Endoscopic Submucosal Dissection: A Safe and Effective Alternative to Surgical Intervention for Esophageal Hemangioma.

BACKGROUND: Hemangiomas represent 3% of all benign esophageal tumors. Conventional esophagectomy is the standard treatment with its invasive nature and possible surgical complications. Now, less invasive techniques are used with better results. Endoscopic submucosal dissection (ESD) is one of the novel noninvasive methods used for en bloc removal of tumors. No available data about the use of ESD in removing esophageal hemangioma. Here, we studied the validity and safety of ESD as a minimally invasive procedure to remove esophageal hemangioma. METHODS: Three patients were diagnosed with esophageal hemangioma and underwent ESD with en bloc resection. Endoscopic ultrasound (EUS) was performed before ESD to better evaluate the layer of origin and vascularity and guard against perforation. Patients were followed up postintervention to document possible complications. RESULTS: Among the 3 studied patients, one presented with chronic abdominal pain, the second was complaining of dysphagia, and the third patient was diagnosed accidentally. Pathology reports confirmed the diagnosis of hemangiomas in all cases with no atypia and complete removal of the lesions. No complications were reported during the procedure or over the follow-up period. CONCLUSIONS: ESD is a proper, minimally invasive method with good en bloc resection that can be used in cases of esophageal hemangiomas.

Treatment of obesity by endoscopic gastric intramural injection of botulinum toxin A: a randomized clinical trial.

BACKGROUND/AIMS: Botulinum toxin A (BTX-A) is an inhibitor of muscular contractions in both striated and smooth muscle. The purpose of this study was to observe the safety and efficacy of endoscopic injections of BTX-A into the gastric wall in obese patients. METHODOLOGY: Twenty obese patients (BMI >28 kg/m2) were randomized into two groups: Group 1 (200 U BTX-A) and Group 2 (300 U BTX-A). For each patient, 20 puncture sites were selected into the gastric wall. Body weights and BMIs were recorded and gastric emptying times were determined before treatment and 1, 4 and 12 weeks after treatment. Blood samples for cholesterol, triglycerides, insulin, leptin, motilin, peptide tyrosine (PYY) and ghrelin levels were obtained before treatment and 1, 4 and 12 weeks after treatment. RESULTS: Nineteen patients completed the follow-up. Both groups showed significant body weight and BMI decrease (p<0.05) with decreased TG levels. The gastric emptying times were longer than those before treatment in both groups, especially at the 1-week point (p<0.05). A significant decrease in fasting ghrelin levels in all 19 obese patients was found after BTX-A administration 4 weeks later, and PYY levels in all 19 patients decreased, especially at the 12-week point. No severe complications were observed. CONCLUSIONS: Endoscopic multi-punctures of BTX-A including fundic injections may decrease body weight and BMI by delaying the gastric emptying time. The effect of BTX-A on ghrelin levels may also be involved in the reduction of appetite.