Full-thickness resection device (FTRD) for treatment of upper gastrointestinal tract lesions: the first international experience.

Background and study aims The Full-Thickness Resection Device (FTRD) provides a novel treatment option for lesions not amenable to conventional endoscopic resection techniques. There are limited data on the efficacy and safety of FTRD for resection of upper gastrointestinal tract (GIT) lesions. Patients and methods This was an international multicenter retrospective study, including patients who had an endoscopic resection of an upper GIT lesion using the FTRD between January 2017 and February 2019. Results Fifty-six patients from 13 centers were included. The most common lesions were mesenchymal neoplasms (n = 23, 41 %), adenomas (n = 7, 13 %), and hamartomas (n = 6, 11 %). Eighty-four percent of lesions were located in the stomach, and 14 % in the duodenum. The average size of lesions was 14 mm (range 3 to 33 mm). Deployment of the FTRD was technically successful in 93 % of patients (n = 52) leading to complete and partial resection in 43 (77 %) and 9 (16 %) patients, respectively. Overall, the FTRD led to negative histological margins (R0 resection) in 38 (68 %) of patients. A total of 12 (21 %) mild or moderate adverse events (AEs) were reported. Follow-up endoscopy was performed in 31 patients (55 %), on average 88 days after the procedure (IQR 68-138 days). Of these, 30 patients (97 %) did not have any residual or recurrent lesion on endoscopic examination and biopsy, with residual adenoma in one patient (3 %). Conclusions Our results suggest a high technical success rate and an acceptable histologically complete resection rate, with a low risk of AEs and early recurrence for FTRD resection of upper GIT lesions

Endobiliary and Pancreatic Radiofrequency Ablations

Radio frequency ablation (RFA) involves use of thermal energy to perform ablation of tissues. It has a wide range of application in gastrointestinal tract. Over the last few years, several studies have reported successful and safe application in the biliary and pancreatic tissues. It is particularly beneficial in patients with biliary malignancies in whom it has shown to improve survival. Additionally, it can be applied in occluded metal stents secondary to tumor ingrowth to prolong the patency of stents. In pancreas, RFA can successfully ablate cystic lesions and neuroendocrine tumors. It has also been applied in unresectable pancreatic cancers. This review discusses the application of endobiliary and pancreatic RFAs

Endoscopic Management of a Complex Biliary Problem

Endoscopic interventions have become increasingly popular in the management of obstructive jaundice. In this case study, we present a case of complex Bismuth type 4 hilar stricture in an elderly lady presenting with obstructive jaundice. Complete endoscopic biliary drainage was accomplished successfully by placement of three metal stents – two with ERCP and one with Endoscopic Ultrasound (EUS) guided hepatico-gastrostomy. She developed cholecystitis later, which was successfully addressed by EUS guided gallbladder drainage using a cautery enhanced lumen apposing metal stent. Thus, a complete internal biliary drainage was achieved with endoscopic interventions

Steroid-Responsive Chronic Pancreatitides: Autoimmune Pancreatitis and Idiopathic Duct-Centric Chronic Pancreatitis

Two different forms of steroid-responsive pancreatitides are recognized, with both being referred to as “autoimmune pancreatitis.” They differ significantly in their clinical, histological, and epidemiological features. It has recently been suggested that the term “AIP” be reserved for the disease associated with elevated serum and tissue IgG4, while the term idiopathic duct centric chronic pancreatitis (IDCP) be used for pancreas-specific form. Clinically the most frequent presentation is painless obstructive jaundice with a mass/enlargement of the pancreas at imaging, and the differential diagnosis with cancer is frequently difficult. AIP is part of a multiorgan disorder called IgG4-related disease and any organ may be involved. Therefore, more than 50 % of the patients suffering from AIP present an inflammatory involvement of other organs (particularly bile ducts, kidneys, and salivary glands). Serum IgG4 elevation is not pathognomonic of AIP and serum IgG4 should be used in combination with other features to make a diagnosis of AIP. Both AIP and IDCP respond to steroids. In relapses of AIP the use of immunosuppressive drugs or of biologic agents may be considered