Endoscopic full thickness resection for gastric tumors originating from muscularis propria

AIM: To do systematic review of current literature for endoscopic full thickness resection(EFTR) technique for gastric tumors originating from muscularis propria.METHODS: An extensive English literature search was done till December 2015; using Pub Med and Google scholar to identify the peer reviewed original and review articles using keywords-EFTR, gastric tumor, muscularis propria. Human only studies were included. The references of pertinent studies were manually searched to identify additional relevant studies. The indications, procedural details, success rates, clinical outcomes, complications and limitations were considered. For the purpose of review, data from individual studies was combined to calculate mean. No other statistical test was applied.RESULTS: A total of 9 original articles were identified. Four articles were from same institute and the time frames of these studies were overlapping. To avoid duplication of data, only the study with patients over the longest time interval was included and other three were excluded. In total six studies were included in the final review. In our systematic review, the mean success rate for EFTR of gastric tumors originating from muscularis propria was 96.8%. The mean procedure time varied from a minimum of 37 min to a maximum of 105 min. There was no reported mortality from the technique itself. The most common histological diagnosis was gastrointestinal stromal tumors and leiomyoma. Gastric wall defect closure by either metallic clips or over the scope clip(OTSC) had similar outcomes although experience with OTSC was limited to smaller lesions(<3cm).CONCLUSION: EFTR is a minimally invasive technique to resect gastric submucosal tumors originating from muscularis propria with a high success rate and low complication rate.

Importance of reporting segmental bowel preparation scores during colonoscopy in clinical practice

AIM: To evaluate the impact of reporting bowel preparation using Boston Bowel Preparation Scale(BBPS) in clinical practice.METHODS: The study was a prospective observational cohort study which enrolled subjects reporting for screening colonoscopy. All subjects received a gallon of polyethylene glycol as bowel preparation regimen. After colonoscopy the endoscopists determined quality of bowel preparation using BBPS. Segmental scores were combined to calculate composite BBPS. Site and size of the polyps detected was recorded. Pathology reports were reviewed to determine advanced adenoma detection rates(AADR). Segmental AADR's were calculated and categorized based on the segmental BBPS to determine the differential impact of bowel prep on AADR. RESULTS: Three hundred and sixty subjects were enrolled in the study with a mean age of 59.2 years, 36.3% males and 63.8% females. Four subjects with incomplete colonoscopy due BBPS of 0 in any segment were excluded. Based on composite BBPS subjects were divided into 3 groups; Group-0(poor bowel prep, BBPS 0-3) n = 26(7.3%), Group-1(Suboptimal bowel prep, BBPS 4-6) n = 121(34%) and Group-2(Adequate bowel prep, BBPS 7-9) n = 209(58.7%). AADR showed a linear trend through Group-1 to 3; with an AADR of 3.8%, 14.8% and 16.7% respectively. Also seen was a linear increasing trend in segmental AADR with improvement in segmental BBPS. There was statistical significant difference between AADR among Group 0 and 2(3.8% vs 16.7%, P < 0.05), Group 1 and 2(14.8% vs 16.7%, P < 0.05) and Group 0 and 1(3.8% vs 14.8%, P < 0.05). χ2 method was used to compute P value for determining statistical significance.CONCLUSION: Segmental AADRs correlate with segmental BBPS. It is thus valuable to report segmental BBPS in colonoscopy reports in clinical practice.

Colon mucosal neoplasia referred for endoscopic mucosal resection:Recurrence of adenomas and prediction of submucosal invasion

BACKGROUND Endoscopic mucosal resection(EMR)is an effective and minimally invasive alternative to surgery for large polyps and laterally spreading lesions.Gross morphology and surface characteristics may help predict submucosal invasion of the lesion(SMIL)during endoscopic evaluation.This is one of the largest singlecenter studies reporting endoscopic mucosal resection for larger(≥20 mm)colorectal lesions in the United States.AIM To determine the recurrence rate of adenomas and endoscopic features that may predict submucosal invasion of colonic mucosal neoplasia.METHODS This is a retrospective cohort study of all the patients referred for endoscopic mucosal resection for lesions≥20 mm,spanning a period from January 2013 to February 2017.The main outcome measure was identifying features that may predict submucosal invasion of mucosal lesions and predict recurrence of adenomas on follow-up surveillance colonoscopy performed at 4-6 mo.RESULTS A total of 480 patients with 500 lesions were included in the study.The median age was 68(Inter quantile range:14)with 52%males.The most common lesion location was ascending colon(161;32%).Paris classification 0-IIa(Flat elevation of mucosa-316;63.2%);Kudo Pit Pattern IIIs(192;38%)and Granular surface morphology(260;52%)were most prevalent.Submucosal invasion was present in 23(4.6%)out of 500 lesions.The independent risk factors for SMIL were Kudo Pit Pattern IIIL+IV and V(Odds ratio:4.5;P value<0.004)and Paris classification 0-IIc(Odds ratio:18.2;P value<0.01).Out of 500,354 post-endoscopic mucosal resection scars were examined at surveillance colonoscopy.Recurrence was noted in 21.8%(77 cases).CONCLUSION There was overall low prevalence of SMIL in our study.Kudo pit pattern(IIIL+IV and V)and Paris classification 0-IIc were the only factors identified as an independent risk factor for submucosal invasion.The independent risk factor for recurrence was adenoma size(>40 mm).Almost all recurrences(98.8%)were treated endoscopically.