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Feiner R, Johns E, Antman-Passig M, Khan D, Witek L, Berisha N, Irie T, Oved H, White RM, Heller DA. Drug-Eluting Rubber Bands for Tissue Ligation. ACS APPLIED MATERIALS & INTERFACES 2022; 14:27675-27685. [PMID: 35670525 PMCID: PMC10015968 DOI: 10.1021/acsami.2c06175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Rubber band ligation is a commonly used method for the removal of tissue abnormalities. Most often, rubber band ligation is performed to remove internal hemorrhoids unresponsive to first line treatments to avoid surgery. While the procedure is considered safe, patients experience mild to significant pain and discomfort until the tissue sloughs off. As patients often require multiple bandings and sessions, reducing these side effects can have a considerable effect on patient adherence and quality of life. To reduce pain and discomfort, we developed drug-eluting rubber bands for ligation procedures. We investigated the potential for a band to elute anesthetics and drug combinations to durably manage pain for a period of up to 5 days while exhibiting similar mechanical properties to conventional rubber bands. We show that the rubber bands retain their mechanical properties despite significant drug loading. Lidocaine, released from the bands, successfully altered the calcium dynamics of cardiomyocytes in vitro and modulated heart rate in zebrafish embryos, while the bands exhibited lower cytotoxicity than conventional bands. Ex vivo studies demonstrated substantial local drug release in enteric tissues. These latex-free bands exhibited sufficient mechanical and drug-eluting properties to serve both ligation and local analgesic functions, potentially enabling pain reduction for multiple indications.
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Affiliation(s)
- Ron Feiner
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY, 10065 USA
| | - Eleanor Johns
- Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center, New York, 10065, USA; Gerstner Sloan Kettering Graduate School of Biomedical Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, 10065 USA
| | - Merav Antman-Passig
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY, 10065 USA
| | - Doha Khan
- Division of Biomaterials – Department of Molecular Pathobiology, NYU College of Dentistry, New York, NY, 10010, USA
| | - Lukasz Witek
- Division of Biomaterials – Department of Molecular Pathobiology, NYU College of Dentistry, New York, NY, 10010, USA; Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY, 11201, USA
| | - Naxhije Berisha
- The Graduate Center of the City University of New York, New York, NY, 10016, USA; Department of Nanotechnology, Advanced Science Research Center (ASRC) at the Graduate Center of the City University of New York, New York, NY, 10031, USA; Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY, 10065 USA
| | - Takeshi Irie
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065 USA; Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY, 10065 USA
| | - Hadas Oved
- Shmunis School of Biomedicine and Cancer Research, Faculty of Life Sciences, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Richard M. White
- Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center, New York, NY, 10065 USA; Weill Cornell Medical College, New York, New York 10065, United States
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Kiremitçi S, Cansız Ersöz C, Savaş B, Ensari A. Gastric and small intestinal traditional serrated adenomas: a detailed morphologic and immunohistochemical analysis. TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 31:441-450. [PMID: 32721915 DOI: 10.5152/tjg.2020.19931] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND/AIMS Traditional serrated adenomas (TSAs), despite their low incidence in colorectum, may originate in other parts of the gastrointestinal (GI) tract, including stomach and small intestine. Malignant transformation for upper GI TSAs has recently been reported in the literature. Here, we present a series of gastric and small intestinal TSAs with the aim to characterize their morphologic and immunophenotypic features as well as their neoplastic potential in a compartmental manner using digitalized images. MATERIALS AND METHODS The study comprised 12 GI polyps with TSA features-5 gastric and 7 small intestinal. The extent of the characteristic features of TSA, including eosinophilic cells, ectopic crypt foci (ECF), slit-like serration, foveolar epithelium, goblet cells, together with dysplastic-carcinomatous foci were assessed on digitalized H-E images and were used as reference for immunohistochemical analysis. RESULTS All polyps in the cohort contained eosinophilic cells as the most extensive morphologic feature followed by ECF and slit-like serration in decreasing order. Serrated dysplasia was more common in gastric polyps, which more frequently showed neoplastic progression compared with the intestinal ones. CK20 was the most widely expressed marker with a preference to eosinophilic cells while ECFs were mostly negative. Ki67 showed the opposite pattern of CK20. MUC6 and MUC2 were selectively expressed in the basal zone and goblet cells, respectively. CONCLUSION Our results showed that the presence of eosinophilic cells with pencillate nuclei commonly accompanied by ECF and slit-like serration are the defining features of gastric and small intestinal TSAs. They frequently harbor neoplastic foci, particularly in gastric location where serrated dysplasia seems to be more common.
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Affiliation(s)
- Saba Kiremitçi
- Department of Pathology, Ankara University School of Medicine, Ankara, Turkey
| | | | - Berna Savaş
- Department of Pathology, Ankara University School of Medicine, Ankara, Turkey
| | - Arzu Ensari
- Department of Pathology, Ankara University School of Medicine, Ankara, Turkey
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Cao HL, Dong WX, Xu MQ, Zhang YJ, Wang SN, Piao MY, Cao XC, Wang BM. Clinical features of upper gastrointestinal serrated lesions: An endoscopy database analysis of 98746 patients. World J Gastroenterol 2016; 22:10038-10044. [PMID: 28018111 PMCID: PMC5143750 DOI: 10.3748/wjg.v22.i45.10038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/03/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To analyse the clinical features of patients with the serrated lesions in the upper gastrointestinal tract (UPGI) tract.
METHODS Patients who underwent routine esophagogastroduodenoscopy (EGD) at the Digestive Endoscopy Centre of General Hospital, Tianjin Medical University between January 2011 and December 2015 were consecutively recruited. Patients with UPGI serrated lesions were consecutively identified. The patients’ demographics and histopathology were recorded. The colorectal findings for patients who underwent colonoscopy simultaneously or within six months were also extracted from the colonoscopy database. In addition, we analysed differences in colorectal neoplasia detection between the study patients and randomly selected patients matched for age and gender who did not exhibit serrated lesions and who also underwent colonoscopy in the same period.
RESULTS A total of 21 patients out of 98746 patients (0.02%) who underwent EGD were confirmed to have serrated lesions with predominantly crenated, sawtooth-like configurations. The mean age of the 21 patients was (55.3 ± 17.2) years, and 11 patients were male (52.4%). In terms of the locations of the serrated lesions, 17 were found in the stomach (including 3 in the cardia, 9 in the corpus and 5 in the antrum), 3 were found in the duodenum, and 1 was found in the esophagus. Serrated lesions were found in different mucosal lesions, with 14 lesions were detected in polyps (8 hyperplastic polyps and 6 serrated adenomas with low grade dysplasia), 3 detected in Ménétrier gastropathy, 3 detected in an area of inflammation or ulcer, and 1 detected in the intramucosal carcinoma of the duodenum. In addition, colonoscopy data were available for 18 patients, and a significantly higher colorectal adenoma detection rate was observed in the UPGI serrated lesions group than in the randomly selected age- and gender-matched group without serrated lesions who also underwent colonoscopy in the same period (38.9% vs 11.1%, OR = 5.091, 95%CI: 1.534-16.890, P = 0.010). The detection rate of advanced adenoma was also higher in the UPGI serrated lesions group (22.2% vs 4.2%, OR = 6.571, 95%CI: 1.322-32.660, P = 0.028).
CONCLUSION Serrated lesions in the UPGI were detected in various mucosal lesions with different pathological morphologies. Moreover colonoscopy is recommended for the detection of concurrent colorectal adenoma for these patients.
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Abstract
For many years, it was generally accepted that the vast majority of the colorectal carcinomas (CRCs) evolved from conventional adenomas, via the adenoma–carcinoma sequence. More recently, serrated colorectal polyps (hyperplastic polyps, sessile serrated polyps and traditional serrated adenomas (TSAs)) have emerged as an alternative pathway of colorectal carcinogenesis. It has been estimated that about 30% of the CRC progress via the serrated pathway. Recently, TSAs were also detected in the upper digestive tract. In this work, we review the literature on TSA in the oesophagus, the stomach, the duodenum, the pancreatic main duct and the gallbladder. The review indicated that 53.4% (n=39) out of the 73 TSA of the upper digestive tract now in record showed a simultaneously growing invasive carcinoma. As a corollary, TSAs of the upper digestive tract are aggressive adenomas that should be radically excised, either endoscopically or surgically, to rule out the possibility of a synchronously growing invasive adenocarcinoma or to prevent cancer progression. The present findings substantiate a TSA pathway of carcinogenesis in the upper digestive tract.
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Rubio CA, Björk J. Serrated adenoma of the stomach: Case report and literature review. World J Gastrointest Endosc 2013; 5:261-4. [PMID: 23678381 PMCID: PMC3653027 DOI: 10.4253/wjge.v5.i5.261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 04/09/2013] [Accepted: 04/17/2013] [Indexed: 02/05/2023] Open
Abstract
Gastric serrated adenomas are histologically characterized by protruding glands with lateral saw tooth-like indentations lined with stratified dysplastic cells containing abundant eosinophilic cytoplasm. Since the first case of gastric serrated adenoma found in 2001, 18 additional cases have been reported. Gastric serrated adenomas have a particular proclivity to progress to invasive carcinoma; 75% or 15 of the 20 cases now in record - including the present one - exhibited invasive carcinoma. The 20(th) case of gastric serrated adenoma reported here differs from the preceding ones in as much as it evolved in a patient with Lynch syndrome, implying that this adenoma phenotype may develop not only sporadically but also in patients with hereditary traits.
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