Browsing by Subject "Endoscopic mucosal resection"

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Diagnosis and Management of Clip Artifact on Endoscopic Mucosal Resection Scars
    (Millennium Medical Publishing, 2021) Rex, Douglas K.; Medicine, School of Medicine
    Delayed hemorrhage is the most common complication of endoscopic mucosal resection (EMR). Studies have shown that prophylactic placement of hemostatic clips on certain EMR scars reduces the risk of delayed hemorrhage. During endoscopic follow-up, mucosal distortions induced by clip closure known as clip artifact can be visualized. Clip artifact can be confused with residual neoplastic polyp, potentially leading to unnecessary treatment and complications. Clip artifact can be classified into 3 different types: Type 1: the presence of inflammation associated with continued clip attachment; Type 2: the presence of inflammation that persists after clip detachment; and Type 3: the presence of noninflamed mucosal distortions after clip detachment. Differentiation of clip artifact from residual neoplasia relies on careful analysis of colonic pit patterns. Management varies greatly; clip artifact requires no treatment, whereas residual polyp requires resection. This article reviews clip artifact and introduces a classification scheme to help endoscopists with diagnosis and management.
  • Thumbnail Image
    Item
    Endoscopic management of large ileocecal valve lesions over an 18-year interval
    (Thieme Open, 2019) Ponugoti, Prasanna L.; Broadley, Heather M.; Garcia, Jonathan; Rex, Douglas K.; Medicine, School of Medicine
    Background and study aims Ileocecal valve (ICV) lesions are challenging to remove endoscopically. Patients and methods This was a retrospective cohort study, performed at an academic tertiary US hospital. Sessile polyps or flat ICV lesions ≥ 20 mm in size referred for endoscopic mucosal resection (EMR) were included. Successful resection rates, complication rates and recurrence were compared to lesions ≥ 20 mm in size not located on the ICV. Results During an 18-year interval, there were 118 ICV lesions ≥ 20 mm with mean size 28.6 mm (44.9 % females; mean age 71.6 years), comprising 9.03 % of all referred polyps. Ninety ICV lesions (76.3 %) were resected endoscopically, compared to 91.3 % of non-ICV lesions (P < 0.001). However, in the most recent 8 years, successful EMR of ICV lesions increased to 93 %. Conventional adenomas comprised 92.2 % of ICV lesions and 7.8 % were serrated. Delayed hemorrhage and perforation occurred in 3.3 % and 0 % of ICV lesions, respectively, compared to 4.8 % and 0.5 % in the non-ICV group. At first follow-up, rates of residual polyp in the ICV and non-ICV groups were 16.5 % and 13.6 %, respectively (P = 0.485). At second follow-up residual rates in the ICV and non-ICV lesion groups were 18.6 % and 6.7 %, respectively (P = .005). Conclusions Large ICV polyps are a common source of tertiary referrals. Over an 18-year experience, risk of EMR for ICV polyps was numerically lower, and risk of recurrence was numerically higher at first follow and significantly higher at second follow-up compared to non-ICV polyps.
  • Thumbnail Image
    Item
    Ligation-assisted endoscopic mucosal resection of gastric heterotopic pancreas
    (Baishideng Publishing Group, 2009-06-14) Khashab, Mouen A; Cummings, Oscar W; DeWitt, John M
    Heterotopic pancreas is a congenital anomaly characterized by ectopic pancreatic tissue. Treatment of heterotopic pancreas may include expectant observation, endoscopic resection or surgery. The aim of this report was to describe the technique of ligation-assisted endoscopic mucosal resection (EMR) for resection of heterotopic pancreas of the stomach. Two patients (both female, mean age 32 years) were referred for management of gastric subepithelial tumors. Endoscopic ultrasound in both disclosed small hypoechoic masses in the mucosa and submucosa. Band ligation-assisted EMR was performed in both cases without complications. Pathology from the resected tumors revealed heterotopic pancreas arising from the submucosa. Margins were free of pancreatic tissue. Ligation-assisted EMR is technically feasible and may be considered for the endoscopic management of heterotopic pancreas.
  • Thumbnail Image
    Item
    Outcomes of submucosal (T1b) esophageal adenocarcinomas removed by endoscopic mucosal resection
    (Baishideng Publishing Group, 2016-12-16) Ballard, Darren D.; Choksi, Neel; Lin, Jingmei; Choi, Eun-Young; Elmunzer, B. Joseph; Appelman, Henry; Rex, Douglas K.; Fatima, Hala; Kessler, William; DeWitt, John M.; Department of Pathology and Laboratory Medicine, IU School of Medicine
    AIM: To investigate the outcomes and recurrences of pT1b esophageal adenocarcinoma (EAC) following endoscopic mucosal resection (EMR) and associated treatments. METHODS: Patients undergoing EMR with pathologically confirmed T1b EAC at two academic referral centers were retrospectively identified. Patients were divided into 4 groups based on treatment following EMR: Endoscopic therapy alone (group A), endoscopic therapy with either chemotherapy, radiation or both (group B), surgical resection (group C) or no further treatment/lost to follow-up (< 12 mo) (group D). Pathology specimens were reviewed by a central pathologist. Follow-up data was obtained from the academic centers, primary care physicians and/or referring physicians. Univariate analysis was performed to identify factors predicting recurrence of EAC. RESULTS: Fifty-three patients with T1b EAC underwent EMR, of which 32 (60%) had adequate follow-up ≥ 12 mo (median 34 mo, range 12-103). There were 16 patients in group A, 9 in group B, 7 in group C and 21 in group D. Median follow-up in groups A to C was 34 mo (range 12-103). Recurrent EAC developed overall in 9 patients (28%) including 6 (38%) in group A (median: 21 mo, range: 6-73), 1 (11%) in group B (median: 30 mo, range: 30-30) and 2 (29%) in group C (median 21 mo, range: 7-35. Six of 9 recurrences were local; of the 6 recurrences, 5 were treated with endoscopy alone. No predictors of recurrence of EAC were identified. CONCLUSION: Endoscopic therapy of T1b EAC may be a reasonable strategy for a subset of patients including those either refusing or medically unfit for esophagectomy.