RESUMO
BACKGROUND AND AIMS: Nonampullary small-bowel adenomas ≥10 mm are typically resected using cautery-based polypectomy, which is associated with significant adverse events. Studies have demonstrated the safety and efficacy of piecemeal cold snare EMR for removing large colon polyps. Our aim was to assess the safety and efficacy of cold snare EMR for removal of large adenomas in the small bowel. METHODS: A retrospective study of patients who underwent lift and piecemeal cold snare EMR of small-bowel adenomas ≥1 cm between January 2014 and March 2019 was conducted at a tertiary care medical center. Polyp characteristics at the time of index and surveillance endoscopy were collected. Primary outcomes were residual or recurrent adenoma (RRA) seen on surveillance endoscopy, polyp eradication rate, and number of endoscopic procedures required for eradication. Adverse events including immediate and delayed bleeding, perforation, stricture, pancreatitis, and postpolypectomy syndrome were assessed. RESULTS: Of 43 patients who underwent piecemeal cold snare EMR, 39 had follow-up endoscopy. Polyps ranged in size from 10 to 70 mm (mean, 26.5 mm). RRA was found in 18 patients (46%), with increased polyp size correlating with higher recurrence (P < .001). Polyp eradication was observed in 35 patients (89%), requiring a median of 2 (range, 1-6) endoscopic procedures. Only 1 patient (2.3%) had immediate postprocedural bleeding. No cases of perforation or postpolypectomy syndrome were seen. CONCLUSIONS: Piecemeal cold snare EMR may be a feasible, safe, and efficacious technique for small-bowel polyps >10 mm. Prospective, randomized studies are needed to assess how outcomes compare with traditional cautery-based polypectomy.
Assuntos
Adenoma , Pólipos do Colo , Neoplasias Duodenais , Ressecção Endoscópica de Mucosa , Adenoma/etiologia , Adenoma/cirurgia , Pólipos do Colo/etiologia , Colonoscopia/métodos , Neoplasias Duodenais/etiologia , Ressecção Endoscópica de Mucosa/métodos , Humanos , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Estudos RetrospectivosRESUMO
We recommend that uncomplicated GERD be diagnosed on the basis of typical symptoms without the use of diagnostic testing, including EGD. We recommend EGD for patients who have symptoms suggesting complicated GERD or alarm symptoms. We recommend that EGD not be routinely performed solely for the assessment of extraesophageal GERD symptoms. We recommend that endoscopic findings of reflux esophagitis be classified according to an accepted grading scale or described in detail. We suggest that repeat EGD be performed in patients with severe erosive esophagitis after at least an 8-week course of PPI therapy to exclude underlying BE or dysplasia. 44BB We recommend against obtaining tissue samples from endoscopically normal tissue to diagnose GERD or exclude BE in adults. We suggest that endoscopy be considered in patients with multiple risk factors for Barrett's esophagus. We recommend that tissue samples be obtained to confirm endoscopically suspected Barrett's esophagus. We suggest that endoscopic antireflux therapy be considered for selected patients with uncomplicated GERD after careful discussion with the patient regarding potential adverse effects, benefits, and other available therapeutic options.
Assuntos
Esôfago de Barrett/diagnóstico , Esofagoscopia/métodos , Esôfago/patologia , Refluxo Gastroesofágico/diagnóstico , Adulto , Esôfago de Barrett/etiologia , Esôfago de Barrett/patologia , Criança , Endoscopia Gastrointestinal , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/cirurgia , Humanos , Lactente , Sociedades MédicasAssuntos
Anestesia/normas , Sedação Consciente/normas , Sedação Profunda/normas , Endoscopia Gastrointestinal/normas , Analgésicos Opioides/administração & dosagem , Anestesiologia/normas , Anestésicos Intravenosos/administração & dosagem , Benzodiazepinas/administração & dosagem , Endoscopia Gastrointestinal/métodos , Humanos , Hipnóticos e Sedativos/administração & dosagem , Monitorização Intraoperatória/normas , Cuidados Pré-Operatórios/normas , Propofol/administração & dosagemAssuntos
Anticoagulantes/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Endoscopia Gastrointestinal/métodos , Fibrinolíticos/uso terapêutico , Inibidores da Agregação Plaquetária/uso terapêutico , Hemorragia Pós-Operatória/prevenção & controle , Anticoagulantes/efeitos adversos , Fibrinolíticos/efeitos adversos , Humanos , Inibidores da Agregação Plaquetária/efeitos adversos , Hemorragia Pós-Operatória/induzido quimicamenteAssuntos
Carcinoma Ductal Pancreático/diagnóstico , Neoplasias Císticas, Mucinosas e Serosas/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Técnicas de Ablação , Antineoplásicos/uso terapêutico , Antígeno Carcinoembrionário/metabolismo , Carcinoma Ductal Pancreático/metabolismo , Carcinoma Ductal Pancreático/patologia , Carcinoma Ductal Pancreático/terapia , Colangiopancreatografia Retrógrada Endoscópica , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Endossonografia , Etanol/uso terapêutico , Humanos , Injeções Intralesionais , Neoplasias Císticas, Mucinosas e Serosas/metabolismo , Neoplasias Císticas, Mucinosas e Serosas/patologia , Neoplasias Císticas, Mucinosas e Serosas/terapia , Paclitaxel/uso terapêutico , Neoplasias Pancreáticas/metabolismo , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/terapia , Solventes/uso terapêuticoAssuntos
Carcinoma Ductal Pancreático/diagnóstico , Endoscopia do Sistema Digestório , Linfoma/diagnóstico , Tumores Neuroendócrinos/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Carcinoma Ductal Pancreático/cirurgia , Colangiopancreatografia Retrógrada Endoscópica , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Endossonografia , Humanos , Linfoma/cirurgia , Imageamento por Ressonância Magnética , Tumores Neuroendócrinos/cirurgia , Neoplasias Pancreáticas/cirurgia , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios XRESUMO
Background and study aims Cold snare endoscopic mucosal resection (EMR) is being increasingly utilized for non-pedunculated polyps ≥â20âmm due to adverse events associated with use of cautery. Larger studies evaluating adenoma recurrence rate (ARR) and risk factors for recurrence following cold snare EMR of large polyps are lacking. The aim of this study was to define ARR for polyps ≥â20âmm removed by cold snare EMR and to identify risk factors for recurrence. Patients and methods A retrospective chart review of colon cold snare EMR procedures performed between January 2015 and July 2019 at a tertiary care medical center was performed. During this period, 310 non-pedunculated polyps ≥â20âmm were excised using cold snare EMR with follow-up surveillance colonoscopy. Patient demographic data as well as polyp characteristics at the time of index and surveillance colonoscopy were collected and analyzed. Results A total of 108 of 310 polyps (34.8â%) demonstrated adenoma recurrence at follow-up colonoscopy. Patients with a higher ARR were older ( P â=â0.008), had endoscopic clips placed at index procedure ( P â=â0.017), and were more likely to be Asian and African American ( P â=â0.02). ARR was higher in larger polyps ( P â<â0.001), tubulovillous adenomas ( P â<â0.001), and polyps with high-grade dysplasia ( P â=â0.003). Conclusions Although cold snare EMR remains a feasible alternative to hot snare polypectomy for resection of non-pedunculated polyps ≥â20âmm, endoscopists must also carefully consider factors associated with increased ARR when utilizing this technique.
Assuntos
Adenocarcinoma , Tumores do Estroma Gastrointestinal , Gastroscopia , Linfoma de Zona Marginal Tipo Células B , Lesões Pré-Cancerosas , Neoplasias Gástricas , Adenocarcinoma/diagnóstico , Adenocarcinoma/terapia , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/terapia , Humanos , Linfoma de Zona Marginal Tipo Células B/diagnóstico , Linfoma de Zona Marginal Tipo Células B/terapia , Metaplasia/diagnóstico , Metaplasia/terapia , Pólipos/diagnóstico , Pólipos/terapia , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/terapia , Estômago/patologia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/terapiaAssuntos
Adenoma/diagnóstico , Ampola Hepatopancreática , Neoplasias do Ducto Colédoco/diagnóstico , Neoplasias Duodenais/diagnóstico , Endoscopia do Sistema Digestório , Gastroenterologia/normas , Sociedades Médicas , Adenoma/cirurgia , Biópsia , Neoplasias do Ducto Colédoco/cirurgia , Neoplasias Duodenais/cirurgia , Humanos , Guias de Prática Clínica como Assunto , Estados UnidosAssuntos
Doenças do Sistema Digestório/diagnóstico , Dispepsia/etiologia , Endoscopia Gastrointestinal , Infecções por Helicobacter/diagnóstico , Helicobacter pylori , Seleção de Pacientes , Fatores Etários , Algoritmos , Doenças do Sistema Digestório/complicações , Dispepsia/tratamento farmacológico , Infecções por Helicobacter/complicações , Infecções por Helicobacter/tratamento farmacológico , HumanosAssuntos
Ductos Biliares/patologia , Doenças Biliares/diagnóstico , Doenças Biliares/terapia , Colangiopancreatografia Retrógrada Endoscópica , Constrição Patológica/terapia , Coledocolitíase/terapia , Constrição Patológica/etiologia , Humanos , Disfunção do Esfíncter da Ampola Hepatopancreática/terapia , StentsRESUMO
BACKGROUND: The therapeutic role of EUS is evolving. We report our experience with EUS-guided transesophageal, transgastric, and transcolonic drainage of various intra-abdominal fluid collections. OBJECTIVE: To determine the technical feasibility and clinical outcomes of EUS-guided drainage. DESIGN: Prospective case series. SETTING: Academic tertiary referral center. PATIENTS: Patients referred for endoscopic drainage of intra-abdominal fluid collections; pancreatic pseudocysts amenable to conventional transgastric or transduodenal drainage were excluded. INTERVENTIONS: Single-step EUS-guided drainage of fluid collections by using a therapeutic linear-array echoendoscope with fluoroscopic guidance. MAIN OUTCOME MEASUREMENTS: Technical success, relief of symptoms, and procedural complications. RESULTS: Nine consecutive patients deemed appropriate for EUS-guided drainage of intra-abdominal fluid collections included transesophageal drainage of pseudocysts (n = 2), transgastric drainage of biloma (n = 2) and upper intra-abdominal abscesses (n = 2), transcolonic drainage of diverticular abscess (n = 1), Crohn's abscess (n = 1), and postoperative hematoma (n = 1). Endoscopic drainage was successful in all patients. Confirmation of complete resolution of the target fluid collection and symptom relief was achieved in 8 (89%) of 9 patients. Pneumothorax and mediastinitis developed in 1 patient after transesophageal drainage, which resolved with chest tube and medical therapy. During multiple stent placement, one of the stents was fully deployed into the abscess cavity in 2 patients; both were successfully retrieved either endoscopically (Crohn's abscess) or at the time of primary colonic resection (diverticular abscess). LIMITATION: Limited number of patients. CONCLUSIONS: EUS-guided transenteric drainage of bilomas, hematomas, abscesses, and inflammatory fluid collections is technically feasible and generally results in complete drainage and symptom relief. Procedural complications may be minimized with more experience.