EARLY CLIP DISLODGEMENT AFTER USING GASTRODUODENAL FULL-THICKNESS ENDOSCOPIC RESECTION DEVICE IN REMOVAL OF SCARRED GASTRIC SUB-EPITHELIAL LESION LEADING TO DELAYED PERFORATION: A CASE SERIES
Peter C. JohnsonAbhishek AgnihotriDavid E. LorenThomas E. KowalskiAlexander SchlachtermanFaisal KamalAnand Kumar
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Keywords:
Perforation
Endoscopic mucosal resection
Endoscopic resection of early gastrointestinal cancer,including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD),has been increasingly accepted and used. The evidence suggests that lesions larger than 15 mm cannot be resected in one piece using the EMR technique. However,specimen of en bloc resection is critically important for pathological evaluation. ESD is a new endoscopic technique developed on this demand. For localized intramucosal lesion,ESD is not limited by the size of lesion,and is expected to replace conventional surgical operation in a certain proportion of early gastrointestinal cancer. However,it requires higher level of endoscopic skill and cautious and full pre-operative evaluation of the lesions including extent of lesion and infiltrating depth,and may associate with a higher incidence of severe complications,such as bleeding and perforation peri-and post-operatively. Indication,technique,and pathological assessment of ESD need to be further improved and perfected. Because ESD has many merits in the management of early gastrointestinal cancer,it is worth for endoscopists in hospitals with proper facilities to emphasize and perform this technique.
Endoscopic submucosal dissection
Perforation
Endoscopic mucosal resection
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Endoscopic mucosal resection
Perforation
Colon resection
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Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) carry a risk of perforation (4 %–10 % and < 1 %, respectively [1] [2]). It is essential that perforations are identified early during resection so they can be managed endoscopically to optimize patient outcomes.
Endoscopic submucosal dissection
Endoscopic mucosal resection
Perforation
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Endoscopic submucosal dissection
Perforation
Endoscopic mucosal resection
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Objective To study the endoscopic resection of stomach,colon tumor and efficacy of the method.Methods In August 2005-July 2008 endoscopic resection using sets of cap-type device,remove the stomach,colon tumors 30 cases.Results Complete resection in 27 cases,complete resection rate of 90%,follow-up of 3 June was no recurrence of bleeding in 4 cases,no perforation,stenosis.Conclusions This method is safe,effective,and to adapt to a wide range; clearly show lesions,precise set of cut is completely removed the key,pay attention to the amount of drugs mucosa bet,master the skills condensate cut can effectively prevent complications.
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SUMMARY A fatal infection with Gnathostoma spinigerum causing a perforated stomach is described in a 3‐year‐old cat. In a second debilitated case a small serosal perforation was found on a gastric lesion, while a third cat in good condition is described with a well developed stomach lesion but without perforation. Histopathological changes in the stomach were found in the submucosa and consisted of marked proliferation of fibrous tissue containing foci of inflammatory cells, necrotic tracts and a cavity in which the adult nematodes were found.
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Endoscopic mucosal resection
Perforation
Mucosal lesions
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Objective To investigate the time and clinical effects of transfer surgery for patients with upper gastrointestinal perforation who had received unsuccessful conservative treatment.Methods Clinical information of 11 patients with upper gastrointestinal perforation who suffered from aggravating abdominal pain and distension,demonstrated hyperpyrexia or shock and received transfer surgery 12 hours after receiving conservative treatment were analyzed retrospectively.Nine patients received perforation repair,one patient received routine palliative gastric cancer resection(subtotal gastrectomy),and one received radical distal gastric cancer resection.Results Ten patients were cured by transfer surgery and one died.Conclusion For patients with upper gastrointestinal perforation,if the clinical effects of early conservative treatment are poor and the peritonitis aggravates,the surgical treatment should be applied timely.
Perforation
Conservative Treatment
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Objective To study the endoscopic resection of stomach,colon tumor and efficacy of the method.Method From March 2006 to October 2009 endoscopic resection using sets of cap-type device,remove the stomach,colon tumors 15 cases.Results Complete resection in 14 cases,complete resection rate of 93.3%,follow-up of 3 or 6 months was no recurrence of bleeding in 2 cases,no perforation,stenosis.Conclusion This method is safe,effective,and to adapt to a wide range;clearly show lesions,precise set of cut is completely removed the key,pay attention to the amount of drugs mucosa bet,master the skills condensate cut can effectively prevent complications.
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Endoscopic mucosal resection
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This study reports on animal experiments regarding the safety of endoscopic esophageal mucosal resection with a ligating device (EEMRL), as well as the amount of mucosa which can be removed by this technique, the depth of resection and the feasibility of piecemeal resection.Three experiments were performed in six mongrel dogs under general anesthesia.When EEMRL was done without submucosal injection of saline, resection reached the muscular layer and caused esophageal perforation. The average dimensions of the mucosal pieces resected using 8-, 10-, and 12-mm devices was 13 x 10 mm, 18 x 15 mm, and 22 x 18 mm, respectively. Resection reached the mid-plane of the submucosa and the depth was almost uniform. After piecemeal resection, there was no macroscopically visible mucosa at the resection site and each mucosal piece was resected along the mid-plane of the submucosa.The experimental study indicated that submucosal injection of saline is essential to prevent esophageal perforation. It also showed that EEMRL allows resection up to the mid-plane of the submucosa, that the 12-mm device allows en bloc resection of lesions < or = 15 mm in diameter and that EEMRL is suitable for piecemeal resection.
Submucosa
Perforation
Endoscopic mucosal resection
Muscular layer
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