Therapeutic endoscopy plays a major role in the management of gastrointestinal (GI) neoplasia. Its indications can be generalized into four broad categories; to remove or obliterate neoplastic lesion, to palliate mali...Therapeutic endoscopy plays a major role in the management of gastrointestinal (GI) neoplasia. Its indications can be generalized into four broad categories; to remove or obliterate neoplastic lesion, to palliate malignant obstruction, or to treat bleeding. Only endoscopic resection allows complete histological staging of the cancer, which is critical as it allows stratification and refinement for further treatment. Although other endoscopic techniques, such as ablation therapy, may also cure early GI cancer, they can not provide a definitive pathological specimen. Early stage lesions reveal low frequency of lymph node metastasis which allows for less invasive treatments and thereby improving the quality of life when compared to surgery. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are now accepted worldwide as treatment modalities for early cancers of the GI tract.展开更多
AIM:To evaluate the proportion of successful complete cure en-bloc resections of large colorectal polyps achieved by endoscopic mucosal resection(EMR). METHODS:Studies using the EMR technique to resect large colorecta...AIM:To evaluate the proportion of successful complete cure en-bloc resections of large colorectal polyps achieved by endoscopic mucosal resection(EMR). METHODS:Studies using the EMR technique to resect large colorectal polyps were selected.Successful complete cure en-bloc resection was defined as one piece margin-free polyp resection.Articles were searched for in Medline,Pubmed,and the Cochrane Control Trial Registry,among other sources. RESULTS:An initial search identified 2620 reference articles,from which 429 relevant articles were selected and reviewed.Data was extracted from 25 studies(n =5221)which met the inclusion criteria.All the studies used snares to perform EMR.Pooled proportion of en-bloc resections using a random effect model was 62.85%(95%CI:51.50-73.52).The pooled proportion for complete cure en-bloc resections using a random effect model was 58.66%(95%CI:47.14-69.71).With higher patient load(>200 patients),this complete cure en-bloc resection rate improves from 44.19%(95%CI: 24.31-65.09)to 69.17%(95%CI:51.11-84.61). CONCLUSION:EMR is an effective technique for the resection of large colorectal polyps and offers an alternative to surgery.展开更多
Several reports have described an apparently uncommon clinicopathological disorder that is characterized by multifocal stenosing small-intestinal ulceration.Compared to Crohn's disease,the ulcers are not transmura...Several reports have described an apparently uncommon clinicopathological disorder that is characterized by multifocal stenosing small-intestinal ulceration.Compared to Crohn's disease,the ulcers are not transmural and typically remain shallow,and involve only the mucosa and submucosa.The disorder seems to be localized in the jejunum and proximal ileum only,and not the distal ileum or colon.Only nonspecif ic inflammatory changes are present without giant cells or other typical features of granulomatous inflammation.Most patients present clinically with recurrent obstructive events that usually respond to steroids,surgical resection,or both.With the development of newer imaging modalities to visualize the small-intestinal mucosa,such as double-balloon enteroscopy,improved understanding of the long-term natural history of this apparently distinctive disorder should emerge.展开更多
Recently, the development of endoscopic procedures has increased the availability of minimally invasive treatments; however, there have been few case reports of duodenal hemangioma treated by endoscopic mucosal resect...Recently, the development of endoscopic procedures has increased the availability of minimally invasive treatments; however, there have been few case reports of duodenal hemangioma treated by endoscopic mucosal resection. The present report describes a case of duodenal hemangioma that showed various endoscopic changes over time and was treated by endoscopic mucosal resection. An 80-year-old woman presented with tarry stools and a loss of appetite. An examination of her blood revealed severe anemia, and her hemoglobin level was 4.2 g/dL. An emergency upper gastrointestinal endoscopy was performed. A red, protrusive, semipedunculated tumor (approximately 20 mm in diameter) with spontaneous bleeding on its surface was found in the superior duodenal angle. Given the semipedunculated appearance of the tumor, it was suspected to be an epithelial tumor with a differential diagnosis of hyperplastic polyp. The biopsy results suggested a telangiectatic hemangioma. Because this lesion was considered to be responsible for her anemia, endoscopic mucosal resection was performed for diagnostic and treatment purposes after informed consent was obtained. A histopathological examination of the resected specimen revealed dilated and proliferated capillary lumens of various sizes, which confirmed the final diagnosis of duodenal hemangioma. Neither anemia nor tumor recurrence has been observed since the endoscopic mucosal resection (approximately 1 year). Duodenal hemangiomas can be treated endoscopically provided that sufficient consideration is given to all of the possible treatment strategies. Interestingly, duodenal hemangiomas show morphological changes that are influenced by various factors, such as mechanical stimuli.展开更多
OBJECTIVE To assess the results of endoscopic mucosal resection （EMR） of benign mucosal neoplasms located on the duodenal bulb using endoscope retroflexion. METHODS This study involved 14 patients with 16 mucosal ne...OBJECTIVE To assess the results of endoscopic mucosal resection （EMR） of benign mucosal neoplasms located on the duodenal bulb using endoscope retroflexion. METHODS This study involved 14 patients with 16 mucosal neoplasms located on the duodenal bulb. The diameter of each neoplasm was less than 15 mm. After endoscope retroflexion within the duodenum for evaluation of the size, extent and depth of the tumor, EMR was attempted with endoscope retroflexion for removing the lesion in the duodenal bulb. The rate of endoscope retroflexion, the time required for endoscope retroflexion, median operation time, curative resection rate, en bloc resection rate, complication, and median follow-up period were evaluated. RESULTS Sixteen lesions in 14 patents （median age of 56 years, 5 female, 9 male） were removed through EMR. The mean size of the lesions resected was 6.9 mm （median size of 5.5 mm, range of 3-15 mm）. Post-EMR histologic examination revealed Brunner＇s gland hyperplasia in 6, gastric mucosal metaplasia in 5, adenoma in 1, chronic inflammation in 3, and benign lymphocytic hyperplasia in 1. The curative resection rate was 100% （16/16）, and the en bloc resection rate was 94% （15/16）, with EMR. One of the lesions was piecemeal removed through EMR for its large size （15 mm） and for its involving the area from the duodenal bulb to the pyloric ring. The success rate of endoscope retroflexion within the duodenum was 94% （15/16）. The time required for endoscope retroflexion was longer for the first 10 lesions （median time of 2 min, range of 1-2.5 min） than that for the last 5 lesions （median time of 1.5 min, range of 1-2 min）. The median follow-up period was 22 months （range of 4-48 months）. During the follow-up, no residual, no pyloric or duodenal stenosis was found in any of the patients after EMR. There was no severe hemorrhage, or perforations occurring. CONCLUSION EMR of mucosal neoplasm located on the duodenal bulb through endoscope retroflexion, which is a feasible and useful adjunctive procedure, appears to be a safe and effective technique.展开更多
文摘Therapeutic endoscopy plays a major role in the management of gastrointestinal (GI) neoplasia. Its indications can be generalized into four broad categories; to remove or obliterate neoplastic lesion, to palliate malignant obstruction, or to treat bleeding. Only endoscopic resection allows complete histological staging of the cancer, which is critical as it allows stratification and refinement for further treatment. Although other endoscopic techniques, such as ablation therapy, may also cure early GI cancer, they can not provide a definitive pathological specimen. Early stage lesions reveal low frequency of lymph node metastasis which allows for less invasive treatments and thereby improving the quality of life when compared to surgery. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are now accepted worldwide as treatment modalities for early cancers of the GI tract.
文摘AIM:To evaluate the proportion of successful complete cure en-bloc resections of large colorectal polyps achieved by endoscopic mucosal resection(EMR). METHODS:Studies using the EMR technique to resect large colorectal polyps were selected.Successful complete cure en-bloc resection was defined as one piece margin-free polyp resection.Articles were searched for in Medline,Pubmed,and the Cochrane Control Trial Registry,among other sources. RESULTS:An initial search identified 2620 reference articles,from which 429 relevant articles were selected and reviewed.Data was extracted from 25 studies(n =5221)which met the inclusion criteria.All the studies used snares to perform EMR.Pooled proportion of en-bloc resections using a random effect model was 62.85%(95%CI:51.50-73.52).The pooled proportion for complete cure en-bloc resections using a random effect model was 58.66%(95%CI:47.14-69.71).With higher patient load(>200 patients),this complete cure en-bloc resection rate improves from 44.19%(95%CI: 24.31-65.09)to 69.17%(95%CI:51.11-84.61). CONCLUSION:EMR is an effective technique for the resection of large colorectal polyps and offers an alternative to surgery.
文摘Several reports have described an apparently uncommon clinicopathological disorder that is characterized by multifocal stenosing small-intestinal ulceration.Compared to Crohn's disease,the ulcers are not transmural and typically remain shallow,and involve only the mucosa and submucosa.The disorder seems to be localized in the jejunum and proximal ileum only,and not the distal ileum or colon.Only nonspecif ic inflammatory changes are present without giant cells or other typical features of granulomatous inflammation.Most patients present clinically with recurrent obstructive events that usually respond to steroids,surgical resection,or both.With the development of newer imaging modalities to visualize the small-intestinal mucosa,such as double-balloon enteroscopy,improved understanding of the long-term natural history of this apparently distinctive disorder should emerge.
文摘Recently, the development of endoscopic procedures has increased the availability of minimally invasive treatments; however, there have been few case reports of duodenal hemangioma treated by endoscopic mucosal resection. The present report describes a case of duodenal hemangioma that showed various endoscopic changes over time and was treated by endoscopic mucosal resection. An 80-year-old woman presented with tarry stools and a loss of appetite. An examination of her blood revealed severe anemia, and her hemoglobin level was 4.2 g/dL. An emergency upper gastrointestinal endoscopy was performed. A red, protrusive, semipedunculated tumor (approximately 20 mm in diameter) with spontaneous bleeding on its surface was found in the superior duodenal angle. Given the semipedunculated appearance of the tumor, it was suspected to be an epithelial tumor with a differential diagnosis of hyperplastic polyp. The biopsy results suggested a telangiectatic hemangioma. Because this lesion was considered to be responsible for her anemia, endoscopic mucosal resection was performed for diagnostic and treatment purposes after informed consent was obtained. A histopathological examination of the resected specimen revealed dilated and proliferated capillary lumens of various sizes, which confirmed the final diagnosis of duodenal hemangioma. Neither anemia nor tumor recurrence has been observed since the endoscopic mucosal resection (approximately 1 year). Duodenal hemangiomas can be treated endoscopically provided that sufficient consideration is given to all of the possible treatment strategies. Interestingly, duodenal hemangiomas show morphological changes that are influenced by various factors, such as mechanical stimuli.
文摘OBJECTIVE To assess the results of endoscopic mucosal resection （EMR） of benign mucosal neoplasms located on the duodenal bulb using endoscope retroflexion. METHODS This study involved 14 patients with 16 mucosal neoplasms located on the duodenal bulb. The diameter of each neoplasm was less than 15 mm. After endoscope retroflexion within the duodenum for evaluation of the size, extent and depth of the tumor, EMR was attempted with endoscope retroflexion for removing the lesion in the duodenal bulb. The rate of endoscope retroflexion, the time required for endoscope retroflexion, median operation time, curative resection rate, en bloc resection rate, complication, and median follow-up period were evaluated. RESULTS Sixteen lesions in 14 patents （median age of 56 years, 5 female, 9 male） were removed through EMR. The mean size of the lesions resected was 6.9 mm （median size of 5.5 mm, range of 3-15 mm）. Post-EMR histologic examination revealed Brunner＇s gland hyperplasia in 6, gastric mucosal metaplasia in 5, adenoma in 1, chronic inflammation in 3, and benign lymphocytic hyperplasia in 1. The curative resection rate was 100% （16/16）, and the en bloc resection rate was 94% （15/16）, with EMR. One of the lesions was piecemeal removed through EMR for its large size （15 mm） and for its involving the area from the duodenal bulb to the pyloric ring. The success rate of endoscope retroflexion within the duodenum was 94% （15/16）. The time required for endoscope retroflexion was longer for the first 10 lesions （median time of 2 min, range of 1-2.5 min） than that for the last 5 lesions （median time of 1.5 min, range of 1-2 min）. The median follow-up period was 22 months （range of 4-48 months）. During the follow-up, no residual, no pyloric or duodenal stenosis was found in any of the patients after EMR. There was no severe hemorrhage, or perforations occurring. CONCLUSION EMR of mucosal neoplasm located on the duodenal bulb through endoscope retroflexion, which is a feasible and useful adjunctive procedure, appears to be a safe and effective technique.
