Browsing by Subject "Endoscopic mucosal resection (EMR)"

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    Endoscopic treatments for early gastroesophageal lesions
    (AME, 2021) Srinivasan, Sachin; Hamade, Nour; Emura, Fabian; Sharma, Prateek; Medicine, School of Medicine
    Gastroesophageal (GEJ) carcinoma is well-recognized since the 1970s and has shown 2.5-fold increase in incidence since then. There still exists much controversy and ambiguity in the literature about the occurrence and recurrence of these lesions post-treatment. This has been attributed to the variability in the terms and definitions used in these junctional lesions. Despite this, great strides have been made in the treatment of early lesions decreasing morbidity and mortality from surgical treatment options. The current modalities involve ablation [like radiofrequency, cryo or argon plasma coagulation (APC)] and/or resection [endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD)] depending on the type and nature of lesion. These techniques are an effective tool demonstrating high rates of complete eradication of metaplasia or dysplasia (CE-IM/CE-D). It is crucial that the endoscopists are mindful about meticulous examination of the GEJ and Cardia as well as partake in appropriate surveillance post-endoscopic eradication. In addition, appropriate documentation of the location and type of lesion is also extremely important. This review aims to compare current endoscopic techniques in their efficacy, need for expertise and risk of complications when used in the treatment of early junctional lesions. Future studies and guideline recommendations to standardize definitions, diagnoses and post-treatment surveillance are needed.
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    Novel modified endoscopic mucosal resection of large GI lesions (> 20 mm) using an external additional working channel (AWC) may improve R0 resection rate: initial clinical experience
    (BMC, 2020-06-19) Sportes, A.; CFM, Jung; Gromski, M. A.; Koehler, P.; Seif Amir Hosseini, A.; Kauffmann, P.; Ellenrieder, V.; Wedi, E.; Medicine, School of Medicine
    Background En-bloc resection of large, flat dysplastic mucosal lesions of the luminal GI tract can be challenging. In order to improve the efficacy of resection for lesions ≥2 cm and to optimize R0 resection rates of lesions suspected of harboring high-grade dysplasia or early adenocarcinoma, a novel grasp and snare EMR technique utilizing a novel over the scope additional accessory channel, termed EMR Plus (EMR+), was developed. The aim of this pilot study is to describe the early safety and efficacy data from the first in human clinical cases. Methods A novel external over-the-scope additional working channel (AWC) (Ovesco, Tuebingen, Germany) was utilized for the EMR+ procedure, allowing a second endoscopic device to be used through the AWC while using otherwise standard endoscopic equipment. The EMR+ technique allows tissue retraction and a degree of triangulation during endoscopic resection. We performed EMR+ procedure in 6 patients between 02/2018–12/2018 for lesions in the upper and lower GI tract. Results The EMR+ technique utilizing the AWC was performed successfully in 6 resection procedures of the upper and/or lower GI tract in 6 patients in 2 endoscopy centers. All resections were performed successfully with the EMR+ technique, all achieving an R0 resection. No severe adverse events occurred in any of the procedures. Conclusions The EMR+ technique, utilizing an additional working channel, had an acceptable safety and efficacy profile in this preliminary study demonstrating it’s first use in humans. This technique may allow an additional option to providers to remove complex, large mucosal-based lesions in the GI tract using standard endoscopic equipment and a novel AWC device.
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    The demise of ORISE, a submucosal lifting agent for endoscopic resection
    (AME Publishing Company, 2023-04-04) Rex, Douglas K.; Lahr, Rachel E.; Medicine, School of Medicine