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Arab NS, Alkhatabi RK, Alhalafi AF, Beyari MB, Alahmadi RA, Almazro AA. Transanal Resection of a Prolapsed Rectal Lipoma: A Report of a Rare Case. Cureus 2025; 17:e78247. [PMID: 39885939 PMCID: PMC11781804 DOI: 10.7759/cureus.78247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2025] [Indexed: 02/01/2025] Open
Abstract
Lipoma is a benign tumor that arises from mesenchymal cells and is considered relatively rare. Although lipomas can develop anywhere in the digestive tract, they are seldom found within the intestinal tract. Typically asymptomatic, colonic lipomas usually do not require treatment unless they result in symptoms that warrant surgical intervention. In this case, a 68-year-old male patient presented to the colorectal clinic with complaints of chronic constipation lasting five years, along with a bulging protrusion through the anus that could be reduced by the patient's finger. He reported no history of abdominal pain, change in bowel habits, rectal bleeding, melena, weight loss, fever, or night sweats. During colonoscopy, large subepithelial lesions, measuring greater than 2 cm, were observed proximal to the anal verge. This case report highlights the significance of accurately diagnosing colonic lipomas to prevent potential misdiagnoses as malignancies or rectal prolapses. Additionally, we advocate for treatment strategies tailored to several factors, including the lipoma's size, location, and any associated symptoms.
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Affiliation(s)
- Nahlah S Arab
- Department of General Surgery, Consultant in Colorectal Surgery, Prince Sultan Military Medical City, Riyadh, SAU
| | - Rawan K Alkhatabi
- Saudi Board General Surgery Residency Program, King Fahad General Hospital, Jeddah, SAU
| | - Abdullah F Alhalafi
- Saudi Board General Surgery Residency Program, Prince Sultan Military Medical City, Riyadh, SAU
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Su MY, Chiu CT. Ligation-assisted endoscopic mucosal resection has high complete resection rate in rectal carcinoid tumor. BMC Gastroenterol 2021; 21:464. [PMID: 34903169 PMCID: PMC8667363 DOI: 10.1186/s12876-021-02061-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
AIM We aimed to compare the outcomes of different therapeutic modalities in rectal carcinoid tumors. METHOD We retrospectively collected 145 patients with rectal carcinoid tumors which were pathologically diagnosed from 2005/01/01 to 2016/12/31. We compared tumor size, complete resection rate and recurrent rate between different therapeutic modalities. Then, prospectively compared the treatment outcomes of 28 patients treated with ligation assisted endoscopic mucosal resection (LEMR) and 25 patients treated with endoscopic mucosal resection with cap (EMRC). RESULT The mean size of tumors was 6.5 mm (1-25 mm), and the mean follow-up duration was 26 months (6-118 months). The therapeutic modalities included ligation-assisted endoscopic mucosal resection (LEMR) (25 tumors, 17%), endoscopic mucosal resection (EMR) (31 tumors, 21%), snare polypectomy (30 tumors, 21%), biopsy forceps removal (46 tumors, 32%) and surgical resection (13 tumors, 11%), including 6 tumors treated with transanal endoscopic microsurgery (TEM) method. In view of pathologically complete resection rate, LEMR was highest (100%), followed by surgical resection (85%). However, EMR only had 42% pathologically complete resection rate. Besides, LEMR and surgical resection had no local recurrence and significantly higher clinically complete resection rate, compared to other treatments. For the further prospective study, complete resection was noted in 28 (100%) patients in LEMR group and 13 (52%) patients in EMRC group. CONCLUSION In the treatment of rectal carcinoid tumors, LEMR is safe and effective compared with traditional endoscopic treatments.
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Affiliation(s)
- Ming-Yao Su
- Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, 6, Sec 2, Jincheng Rd, Tucheng Dist, New Taipei City, Taiwan, Republic of China. .,Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan. .,Chang Gung University College of Medicine, Taoyuan, Taiwan. .,Taiwan Association for the Study of Small Intestinal Diseases, Taoyuan, Taiwan.
| | - Cheng-Tang Chiu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan.,Taiwan Association for the Study of Small Intestinal Diseases, Taoyuan, Taiwan
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Wang N, Yang C, Xu J, Shi W, Huang W, Cui Y, Jian X. An Improved Chirp Coded Excitation Based on Compression Pulse Weighting Method in Endoscopic Ultrasound Imaging. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:446-452. [PMID: 32746209 DOI: 10.1109/tuffc.2020.3008920] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Chirp coded excitation is an effective method to improve the signal-to-noise ratio (SNR) and penetration depth of high-frequency endoscopic ultrasound (EUS) imaging. In coded excitation, pulse compression is applied to compress the elongated coded signals into a short pulse, which determines the final imaging performance, including spatial resolution and SNR. However, with the current pulse compression methods, it is hard to get high performance in the peak sidelobe level (PSL), image contrast, and axial resolution at the same time. To solve this problem, in this article, a new method named compressed pulse weighting method (CPWM) was proposed based on the combination of two kinds of pulse compression signals. A brief theoretical derivation proved the feasibility of method. The proposed method was evaluated by the simulation and phantom experiments. Compared with traditional method, the results showed that the proposed adaptive weighting method can provide increases of 32.42% in the penetration depth, 9.48 dB in the SNR, 5.60 dB in the contrast ratio (CR), 5.46 in the contrast-to-noise ratio (CNR), and 0.13 mm in the axial imaging resolution for 12-MHz EUS. Therefore, this method can effectively improve the ultrasound penetration depth and imaging quality, which made it have good potential for high-frequency ultrasound imaging.
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Liu C, Yang Y, Qiu W, Chen Y, Dai J, Sun L. Quantitative characterization of the colorectal cancer in a rabbit model using high-frequency endoscopic ultrasound. ULTRASONICS 2021; 110:106289. [PMID: 33130363 DOI: 10.1016/j.ultras.2020.106289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/06/2020] [Accepted: 10/20/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Colonoscopy accompanied with biopsy works as the routine endoscopic strategy for the diagnosis of colorectal cancer (CRC) in clinic; however, the colonoscopy is limited to the tissue surface. During the last decades, enabling technologies are emerging to complement with the colonoscopy for better administration of CRC. The conventional low-frequency (<12 MHz) endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) has been widely used to assess the lesion penetration. With the high-frequency ultrasound transducer (>20 MHz), EUS allows more precise visualization of the colorectal abnormalities. In order to achieve the accurate detection or in situ characterization of the colorectal lesions, the EUS diagnosis needs more patho-physiological related information in the micro-structural or molecular level. Quantitative ultrasound (QUS) technique, which could extract the micro-structural information from the ultrasound radio-frequency (RF) signal, is promising for the non-invasive tissue characterization. To date, the knowledge of the high-frequency endoscopic QUS for the CRC characterization has not been fully determined. METHODS In this work, to our best knowledge, it is the first application of the QUS technique based on a customized high-frequency EUS system (30.5 MHz center frequency) to characterize the colorectal malignancies in a VX2 rabbit CRC model. To eliminate the response from the ultrasound electronic system and transducer, the ultrasound signals from colon tissue were calibrated. And, the resulting quasi-liner ultrasound spectra were fit by the linear regression test. As a result, three spectral parameters, including the slope (k), intercept (I) and Midband Fit (M), were obtained from the best-fit line. The three spectral parameters were compared between the malignant tissue regions and adjacent normal tissue regions of the colon tissue specimen ex vivo. The independent t-test was conducted between the three parameters from the normal and malignant group. The statistical method of Fisher Linear Discriminant (FLD) was used to explore the linear combinations of the three parameters, so as to provide more tissue micro-structural features than the single parameter alone. The three FLD values were derived from three different combinations among k, I and M. The threshold was selected from the statistical analysis to optimize the differentiation criteria between the malignant and the normal tissues. The color-coded images were used to display the local FLD values and combined with the EUS B-mode image. RESULTS AND CONCLUSIONS The mean Midband Fit (M) and intercept (I) showed significant differences between the malignant and normal tissue regions. The statistical analysis showed that there were significant differences in all the mean FLD values of the spectral parameter combinations (kI, kM and IM) (t test, P < 0.05). And, the combined image result from the B-mode image and color-coded image could visually correlate with the histology result. In conclusion, the high-frequency endoscopic QUS technique was potential to be used as a complementary method to distinguish the colorectal malignancies by leveraging its morphological and micro-structural ultrasound information.
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Affiliation(s)
- Cheng Liu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Yaoheng Yang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Weibao Qiu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Yan Chen
- Department of Applied Physics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Jiyan Dai
- Department of Applied Physics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Lei Sun
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region.
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Varas Lorenzo MJ, Abad Belando R, Sánchez-Vizcaíno Mengual E. Miniprobe Endoscopic Sonography for Gastrointestinal Tract Assessment: A Case Series of 1451 Procedures. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:293-303. [PMID: 28748539 DOI: 10.1002/jum.14330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/10/2017] [Accepted: 04/18/2017] [Indexed: 06/07/2023]
Abstract
Conventional endoscopic sonography has allowed precise diagnostics without disturbances, and miniprobes can be easily introduced through the biopsy channel of the endoscope. Miniprobe endoscopic sonography has many benefits compared with conventional endoscopic sonography. Although there are well-known indications for miniprobe endoscopic sonography in endoscopic digestive tract assessment, there is still a need for this method to be widely spread among physicians and commonly used by most endoscopists. The aim of this series was to describe a multicenter retrospective experience with 1451 procedures using miniprobes, presenting examples and the applicability and usefulness of this technology in the daily activities of an endoscopy department.
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Affiliation(s)
- Modesto J Varas Lorenzo
- Endoscopy Unit, Sanitas CIMA Hospital, Barcelona, Spain
- Department of Gastroenterology, Sanitas CIMA Hospital, Barcelona, Spain
- Teknon Medical Center, Barcelona, Spain
- Faculty of Health Sciences, Universitat Oberta de Cataluny (UOC), Barcelona, Spain
| | - Ramón Abad Belando
- Endoscopy Unit, Sanitas CIMA Hospital, Barcelona, Spain
- Department of Gastroenterology, Sanitas CIMA Hospital, Barcelona, Spain
- Planas Clinic, Barcelona, Spain
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Choi HH, Cho YS, Choi SK, Kim HK, Kim SS, Chae HS, Shin OR. Clinical Outcomes of Endoscopic Removal in Patients with Colorectal Polypoid Leiomyomas. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2016; 68:179-185. [PMID: 27780941 DOI: 10.4166/kjg.2016.68.4.179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND/AIMS Although polypoid leiomyomas in the colon and rectum are rare, they are increasingly detected during colonoscopy. The aim of this study was to evaluate the efficacy and clinical outcomes of endoscopic removal for colorectal polypoid leiomyoma. METHODS Data were retrospectively collected from 22 patients with polypoid leiomyoma arising from the muscularis mucosae in the colon and rectum who underwent endoscopic removal at single referral gastrointestinal endoscopy unit. Colonoscopic findings, endoscopic removal, success rates, complication rates (bleeding or perforation), pathologic characteristics, and recurrence rates were investigated. RESULTS Most polypoid leiomyomas were small asymptomatic lesions less than 1 cm. The tumors were located predominantly in the left colon. Ten leiomyomas were removed using cold biopsy forceps, and 12 were resected by conventional polypectomy or endoscopic mucosal resection. All tumors arose from or involved the muscularis mucosa. There were no complications, such as bleeding or perforation. No local remnant lesions were found in 19 patients who underwent at least one follow-up colonoscopy. CONCLUSIONS This case series represent cases of small colorectal polypoid leiomyoma that were safely removed endoscopically. An awareness of their endoscopic and clinic-pathological characteristics may provide safe treatment strategy for colonic leiomyomatous tumors of similar size in capable hands.
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Affiliation(s)
- Hyun Ho Choi
- Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University, Uijeongbu, Korea
| | - Young Seok Cho
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University, Seoul, Korea
| | - Soo Kyoung Choi
- Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University, Uijeongbu, Korea
| | - Hyung Keun Kim
- Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University, Uijeongbu, Korea
| | - Sung Soo Kim
- Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University, Uijeongbu, Korea
| | - Hiun Suk Chae
- Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University, Uijeongbu, Korea
| | - Ok Ran Shin
- Department of Hospital Pathology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University, Uijeongbu, Korea
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Kipshidze N, Prakash A, Kipshidze N, Chakhunashvili D, Kakabadze Z. A Novel Endoscopic Bariatric Procedure: Results of an Experimental Study. Obes Surg 2016; 26:3058-3065. [PMID: 27718177 DOI: 10.1007/s11695-016-2389-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Surgical treatment of obesity is characterized by both early and late complications, and thus, there is a need to develop safe and non-invasive techniques. Ghrelin is an orexigenic hormone produced by the fundus of the stomach, which may represent a novel target for obesity management. Unfortunately, numerous attempts to alter ghrelin levels have failed to present significant clinical results. We describe a novel procedure that involves modifying arterial blood flow to the gastric fundus for limiting plasma ghrelin levels. METHODS A gastroscope was advanced into the gastric fundus of 13 healthy Yorkshire swine, and the fundus was clipped under direct visualization to restrict left gastric artery blood flow. Body weights and ghrelin levels were recorded before and once a week for 4 weeks after the procedure. RESULTS Compared to controls, gastroscopic clipping of the fundus decreased plasma ghrelin levels and prevented further weight gain in the 4 weeks of follow-up. Immunohistochemistry and histomorphometry revealed reduced numbers of ghrelin-positive cells in the fundus of experimental animals. We also observed thrombosis in submucosal arteries and submucosal fibrosis. Histological studies demonstrated minimal gastric mucosal injury. CONCLUSION Gastroscopic clipping of the fundus in an experimental porcine model resulted in sustained weight loss and a reduction in plasma ghrelin levels at 1 month post-procedure, with no adverse events. Further experimental studies in human patients are needed to examine the clinical utility of this procedure and to optimize a technique, which can facilitate adequate weight loss while minimizing the risk of mucosal injury.
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Affiliation(s)
- Nickolas Kipshidze
- New York Cardiovascular Research, 1726 2nd Ave., Suite 4S, New York, NY, 10028, USA. .,N. Kipshidze Central University Hospital, 29 Vazha Pshavela Ave, Tbilisi, Georgia.
| | - Anaka Prakash
- NJ Medical Health Associates, 1 Journal Square Plz. Ste. 2, Jersey City, NJ, USA
| | - Nodar Kipshidze
- New York Cardiovascular Research, 1726 2nd Ave., Suite 4S, New York, NY, 10028, USA.,College of Global Public Health, New York University, New York, NY, USA
| | | | - Zurab Kakabadze
- Tbilisi State Medical University, 7 Mikheli Asatianti St, Tbilisi, Georgia
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Murad FM, Komanduri S, Abu Dayyeh BK, Chauhan SS, Enestvedt BK, Fujii-Lau LL, Konda V, Maple JT, Pannala R, Thosani NC, Banerjee S. Echoendoscopes. Gastrointest Endosc 2015; 82:189-202. [PMID: 26077457 DOI: 10.1016/j.gie.2015.02.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 02/10/2015] [Indexed: 02/08/2023]
Abstract
Advances in echoendoscopes and their processors have significantly expanded the role of EUS and its clinical applications.The diagnostic and therapeutic capabilities of EUS continue to evolve and improve. EUS has made a large impact on patient care but comes with significant startup and maintenance costs. As improved technology continues to enhance image resolution while decreasing the size of EUS processors, use of endosonography will become more widespread. EUS will continue to be a vital part of patient care and complement currently available cross-sectional imaging.
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Haddad J, Bouazza F, Baraké H, Liberale G, Flamen P, Nakadi IE. Surgical strategy in abnormally increased Fluorine-18 fluorodeoxyglucose uptake in an asymptomatic lower esophageal submucosal tumor - Report of a case. Int J Surg Case Rep 2014; 5:589-93. [PMID: 25105772 PMCID: PMC4201026 DOI: 10.1016/j.ijscr.2014.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 04/14/2014] [Accepted: 06/20/2014] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Leiomyoma is the most common benign tumor of the esophagus (67-80%), it represents 0.4-1% of all esophageal tumors. PRESENTATION OF CASE An incidentally discovered gastro-esophageal submucosal tumor was found to have increased fluorine-18-fluorodeoxyglucose (FDG) uptake on positron emission computed tomography (PET/CT). After laparoscopic surgical exploration and local enucleation the tumor turned out to be a benign esophageal leiomyoma. DISCUSSION There are few reports of esophageal leiomyomas with a positive uptake on (PET/CT) and even fewer adopting our combination of a minimally invasive approach and frozen section examination as a management plan. Our approach avoided excessive morbid surgical resections and underestimation of a malignant disease. CONCLUSION We report this case hoping to expand the existing literature on the topic and to highlight the limitations of PET/CT in guiding the diagnosis and subsequently the management of esophageal submucosal tumors.
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Affiliation(s)
- Johnny Haddad
- Clinic of Digestive Surgical Oncology, Jules Bordet Institute, Rue Héger-Bordet, 1, B-1000 Brussels, Belgium
| | - Fikri Bouazza
- Clinic of Digestive Surgical Oncology, Jules Bordet Institute, Rue Héger-Bordet, 1, B-1000 Brussels, Belgium
| | - Hassan Baraké
- Clinic of Digestive Surgical Oncology, Jules Bordet Institute, Rue Héger-Bordet, 1, B-1000 Brussels, Belgium
| | - Gabriel Liberale
- Clinic of Digestive Surgical Oncology, Jules Bordet Institute, Rue Héger-Bordet, 1, B-1000 Brussels, Belgium
| | - Patrick Flamen
- Nuclear Medicine Department, Jules Bordet Institute, Rue Héger-Bordet, 1, B-1000 Brussels, Belgium
| | - Issam El Nakadi
- Clinic of Digestive Surgical Oncology, Jules Bordet Institute, Rue Héger-Bordet, 1, B-1000 Brussels, Belgium.
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de Britto MAP, Soletti RC, Schanaider A, Madi K, de Souza HSP, Machado JC. Endoluminal ultrasound biomicroscopy as a reliable tool for in vivo assessment of colonic inflammation in rats. Int J Colorectal Dis 2013; 28:1613-1620. [PMID: 23925435 DOI: 10.1007/s00384-013-1755-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE Endoscopic ultrasound (EUS) imaging of the colon is an important diagnostic tool for early neoplasia, although usually restricted to the rectum in inflammatory bowel disease (IBD). This study aimed to evaluate the ability of an endoluminal ultrasound biomicroscopic (eUBM) system to detect and characterize lesions simulating Crohn's disease in the colon of rats in vivo. METHODS Colitis was induced with trinitrobenzene sulfonic acid instillated in the distal colon. Eighteen Wistar rats were submitted to eUBM in three time points: week 1 group (18 animals examined on day 3 after colitis induction), week 2 group (12 animals on days 3 and 10), and week 3 group (7 animals on days 3, 10, and 17). This design yielded distinct inflammation intensities. Three untreated rats were used for acquisition of control images. Scores were used for comparison with histology. RESULTS Scores for eUBM and histology in the different moments of examination achieved a Spearman's rank correlation coefficient of 0.87 (p < 0.001). Findings of wall thickening presented positive predictive value (PPV) and sensitivity of 94 and of 100 %, respectively. Superficial and deep ulcers presented a PPV of 89 and 80 %, respectively, and negative predictive values of 100 and 85 %, respectively. CONCLUSION Accurate detection and analysis of the lesions was achieved. The model is essential for the clinical development of the technique and a reproducible method for the evaluation of experimental colitis. eUBM might be applicable in different segments of the gut, developing into a novel adjunct method for IBD evaluation.
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Affiliation(s)
- Marcelo Alexandre Pinto de Britto
- Post-Graduation Program in Surgical Sciences, Department of Surgery, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Kobara H, Mori H, Rafiq K, Fujihara S, Nishiyama N, Ayaki M, Yachida T, Tani J, Miyoshi H, Kamada H, Morishita A, Oryu M, Tsutsui K, Haba R, Masaki T. Indications of endoscopic submucosal dissection for symptomatic benign gastrointestinal subepithelial or carcinoid tumors originating in the submucosa. Mol Clin Oncol 2013; 1:1002-1008. [PMID: 24649284 DOI: 10.3892/mco.2013.177] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 08/19/2013] [Indexed: 02/06/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) for upper gastrointestinal (GI) subepithelial tumors (SETs) originating in the muscularis propria (MP) layer is associated with numerous issues regarding secure closure and measures against accidental perforation. However, symptomatic benign GI SETs or carcinoid tumors originating in the submucosa (SM) may be safely resected en-bloc using ESD. In this study, the feasibility and safety of ESD as a novel method for endoscopic resection for such GI SETs revealed on endoscopic ultrasonography (EUS) was investigated. A total of 12 consecutive cases of patients with symptomatic benign SETs (n=3; 1 esophageal hemangioma and 2 gastric lipomas) or small carcinoid tumors (n=9; <10 mm, with an extremely low risk of metastasis) originating in the SM as determined on EUS, between March, 2009 and April, 2013, were retrospectively reviewed. The lesions were resected by ESD after confirming that the tumors originated from the SM. The complication rate following en-bloc resection was also determined. En-bloc resection was achieved in all 12 cases, the mean procedure time was 45 min (range, 20-120 min) and no complications occurred intra- or postoperatively. There was no tumor recurrence or disease-related mortality reported during the follow-up period (median follow-up time, 13.4 months). Histopathological curative resection was achieved with ESD without complications in all 9 cases with carcinoid tumors. Therefore, if EUS reveals a SET originating in the SM without infiltration of the MP and resection is indicated due to the presence of abdominal symptoms, ESD may be a feasible option for diagnostic treatment with minimal invasiveness. However, larger-scale prospective studies are required to establish the feasibility and safety of this procedure.
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Affiliation(s)
- Hideki Kobara
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Hirohito Mori
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Kazi Rafiq
- Pharmacology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Shintarou Fujihara
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Noriko Nishiyama
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Maki Ayaki
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Tatsuo Yachida
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Johji Tani
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Hisaaki Miyoshi
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Hideki Kamada
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Asahiro Morishita
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Makoto Oryu
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Kunihiko Tsutsui
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Reiji Haba
- Diagnostic Pathology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Tsutomu Masaki
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
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Alves KZ, Soletti RC, de Britto MA, de Matos DG, Soldan M, Borges HL, Machado JC. In vivo endoluminal ultrasound biomicroscopic imaging in a mouse model of colorectal cancer. Acad Radiol 2013; 20:90-8. [PMID: 22959583 DOI: 10.1016/j.acra.2012.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 07/17/2012] [Accepted: 07/31/2012] [Indexed: 12/14/2022]
Abstract
RATIONALE AND OBJECTIVES The gold-standard tool for colorectal cancer detection is colonoscopy, but it provides only mucosal surface visualization. Ultrasound biomicroscopy allows a clear delineation of the epithelium and adjacent colonic layers. The aim of this study was to design a system to generate endoluminal ultrasound biomicroscopic images of the mouse colon, in vivo, in an animal model of inflammation-associated colon cancer. MATERIALS AND METHODS Thirteen mice (Mus musculus) were used. A 40-MHz miniprobe catheter was inserted into the accessory channel of a pediatric flexible bronchofiberscope. Control mice (n = 3) and mice treated with azoxymethane and dextran sulfate sodium (n = 10) were subjected to simultaneous endoluminal ultrasound biomicroscopy and white-light colonoscopy. The diagnosis obtained with endoluminal ultrasound biomicroscopy and colonoscopy was compared and confirmed by postmortem histopathology. RESULTS Endoluminal ultrasound biomicroscopic images showed all layers of the normal colon and revealed lesions such as lymphoid hyperplasias and colon tumors. Additionally, endoluminal ultrasound biomicroscopy was able to detect two cases of mucosa layer thickening, confirmed by histology. Compared to histologic results, the sensitivities of endoluminal ultrasound biomicroscopy and colonoscopy were 0.95 and 0.83, respectively, and both methods achieved specificities of 1.0. CONCLUSIONS Endoluminal ultrasound biomicroscopy can be used, in addition to colonoscopy, as a diagnostic method for colonic lesions. Moreover, experimental endoluminal ultrasound biomicroscopy in mouse models is feasible and might be used to further develop research on the differentiation between benign and malignant colonic diseases.
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Komori K, Akahoshi K, Tanaka Y, Motomura Y, Kubokawa M, Itaba S, Hisano T, Osoegawa T, Nakama N, Iwao R, Oya M, Nakamura K. Endoscopic submucosal dissection for esophageal granular cell tumor using the clutch cutter. World J Gastrointest Endosc 2012; 4:17-21. [PMID: 22267979 PMCID: PMC3262174 DOI: 10.4253/wjge.v4.i1.17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 09/01/2011] [Accepted: 01/12/2012] [Indexed: 02/05/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) with a knife is a technically demanding procedure associated with a high complication rate. The shortcomings of this method are the deficiencies of fixing the knife to the target lesion, and of compressing it. These shortcomings can lead to major complications such as perforation and bleeding. To reduce the risk of complications related to ESD, we developed a new grasping type scissors forceps (Clutch Cutter®, Fujifilm, Japan) which can grasp and incise the targeted tissue using an electrosurgical current. Esophagogastroduodenoscopy on a 59-year-old Japanese man revealed a 16mm esophageal submucosal nodule with central depression. Endoscopic ultrasonography demonstrated a hypoechoic solid tumor limited to the submucosa without lymph node involvement. The histologic diagnosis of the specimen obtained by biopsy was granular cell tumor. It was safely and accurately resected without unexpected incision by ESD using the CC. No delayed hemorrhage or perforation occurred. Histological examination confirmed that the granular cell tumor was completely excised with negative resection margin.We report herein a case of esophageal granular cell tumor successfully treated by an ESD technique using the CC.
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Affiliation(s)
- Keishi Komori
- Keishi Komori, Kazuya Akahoshi, Yoshimasa Tanaka, Yasuaki Motomura, Masaru Kubokawa, Soichi Itaba, Terumasa Hisano, Takashi Osoegawa, Naotaka Nakama, Risa Iwao, Department of Gastroenterology, Aso Iizuka Hospital, 3-83, Yoshio-machi, Iizuka, Fukuoka 820-8505, Japan
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15
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Ryu CB, Chen YK. Endoscopic Therapy for Gastric Neoplasms. CLINICAL GASTROINTESTINAL ENDOSCOPY 2012:425-447. [DOI: 10.1016/b978-1-4377-1529-3.00033-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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16
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Alves KZ, Borges HL, Soletti RC, Viana ALP, Petrella LI, Soldan M, Chagas VL, Schanaider A, Machado JC. Features of in vitro ultrasound biomicroscopic imaging and colonoscopy for detection of colon tumor in mice. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:2086-2095. [PMID: 22033129 DOI: 10.1016/j.ultrasmedbio.2011.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 07/13/2011] [Accepted: 09/06/2011] [Indexed: 05/31/2023]
Abstract
The present work tested the capability of ultrasound biomicroscopy (UBM), at 45 MHz, to provide cross-sectional images with appropriate resolution and contrast to detect tumors and determine their penetration depths on the colon of mice, Mus musculus (Linnaeus 1758), treated with carcinogen for colon tumor induction. B-mode images were obtained, in vitro, from each animal (13 treated and 4 untreated) colon opened longitudinally and immersed in saline solution at room temperature. Prior to UBM inspection, all animals were also examined by colonoscopy. The layers of normal colon identified by UBM are: mucosa (hyperechoic), muscularis mucosae (hypoechoic), submucosa (hyperechoic) and muscularis externa (hypoechoic). UBM images of colon lesions presented structures corresponding to tumors (hyperechoic), lymphoid hyperplasia (hypoechoic) and polypoid tumors (hyperechoic). Additionally, tumoral lesion invasion through the colon was also identified. When compared with histopathologic analysis, all colon lesions detected by UBM were confirmed, while colonoscopic findings had two false negatives.
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Affiliation(s)
- Kelly Z Alves
- Biomedical Engineering Program, COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Zhang XL, Qian LX. Application of ultrasonography in the diagnosis and treatment of gastric stromal tumors. Shijie Huaren Xiaohua Zazhi 2011; 19:2311-2315. [DOI: 10.11569/wcjd.v19.i22.2311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gastric stromal tumors are common mesenchymal tumors of the gastrointestinal tract. Common clinical manifestations include abdominal pain, bowel obstruction, gastrointestinal bleeding, and abdominal mass. Gastric stromal tumors show a histological feature of spontaneous differentiation. Ultrasound examination plays an important role in the diagnosis and treatment of gastric stromal tumors. Here we review the application of ultrasonography in the diagnosis and treatment of gastric stromal tumors.
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Zhang P, Tao KX. Gastric gastrointestinal stromal tumors: an analysis of 114 cases. Shijie Huaren Xiaohua Zazhi 2011; 19:2181-2184. [DOI: 10.11569/wcjd.v19.i20.2181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical characteristics, diagnosis, treatment and prognosis of gastrointestinal stromal tumors (GISTs) of the stomach.
METHODS: The clinical and pathological data for 114 patients with GISTs of the stomach who were treated from January 2005 to September 2010 at Wuhan Union Hospital were analyzed retrospectively.
RESULTS: GISTs of the stomach were mainly located in the cardia or fundus (53.5%) and the stomach body (36.8%). The common presenting symptoms included gastrointestinal hemorrhage and abdominal pain. EUS and CT had a high accuracy of preoperative diagnosis. Pathological and immunohistochemical examinations were necessary for a clear diagnosis. All but one patient received complete surgical resection. Immunohistochemistry demonstrated that tumor cells were positive for CD117 in 112 cases (98.2%) and for CD34 in 105 cases (92.1%). The follow-up period ranged from 3 to 68 months, with a mean value of 26.2 months. Twenty-four cases received imatinib mesylate after surgery. The 5-year survival rate and tumor-free survival rate were 100% and 98.0%, respectively.
CONCLUSION: Gastric GISTs have atypical clinical features. EUS and CT are effective diagnostic methods. Surgery is the main therapy and targeted therapy can significantly improve the survival of patients with gastric GISTs.
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Abstract
PURPOSE OF REVIEW To summarize the literature to date on endoscopic mucosal removal techniques as applied to the upper gastrointestinal tract, predominantly the stomach and esophagus. This is an area that has rapidly advanced in terms of new procedures and techniques with a large body of outcomes that support their use. RECENT FINDINGS The resection techniques can be divided into two forms, mucosal resection and submucosal dissection. Mucosal resection is typically done with cap techniques and is more suitable for removable of neoplastic lesions that are less than 1.5 cm in size. Submucosal dissection techniques are more difficult, associated with increased complications, and typically reserved for lesions greater than 1.5 cm and less than 3 cm in size. Ideal lesions for mucosal resection are generally flat and are located in areas easily accessible by the endoscope. SUMMARY Endoscopic tissue removal methods are capable of removing neoplastic lesions en bloc in the upper gastrointestinal tract. These techniques fulfill cancer treatment guidelines by having histological confirmation of total removal of neoplastic lesions with assessment of the margins of resections. Long-term clinical outcomes of these techniques are emerging and seem promising in terms of disease-free and overall survival.
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Sakamoto H, Kitano M, Kudo M. Diagnosis of subepithelial tumors in the upper gastrointestinal tract by endoscopic ultrasonography. World J Radiol 2010; 2:289-97. [PMID: 21160683 PMCID: PMC2998868 DOI: 10.4329/wjr.v2.i8.289] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 07/29/2010] [Accepted: 08/05/2010] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasonography (EUS) is the most accurate procedure for detecting and diagnosing subepithelial tumors, due to its higher sensitivity and specificity than other imaging modalities. EUS can characterize lesions by providing information on echogenic origin, size, borders, homogeneity, and the presence of echogenic or anechoic foci. Linear echoendoscopes, and recently also electronic radial echoendoscopes, can be used with color Doppler or power Doppler to assess the vascular signals from subepithelial masses, and thus permit the differentiation of vascular structures from cysts, as well as the assessment of the tumor blood supply. However, the diagnostic accuracy of EUS imaging alone has been shown to be low in subepithelial lesions with 3rd and 4th layers. It is also difficult to differentiate exactly between benign and malignant tumors and to gain an accurate picture of histology using EUS. On the other hands, EUS guided fine needle aspiration (EUS-FNA) can provide samples for cytologic or histologic analysis. Hypoechoic lesions of the 3rd and the 4th EUS layers, more than in 1 cm diameter are recommended, and histologic confirmation using endoscopic submucosal resection or EUS-FNA should be obtained when possible. Therefore, EUS-FNA plays an important role in the clinical management of subepithelial tumors. Furthermore improvements in endoscopic technology are expected to be more useful modalities in differential diagnosis and discrimination between benign and malignant subepithelial tumors.
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Bujanda L, Cosme A, Gil I, Arenas-Mirave JI. Malignant colorectal polyps. World J Gastroenterol 2010; 16:3103-3111. [PMID: 20593495 PMCID: PMC2896747 DOI: 10.3748/wjg.v16.i25.3103] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 04/07/2010] [Accepted: 04/14/2010] [Indexed: 02/06/2023] Open
Abstract
Nowadays, the number of cases in which malignant colorectal polyps are removed is increasing due to colorectal cancer screening programmes. Cancerous polyps are classified into non-invasive high grade neoplasia (NHGN), when the cancer has not reached the muscularis mucosa, and malignant polyps, classed as T1, when they have invaded the submucosa. NHGN is considered cured with polypectomy, while the prognosis for malignant polyps depends on various morphological and histological factors. The prognostic factors include, sessile or pedunculated morphology of the polyp, whether partial or en bloc resection is carried out, the degree of differentiation of the carcinoma, vascular or lymphatic involvement, and whether the polypectomy resection margin is tumor free. A malignant polyp at T1 is considered cured with polypectomy if it is a pedunculated polyp (Ip of the Paris classification), it has been completely resected, it is not poorly differentiated, the resection edge is not affected by the tumor and there is no vascular or lymphatic involvement. The sessile malignant polyp (Is of the Paris classification) at T1 is considered not cured with polypectomy. Only in some cases (e.g. older people with high surgical risk) local excision (polypectomy or endoscopic submucosal dissection or conventional endoscopic mucosal resection) is considered the definitive treatment.
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Karaca C, Turner BG, Cizginer S, Forcione D, Brugge W. Accuracy of EUS in the evaluation of small gastric subepithelial lesions. Gastrointest Endosc 2010; 71:722-7. [PMID: 20171632 DOI: 10.1016/j.gie.2009.10.019] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 10/08/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND EUS combined with endoluminal resection techniques is increasingly used to provide a definitive diagnosis of small gastric subepithelial lesions seen on standard upper endoscopy. OBJECTIVE To evaluate the accuracy of EUS in diagnosing small gastric subepithelial lesions by using histology as the criterion standard. DESIGN A retrospective study. SETTING Academic tertiary care center. PATIENTS A total of 22 patients (15 women, mean age 62.2 years) with an endoscopically resected gastric subepithelial lesion were included in this 3-year retrospective study. MAIN OUTCOME MEASUREMENTS The size, echogenicity, the layer of origin, and presumptive diagnosis were determined by EUS. The diagnostic accuracy of EUS was determined by using histology as the criterion standard. RESULTS The mean size of the 22 lesions was 13.6 mm (range 8-20 mm). An endoscopic cap band mucosectomy device was used to resect 16 (72.7%) lesions, whereas 6 (27.3%) were resected with a saline solution-assisted and snare technique. Using histology as a criterion standard, we found that the accuracy of the EUS diagnosis was 10 of 22 (45.5%). EUS alone had an accuracy rate of 30.8% and 66.7%, respectively, in the diagnosis of neoplastic and non-neoplastic lesions. LIMITATIONS A single-center, retrospective analysis. CONCLUSION EUS imaging had a low accuracy rate in the diagnosis of gastric subepithelial lesions, and endoscopic submucosal resection should be performed to provide a histologic diagnosis. Resection of small subepithelial lesions of 20 mm or less can be accomplished en bloc with an endoscopic cap band mucosectomy device.
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Affiliation(s)
- Cetin Karaca
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
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Endoscopic balloon dilation for obstructive colorectal cancer: a basic study on morphologic and pathologic features associated with perforation. Gastrointest Endosc 2010; 71:799-805. [PMID: 20363422 DOI: 10.1016/j.gie.2009.10.059] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Accepted: 10/27/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND The use of endoscopic dilation and a self-expandable stent for colorectal cancer (CRC) presenting with a stricture or obstruction, either prior to surgery or as a palliative measure (an alternative to colostomy), causes perforation with relative high incidence (1%-17%). OBJECTIVE To experimentally investigate risk factors associated with perforation in excised CRC specimens. DESIGN Experimental study. SETTING Ex vivo experiment on freshly excised human colon cancer specimens at an academic hospital. PATIENTS This study involved 47 patients with strictured CRCs of <15 mm in internal diameter as assessed by a preoperative contrast enema. INTERVENTION Immediately after surgical resection, a balloon with a diameter of 18 mm was placed in the stricture. The balloon was inflated slowly with hydrostatic pressure over 1 minute and kept at the maximum diameter for 1 minute. MAIN OUTCOME MEASUREMENTS Correlations between macroscopic perforation and 20 items, including morphological and histopathological characteristics. RESULTS Perforation occurred in 8 of 47 (17.0%) CRC specimens. Four items showed statistically significant (P < .05) correlations with perforation: peritumoral proliferation of collagen fibers (relative area > or =23.9% in the visual field), annularity of the tumor, severe stricture (<7.9 mm), and fewer residual smooth muscle cells in the muscularis propria, reflecting tumor encroachment. The best predictor of perforation was a combination of severe stricture and pronounced peritumoral proliferation of collagen fibers. LIMITATIONS An uncontrolled study with a small number of patients. CONCLUSION Histopathological and morphological items associated with a decrease in elastic compliance were more important as predictors of perforation than dilation procedure parameters, such as balloon pressure.
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Asteriou C, Konstantinou D, Lalountas M, Kleontas A, Setzis K, Zafiriou G, Barbetakis N. Nine years experience in surgical approach of leiomyomatosis of esophagus. World J Surg Oncol 2009; 7:102. [PMID: 20030817 PMCID: PMC2804581 DOI: 10.1186/1477-7819-7-102] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2009] [Accepted: 12/23/2009] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Leiomyomas of esophagus, although rare, are the most frequent benign tumors of esophagus. Aim of this study is the presentation of 7 patients with esophageal leiomyomas who underwent surgical treatment during a 9-year period. METHODS Epidemiological data (sex, age), the presenting symptoms, diagnostic examinations, tumor location, histopathological findings and the safety and efficacy of surgical resection are analyzed and assessed. RESULTS 5 men and 2 women with mean age of 56.9 years were operated. In 3 cases the tumor was located at the lower esophagus, while in the other 4 cases, the leiomyoma was found at the median third of esophagus. 4 patients had severe symptoms related to the leiomyoma, such as dysphagia and epigastric pain. All patients underwent a right postolateral thoracotomy with enucleation of the lesion. None of them received resection of part of the esophagus. The mean diameter of the resected tumors was 4.3 cm. The dimensions of leiomyomas were immediately associated with the symptoms. In no case was detected malignancy or recurrence. All patients were relieved from their symptoms, while postoperative morbidity and mortality did not occur. CONCLUSIONS Esophageal leiomyoma is a benign tumor, which causes symptoms only if its size becomes large. Surgical enucleation is considered to be safe and effective, without complications.
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Affiliation(s)
- Christos Asteriou
- CardioThoracic Surgery Department, Theagenio Cancer Hospital, Al. Symeonidi 2, Thessaloniki, 54007, Greece
| | - Dimitrios Konstantinou
- 2nd Department of Chemotherapy, Theagenio Cancer Hospital, Al. Symeonidi 2, Thessaloniki, 54007, Greece
| | - Miltiadis Lalountas
- 2nd Propedeutical Department of Surgery, Aristotle University of Thessaloniki, Hippokratio General Hospital, Konstantinoupoleos 49, Thessaloniki, Greece
| | - Athanassios Kleontas
- CardioThoracic Surgery Department, Theagenio Cancer Hospital, Al. Symeonidi 2, Thessaloniki, 54007, Greece
| | - Konstantinos Setzis
- 1st Department of Surgery, Theagenio Cancer Hospital, Al. Symeonidi 2, Thessaloniki, 54007, Greece
| | - Georgios Zafiriou
- 1st Department of Surgery, Theagenio Cancer Hospital, Al. Symeonidi 2, Thessaloniki, 54007, Greece
| | - Nikolaos Barbetakis
- CardioThoracic Surgery Department, Theagenio Cancer Hospital, Al. Symeonidi 2, Thessaloniki, 54007, Greece
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Choice of endosonographic equipment and normal endosonographic anatomy. Best Pract Res Clin Gastroenterol 2009; 23:623-37. [PMID: 19744628 DOI: 10.1016/j.bpg.2009.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Accepted: 07/14/2009] [Indexed: 01/31/2023]
Abstract
Endosonography may be considered as a very special area in endoscopy. It really revolutionised endoscopy in allowing seeing behind the digestive lumen, in accessing the mediastinum and the pancreas, and in performing the first "NOTES" procedures. Endoscopists have usually mixed feelings towards endosonography: most of them consider EUS as the "Holy Grail" since it is one of the most complex diagnostic and therapeutic endoscopic procedures, but many users are still uncomfortable with some anatomical landmarks and with the choice of equipment. Echoendoscopes are indeed known to be costly and fragile, and quite versatile with the choice between different manufacturers, and between radial or linear (convex array) oriented instruments. This review aims at providing up-to-date information on the different types of echoendoscopes and processors and on normal endosonographic anatomy of the digestive tract, the mediastinum, the pancreas and the biliary tree.
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Kanao H, Tanaka S, Oka S, Hirata M, Yoshida S, Chayama K. Narrow-band imaging magnification predicts the histology and invasion depth of colorectal tumors. Gastrointest Endosc 2009; 69:631-6. [PMID: 19251003 DOI: 10.1016/j.gie.2008.08.028] [Citation(s) in RCA: 162] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 08/21/2008] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are several reports concerning the differential diagnosis of non-neoplastic and neoplastic colorectal lesions by narrow-band imaging (NBI). However, there are only a few NBI articles that assessed invasion depth. OBJECTIVE To determine the clinical usefulness of NBI magnification for evaluating microvessel architecture in relation to pit appearances and in the qualitative diagnosis of colorectal tumors. DESIGN A retrospective study. SETTING Department of Endoscopy, Hiroshima University, Hiroshima, Japan. PATIENTS AND MAIN OUTCOME MEASUREMENTS A total of 289 colorectal lesions were analyzed: 12 hyperplasias (HP), 165 tubular adenomas (TA), 65 carcinomas with intramucosal to scanty submucosal invasion (M-SM-s), and 47 carcinomas with massive submucosal invasion (SM-m). Lesions were observed by NBI magnifying endoscopy and were classified according to microvessel features and pit appearances: type A, type B, and type C. Type C was divided into 3 subtypes (C1, C2, and C3), according to the detailed NBI magnifying findings of pit visibility, vessel diameter, irregularity, and distribution. These were compared with histologic findings. RESULTS Histologic findings of HP and TA were seen in 80.0% and 20.0%, respectively, of type A lesions. TA and M-SM-s were found in 79.7% and 20.3%, respectively, of type B lesions. TA, M-SM-s, and SM-m were found in 21.6%, 29.9%, and 48.5, respectively, of type C lesions. HPs were observed significantly more often than TAs in type A lesions, TAs were observed significantly more often than carcinomas in type B lesions, carcinomas were observed significantly more often than TAs in type C (P < .01). TA, M-SM-s, and SM-m were found in 46.7%, 42.2%, and 11.1% of type C1 lesions, respectively. M-SM-s and SM-m were found in 45.5% and 54.5%, respectively, of type C2 lesions. SM-m was found in 100% of type C3 lesions. TAs and M-SM-s were observed significantly more often than SM-m in type C1 lesions, and SM-m were observed significantly more often than TAs and M-SM-s in type C3 lesions (P < .01). CONCLUSIONS NBI magnification findings of colorectal lesions were associated with histologic grade and invasion depth.
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Affiliation(s)
- Hiroyuki Kanao
- Department of Medicine and Molecular Science, Hiroshima University, Hiroshima, Japan
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Abe T, Kakemura T, Fujinuma S, Maetani I. Successful outcomes of EMR-L with 3D-EUS for rectal carcinoids compared with historical controls. World J Gastroenterol 2008; 14:4054-8. [PMID: 18609690 PMCID: PMC2725345 DOI: 10.3748/wjg.14.4054] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the results of endoscopic mucosal resection with a ligation device (EMR-L) combined with three dimensional endoscopic ultrasonography (3D-EUS) using an ultrasonic probe for rectal carcinoids. In addition, diagnosis of the depth and size of lesions by EUS was evaluated.
METHODS: Between January 2003 and March 2007, 20 patients underwent EMR-L with 3D-EUS using an ultrasonic probe (group A). 3D-EUS was combined with EMR-L at the time of injection of sterile physiological saline into the submucosal layer. For comparison, 14 rectal carcinoids that had been treated by EMR-L without 3D-EUS between April 1998 and December 2002 were evaluated as historical controls (group B). EUS was conducted for all of the patients before treatment to evaluate tumor diameter and depth of invasion. The percentage of complete resection and the vertical resection margin were compared between the two groups.
RESULTS: The depth of invasion upon histopathological examination was in complete agreement with the pre-operative findings by EUS. The tumor diameter determined by EUS approximated that found in the tissue samples. There were no significant differences in the gender, tumor sites or tumor diameters between the two groups. The rate of complete resection for groups A and B was 100% and 71%, respectively (P < 0.05). The vertical resection margin of group A was longer than that of group B.
CONCLUSION: EMR-L is effective as an endoscopic treatment for rectal carcinoids. In combination with 3D-EUS, safe and complete resection is further assured.
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Xu GQ, Wu YQ, Wang LJ, Chen HT. Values of endoscopic ultrasonography for diagnosis and treatment of duodenal protruding lesions. J Zhejiang Univ Sci B 2008; 9:329-34. [PMID: 18381809 DOI: 10.1631/jzus.b0710546] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The diagnoses of patients with duodenal protruding lesions are difficult when using conventional examinations such as computed tomography (CT) and conventional endoscope etc. Thus, we investigated the clinical value of endoscopic ultrasonography (EUS) with miniature ultrasonic probes on the diagnosis and treatment of duodenal protruding lesions. METHODS Patients with duodenal protruding lesions who were indicated for EUS were examined by EUS with 12 approximately 15 MHz miniature ultrasonic probes and double-cavity electronic endoscope. According to diagnosis of EUS, those patients were indicated for biopsy and treatment received biopsy, endoscopic resection or surgical excision. The postoperative histological results were compared with the preoperative diagnosis of EUS. Those patients without endoscopic resection or surgical excision were periodically followed up with EUS. RESULTS A total of 169 patients with duodenal protruding lesions were examined by EUS, of which 40 were diagnosed with cysts, 36 with inflammatory protruding or polyp, 25 with Brunner's gland adenoma, 19 with ectopic pancreas, 17 with gastrointestinal stromal tumor, 12 with extrinsic compression, 12 with minor papilla, 6 with lipoma, 1 with adenocarcinoma and 1 with lymphoma. After EUS examinations, 75 patients received biopsy, endoscopic resection or surgical excision respectively. The postoperative histological results of 70 patients were completely consistent with the preoperative diagnosis of EUS, with 93.33% diagnostic accuracy. The results of follow-up with EUS indicated that duodenal cyst, Brunner's gland adenoma, ectopic pancreas, gastrointestinal stromal tumor and lipoma remained unchanged within 1 approximately 3 years. No related complications occurred among all patients that received EUS examinations. CONCLUSION EUS is an effective and reliable diagnostic method for duodenal protruding lesions.
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Affiliation(s)
- Guo-qiang Xu
- Department of Gastroenterology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
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Abstract
The finding of a mass lesion in the upper gastrointestinal tract at endoscopy with apparent normal overlying mucosa is common. The differential diagnosis of such lesions is broad and includes those of intramural or extramural origin. Endoscopic ultrasound provides accurate imaging of subepithelial mass lesions and characterizes them according to size, echogenicity, and origin including the histologic layer if the lesion is intramural which narrows the differential diagnosis. Endoscopic ultrasound allows a guided tissue sample to be obtained for histologic confirmation which is especially important for hypoechoic lesions arising from the 3rd or 4th echogenic layers. The purpose of this article is to review the diagnosis of the more common subepithelial mass lesions with an emphasis on endoscopic ultrasound and the subsequent management or monitoring.
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Affiliation(s)
- Jeremy L Humphris
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, and University of Sydney, Sydney, New South Wales, Australia
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Atkinson RJ, Hurlstone DP. Techniques for the treatment of submucosal rectal tumors: the role of ESMRL. J Gastroenterol Hepatol 2008; 23:165-6. [PMID: 18289348 DOI: 10.1111/j.1440-1746.2007.04974.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Kanao H, Tanaka S, Oka S, Kaneko I, Yoshida S, Arihiro K, Yoshihara M, Chayama K. Clinical significance of type V I pit pattern subclassification in determining the depth of invasion of colorectal neoplasms. World J Gastroenterol 2008; 14:211-7. [PMID: 18186557 PMCID: PMC2675116 DOI: 10.3748/wjg.14.211] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To clarify whether subclassification of the type VI pit pattern on the basis of magnifying colonoscopy findings is useful in determining the type and depth of invasion of colorectal neoplasms.
METHODS: We retrospectively analyzed 272 colorectal neoplasms (117 dysplasias and 155 submucosal invasive carcinomas; 228 patients) with a type V pit pattern [type VI, n = 202; type VN, n = 70 (Kudo and Tsuruta classification system)]. We divided lesions with a type VI pit pattern into two subclasses, mildly irregular lesions and severely irregular lesions, according to the prominent and detailed magnifying colonoscopy findings. We examined the relation between these two subclasses and histology/invasion depth.
RESULTS: One hundred and four lesions (51.5%) were judged to be mildly irregular, and 98 lesions (48.5%) were judged to be severely irregular. Ninety-seven (93.3%) mildly irregular lesions showed dysplasias or submucosal invasion of less than 1000 &mgr;m (SM < 1000 &mgr;m). Fifty-five (56.1%) severely irregular lesions showed submucosal invasion equal to or deeper than 1000 &mgr;m (SM ≥ 1000 &mgr;m). Mild irregularity was found significantly more often in dysplasias or lesions with SM < 1000 &mgr;m than in lesions with SM ≥ 1000 &mgr;m (P < 0.01).
CONCLUSION: Subclassification of the type VI pit pattern is useful for identifying dysplasias or lesions with SM < 1000 &mgr;m.
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Zhou XD, Lv NH, Chen HX, Wang CW, Zhu X, Xu P, Chen YX. Endoscopic management of gastrointestinal smooth muscle tumor. World J Gastroenterol 2007; 13:4897-902. [PMID: 17828822 PMCID: PMC4611769 DOI: 10.3748/wjg.v13.i36.4897] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To systematically evaluate the efficacy and safety of endoscopic resection of gastrointestinal smooth muscle tumors (SMTs, including leiomyoma and leiomyosarcoma) and to review our preliminary experiences on endoscopic diagnosis of gastrointestinal SMTs.
METHODS: A total of 69 patients with gastrointestinal SMT underwent routine endoscopy in our department. Endoscopic ultrasonography (EUS) was also performed in 9 cases of gastrointestinal SMT. The sessile submucosal gastrointestinal SMTs with the base smaller than 2 cm in diameter were resected by “pushing” technique or “grasping and pushing” technique while the pedunculated SMTs were resected by polypectomy. For those SMTs originating from muscularis propria or with the base size ≥ 2 cm, ordinary biopsy technique was performed in tumors with ulcers while the “Digging” technique was performed in those without ulcers.
RESULTS: 54 cases of leiomyoma and 15 cases of leiomyosarcoma were identified. In them, 19 cases of submucosal leiomyoma were resected by “pushing” technique and 10 cases were removed by “grasping and pushing” technique. Three cases pedunculated submucosal leiomyoma were resected by polypectomy. No severe complications developed during or after the procedure. No recurrence was observed. The diagnostic accuracy of ordinary and the “Digging” biopsy technique was 90.0% and 94.1%, respectively.
CONCLUSION: Endoscopic resection is a safe and effective treatment for leiomyomas with the base size ≤ 2 cm. The “digging” biopsy technique would be a good option for histologic diagnosis of SMTs.
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Affiliation(s)
- Xiao-Dong Zhou
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China.
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Larghi A, Waxman I. State of the art on endoscopic mucosal resection and endoscopic submucosal dissection. Gastrointest Endosc Clin N Am 2007; 17:441-69, v. [PMID: 17640576 DOI: 10.1016/j.giec.2007.05.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) provide new alternatives for minimally invasive treatment of superficial gastrointestinal malignancies. Evidence suggests that these techniques can be performed safely and have comparable outcomes to surgery with less morbidity and better quality of life due to their tissue-sparing nature when compared with conventional surgery. Although the techniques and accessories have become standardized, there is room for improvement, and further research and development are required. Current challenges facing American gastroenterologists or endoscopic surgeons include access to training and lack of appropriate reimbursement for these heavy-weighted and technically demanding procedures. Nevertheless, EMR and ESD are here to stay and are only the first steps toward true radical endoluminal resection of GI malignancies.
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Affiliation(s)
- Alberto Larghi
- Digestive Endoscopy Unit, Catholic University, Largo A. Gemelli 8, 00192 Rome, Italy
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34
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Yusuf TE, Tsutaki S, Wagh MS, Waxman I, Brugge WR. The EUS hardware store: state of the art technical review of instruments and equipment (with videos). Gastrointest Endosc 2007; 66:131-43. [PMID: 17591487 DOI: 10.1016/j.gie.2006.03.935] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2005] [Accepted: 03/31/2006] [Indexed: 01/04/2023]
Affiliation(s)
- Tony E Yusuf
- GI Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, and Division of Gastroenterology and Hepatology, University of Chicago Hospitals, Chicago, Illinois, USA
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35
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Abstract
This review is part three of three and will present an update on the therapeutic options and procedures concerning gastrointestinal (GI) submucosal tumors (SMTs). The aim of this paper is to investigate the treatments of GI SMTs and to present a case of a gastrointestinal stromal tumor (GIST). Literature searches were performed to find information on therapy for GI SMTs. Based on these searches, the optimal therapeutic procedures could be outlined. The choice of treatment of localized tumors is endoscopic resection if possible or, alternatively, laparoscopic resection or surgical resection by an open procedure. However, benign SMTs should only be excised if symptoms are present, and GISTs should be treated with particular precautions. Irresectable or recurrent GISTs may be successfully treated with the tyrosine kinase inhibitor, imatinib.
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Affiliation(s)
- Laura-Graves Ponsaing
- Department of Surgical Gastroenterology K, Bispebjerg University Hospital of Copenhagen, Bispebjerg Bakke 23, 2400 NV Copenhagen, Denmark.
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Ponsaing LG, Kiss K, Loft A, Jensen LI, Hansen MB. Diagnostic procedures for submucosal tumors in the gastrointestinal tract. World J Gastroenterol 2007; 13:3301-10. [PMID: 17659668 PMCID: PMC4172709 DOI: 10.3748/wjg.v13.i24.3301] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This review is part one of three, which will present an update on diagnostic procedures for gastrointestinal (GI) submucosal tumors (SMTs). Part two identifies the classification and part three the therapeutic methods regarding GI SMTs. Submucosal tumors are typically asymptomatic and therefore encountered incidentally. Advances in diagnostic tools for gastrointestinal submucosal tumors have emerged over the past decade. The aim of this paper is to provide the readers with guidelines for the use of diagnostic procedures, when a submucosal tumor is suspected. Literature searches were performed to find information on diagnostics for gastrointestinal submucosal tumors. Based on the searches, the optimal diagnostic procedures and specific features of the submucosal tumors could be outlined. Standard endoscppy, capsule endoscopy and push-and-pull enteroscopy (PPE) together with barium contrast X-ray do not alone provide sufficient information, when examining submucosal tumors. Endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI) and fluorodeoxyglucose-labeled positron emission tomography (FDG-PET) are recommended as supplementary tools.
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Affiliation(s)
- Laura-Graves Ponsaing
- Department of Surgical Gastroenterology K, Bispebjerg University Hospital of Copenhagen, Bispebjerg Bakke 23, 2400 NV Copenhagen, Denmark.
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37
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Hassan C, Zullo A, Winn S, Eramo A, Tomao S, Rossini FP, Morini S. The colorectal malignant polyp: scoping a dilemma. Dig Liver Dis 2007; 39:92-100. [PMID: 17113842 DOI: 10.1016/j.dld.2006.06.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Revised: 06/19/2006] [Accepted: 06/26/2006] [Indexed: 12/11/2022]
Abstract
Colorectal adenomas containing invasive carcinoma represent the majority of early colorectal cancers. The malignant polyp carries a significant risk of lympho-haematic metastasis and mortality due to the penetration of cancerous cells into the submucosal layer. The therapeutic dilemma is whether to perform endoscopic or surgical resection. A thorough assessment of the endoscopic, histological and clinical variables is needed to unravel the best treatment for each patient. In particular, a unique staging of such lesions, based on certain histopathological features, has been deeply implicated in the therapeutic choice. Aim of this article is to review the main endoscopic, histological and clinical features of the malignant polyp in order to propose a systematic management of this lesion.
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Affiliation(s)
- C Hassan
- Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
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38
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Martínez-Ares D, Martínez Cadilla J, Cáceres Alvarado N, González Carreró-Fojón J, Martín-Granizo Barrenechea I, Pallarés Peral A. Tumor estromal gástrico de riesgo intermedio: diagnóstico mediante ecografía hidrogástrica. GASTROENTEROLOGIA Y HEPATOLOGIA 2006; 29:622-4. [PMID: 17198640 DOI: 10.1157/13095197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Evaluation of submucosal lesions of the digestive tract with conventional endoscopy is unsatisfactory since this technique does not allow direct observation or correct evaluation of the size and layer of origin of the tumor; therefore, in most patients an etiological diagnosis cannot be established with this procedure. However, in most patients, endoscopic ultrasonography can resolve these problems: to a fair degree of certainty, this technique can differentiate malignant from benign lesions, measure their size, and establish their layer of origin. Endoscopic ultrasonography is the technique of choice to establish the presence and characteristics of submucosal tumors and their suitability for treatment. Moreover, this procedure can identify tumors that can be removed endoscopically without excessive risk. Hydrogastric ultrasonography can be an effective substitute for echoendoscopy when evaluating submucosal lesions and for staging tumors of the gastric antrum when echoendoscopy is not available or in patients in whom it cannot be performed. Hydrogastric ultrasonography is safe, inexpensive and very well tolerated by patients. We present the case of a female patient with a gastric GIST that was evaluated using hydrogastric ultrasonography. The size, layer of origin, and malignancy of the tumor were accurately established.
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Affiliation(s)
- David Martínez-Ares
- Servicio de Digestivo, Complejo Hospitalario Universitario Xeral-Cíes, Vigo, Pontevedra, España.
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39
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Gómez Senent S, Gómez Raposo C, Segura Cabral JM. Tratamiento de los tumores de la estroma gastrointestinal (GIST). Med Clin (Barc) 2006; 127:660-8. [PMID: 17169285 DOI: 10.1157/13094822] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Silvia Gómez Senent
- Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid. España.
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40
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Abstract
PURPOSE OF REVIEW To provide an updated review of the diagnosis, management, and treatment of rectal carcinoid tumors, with special emphasis on minimally invasive surgical techniques to treat localized disease. RECENT FINDINGS Carcinoids are morphologically and biologically heterogeneous neuroendocrine tumors that have malignant potential, and are most commonly found in the gastrointestinal tract. The incidence of all carcinoids appears to be increasing, which may reflect improved diagnostic modalities. The rectum is the third most common location for gastrointestinal carcinoids. Recent data have suggested that rectal carcinoids are over-represented in Black and Asian populations. The survival rate for patients with rectal carcinoids is superior to that of carcinoids found elsewhere in the gastrointestinal tract. Tumor size in rectal carcinoids is predictive of metastasis and can reliably guide management. Review of recent literature demonstrates good evidence that localized rectal carcinoids are amenable to local resection. SUMMARY With widespread colorectal cancer screening, heightened awareness, and improved diagnostic modalities, the incidence of rectal carcinoids should continue to increase. There is evidence that convincingly demonstrates that patients with rectal carcinoids less than 2 cm in diameter, localized to the mucosa or submucosa, may be safely and effectively removed via minimally invasive resection.
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Affiliation(s)
- Andrew Y Wang
- Gastroenterology Division, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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41
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Cantor MJ, Davila RE, Faigel DO. Yield of tissue sampling for subepithelial lesions evaluated by EUS: a comparison between forceps biopsies and endoscopic submucosal resection. Gastrointest Endosc 2006; 64:29-34. [PMID: 16813799 DOI: 10.1016/j.gie.2006.02.027] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Accepted: 02/03/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND In most circumstances, subepithelial tumors lack distinct endoscopic and ultrasonographic features. Consequently, definitive diagnosis usually requires tissue acquisition and pathologic confirmation. Establishing a tissue diagnosis is difficult because the yield of forceps biopsies is low. However, prospective data evaluating tissue sampling techniques for subepithelial lesions are currently lacking. OBJECTIVE Our purpose was to prospectively determine the diagnostic yield of endoscopic submucosal-mucosal resection (ESMR) compared with forceps biopsy for lesions limited to the submucosa (third endosonographic layer) of the GI tract. DESIGN A prospective head-to-head comparison was performed. SETTING The study was performed in a tertiary care hospital. PATIENTS Study patients were 23 adults with subepithelial lesions limited to the submucosa. INTERVENTION All submucosal lesions underwent forceps biopsy followed by endoscopic submucosal resection. Biopsy specimens were obtained with large-capacity "jumbo" forceps. A total of 4 double passes (8 biopsy specimens) were collected from each lesion with use of the bite-on-bite technique. Endoscopic resection was then performed with an electrosurgical snare or cap-fitted endoscopic mucosal resection device. MAIN OUTCOME MEASUREMENT The main outcome measurement was the diagnostic yield of biopsy forceps compared with endoscopic submucosal resection. RESULTS Twenty-three patients with lesions limited to the submucosa were identified by endoscopic ultrasonography. All lesions underwent forceps biopsy followed by ESMR. The diagnostic yield of the jumbo forceps biopsy was 4 of 23 (17%), whereas the diagnostic yield of ESMR was 20 of 23 (87%) (P = .0001, McNemar test). CONCLUSION In the evaluation of subepithelial lesions limited to the submucosa, ESMR has a significantly higher diagnostic yield than jumbo forceps biopsy with use of the bite-on-bite technique.
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Affiliation(s)
- Michael J Cantor
- Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA
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42
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Hwang JH, Rulyak SD, Kimmey MB. American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses. Gastroenterology 2006; 130:2217-28. [PMID: 16762644 DOI: 10.1053/j.gastro.2006.04.033] [Citation(s) in RCA: 190] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This literature review and the recommendations therein were prepared for the American Gastroenterological Association Institute Clinical Practice and Economics Committee. The paper was approved by the Committee on January 19, 2006, and by the AGA Institute Governing Board on April 20, 2006.
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Affiliation(s)
- Joo Ha Hwang
- Division of Gastroenterology, University of Washington, Seattle, Washington, USA
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43
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Abstract
Benign tumors of the esophagus are a rare but diverse group of lesions. Although non-malignant in biology, their presence can cause significant morbidity, including dysphagia, bleeding, gastrointestinal obstruction, and even asphyxiation. Diagnosis is frequently made using radiographic and endoscopic means, even in the absence of definitive biopsy. If discovered early, endoscopic or minimally invasive techniques may be used to excise these lesions, with essentially 100% cure rates. However, if discovered late, open excision or even esophagectomy may be required. Angiolipoma represents perhaps one of the rarest of the benign entities to affect the esophagus, with only a few cases reported in the current literature. We present the case of an 85-year-old man who developed complete esophageal obstruction due to a large, pedunculated angiolipoma, requiring open surgical excision.
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Affiliation(s)
- E H Jensen
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA
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44
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Liu J, Carpenter S, Chuttani R, Croffie J, Disario J, Mergener K, Mishkin DS, Shah R, Somogyi L, Tierney W, Petersen BT. Endoscopic ultrasound probes. Gastrointest Endosc 2006; 63:751-4. [PMID: 16650532 DOI: 10.1016/j.gie.2006.02.043] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Hurlstone DP, Cross SS, Sanders DS. 20-MHz high-frequency endoscopic ultrasound-assisted endoscopic mucosal resection for colorectal submucosal lesions: a prospective analysis. J Clin Gastroenterol 2005; 39:596-9. [PMID: 16000927 DOI: 10.1097/01.mcg.0000170740.82004.39] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
GOALS To prospectively assess the safety and efficacy of high-frequency ultrasound assisted mini-probe endoscopic mucosal resection for the treatment of colorectal submucosal tumors. Primary endpoints were tumor free vertical/horizontal resection margins and positive histopathologic diagnosis. Outcome data over a 24-month period were assessed. BACKGROUND A 20-MHz high-frequency mini-probe ultrasound is an accurate modality for the diagnosis of stage T1m and T1 colorectal lesions. Few studies have addressed the safety and efficacy of this technology as applicable to submucosal lesions of the colorectum. METHODS Thirty patients underwent high-frequency mini-probe ultrasound-guided endoscopic mucosal resection of 30 lesions (<20 mm diameter) using the inject and cut technique. Repeat endoscopy and ultrasound was performed at 3, 6, and 12 months post-"index" resection. RESULTS A total of 27 lesions (90%) underwent complete resection with negative histologic margin status (median diameter, 8 mm; range, 3-20 mm). No statistical difference (P > 0.1) was observed between submucosal lesion position and histologic resection margin negativity. Three rectal lesions (10%) within the submucosal layer 3 failed to separate from the muscularis and underwent transanal excision of tumor. Bleeding occurred in 1 patient (3%). No recurrence was evident at the resection site in 27 cases (median follow-up, 9 months; range, 4-18 months). CONCLUSIONS High-frequency mini-probe ultrasound-guided endoscopic mucosal resection is a safe and effective therapeutic modality for submucosal lesions of the colorectum. The technique offers a single-stage diagnostic and therapeutic technique for selected submucosal lesions and may offer an alternative to surgical resection.
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Affiliation(s)
- David P Hurlstone
- Gastroenterology and Liver Unit at the Royal Hallamshire Hospital, Sheffield, UK.
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47
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Abstract
Techniques of endoscopic mucosal resection (EMR) can dramatically improve the ability to diagnose and treat superficial lesions in the gastrointestinal (GI) tract. Early cancers, submucosal tumors, and sessile polyps can be safely and completely removed in a single procedure, with long-term outcome results comparable to surgery. This is accomplished with a minimum cost, morbidity, and mortality and with little or no impact on the quality of life of patients. This article provides an overview of the techniques, indications, and outcomes of EMR in the management of GI malignancy.
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Affiliation(s)
- Alberto Larghi
- Department of Endoscopy and Therapeutics, Section of Gastroenterology, The University of Chicago, MC 9028, Illinois 60637, USA
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48
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Martínez-Ares D, Lorenzo MJV, Souto-Ruzo J, Pérez JCE, López JY, Belando RA, Vilas JD, Colell JMM, Iglesias JLV. Endoscopic resection of gastrointestinal submucosal tumors assisted by endoscopic ultrasonography. Surg Endosc 2005; 19:854-8. [PMID: 15868257 DOI: 10.1007/s00464-004-9123-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2004] [Accepted: 10/01/2004] [Indexed: 12/17/2022]
Abstract
BACKGROUND The resection and histologic examination of the lesions is generally considered the treatment of choice in order to achieve diagnosis in gastrointestinal submucosal tumors. Moreover, the degree of malignancy of the tumor depends on certain features that can only be studied on the entire resected piece. METHODS We revised the cases of patients who underwent endoscopic resection of gastrointestinal submucosal tumors in the period from 1997 through 2002. RESULTS Fifty submucosal lesions were resected in 45 patients (64.4% men). Patient mean age was 55.31 years. Of the lesions, 52% were gastric tumors and 88% were located in the second layer. Mean size was 12.34 mm, and 54% were smaller than 10 mm. Resection with submucosal injection of saline solution and diluted adrenaline was performed on 46% of the lesions, and standard resection using polypectomy snare on 48%. Ligation was used in three cases. Resection was successful in 98% and major complications were observed in 4% (two cases of bleeding, endoscopically resolved). CONCLUSIONS The endoscopic resection of submucosal tumors is a safe and efficient technique: It has few associated complications and allows diagnosis in all the cases and cure of the lesion in the great majority of cases.
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Affiliation(s)
- D Martínez-Ares
- Department of Gastroenterology, Complejo Hospitalario Universitario Juan Canalejo-A Coruña, Spain.
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DeWitt J, Kesler K, Brooks JA, LeBlanc J, McHenry L, McGreevy K, Sherman S. Endoscopic ultrasound for esophageal and gastroesophageal junction cancer: Impact of increased use of primary neoadjuvant therapy on preoperative locoregional staging accuracy. Dis Esophagus 2005; 18:21-7. [PMID: 15773837 DOI: 10.1111/j.1442-2050.2005.00444.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Initial treatment of locally advanced esophageal and gastroesophageal junction (GEJ) malignancies for selected patients at some institutions has recently changed from surgical resection to neoadjuvant therapy. The aim of this study is to evaluate the impact of this change in treatment strategy on both the overall disease profile and locoregional endoscopic ultrasound (EUS) staging accuracy for a cohort of patients managed with primary surgical resection over a 10-year period at our institution. All subjects at our institution who underwent primary esophagectomy from 1993 to 2002 following preoperative EUS for known or suspected esophageal and/or GEJ cancers were identified. Patients with dysplasia alone, prior upper gastrointestinal tract surgery, preoperative neoadjuvant therapy, cancer of the gastric cardia or recurrent malignancy were excluded. EUS findings and staging results were compared to surgical pathology following resection. The impact of the gradually increased use of primary chemoradiation during the second half of the study was assessed. Of the 286 operations performed, 184 subjects were excluded. The remaining 102 underwent primary surgical resection a median of 18 days following EUS staging for adenocarcinoma (88%) or squamous cell carcinoma (12%) of the esophagus (69%) or GEJ (31%). Overall EUS locoregional T and N staging accuracy was 72% and 75% respectively; accuracy for T1, T2, T3 and T4 cancer was 42%, 50%, 88% and 50% respectively. Despite an increased frequency of pathologically confirmed T1 and T2 cancers (P = 0.005) and an insignificant trend toward increased N0 malignancy (P = 0.05) during the second half of the study period, no statistically significant changes in T (P = 0.07) or N (P = 0.82) staging accuracies for EUS or disease characteristics were noted between the first and second half of the study period. Despite both inaccurate radial EUS staging and increased relative use of primary surgery for early cancers, recent increased use of primary neoadjuvant therapy did not change overall disease characteristics and accuracy of locoregional EUS staging of esophageal and GEJ cancers managed with primary surgical resection.
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Affiliation(s)
- J DeWitt
- Department of Gastroenterology & Hepatology, Indiana University Medical Center, IN 46202, USA.
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50
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Abstract
Early esophageal cancer is defined by its limitation to the esophageal mucosa and submucosa. It has become a curable malignant disease, in sharp contrast to the dismal prognosis of esophageal cancer at advanced stages, which still represents the majority of patients. Understanding the risk factors, establishing surveillance programs for patients at risk, and developing preventative interventions such as dietary and lifestyle changes or pharmacologic interventions hold the potential of reducing the incidence of the disease and of shifting the stage distribution toward early cancer. Endoscopic ultrasound examination is pivotal for distinguishing early from advanced stages of the disease because it allows for accurate assessment of tumor infiltration and regional lymph node involvement. The therapeutic mainstay for early esophageal cancer remains surgery. New, less invasive surgical techniques are being tested that are associated with less morbidity and mortality than standard radical esophagectomies. For patients who are not candidates for surgery, definitive chemoradiation is a viable alternative. New endoscopic ablation techniques, such as endoscopic mucosa resection and photodynamic therapy, are potential alternatives to surgery in patients with cancers limited to the mucosa. For patients with adenocarcinoma of the gastroesophageal junction with submucosal involvement, adjuvant chemoradiation should be considered because of its potential to increase survival.
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Affiliation(s)
- W Michael Korn
- University of California, 2340 Sutter Street, San Francisco, CA 94115, USA.
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