11 research outputs found
Endoscopic mucosal resection with anchoring of the snare tip: multicenter retrospective evaluation of effectiveness and safety
International audienc
A simplified table using validated diagnostic criteria is effective to improve characterization of colorectal polyps: the CONECCT teaching program
International audienceIntroduction and study aimsâAccurate real-time endoscopic characterization of colorectal polyps is key to choosing the most appropriate treatment. Mastering the currently available classifications is challenging. We used validated criteria for these classifications to create a single table, named CONECCT, and evaluated the impact of a teaching program based on this tool.MethodsâA prospective multicenter study involving GI fellows and attending physicians was conducted. During the first session, each trainee completed a pretest consisting in histological prediction and choice of treatment of 20 colorectal polyps still frames. This was followed by a 30-minute course on the CONECCT table, before taking a post-test using the same still frames reshuffled. During a second session at 3âââ6 months, a last test (T3âM) was performed, including these same still frames and 20 new ones.ResultsâA total 419 participants followed the teaching program between April 2017 and April 2018.âThe mean proportion of correctly predicted/treated lesions improved significantly from pretest to post-test and to T3âM, from 51.0â% to 74.0â% and to 66.6â% respectively (Pâ<â0.001). Between pretest and post-test, 343 (86.6â%) trainees improved, and 153 (75.4â%) at T3âM. Significant improvement occurred for each subtype of polyp for fellows and attending physicians. Between the two sessions, trainees continued to progress in the histology prediction and treatment choice of polyps CONECCT IIA. Over-treatment decreased significantly from 30.1â% to 15.5â% at post-test and to 18.5â% at T3âM (Pâ<â0.001).ConclusionâThe CONECCT teaching program is effective to improve the histology prediction and the treatment choice by gastroenterologists, for each subtype of colorectal polyp
Safe and effective digestive endoscopic resection in patients with cirrhosis: a single-center experience
Abstract BackgroundâEndoscopic resection has developed over the years. The main complications are perforation and bleeding. This study aimed to evaluate safety and effectiveness of digestive endoscopic resection in patients with cirrhosis. MethodsâThis retrospective, open-label, single-center study included all consecutive patients with cirrhosis who were admitted for endoscopic resection between 2009 and 2016. Safety, efficacy, and risk factors for delayed bleeding were analyzed. Resultsâ126 patients undergoing 164 procedures were included: 65 endoscopic resections (49 patients) in the upper gastrointestinal tract (esophagus 34, stomach 20, duodenum 11) and 99 in the lower gastrointestinal tract (77 patients). Mean Model for End-Stage Liver Disease score was 9.9 (standard deviation 4.5). Esophageal varices were present in 50 patients, and 21 patients had decompensated cirrhosis. The overall curative rate of endoscopic resection was 84.0â%. No patients died during 30-day follow-up. Immediate overall morbidity was 6.1â%, with two postoperative fevers and eight bleeds. Risk factors for delayed bleeding were duodenal location (Pâ<â0.01), antiplatelet medication (Pâ=â0.02), and lower glomerular filtration rate (GFR) (Pâ=â0.01) in univariate analysis. Duodenal location and lower GFR remained statistically significant in multivariate analysis, with respective odds ratios for bleeding of 52.12 and 1.04. No liver decompensation occurred after endoscopic resection. ConclusionsâEndoscopic resection was safe and effective in patients with mild (ChildâââPugh class A/B) cirrhosis, and should be proposed as a first option for treatment of superficial neoplasia. Additional data in patients with severe cirrhosis are needed to confirm the safety in this population
High pressure jet injection of viscous solutions for endoscopic submucosal dissection (ESD): first clinical experience.
Long lasting elevation is a key factor during endoscopic submucosal dissection (ESD) and can be obtained by water jet injection of saline solution or by viscous macromolecular solutions. In a previous animal study, we assessed the Nestis Enki II system to combine jet injection and viscous solutions. In the present work, we used this combination in humans in different sites of the digestive tract
Endoscopic submucosal dissection of appendicular lesions is feasible and safe: a retrospective multicenter study (with video)
International audienc
Diagnostic endoscopic submucosal dissection for colorectal lesions with suspected deep invasion
International audienceAbstract BackgroundâEndoscopic submucosal dissection (ESD) is potentially a curative treatment for T1 colorectal cancer under certain conditions. The aim of this study was to evaluate the feasibility and effectiveness of ESD for lesions with a suspicion of focal deep invasion. MethodsâIn this retrospective multicenter study, consecutive patients with colorectal neoplasia displaying a focal (< 15âmm) deep invasive pattern (FDIP) that were treated by ESD were included. We excluded ulcerated lesions (Paris III), lesions with distant metastasis, and clearly advanced tumors (tumoral strictures). Resultsâ124 patients benefited from 126 diagnostic dissection attempts for FDIP lesions. Dissection was feasible in 120/126 attempts (95.2â%) and, where possible, the en bloc and R0 resection rates were 95.8â% (115/120) and 76.7â% (92/120), respectively. Thirty-three resections (26.2â%) were for very low risk tumors, so considered curative, and 38 (30.2â%) were for low risk lesions. Noncurative R0 resections were for lesions with lymphatic or vascular invasion (LVI; nâ=â8), or significant budding (nâ=â9), and LVIâ+âbudding combination (nâ=â4). ConclusionâESD is feasible and safe for colorectal lesions with an FDIPââ€â15âmm. It was curative in 26.6â% of patients and could be a valid option for a further 30.6â% of patients with low risk T1 cancers, especially for frail patients with co-morbidities
Endoscopic resection of Barrett's adenocarcinoma: Intramucosal and lowârisk tumours are not associated with lymph node metastases
BACKGROUND: Superficial oesophageal adenocarcinoma can be resected endoscopically, but data to define a curative endoscopic resection are scarce. OBJECTIVE: Our study aimed to assess the risk of lymph node metastasis depending on the depth of invasion and histological features of oesophageal adenocarcinoma. METHODS: We retrospectively included all patients undergoing an endoscopic resection for T1 oesophageal adenocarcinoma among seven expert centres in France in 2004â2016. Mural invasion was defined as either intramucosal or submucosal tumours; the latter were further divided into superficial submucosal (1000 mm). Absence or presence of lymphovascular invasion and/or poorly differentiated cancer (G3) defined a lowârisk or a highârisk tumour, respectively. For submucosal tumours, invasion depth and histological features were systematically confirmed after a second dedicated histological assessment (new 2âmm thick slices) performed by a second pathologist. Occurrence of lymph node metastasis was recorded during the followâup from histological or PET CT reports when an invasive procedure was not possible. RESULTS: In total, 188 superficial oesophageal adenocarcinomas were included with a median followâup of 34 months. No lymph node metastases occurred for intramucosal oesophageal adenocarcinomas (n = 135) even with highârisk histological features. Among submucosal oesophageal adenocarcinomas, only tumours with lymphovascular invasion or poorly differentiated cancer or with a depth of invasion >1000 Όm developed lymph node metastasis tumours (n = 10/53%; 18.9%; hazard ratio 12.04). No metastatic evolution occurred under a 1000âmm threshold for all lowârisk tumours (0/25), nor under 1200 mm (0/1) and three over this threshold (3/13%, 23.1%). CONCLUSION: Intramucosal and lowârisk tumours with shallow submucosal invasion up to 1200 mm were not associated with lymph node metastasis during followâup. In case of highârisk features and/or deep submucosal invasion, endoscopic resections are not sufficient to eliminate the risk of lymph node metastasis, and surgical oesophagectomy should be carried out. These results must be confirmed by larger prospective series
Efficacy of Organ Preservation Strategy by Adjuvant Chemoradiotherapy after Non-Curative Endoscopic Resection for Superficial SCC: A Multicenter Western Study
Background. In case of high risk of lymph node invasion after endoscopic resection (ER) of superficial esophageal squamous cell carcinoma (SCC), adjuvant chemoradiotherapy (CRT) can be an alternative to surgery. We assessed long-term clinical outcomes of adjuvant therapy by CRT after non-curative ER for superficial SCC. Methods. We performed a retrospective multicenter study. From April 1999 to April 2018, all consecutive patients who underwent ER for SCC with tumor infiltration beyond the muscularis mucosae were included. Results. A total of 137 ER were analyzed. The overall nodal or metastatic recurrence-free survival rate at 5 years was 88% and specific recurrence-free survival rates at 5 years with and without adjuvant therapy were, respectively, 97.9% and 79.1% (p = 0.011). Independent factors for nodal and/or distal metastatic recurrence were age (HR = 1.075, p = 0.031), Sm infiltration depth > 200 ”m (HR = 4.129, p = 0.040), and the absence of adjuvant CRT or surgery (HR = 11.322, p = 0.029). Conclusion. In this study, adjuvant therapy is associated with a higher recurrence-free survival rate at 5 years after non-curative ER. This result suggests this approach may be considered as an alternative to surgery in selected patients
Endoscopic characterization of colorectal neoplasia with different published classifications: comparative study involving CONECCT classification
International audienceBackground and study aimsâThe aim of this study was to validate the COlorectal NEoplasia Classification to Choose the Treatment (CONECCT) classification that groups all published criteria (including covert signs of carcinoma) in a single table.Patients and methodsâFor this multicenter comparative study an expert endoscopist created an image library (nâ=â206 lesions; from hyperplastic to deep invasive cancers) with at least white light Imaging and chromoendoscopy images (virtual ± dye based). Lesions were resected/biopsied to assess histology. Participants characterized lesions using the Paris, Laterally Spreading Tumours, Kudo, Sano, NBI International Colorectal Endoscopic Classification (NICE), Workgroup serrAted polypS and Polyposis (WASP), and CONECCT classifications, and assessed the quality of images on a web-based platform. Krippendorff alpha and Cohenâs Kappa were used to assess interobserver and intra-observer agreement, respectively. Answers were cross-referenced with histology.ResultsâEleven experts, 19 non-experts, and 10 gastroenterology fellows participated. The CONECCT classification had a higher interobserver agreement (Krippendorff alphaâ=â0.738) than for all the other classifications and increased with expertise and with quality of pictures. CONECCT classification had a higher intra-observer agreement than all other existing classifications except WASP (only describing Sessile Serrated Adenoma Polyp). Specificity of CONECCT IIA (89.2, 95â% CI [80.4;94.9]) to diagnose adenomas was higher than the NICE2 category (71.1, 95â% CI [60.1;80.5]). The sensitivity of Kudo Vi, Sano IIIa, NICE 2 and CONECCT IIC to detect adenocarcinoma were statistically different (Pâ<â0.001): the highest sensitivities were for NICE 2 (84.2â%) and CONECCT IIC (78.9â%), and the lowest for Kudo Vi (31.6â%).ConclusionsâThe CONECCT classification currently offers the best interobserver and intra-observer agreement, including between experts and non-experts. CONECCT IIA is the best classification for excluding presence of adenocarcinoma in a colorectal lesion and CONECCT IIC offers the better compromise for diagnosing superficial adenocarcinoma
Endoscopic En Bloc Versus Piecemeal Resection of Large Nonpedunculated Colonic Adenomas
International audienc