Polyaniline/camphorsulphonic acid composite nanostructures dispersed in silicone oil exhibited the highest electrorheological activity, higher than three decades increase in apparent viscosity for low shear rates and high electric fields, showing their potential application as electrorheological smart materials.authorsversionpublishe