POST ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) STRICTURES - IS RISK RELATED TO PATHOLOGY? A EUROPEAN COMPARISON OF BARRETT’S VERSUS SQUAMOUS NEOPLASIA
Sophie ArndtzSharmila SubramaniamAsma AlkandariEjaz HossainMohamed E. A. AbdelrahimPA GaltieriGaia PellegattaStefan SeewaldRoberta MaselliAlessandro RepiciPrasha Bhandari
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Aims ESD is a minimally invasive therapeutic option for early oesophageal neoplasia, however is not without risk. In Europe, the complication profile is most established for Barrett’s neoplasia, being the predominant pathology, and stricture risk has been shown to be related to lesion circumference. Our aim was to compare the safety of ESD between Barrett’s and squamous neoplasia in a Western population.Keywords:
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Premalignant lesion
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The secondary prevention of cancer of the digestive system relies on the logical assumption that early detection benefits the patient. Endoscopy is the gold standard procedure in early detection of neoplasia (either confirmed cancer or high-grade and low-grade dysplasia), particularly when the morphology is not polypoid. Furthermore, diagnosis is often accompanied by treatment in the same endoscopy session.
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Background and Aims: The aim of this study was to retrospectively analyze use of argon plasma coagulation in lesions of the gastrointestinal tract. Materials and Methods: Data of 92 patients treated with an argon plasma coagulation system in the upper and lower gastrointestinal tract between May 2005 and November 2006, using a VIO argon plasma coagulation device (VIO 300 D with argon plasma coagulation 2; Erbe Elektromedizin, Tubingen, Germany; pulsed argon plasma coagulation, 20?120 W), were reviewed and analyzed. Results: Ninety-two patients were treated with argon plasma coagulation, and the mean age was 61.84 (3-91) years. Fifty of these patients were male (54.3%) and 42 (45.7%) were female. Ninety-two patients were treated in 155 sessions. The mean number of treatment sessions required was 1.68 (1?12). Indications were vascular lesions (24 patients), bleeding peptic ulcers or prevention of bleeding recurrence (19 patients), adjunctive therapy after piecemeal resection of colonic polyps (17 patients), palliative treatment of gastrointestinal tract cancers, treatment of bleeding after polypectomy or biopsy (11 patients), ablation of inlet patch (11 patients), ablation of Barrett?s esophagus (5 patients), radiation proctopathy (4 patients), and metallic stent cut (1 patient). There were no major complications observed. Minor complications were seen in only five patients (bleeding in 2, chest pain in 1, anal pain in 2 patients). Conclusions: Argon plasma coagulation system was an effective and safe method in various gastrointestinal pathologies.
Polypectomy
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Argon plasma coagulation is an innovative non-touch electrocoagulation technique. A broad spectrum of indications has been proposed for argon plasma coagulation since its introduction into endoscopy in 1991. The aim of this study is to evaluate the efficacy of utilizing argon plasma coagulation in the endoscopic hemostasis of non-ulcer, non-variceal gastrointestinal bleeding in Taiwan.A total of 26 consecutive patients (15 men, 11 women; mean age: 67.6 years) underwent argon plasma coagulation treatment between May 1999 and August 2000. Causes of bleeding included angiodysplasia in 3, tumor bleeding in 8, radiation colitis in 11, watermelon stomach in 1, Osler-Weber-Rendu syndrome in 1, and post-intervention in 2. Argon plasma coagulation was performed in 2 patients with bleeders in the esophagus, 10 in the stomach, 1 in the stomach and duodenum, and 13 in the colon.A total of 38 sessions of application in 26 patients were performed. Successful endoscopic argon plasma coagulation treatment was achieved in 21 (80.8%) patients. Neither complication nor mortality related to argon plasma coagulation was observed in these 26 patients.Argon plasma coagulation is a safe, efficacious, and low-cost hemostatic modality for non-ulcer, non-variceal gastrointestinal bleeding. It is mandatory to establish a comparative trial with other treatment modalities with a longer follow-up in the future.
Angiodysplasia
Electrocoagulation
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ObjectiveTo evaluate clinical efficacy on argon plasma coagulation(APC) treatment of Barrett esophagus(BE) under endoscopy.MethodsEighty-seven BE patients were diagnosed by endoscopy and pathology and treated by APC.Re-examined by endoscopy and pathology in the third month and sixth month after APC treatment.ResultsComplete squamous re-epithelialization were observed in 78 patients(89.7%) after 3 months,while remnant islands of columnar epithelium dispersedly in original lesion were observed in 9 patients(10.3%) and then retreated with APC.Complete squamous re-epithelialization were observed in all patients after six month.ConclusionAPC is a new therapeutic approach for BE without contact.It's more efficient and more convinent.
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Abstract CASE DESCRIPTION A 10-year-old neutered male mixed-breed dog was evaluated for a 5-year history of intermittent hematochezia and chronic anemia that were unresponsive to medical treatment. CLINICAL FINDINGS Colonoscopy revealed multifocal areas of coalescing tortuous mucosal blood vessels throughout the colon and rectum. Colonic vascular ectasia (angiodysplasia) was diagnosed on the basis of the endoscopic appearance of the lesions. TREATMENT AND OUTCOME The dog failed to respond to traditional medical treatments for colonic vascular ectasia and required multiple plasma and blood transfusions. The dog received 4 endoscopic-assisted argon plasma coagulation treatments, which resulted in long-term resolution of gastrointestinal hemorrhage. Colonic perforation occurred during the third argon plasma coagulation treatment. The perforation was surgically repaired. The dog remained free from clinical signs of colonic vascular ectasia for > 1 year after the third argon plasma coagulation treatment and was euthanized because of clinical deterioration associated with progressive heart disease. CLINICAL RELEVANCE Endoscopic-assisted argon plasma coagulation treatment is a novel treatment for dogs with colonic vascular ectasia and provided long-term resolution of clinical signs for the dog of this report. In human patients, complications associated with endoscopic-assisted argon plasma coagulation treatment include colonic perforation, which also occurred in the dog of this report.
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