Short and long-term outcomes of underwater EMR compared to the traditional procedure in the real clinical practice

Background and aims: underwater endoscopic mucosal resection (U-EMR) has been recently described as an alternative to endoscopic mucosal resection (EMR) for flat colorectal polyps. However, the real applications remain unclear due to the lack of comparative studies. Methods: a multi-centric prospective study was performed from November 2016 to December 2017. All lesions larger than 15 mm that were resected with both techniques were included in the study. The samples were matched using the size, morphology, site and access (SMSA) score as a reference. The efficacy, efficiency and adverse events rates were compared. Results: a total of 162 resections were collected (112 EMR and 50 U-EMR) with an average size of 25 mm. U-EMR achieved better results for the en bloc resection rate (49 vs 62%; p = 0.08) and there were no cases of an incomplete resection (10.7 vs 0%; p = 0.01). U-EMR was faster than EMR and there were no differences in the adverse events rate. Furthermore, U-EMR tended to achieve better results in terms of recurrence. Performing the resection in emersion appeared to prevent the cautery artefact, especially in sessile serrated adenomas. Conclusion: in the real clinical practice, U-EMR and EMR are equivalent in terms of efficacy and safety. Furthermore, U-EMR may be a feasible approach to prevent cautery artefact, allowing an accurate pathologic assessment

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Short and long-term outcomes of underwater EMR compared to the traditional procedure in the real clinical practice.

BACKGROUND AND AIMS: underwater endoscopic mucosal resection (U-EMR) has been recently described as an alternative to endoscopic mucosal resection (EMR) for flat colorectal polyps. However, the real applications remain unclear due to the lack of comparative studies. METHODS: a multi-centric prospective study was performed from November 2016 to December 2017. All lesions larger than 15 mm that were resected with both techniques were included in the study. The samples were matched using the size, morphology, site and access (SMSA) score as a reference. The efficacy, efficiency and adverse events rates were compared. RESULTS: a total of 162 resections were collected (112 EMR and 50 U-EMR) with an average size of 25 mm. U-EMR achieved better results for the en bloc resection rate (49 vs 62%; p = 0.08) and there were no cases of an incomplete resection (10.7 vs 0%; p = 0.01). U-EMR was faster than EMR and there were no differences in the adverse events rate. Furthermore, U-EMR tended to achieve better results in terms of recurrence. Performing the resection in emersion appeared to prevent the cautery artefact, especially in sessile serrated adenomas. CONCLUSION: in the real clinical practice, U-EMR and EMR are equivalent in terms of efficacy and safety. Furthermore, U-EMR may be a feasible approach to prevent cautery artefact, allowing an accurate pathologic assessment.

Underwater hybrid endoscopic submucosal dissection in a rectal polyp: a case report of a new application of "underwater endoscopy"

Background: Hybrid endoscopic submucosal dissection (ESD) has been described as an alternative to traditional ESD. This technique is less time consuming, but the en bloc resection rate is lower than in ESD. Similar to endoscopic mucosal resection, the underwater technique could improve preliminary disadvantages of hybrid ESD. Case report: We attempted a mixture resection technique of Hybrid ESD with underwater endoscopic mucosal resection (EMR). Using this approach, an underwater hybrid ESD was successfully performed without adverse events on a 71 year old woman with a 20 mm adenoma. The histologic analysis identified a tubulovillious adenoma with high grade dysplasia and tumor free margins. Discussion: Underwater hybrid ESD could be an alternative to ESD. Moreover the modification of the "underwater method" provides a suitable way to overcome the technical drawbacks of the hybrid ESD

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Multiband mucosectomy for the treatment of challenging non-pedunculated colorectal polyps.

BACKGROUND AND STUDY AIMS: Endoscopic mucosal resection is the gold standard treatment for non-pedunculated colorectal polyps; however, some specific situations (location behind folds, scarred or flat morphology) can make this technique challenging. We aimed to assess the efficacy and safety of multiband mucosectomy (MBM) for resection of non-pedunculated colorectal polyps. PATIENTS AND METHODS: This was a retrospective study of patients in whom MBM was performed to resect large non-pedunculated colorectal polyps. All procedures were carried out using the Shooter multiband ligator kit (Cook Medical, Limerick, Ireland). A 3-month follow-up colonoscopy was performed in all patients. RESULTS: 10 patients underwent MBM for resection of 10 large (median 33.5 mm) non-pedunculated polyps. A total of 45 MBM sessions were carried out to resect all of the lesions using on average one rubber band per 1.5 cm2 of resected tissue. Complete resection was possible in 9 out of 10 lesions, although en bloc resection was only feasible in one lesion. Follow-up colonoscopy revealed residual adenoma in just one patient. No major complications were registered. CONCLUSIONS: In this small series of patients, MBM proved to be a safe and effective endoscopic resection technique for challenging non-pedunculated colorectal polyps.

Underwater hybrid endoscopic submucosal dissection in a rectal polyp: a case report of a new application of "underwater endoscopy".

BACKGROUND: Hybrid endoscopic submucosal dissection (ESD) has been described as an alternative to traditional ESD. This technique is less time consuming, but the en bloc resection rate is lower than in ESD. Similar to endoscopic mucosal resection, the underwater technique could improve preliminary disadvantages of hybrid ESD. CASE REPORT: We attempted a mixture resection technique of Hybrid ESD with underwater endoscopic mucosal resection (EMR). Using this approach, an underwater hybrid ESD was successfully performed without adverse events on a 71 year old woman with a 20 mm adenoma. The histologic analysis identified a tubulovillious adenoma with high grade dysplasia and tumor free margins. DISCUSSION: Underwater hybrid ESD could be an alternative to ESD. Moreover the modification of the "underwater method" provides a suitable way to overcome the technical drawbacks of the hybrid ESD.

Actinomyces infection as a complication of a post-radiotherapy rectal ulcer.

INTRODUCTION: Pelvic radiotherapy is associated with early and late local complication. Actinomyces bacterium is part of the saprophyte flora, although some infection underlying factors are known , the pathophysiology of the disease is still unexplained. Frequently it is involved in oral, gastrointestinal and respiratory infections. CASE REPORT: We present the description of a clinical case supported with images. So that we have developed a bibliographical research in Pubmed data base including the following key words: Ulcer, rectum, brachitherapy and Actinomyces. The most recent original articles published in the last teen years, related with the pathology observed in the patient of the case, were selected. DISCUSSION: Brachitherapy over pelvic beds ( prostate, cervix and uterus) could be associated with digestive complications specially in the rectum. Those complications might oscillate from mild inflammatory changes in the mucosa to serious damages as ulcers and lack of tissue. This situation increase the risk of opportunistic infections which could endanger the clinical improve of our patients. We suggest to remember those germen in the diagnosis process in other to achieve an early diagnosis and to use a targeted treatment.

Úlcera rectal postradioterapia complicada con infección por Actinomyces / Actinomyces infection as a complication of a post-radiotherapy rectal ulcer

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[Adult celiac disease and intraepithelial lymphocytes. New options for diagnosis?]. / Enfermedad celíaca del adulto y linfocitos intraepiteliales. Nuevas opciones para el diagnóstico?

BACKGROUND: Permanent changes have been found in intraepithelial lymphocyte (IEL) subsets in patients with celiac disease. OBJECTIVE: The main aim of this study was to demonstrate the utility of determining CD3()/CD7(+) and T cell receptor (TCR) gamma-delta IEL subsets by flow cytometry as a diagnostic marker of adult celiac disease. PATIENTS AND METHODS: We performed a prospective study in a sample of 128 adult patients (70 with celiac disease and 58 controls). In all patients, distal duodenal biopsy was performed and IEL subsets were determined by flow cytometry. RESULTS: Patients with celiac disease showed an increase in gamma-delta IEL subsets and a decrease in CD3(-)/CD7(+) IEL subsets in comparison with the control group, independently of diet. CONCLUSIONS: The results indicate that IEL subset determination by flow cytometry could be useful to confirm diagnosis of celiac disease. IEL subsets should be investigated in diseases other than celiac disease, as well as in patients with potential or latent celiac disease.

Enfermedad celíaca del adulto y linfocitos intraepiteliales. ¿Nuevas opciones para el diagnóstico? / Adult celiac disease and intraepithelial lymphocytes. New options for diagnosis?

INTRODUCCIÓN: Se han apreciado cambios permanentes enlas subpoblaciones de linfocitos intraepiteliales (LIE) en lospacientes con enfermedad celíaca.OBJETIVO: El objetivo principal de este estudio fue demostrarla utilidad de la determinación de las subpoblaciones deLIE receptores de células T gamma-delta y CD3–/CD7+, mediantecitometría de flujo, como marcador diagnóstico de laenfermedad celíaca del adulto.PACIENTES Y MÉTODOS: Para ello, hemos realizado un estudioprospectivo sobre una muestra de 128 pacientes adultos (70con enfermedad celíaca y 58 controles). A todos ellos se lesrealizaron biopsias de duodeno distal, que fueron procesadasmediante citometría de flujo para la determinación desubpoblaciones de LIE.RESULTADOS: Según los resultados obtenidos, la muestra depacientes celíacos presenta un aumento de la subpoblaciónde LIE gamma-delta y un descenso en la subpoblación deLIE CD3–/CD7+, independientemente de la dieta realizada,cuando se comparan con el grupo control.CONCLUSIONES: Según los datos obtenidos, se puede concluirque la determinación de subpoblaciones de LIE mediante citometríade flujo podría resultar de utilidad para confirmarel diagnóstico de enfermedad celíaca. Sería necesario investigarlas subpoblaciones de linfocitos intraepiteliales en otrasenfermedades distintas de la enfermedad celíaca, así como enpacientes con enfermedad celíaca latente o potencial

BACKGROUND: Permanent changes have been found in intraepitheliallymphocyte (IEL) subsets in patients with celiacdisease.OBJECTIVE: The main aim of this study was to demonstratethe utility of determining CD3–/CD7+ and T cell receptor(TCR) gamma-delta IEL subsets by flow cytometry as adiagnostic marker of adult celiac disease.PATIENTS AND METHODS: We performed a prospective studyin a sample of 128 adult patients (70 with celiac disease and58 controls). In all patients, distal duodenal biopsy was performedand IEL subsets were determined by flow cytometry.RESULTS: Patients with celiac disease showed an increase ingamma-delta IEL subsets and a decrease in CD3–/CD7+ IELsubsets in comparison with the control group, independentlyof diet.CONCLUSIONS: The results indicate that IEL subset determinationby flow cytometry could be useful to confirm diagnosisof celiac disease. IEL subsets should be investigated in diseasesother than celiac disease, as well as in patients withpotential or latent celiac disease