Aims The adoption of endoscopic submucosal dissection (ESD) as the main treatment for large colorectal lesions is still limited in the West. A recent high-quality study showed colorectal ESD has been proved equally safe and more effective than piecemeal endoscopic mucosal resection (EMR). Reproducibility outside experts centers has been questioned. Therefore, we evaluated results according to volume case load per year in a large multicentric prospective cohort of colorectal ESDs.
Aims Cirrhotic patients are considered to be at high risk for esophageal cancer. Nowadays, endoscopic resection is the standard treatment for superficial tumors. Data are lacking about the management of portal hypertension in patients diagnosed with endoscopically resectable tumors. This study aims to assess safety, effectiveness and methods to prevent potential complications, especially bleeding in portal hypertension context.
La caractérisation endoscopique des lésions néoplasiques colorectales est un élément clef pour choisir en cours de coloscopie la meilleure thérapeutique pour le patient. Cette caractérisation repose sur 5 classifications actuellement, difficiles à combiner pour les non-experts. Nous avons donc mixé les critères validés dans une classification unique (CONECCT) pour simplifier la prédiction histologique et le choix thérapeutique. Cette étude visait à mesurer le bénéfice de cette classification pour la caractérisation.
Background and study aims: The differential diagnosis of solitary pancreatic cystic lesions is frequently difficult. Needle-based confocal laser endomicroscopy (nCLE) performed during endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a new technology enabling real-time imaging of the internal structure of such cysts. The aim of this pilot study was to identify and validate new diagnostic criteria on nCLE for pancreatic cystic lesions. Patients and methods: A total of 31 patients with a solitary pancreatic cystic lesion of unknown diagnosis were prospectively included at three centers. EUS-FNA was combined with nCLE. The final diagnosis was based on either a stringent gold standard (surgical specimen and/or positive cytopathology) or a committee consensus. Six nonblinded investigators reviewed nCLE sequences from patients with the most stringent final diagnosis, and identified a single feature that was only present in serous cystadenoma (SCA). The findings were correlated with the pathology of archived specimens. After a training session, four blinded independent observers reviewed a separate independent video set, and the yield and interobserver agreement for the criterion were assessed. Results: A superficial vascular network pattern visualized on nCLE was identified as the criterion. It corresponded on pathological specimen to a dense and subepithelial capillary vascularization only seen in SCA. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of this sign for the diagnosis of SCA were 87 %, 69 %, 100 %, 100 %, and 82 %, respectively. Interobserver agreement was substantial (κ = 0.77). Conclusion: This new nCLE criterion seems highly specific for the diagnosis of SCA. The visualization of this criterion could have a direct impact on the management of patients by avoiding unnecessary surgery or follow-up. Clinicaltrials.gov NCT01563133.
Aims Dysplasia is frequent in Inflammatory Bowel Disease (IBD) patients and can be managed endoscopically providing organ sparing. Endoscopic submucosal dissection (ESD) allows en-bloc resection and very low recurrence rates. We aimed to assess the efficacy of ESD in IBD patients for visible dysplasia.
Abstract Background Endoscopic 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. Methods This 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. Results 126 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 84.0 %. No patients died during 30-day follow-up. Immediate overall morbidity was 6.1 %, with two postoperative fevers and eight bleeds. Risk factors for delayed bleeding were duodenal location (P < 0.01), antiplatelet medication (P = 0.02), and lower glomerular filtration rate (GFR) (P = 0.01) 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. Conclusions Endoscopic resection was safe and effective in patients with mild (Child – Pugh 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.
Avec un endoscope de petit diamètre, la gastroscopie peut être réalisée par voie nasale chez l'adulte, ce qui en améliore la tolérance (1, 2). Le but de cette étude était d'évaluer l'intérêt d'un nouveau vidéo-endoscope de très petit diamètre avec simple béquillage, pour la faisabilité, l'efficacité et la tolérance de la gastroscopie par voie nasale.
Endoscopic resection of adenomas prevents colorectal cancer, but the optimal technique for larger lesions is controversial. Piecemeal endoscopic mucosal resection (EMR) has a low adverse event (AE) rate but a variable recurrence rate necessitating early follow-up. Endoscopic submucosal dissection (ESD) can reduce recurrence but may increase AEs.
