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Neoplasias Gastrointestinales , Enfermedades del Íleon , Leiomioma , Pólipos , Femenino , Humanos , Adulto , Pólipos/diagnóstico , Pólipos/cirugía , Leiomioma/diagnóstico por imagen , Leiomioma/cirugía , Pólipos Intestinales/diagnóstico , Pólipos Intestinales/cirugía , Pólipos Intestinales/patología , Enfermedades del Íleon/diagnóstico , Enfermedades del Íleon/cirugíaRESUMEN
Background and study aims The thulium laser system (TLS) is an emerging surgical tool. The 2-µm wavelength provides a confined coagulation depth (0.2â-â0.4âmm) to reduce the potential for inadvertent injuries. For the first time ever, we assessed TLS feasibility for endoscopic hemostasis ex vivo in pigs. In addition, we performed the first in vivo hemostatic treatments in humans. Patients and methods Tissue damage induced by TLS using different settings and optical fibers was compared to that from argon plasma coagulation (APC) in established ex vivo animal models. Three consecutive patients with complex nonvariceal upper gastrointestinal bleedings were treated and followed up. Results No deep submucosal injury was observed in animal models. The TLS showed a progressive penetration depth with increased power outputs and tissue exposures but very limited vertical tissue injury (0.1â-â2.0âmm) and lateral spreading damage (0.1â-â0.3âmm and 0.2â-â0.7âmm using the 365-µm and 550-µm fibers, respectively). In vivo, endoscopic hemostasis with TLS was always successful without complications. Conclusions The TLS has proven to be very precise and easy to use. This novel technique appears to be a promising tool for advanced interventional endoscopy.
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Hemorragia Gastrointestinal/terapia , Hemostasis Endoscópica/métodos , Láseres de Estado Sólido/uso terapéutico , Neoplasias Peritoneales/complicaciones , Tulio , Anciano , Animales , Coagulación con Plasma de Argón , Úlcera Duodenal/complicaciones , Endoscopía del Sistema Digestivo , Estudios de Factibilidad , Ectasia Vascular Antral Gástrica/complicaciones , Ectasia Vascular Antral Gástrica/terapia , Mucosa Gástrica , Hemorragia Gastrointestinal/etiología , Hemostasis Endoscópica/efectos adversos , Hemostasis Endoscópica/instrumentación , Humanos , Terapia por Láser/instrumentación , Láseres de Estado Sólido/efectos adversos , Masculino , Persona de Mediana Edad , Úlcera Péptica Hemorrágica/etiología , Úlcera Péptica Hemorrágica/terapia , Neoplasias Peritoneales/patología , PorcinosAsunto(s)
Vesícula , Dolor en el Pecho , Endoscopía del Sistema Digestivo/métodos , Epidermólisis Ampollosa/diagnóstico , Esófago , Liquen Plano Oral/diagnóstico , Penfigoide Benigno de la Membrana Mucosa/diagnóstico , Vesícula/complicaciones , Vesícula/diagnóstico , Vesícula/fisiopatología , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Diagnóstico Diferencial , Esófago/diagnóstico por imagen , Esófago/patología , Femenino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Humanos , Persona de Mediana Edad , Mucosa Bucal/patología , Hemorragia Bucal/diagnóstico , Hemorragia Bucal/etiologíaRESUMEN
INTRODUCTION: Bowel preparation is crucial for colonoscopy completeness and lesions detection. Today, several cleansing products are equally recommended by guidelines, irrespective of patients' characteristics. Identification of preparation-specific risk factors for inadequate bowel preparation may lead to a personalized prescription of cleansing products to refine patients' tolerance and improve endoscopic outcomes. METHODS: We prospectively enrolled consecutive outpatients referred for colonoscopy using either a high-volume [HV: 4 l polyethylene glycol (PEG)] or a low-volume (LV: 2 l PEG + bisacodyl) preparation. Day-before regimen or split-dose regimen was used for morning or afternoon colonoscopies, respectively. Univariate and multivariate analyses were conducted to identify risk factors related to inadequate bowel preparation, according to the Boston bowel preparation scale for HV and LV preparations. RESULTS: We enrolled 2040 patients, of which 1815 were included in the final analysis (average age 60.6 years, 50.2% men). Half of them (52%) used LV preparation. Adequate preparation was achieved by 87.6% without differences between the HV and LV groups (89.2% vs. 86.6%; P = 0.098). The use of day-before regimen and incomplete assumption of PEG were independent predictors of poor visibility for either HV or LV preparation. However, different specific risk factors for HV [diabetes: odds ratio (OR), 3.81; 95% confidence interval (CI), 1.91-7.58; low level of instruction: OR, 1.95; 95% CI, 1.11-3.44; and previous abdominal surgery: OR, 2.27; 95% CI, 1.20-4.30] and for LV (heart disease: OR, 2.06; 95% CI, 1.09-3.88; age > 65 years: OR, 1.51; 95% CI, 1.01-2.27) preparations were identified. CONCLUSION: Day-before preparation and incomplete assumption of the purgative agents affect bowel visibility irrespective of the preparation volume. LV should be preferred to HV preparations in patients with diabetes, low level of instruction, and previous abdominal surgery, whereas an HV preparation should be preferred in patients with heart disease and in older patients.
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Catárticos , Diabetes Mellitus , Masculino , Humanos , Anciano , Persona de Mediana Edad , Femenino , Catárticos/efectos adversos , Bisacodilo/efectos adversos , Polietilenglicoles/efectos adversos , Colonoscopía/efectos adversos , Factores de RiesgoAsunto(s)
Adenocarcinoma/cirugía , Endoscopía Gastrointestinal/instrumentación , Neoplasias del Recto/cirugía , Adenocarcinoma/complicaciones , Anciano , Anticoagulantes/uso terapéutico , Endoscopía Gastrointestinal/métodos , Humanos , Masculino , Embolia Pulmonar/complicaciones , Embolia Pulmonar/tratamiento farmacológico , Neoplasias del Recto/complicaciones , ReoperaciónAsunto(s)
Absceso/cirugía , Adenocarcinoma/cirugía , Fuga Anastomótica/terapia , Neoplasias del Recto/cirugía , Sigmoidoscopía/instrumentación , Dehiscencia de la Herida Operatoria/terapia , Absceso/etiología , Anciano , Fuga Anastomótica/etiología , Drenaje , Femenino , Humanos , Pelvis , Dehiscencia de la Herida Operatoria/complicacionesRESUMEN
BACKGROUND AND STUDY AIMS: Endoscopic treatment of malignant colorectal polyps is often challenging, especially for early rectal cancer (ERC) localized close to the dentate line. Conversely, the surgical approach may result in temporary or definitive stoma and in frequent post-surgical complications. The Full-Thickness Resection Device (FTRD ® ) System (Ovesco Endoscopy, Tübingen, Germany) is a novel system that, besides having other indications, appears to be promising for wall-thickness excision of intestinal T1 carcinoma following incomplete endoscopic resection. However, follow-up data on patients treated with this device are scarce, particularly for ERC. PATIENTS AND METHODS: Six consecutive patients with incomplete endoscopic resection of T1-ERC were treated with the FTRD and their long-term outcomes were evaluated based on a detailed clinical and instrumental assessment. RESULTS: The endoscopic en bloc full-thickness resection was technically feasible in all patients. The histopathologic analysis showed a complete endoscopic resection in all cases, and a full-thickness excision in four. Neither complications, nor disease recurrence were observed during the 1-year follow-up period. CONCLUSIONS: The FTRD System is a promising tool for treating ERC featuring a residual risk of disease recurrence after incomplete endoscopic mucosal resection in patients unfit for surgery or refusing a surgical approach.