Browsing by Subject "Endoscopic resection"

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    A new through-the-scope clip with anchor prongs is safe and successful for a variety of endoscopic uses
    (Thieme, 2024-06-21) Guardiola, John J.; Rex, Douglas K.; Thompson, Christopher C.; Mosko, Jeffrey; Ryou, Marvin; Peetermans, Joyce; Rousseau, Matthew J.; von Renteln, Daniel; Medicine, School of Medicine
    Background and study aims Endoscopic through-the-scope clips (TTSC) are used for hemostasis and closure. We documented the performance of a new TTSC with anchor prongs. Patients and methods We conducted a prospective case series of the new TTSC in 50 patients with an indication for endoscopic clipping at three hospitals in the United States and Canada. Patients were followed for 30 days after the index procedure. Outcomes included defect closure and rate of serious adverse events (SAEs) related to the device or procedure. Results Fifty patients had 56 clipping procedures. Thirty-four procedures were clipping after endoscopic mucosal resection (EMR) in the colon (33) or stomach (1), 16 after polypectomy, two for hemostasis of active bleeding, and one each for fistula closure, per-oral endoscopic myotomy mucosal closure, or anchoring a feeding tube. Complete defect closure was achieved in 32 of 33 colon EMR defects and 21 of 22 other defects. All clips were placed per labeled directions for use. In 41 patients (82.0%), prophylaxis of delayed bleeding was reported as an indication for endoscopic clipping. There were three instances of delayed bleeding. There were no device-related SAEs. The only technical difficulty was one instance of premature clip deployment. Conclusions A novel TTSC with anchor prongs showed success in a range of defect closures, an acceptable safety profile, and low incidence of technical difficulties.
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    Frequency and nature of endoscopic and pathologic errors leading to referral for endoscopic resection to a tertiary center
    (Thieme, 2022-12-15) Lahr, Rachel E.; McWhinney, Connor D.; Cummings, Oscar W.; Rex, Douglas K.; Medicine, School of Medicine
    Background and study aims: We anecdotally encounter cases where referring endoscopists made errors in endoscopic interpretation of a colorectal lesion, sometimes combined with pathology errors at the referring centers, resulting in referral to our center for endoscopic resection. In this paper, we describe the frequency and nature of endoscopic and pathology errors leading to consultation for endoscopic resection. Patients and methods: Review of 760 consecutive referrals to our center over a 26-month interval. Results: In total, 28 (3.7 %) of all referred patients had ≥ 1 lesion that did not require any resection after investigation. There were 12 cases (1.6 % of all referrals) involving errors by both the referring endoscopist and the pathologist at the referring center. Errors commonly involved the ileocecal valve, lipomas, and mucosal prolapse changes. There were 15 additional referrals (2.0 % of all referrals) where no neoplastic lesion was identified at our center and either no biopsy was taken at the referring center (n = 9 patients, 10 lesions), the patient was referred although biopsy showed no neoplasia (n = 6), or the referring doctor correctly interpreted the lesion (lipoma), but the outside pathologist incorrectly reported adenoma (n = 1). Conclusions: Endoscopists at tertiary centers should expect referrals to clarify the nature of colorectal lesions as neoplastic or non-neoplastic. Community endoscopists with equivocal endoscopic findings and unexpected or equivocal pathology results can consider pathology review at their center or at an expert center before referral for endoscopic or surgical resection.