AIM: To evaluate endoscopic mucosal resection (EMR)in patients with high-grade dysplasia (HGD) and/or intramucosal cancer (IMC) in Barrett's esophagus (BE).METHODS: Between June 2000 and December 2003,39 consecuti...AIM: To evaluate endoscopic mucosal resection (EMR)in patients with high-grade dysplasia (HGD) and/or intramucosal cancer (IMC) in Barrett's esophagus (BE).METHODS: Between June 2000 and December 2003,39 consecutive patients with HGD (35) and/or IMC (4)underwent EMR. BE ＞30 mm was present in 27 patients.In three patients with short segment BE (25.0%), HGDwas detected in a normal appearing BE. Lesions had a mean diameter of 14.8±10.3 mm. Mucosal resection was carried out using the cap method.RESULTS: The average size of resections was 19.7±9.4×14.6±8.2 mm. Histopathologic assessment postresection revealed 5 low-grade dysplasia (LGD) (12.8%),27 HGD (69.2%), 2 IMC (5.1%), and 5 SMC (-12.8%).EMR changed the pre-treatment diagnosis in 10 patients (25.6%). Three patients with SMC underwehtsurgery.Histology of the surgical specimen revealed 1 T0N0 and 2 T1N0 lesions. The remaining two patients were cancer free at 32.5 and 45.6 mo, respectively. A metachronous lesion was detected after 25 mo in one patient with HGD. Intra-procedural bleeding, controlled at endoscopy,occurred in four patients (10.3%). After a median followup of 34.9 mo, all patients remained in remission.CONCLUSION: In the medium term, EMR is effective and safe to treat HGD and/or IMC within BE and is a valuable staging method. It could become an alternative to surgery.展开更多
BACKGROUND Duodenal duplications are rare congenital anomalies of the gastrointestinal tract.As the periampullary variant is much rarer,literature is scant and only few authors have reported their experience in diagno...BACKGROUND Duodenal duplications are rare congenital anomalies of the gastrointestinal tract.As the periampullary variant is much rarer,literature is scant and only few authors have reported their experience in diagnosis and treatment,particularly with operative endoscopy.CASE SUMARY To report our experience with the endoscopic treatment in a series of children with periampullary duodenal duplication cysts,focusing on the importance of obtaining an accurate preoperative anatomic assessment of the malformations.The pediatric periampullary duodenal duplication cyst literature is reviewed.We conducted a systematic review according to the PRISMA guidelines.The PubMed database was searched for original studies on“duodenal duplication”,“periampullary duplication”or“endoscopic management”published since 1990,involving patients younger than 18 years of age.Eligible study designs were case report,case series and reviews.We analyzed the data and reported the results in table and text.Fifteen eligible articles met the inclusion criteria with 16 patients,and analysis was extended to our additional 4 cases.Median age at diagnosis was 13.5 years.Endoscopic treatment was performed in 10(50%)patients,with only 2 registered complications.CONCLUSION Periampullary duodenal duplication cysts in pediatric patients are very rare.Our experience suggests that an accurate preoperative assessment is critical.In the presence of sludge or stones inside the duplication,endoscopic retrograde cholangio-pancreatography is mandatory to demonstrate a communication with the biliary tree.Endoscopic treatment resulted in a safe,minimally invasive and effective treatment.In periampullary duodenal duplication cyst endoscopically treated children,long-term follow-up is still necessary considering the potential malignant transformation at the duplication site.展开更多
文摘AIM: To evaluate endoscopic mucosal resection (EMR)in patients with high-grade dysplasia (HGD) and/or intramucosal cancer (IMC) in Barrett's esophagus (BE).METHODS: Between June 2000 and December 2003,39 consecutive patients with HGD (35) and/or IMC (4)underwent EMR. BE ＞30 mm was present in 27 patients.In three patients with short segment BE (25.0%), HGDwas detected in a normal appearing BE. Lesions had a mean diameter of 14.8±10.3 mm. Mucosal resection was carried out using the cap method.RESULTS: The average size of resections was 19.7±9.4×14.6±8.2 mm. Histopathologic assessment postresection revealed 5 low-grade dysplasia (LGD) (12.8%),27 HGD (69.2%), 2 IMC (5.1%), and 5 SMC (-12.8%).EMR changed the pre-treatment diagnosis in 10 patients (25.6%). Three patients with SMC underwehtsurgery.Histology of the surgical specimen revealed 1 T0N0 and 2 T1N0 lesions. The remaining two patients were cancer free at 32.5 and 45.6 mo, respectively. A metachronous lesion was detected after 25 mo in one patient with HGD. Intra-procedural bleeding, controlled at endoscopy,occurred in four patients (10.3%). After a median followup of 34.9 mo, all patients remained in remission.CONCLUSION: In the medium term, EMR is effective and safe to treat HGD and/or IMC within BE and is a valuable staging method. It could become an alternative to surgery.
文摘BACKGROUND Duodenal duplications are rare congenital anomalies of the gastrointestinal tract.As the periampullary variant is much rarer,literature is scant and only few authors have reported their experience in diagnosis and treatment,particularly with operative endoscopy.CASE SUMARY To report our experience with the endoscopic treatment in a series of children with periampullary duodenal duplication cysts,focusing on the importance of obtaining an accurate preoperative anatomic assessment of the malformations.The pediatric periampullary duodenal duplication cyst literature is reviewed.We conducted a systematic review according to the PRISMA guidelines.The PubMed database was searched for original studies on“duodenal duplication”,“periampullary duplication”or“endoscopic management”published since 1990,involving patients younger than 18 years of age.Eligible study designs were case report,case series and reviews.We analyzed the data and reported the results in table and text.Fifteen eligible articles met the inclusion criteria with 16 patients,and analysis was extended to our additional 4 cases.Median age at diagnosis was 13.5 years.Endoscopic treatment was performed in 10(50%)patients,with only 2 registered complications.CONCLUSION Periampullary duodenal duplication cysts in pediatric patients are very rare.Our experience suggests that an accurate preoperative assessment is critical.In the presence of sludge or stones inside the duplication,endoscopic retrograde cholangio-pancreatography is mandatory to demonstrate a communication with the biliary tree.Endoscopic treatment resulted in a safe,minimally invasive and effective treatment.In periampullary duodenal duplication cyst endoscopically treated children,long-term follow-up is still necessary considering the potential malignant transformation at the duplication site.
