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Dang F, Monachese M. Endoscopic Management of Tumor Bleeding: Techniques and Strategies. Gastrointest Endosc Clin N Am 2024; 34:155-166. [PMID: 37973226 DOI: 10.1016/j.giec.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Endoscopic management of gastrointestinal (GI) tumor-related bleeding is challenging for many reasons including high rebleeding rates, poor tissue response to endoscopic therapies, altered wound healing and underlying coagulopathy. However, endoscopic treatment may help reduce transfusion requirements, avoid surgery, and provide a temporary bridge to oncologic therapy. This article explores various endoscopic techniques in managing tumor bleeding from more traditional approaches of using thermal or mechanical therapy with injection therapy to newer topical agents.
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Affiliation(s)
- Frances Dang
- University of Toronto, 6 Queen's Park Crescent West, Third Floor, Toronto, Ontario, M5S 3H2, Canada.
| | - Marc Monachese
- Trillium Health Partners, 101 Queensway West, Unit 200, Mississauga, Ontario, L5B2P7, Canada
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Sheehan MC, Collins S, Wimmer T, Gutta NB, Monette S, Durack JC, Solomon SB, Srimathveeravalli G. Non-Contact Irreversible Electroporation in the Esophagus With a Wet Electrode Approach. J Biomech Eng 2023; 145:091004. [PMID: 37144889 PMCID: PMC10259469 DOI: 10.1115/1.4062491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 05/06/2023]
Abstract
Our objective was to develop a technique for performing irreversible electroporation (IRE) of esophageal tumors while mitigating thermal damage to the healthy lumen wall. We investigated noncontact IRE using a wet electrode approach for tumor ablation in a human esophagus with finite element models for electric field distribution, joule heating, thermal flux, and metabolic heat generation. Simulation results indicated the feasibility of tumor ablation in the esophagus using an catheter mounted electrode immersed in diluted saline. The ablation size was clinically relevant, with substantially lesser thermal damage to the healthy esophageal wall when compared to IRE performed by placing a monopolar electrode directly into the tumor. Additional simulations were used to estimate ablation size and penetration during noncontact wet-electrode IRE (wIRE) in the healthy swine esophagus. A novel catheter electrode was manufactured and wIRE evaluated in seven pigs. wIRE was performed by securing the device in the esophagus and using diluted saline to isolate the electrode from the esophageal wall while providing electric contact. Computed tomography and fluoroscopy were performed post-treatment to document acute lumen patency. Animals were sacrificed within four hours following treatment for histologic analysis of the treated esophagus. The procedure was safely completed in all animals; post-treatment imaging revealed intact esophageal lumen. The ablations were visually distinct on gross pathology, demonstrating full thickness, circumferential regions of cell death (3.52 ± 0.89 mm depth). Acute histologic changes were not evident in nerves or extracellular matrix architecture within the treatment site. Catheter directed noncontact IRE is feasible for performing penetrative ablations in the esophagus while avoiding thermal damage.
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Affiliation(s)
- Mary Chase Sheehan
- Department of Mechanical Engineering, Amherst Life Sciences Laboratories, University of Massachusetts, 240 Thatcher Road, Amherst, MA 01003
| | - Scott Collins
- Department of Biomedical Engineering, Amherst Life Sciences Laboratories, University of Massachusetts, 240 Thatcher Road, Amherst, MA 01003
| | - Thomas Wimmer
- Department of Radiology, Division of General Radiology, Medical University of Graz, Auenbruggerplatz 9, Graz 8036, Austria
| | | | - Sebastian Monette
- Laboratory of Comparative Pathology, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, The Rockefeller University, New York, NY 10065
| | | | - Stephen B. Solomon
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Govindarajan Srimathveeravalli
- Department of Mechanical Engineering Institute for Applied Life Sciences, Amherst Life Sciences Laboratories, University of Massachusetts, 240 Thatcher Road, Amherst, MA 01003
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Hemostatic Powders in Non-Variceal Upper Gastrointestinal Bleeding: The Open Questions. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010143. [PMID: 36676767 PMCID: PMC9863809 DOI: 10.3390/medicina59010143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/12/2023]
Abstract
Hemostatic powder (HP) is a relatively recent addition to the arsenal of hemostatic endoscopic procedures (HEPs) for gastrointestinal bleeding (GIB) due to benign and malignant lesions. Five types of HP are currently available: TC-325 (Hemospray™), EndoClot™, Ankaferd Blood Stopper®, and, more recently, UI-EWD (NexpowderTM) and CEGP-003 (CGBio™). HP acts as a mechanical barrier and/or promotes platelet activation and coagulation cascade. HP may be used in combination with or as rescue therapy in case of failure of conventional HEPs (CHEPs) and also as monotherapy in large, poorly accessible lesions with multiple bleeding sources. Although the literature on HP is abundant, randomized controlled trials are scant, and some questions remain open. While HP is highly effective in inducing immediate hemostasis in GIB, the rates of rebleeding reported in different studies are very variable, and conditions affecting the stability of hemostasis have not yet been fully elucidated. It is not established whether HP as monotherapy is appropriate in severe GIB, such as spurting peptic ulcers, or should be used only as rescue or adjunctive therapy. Finally, as it can be sprayed on large areas, HP could become the gold standard in malignancy-related GIB, which is often nonresponsive or not amenable to treatment with CHEPs as a result of multiple bleeding points and friable surfaces. This is a narrative review that provides an overview of currently available data and the open questions regarding the use of HP in the management of non-variceal upper GIB due to benign and malignant diseases.
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Best Supportive Care of the Patient with Oesophageal Cancer. Cancers (Basel) 2022; 14:cancers14246268. [PMID: 36551753 PMCID: PMC9776873 DOI: 10.3390/cancers14246268] [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] [Received: 10/17/2022] [Revised: 12/08/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Oesophageal cancer patients have poor survival, and most are unfit for curative or systemic palliative treatment. This article aims to review the best supportive care for oesophageal cancer, focusing on the management of its most frequent or distinctive symptoms and complications. METHODS Evidence-based review on palliative supportive care of oesophageal cancer, based on Pubmed search for relevant clinical practice guidelines, reviews and original articles, with additional records collected from related articles suggestions, references and societies recommendations. RESULTS We identified 1075 records, from which we screened 138 records that were related to oesophageal cancer supportive care, complemented with 48 additional records, finally including 60 records. This review summarizes the management of oesophageal cancer-related main problems, including dysphagia, malnutrition, pain, nausea and vomiting, fistula and bleeding. In recent years, several treatments have been developed, while optimal management is not yet standardized. CONCLUSION This review contributes toward improving supportive care and decision making for oesophageal cancer patients, presenting updated summary recommendations for each of their main symptoms. A robust body of evidence is still lacking, and the best supportive care decisions should be individualized and shared.
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Mohapatra S, Santharaman A, Gomez K, Pannala R, Kachaamy T. Optimal Management of Dysphagia in Patients with Inoperable Esophageal Cancer: Current Perspectives. Cancer Manag Res 2022; 14:3281-3291. [PMID: 36448034 PMCID: PMC9701451 DOI: 10.2147/cmar.s362666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/08/2022] [Indexed: 08/30/2023] Open
Abstract
The majority of patients with esophageal cancer are diagnosed at an advanced, incurable stage. Palliation of symptoms, specifically dysphagia, is a crucial component to improve quality of life and optimize nutritional status. Despite multiple available treatment modalities, there is not one accepted or recommended to be the preferred treatment option. Palliative management is often decided by a multidisciplinary team considering factors including local availability, preference, patient life expectancy, and symptom severity. Systemic therapies such as chemotherapy are the most commonly used palliative modalities. Oncologists are most familiar with radiation for dysphagia palliation, especially for advanced metastatic cancer patients with good performance status. One common approach used by endoscopist is self-expandable metal stents. This is preferred for patients with short-term survival and poor functional status as it provides rapid relief of dysphagia. Cryotherapy is a relatively new endoscopic ablative modality and appears to be a promising option for dysphagia palliation, but more data is needed for wider adoption. This review summarizes the current literature on endoscopic and non-endoscopic treatment options for malignant dysphagia.
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Affiliation(s)
- Sonmoon Mohapatra
- Department of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, 85054, USA
| | - Aadhithyaraman Santharaman
- Department of Internal Medicine, Saint Peter’s University Hospital, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, 08901, USA
| | - Krista Gomez
- Department of Gastroenterology and Hepatology, Cancer Treatment Centers of America, Phoenix, AZ, 85338, USA
| | - Rahul Pannala
- Department of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, 85054, USA
| | - Toufic Kachaamy
- Department of Gastroenterology and Hepatology, Cancer Treatment Centers of America, Phoenix, AZ, 85338, USA
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Egeland C, Bazancir LA, Bui NH, Baeksgaard L, Gehl J, Gögenur I, Achiam M. Palliation of dysphagia in patients with non-curable esophageal cancer - a retrospective Danish study from a highly specialized center. Support Care Cancer 2022; 30:9029-9038. [PMID: 35947208 DOI: 10.1007/s00520-022-07316-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 08/02/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE A majority of the patients with esophageal cancer (EC) suffer from dysphagia. Several endoscopic treatment options are available such as stent placement, argon plasma coagulation, and esophageal dilatation. This study aimed to map the use of endoscopic dysphagia relieving interventions and secondly investigate possible impact on survival. METHODS Data was collected at the Dept. of Surgery & Transplantation, Rigshospitalet, Denmark. Patients with non-curable EC referred from 2016 to 2019 were included. Type of dysphagia treatment, complications and the need for repeated treatments, and survival were registered. RESULTS In the study, 601 patients were included. Forty-five percent were treated with an endoscopic procedure due to dysphagia (82% had a stent placed). The median time from diagnosis to intervention was 24 days. The overall complication rate was 35% (38% in the stent group and 20% in the non-stent group, p = 0.03) and 13% of the patients were readmitted due to a complication. After 26% of the procedures, a repeated treatment was required. Patients having an endoscopic intervention had a worsened survival prognosis compared with the patients in the non-intervention group (HR: 2.17, 95% CI: 1.80-2.61, p < 0.001). In the sub analysis where only patients who had an intervention was included, a survival difference in favor of the non-stent group was found (HR: 0.61, 95% CI: 0.43-0.86, p = 0.005). CONCLUSION In this cohort, the incidence of endoscopic procedures was high, complication rates were considerable, and many the patients required a second treatment. A survival difference was seen, where the patients who had a stent placed seemed to have the worst survival outcomes. However, the causal relationship is yet to be determined why the results must be interpreted carefully. New interventions and tailored approaches that may positively affect functional and long-term oncological outcomes are highly warranted and this should preferably be investigated in randomized clinical trials.
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Affiliation(s)
- Charlotte Egeland
- Department of Surgery and Transplantation, Rigshospitalet, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark.
| | - Laser Arif Bazancir
- Department of Surgery and Transplantation, Rigshospitalet, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| | - Nam Hai Bui
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lene Baeksgaard
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Julie Gehl
- Center for Experimental Drug and Gene Electrotransfer (C*EDGE), Department of Clinical Oncology and Palliative Care, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ismail Gögenur
- Department of Surgery, Center for Surgical Science, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Michael Achiam
- Department of Surgery and Transplantation, Rigshospitalet, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
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Abu-Sbeih H, Szafron D, Elkafrawy AA, Garcia-Rodriguez V, Ma W, Xu A, Khurana S, Numan L, Chen E, Goldstein R, Tsen A, Peng Y, Blum M, Kopetz ES, Ikoma N, Shatila M, Qiao W, Raju GS, Ross WA, Ge PS, Coronel E, Wang Y. Endoscopy for the diagnosis and treatment of gastrointestinal bleeding caused by malignancy. J Gastroenterol Hepatol 2022; 37:1983-1990. [PMID: 35730192 DOI: 10.1111/jgh.15922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 06/13/2022] [Accepted: 06/18/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM The diagnosis and treatment of gastrointestinal (GI) bleeding secondary to malignancy can be challenging. Endoscopy is the gold standard to diagnose and treat gastrointestinal bleeding but clinical characteristics and outcomes of patients with malignancy-related bleeding are not well understood. This study aims to look at clinical characteristics, endoscopic findings, safety and clinical outcomes of endoscopic interventions for GI malignancy-related bleeding. METHODS We retrospectively reviewed outcomes of patients with confirmed GI malignancies who underwent endoscopy for GI bleeding at MD Anderson Cancer Center between 2010 and 2019. Cox hazard analysis was conducted to identify factors associated with survival. RESULTS A total of 313 patients were included, with median age of 59 years; 74.8% were male. The stomach (30.0%) was the most common tumor location. Active bleeding was evident endoscopically in 47.3% of patients. Most patients (77.3%) did not receive endoscopic treatment. Of the patients who received endoscopic treatment, 57.7% had hemostasis. No endoscopy-related adverse events were recorded. Endoscopic treatment was associated with hemostasis (P < 0.001), but not decreased recurrent bleeding or mortality. Absence of active bleeding on endoscopy, stable hemodynamic status at presentation, lower cancer stage, and surgical intervention were associated with improved survival. CONCLUSIONS This study indicates that endoscopy is a safe diagnostic tool in this patient population; while endoscopic treatments may help achieve hemostasis, it may not decrease the risk of recurrent bleeding or improve survival.
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Affiliation(s)
- Hamzah Abu-Sbeih
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Internal Medicine, The University of Missouri, Kansas City, Missouri, USA
| | - David Szafron
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Ahmed A Elkafrawy
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Victor Garcia-Rodriguez
- Department of Internal Medicine, The University of Texas Health Science Center, Houston, Texas, USA
| | - Weijie Ma
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ann Xu
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Shruti Khurana
- Department of Internal Medicine, The University of Texas Health Science Center, Houston, Texas, USA
| | - Laith Numan
- Department of Internal Medicine, The University of Missouri, Kansas City, Missouri, USA
| | - Ellie Chen
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Ryan Goldstein
- Department of Internal Medicine, The University of Texas Health Science Center, Houston, Texas, USA
| | - Adrianne Tsen
- Department of Internal Medicine, The University of Texas Health Science Center, Houston, Texas, USA
| | - Yuanzun Peng
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Bioscience, Rice University, Houston, Texas, USA
| | - Mariela Blum
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Edmund S Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naruhiko Ikoma
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Malek Shatila
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wei Qiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gottumukkala S Raju
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - William A Ross
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Phillip S Ge
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Emmanuel Coronel
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yinghong Wang
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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So S, Noh JH, Ahn JY, Na HK, Jung KW, Lee JH, Kim DH, Choi KD, Song HJ, Lee GH, Jung HY. Effect of Antithrombotic Therapy on Bleeding after Argon Plasma Coagulation for Gastric Neoplasms. Gut Liver 2021; 16:198-206. [PMID: 34373364 PMCID: PMC8924796 DOI: 10.5009/gnl210157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/25/2021] [Accepted: 04/30/2021] [Indexed: 12/02/2022] Open
Abstract
Background/Aims Postprocedural bleeding is known to be relatively low after argon plasma coagulation (APC) for gastric neoplasms; however, there are few studies proving the effect of antithrombotic agents. This study aimed to analyze the incidence of delayed bleeding (DB) based on antithrombotic agents administered and to identify the risk factors for DB in APC for gastric tumors. Methods A total of 785 patients with 824 lesions underwent APC for single gastric neoplasm between January 2011 and January 2018. After exclusion, 719 and 102 lesions were classified as belonging to the non-antithrombotics (non-AT) and AT groups, respectively. The clinical outcomes were compared between the two groups, and we determined the risk factors for DB in gastric APC. Results Of the total 821 cases, DB occurred in 20 cases (2.4%) 17 cases in the non-AT group and three cases in the AT group (2.4% vs 2.9%, p=0.728). Multivariate analysis of the risk factors for DB confirmed the following significant, independent risk factors male sex (odds ratio, 7.66; 95% confidence interval, 1.02 to 57.69; p=0.048) and chronic kidney disease (odds ratio, 4.51; 95% confidence interval, 1.57 to 13.02; p=0.005). Thromboembolic events and perforation were not observed in all patients regardless of whether they took AT agents. Conclusions AT therapy is acceptably safe in gastric APC because it does not significantly increase the incidence of DB. However, patients with chronic kidney disease or male sex need to receive careful follow-up on the incidence of post-APC bleeding.
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Affiliation(s)
- Seol So
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Hee Noh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Fetz A, Farnell D, Irani S, Gan SI. Spray coagulation with snare-tip versus argon plasma coagulation: An ex vivo study evaluating tissue effects. Endosc Int Open 2021; 9:E790-E795. [PMID: 34079859 PMCID: PMC8159595 DOI: 10.1055/a-1373-4162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/09/2020] [Indexed: 11/14/2022] Open
Abstract
Background and study aims Argon plasma coagulation (APC) is an effective and safe modality for many gastrointestinal conditions requiring hemostasis and/or ablation. However, it can be quite costly. A potentially more cost-effective alternative is snare-tip spray coagulation (SC). This study aimed to determine whether SC would be a safe and effective alternative to APC using an ex-vivo model. Methods Using two resected porcine stomach, 36 randomized gastric areas were ablated for 2 seconds with either APC at 1.0 L/min 20 W (APC20) and 1.4 L/min 40 W (APC40) or SC with Effect 2 60 W (SC60) and 80 W (SC80) from 3 mm. Extent of tissue injury was then analyzed histopathologically. Results The mean coagulation depth was 790 ± 159 µm and 825 ± 467 µm for SC60 (n = 9) and SC80 (n = 8), respectively. This was compared to 539 ± 151 µm for APC20 (n = 8) and 779 ± 267 µm for APC40 (n = 9). Mean difference (MD) in coagulation depth between SC60 and APC40 was 12 µm (95 % confidence interval [CI], -191 to 214 µm; P = 0.91) and was 47 µm (95 %CI, -162 to 255 µm; P = 0.81) between SC80 and APC40. There was a greater depth of injury with APC40 (MD, 240 µm; 95 %CI, 62 to 418 µm; P = 0.04) and with SC60 (MD, 252 µm; 95 %CI, 141 to 362 µm; P = 0.004) when compared to APC20. Mean cross-sectional area of coagulation was 2.39 ± 0.852 mm² for SC60 and 2.54 ± 1.83 mm² for SC80 compared to 1.22 ± 0.569 mm² for APC20 and 1.99 ± 0.769 mm² for APC40. Seventy-eight percent reached the muscularis mucosa (MM) and 11 % the submucosa in the SC60 group compared to 50 % and 38 % in SC80 and 56 % and 11 % in APC40, respectively. Thirty-eight percent of APC20 specimens reached the MM. The muscularis propria was unaffected. Conclusions This small ex-vivo study suggests that SC60 and SC80 may be safe alternatives to APC40 with comparable coagulation depths and area effects.
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Affiliation(s)
- Andrew Fetz
- Gastroenterology Department, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - David Farnell
- Pathology Department, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Shayan Irani
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, United States
| | - S. Ian Gan
- Gastroenterology Department, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
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Saisho K, Tanaka T, Matono S, Mori N, Hino H, Kadoya K, Nishida R, Fujisaki M, Fujita F, Akagi Y. Argon plasma coagulation for superficial squamous cell carcinoma in the residual esophagus after esophagectomy. Esophagus 2020; 17:448-455. [PMID: 32211993 DOI: 10.1007/s10388-020-00733-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/18/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients after esophagectomy for esophageal squamous cell carcinoma (SCC) occasionally develop metachronous SCC in the residual esophagus. Although most of these second primary lesions are detected as superficial cancer at follow-up endoscopy, it is often difficult to perform endoscopic resection for these lesions near the site of anastomosis. METHODS The objective of this study was to evaluate the effectiveness of argon plasma coagulation (APC) for superficial SCC in the residual esophagus after esophagectomy. Twelve patients (involving 15 s primary lesions) received APC for superficial SCC in the residual esophagus after esophagectomy. These lesions were difficult to perform endoscopic resection and they were treated using APC. RESULTS There was no treatment-related complication. Complete remission (CR) was achieved in 13 (86.6%) of the 15 lesions: CR was achieved in 11 lesions (73.3%) after the first APC course, and in another 2 lesions (13.3%) after two or more APC courses. Of the 2 patients with persisting residual tumor, 1 patient received 12 times repeated-APC courses over 6 years, and eventually achieved local control without metastasis, the other patient received radiotherapy and cervical esophagectomy after treatment failure with APC. All patients survived except for one patient who died of old age and another patient who died of tongue cancer. CONCLUSIONS APC was a safe treatment that was easy to perform. APC was concluded to be an effective treatment for superficial SCC in the residual esophagus after esophagectomy when endoscopic resection was difficult.
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Affiliation(s)
- Kohei Saisho
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan.
| | - Toshiaki Tanaka
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Satoru Matono
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Naoki Mori
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Haruhiro Hino
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Kazutaka Kadoya
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Ryosuke Nishida
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Masahiro Fujisaki
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Fumihiko Fujita
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan
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Chen YI, Wyse J, Lu Y, Martel M, Barkun AN. TC-325 hemostatic powder versus current standard of care in managing malignant GI bleeding: a pilot randomized clinical trial. Gastrointest Endosc 2020; 91:321-328.e1. [PMID: 31437456 DOI: 10.1016/j.gie.2019.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/05/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS TC-325 (Hemospray; Cook Medical, Winston-Salem, NC, USA), an endoscopic hemostatic powder, exhibits possible benefits in patients with malignant GI bleeding. Our aim is to assess feasibility and determine estimates of efficacy of TC-325 compared with standard of care (SOC) in terms of initial hemostasis and recurrent bleeding rates in comparable groups of patients with malignant GI bleeding. METHODS Adult patients presenting with acute malignant upper or lower GI bleeding were randomized to TC-325 or SOC. Measured outcomes included feasibility of recruitment and randomization in the urgent care setting, immediate hemostasis, recurrent bleeding, need for additional treatment modalities, and mortality. RESULTS A preplanned 20 patients (upper GI source in 85%) were randomized 1:1 to TC-325 or SOC (25% women, age 67.2 ± 15.9 years, oozing in 95%) over 20 months. Immediate hemostasis was achieved in 90% of patients treated initially with TC-325 versus 40% in the SOC group (P = .057). Overall, 83.3% crossed over to TC-325, with hemostasis then achieved at index endoscopy in 80%. Overall, hemostasis at index endoscopy (before or after crossover) was obtained in 87.7% of patients treated with TC-325. Recurrent bleeding over the next 180 days was 20% in the TC-325 group compared with 60% in the SOC group (P = .170). CONCLUSIONS This pilot trial demonstrates the feasibility of TC-325 in malignant GI bleeding and provides results to help inform a larger randomized trial. Although not powered for such, results suggest that use of TC-325 is a very promising modality in malignant GI bleeding in achieving immediate hemostasis and may even result in decreased subsequent recurrent bleeding. (Clinical trial registration number: NCT02135627.).
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Affiliation(s)
- Yen-I Chen
- Division of Gastroenterology, McGill University Health Centre, McGill University, Montréal, Quebec, Canada
| | - Jonathan Wyse
- Division of Gastroenterology, Jewish General Hospital, McGill University, Montréal, Quebec, Canada
| | - Yidan Lu
- Division of Gastroenterology, McGill University Health Centre, McGill University, Montréal, Quebec, Canada
| | - Myriam Martel
- Division of Gastroenterology, McGill University Health Centre, McGill University, Montréal, Quebec, Canada
| | - Alan N Barkun
- Division of Gastroenterology, McGill University Health Centre, McGill University, Montréal, Quebec, Canada; Department of Clinical Epidemiology, McGill University Health Centre, McGill University, Montréal, Quebec, Canada
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Abstract
Background: Plummer-Vinson syndrome (PVS), a rare disorder characterized by dysphagia, iron deficiency anemia, and esophageal webs, has principally been described in middle-aged women. This disorder is uncommon in the 21st century because of the abundance of iron-fortified foods. Clotting factor deficiencies are also rare. Factor VII deficiency is a bleeding disorder characterized by the absence of a critical protein in the coagulation cascade. Case Report: We present a case of PVS associated with factor VII deficiency in a 26-year-old African American female. The patient had a history of anemia that was repeatedly attributed to menstrual bleeding and dysphagia for 10 years. She presented with symptomatic anemia requiring transfusion. She reported a history of food getting stuck in her chest, and workup revealed esophageal webs with no evidence of overt luminal gastrointestinal bleeding. Coagulation laboratory tests revealed the incidental finding of a borderline increased prothrombin time. Hematologic studies confirmed the presence of factor VII deficiency. Conclusion: To our knowledge, no case has been published about a patient diagnosed with PVS and concomitant factor VII deficiency. Our case illustrates several learning points: (1) PVS is an uncommon disorder that may still be diagnosed in a developed country in the 21st century; (2) PVS requires close follow-up and esophageal surveillance because of the increased risk of esophageal cancer; (3) factor VII exhibits a high degree of phenotypic variability; (4) phenotype in factor VII deficiency does not always correlate with factor VII activity, although life-threatening spontaneous bleeding is not expected with levels >2%.
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Ofosu A, Ramai D, Latson W, Adler DG. Endoscopic management of bleeding gastrointestinal tumors. Ann Gastroenterol 2019; 32:346-351. [PMID: 31263356 PMCID: PMC6595926 DOI: 10.20524/aog.2019.0391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/01/2019] [Indexed: 02/07/2023] Open
Abstract
Bleeding due to primary or metastatic gastrointestinal (GI) tumors remains clinically challenging. Bleeding is further complicated in the setting of underlying friable neovascularization of tumors and coagulopathy. Endoscopic hemostatic therapeutic options have traditionally involved the use of thermal/mechanical therapy in conjunction with injection therapy. This review looks at the role of endoscopy in managing tumor-related GI bleeding, specifically contact and non-contact thermal therapy, radiofrequency ablation, endoloops, epinephrine and ethanol injection, and, most recently, Hemospray. Overall, current data show that endoscopic therapy is limited, with high rebleeding rates and a failure to improve overall outcomes. Larger clinical trials are needed to determine the efficacy of current techniques and establish therapeutic algorithms, with the goal of achieving primary hemostasis and reducing rebleeding rates.
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Affiliation(s)
- Andrew Ofosu
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, NY (Andrew Ofosu, Will Latson)
| | - Daryl Ramai
- Department of Medicine, The Brooklyn Hospital Center, NY (Daryl Ramai)
| | - Will Latson
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, NY (Andrew Ofosu, Will Latson)
| | - Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, Utah (Douglas G. Adler), USA
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15
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Chen B, Xiong L, Chen WD, Zhao XH, He J, Zheng YW, Kong FH, Liu X, Zhang ZJ, Miao XY. Photodynamic therapy for middle-advanced stage upper gastrointestinal carcinomas: A systematic review and meta-analysis. World J Clin Cases 2018; 6:650-658. [PMID: 30430120 PMCID: PMC6232558 DOI: 10.12998/wjcc.v6.i13.650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/13/2018] [Accepted: 10/11/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To determine the therapeutic effect of photodynamic therapy (PDT) for middle-advanced stage upper gastrointestinal carcinomas.
METHODS We searched PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Database from inception to April 2018 for randomized controlled studies. These studies compared PDT with other palliative therapies (radiotherapy, chemotherapy, or Nd:YAG laser) and compared PDT, radiotherapy, or chemotherapy alone with PDT combined with chemotherapy/radiotherapy. In our meta-analysis, both fixed and random effects models were used to estimate the risk ratio (RR) for dichotomous outcomes (the response rate and one-year survival rate).
RESULTS Ten random controlled clinical studies with 953 patients were included in the analysis. The effective rate for PDT was better than that of radiotherapy or Nd:YAG laser for the treatment of middle-advanced upper gastrointestinal carcinomas [RR = 1.36; 95% confidence interval (CI): 1.13-1.65; P = 0.001]. In addition, PDT combined with chemotherapy had significantly better efficacy and a higher one-year survival rate than PDT or chemotherapy alone (significant remission rate, RR = 1.62; 95%CI: 1.34-1.97; P < 0.00001; one-year survival rate, RR = 1.81; 95%CI: 1.13-2.89; P = 0.01).
CONCLUSION PDT is a useful method for the treatment of middle-advanced stage upper gastrointestinal carcinomas. PDT combined with chemotherapy or radiotherapy can enhance its efficacy and prolong survival time.
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Affiliation(s)
- Bo Chen
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Li Xiong
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Wei-Dong Chen
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Xiao-Hua Zhao
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Jun He
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Yan-Wen Zheng
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Fan-Hua Kong
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Xi Liu
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Zi-Jian Zhang
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Xiong-Ying Miao
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
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Salvage Endoscopic Argon Plasma Coagulation After Chemoradiotherapy for Inoperable Esophageal Cancer. Surg Laparosc Endosc Percutan Tech 2018; 27:384-390. [PMID: 28727635 DOI: 10.1097/sle.0000000000000454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the effectiveness of salvage endoscopic argon plasma coagulation (APC) therapy for local failure occurring after definitive chemoradiotherapy (CRT) in patients with inoperable esophageal cancer. PATIENTS AND METHODS A total of 47 patients with esophageal squamous cell carcinoma received CRT from January 2009 through November 2011 in our hospital. Thirty-five of these patients were excluded because of long-term disease-free status or because they received salvage surgery, systemic chemotherapy, or best supportive care. The other 12 patients had local relapse (n=8) or residual lesions (n=4) after definitive CRT and received salvage APC therapy. Local failures after definitive CRT were divided into 2 groups: the superficial growth group (n=6) and the submucosal growth group (n=6). The primary endpoints were relapse-free survival and overall survival after 60 months of follow-up. RESULTS Six patients in the superficial growth group and 1 patient in submucosal growth group had a complete response after salvage APC. The rates of both relapse-free survival and overall survival were higher in the superficial growth group than in the submucosal growth group. No complications occurred after APC. CONCLUSIONS Salvage APC is a potentially curative treatment for patients who have local failure associated with superficial tumors after CRT for esophageal squamous cell carcinoma.
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17
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Song IJ, Kim HJ, Lee JA, Park JC, Shin SK, Lee SK, Lee YC, Chung H. Clinical Outcomes of Endoscopic Hemostasis for Bleeding in Patients with Unresectable Advanced Gastric Cancer. J Gastric Cancer 2017; 17:374-383. [PMID: 29302377 PMCID: PMC5746658 DOI: 10.5230/jgc.2017.17.e42] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/22/2017] [Accepted: 12/22/2017] [Indexed: 12/16/2022] Open
Abstract
Purpose Bleeding is one of the most serious complications of advanced gastric cancer (AGC) and is associated with a poor prognosis. This study aimed to evaluate the clinical outcomes of endoscopic hemostasis for bleeding in patients with unresectable AGC. Materials and Methods This study included 106 patients with bleeding associated with gastric cancer who had undergone endoscopic hemostasis between January 2010 and December 2013. Clinical characteristics, treatment outcomes, including rates of successful endoscopic hemostasis and rebleeding, risk factors for rebleeding, and overall survival (OS) were investigated. Results Successful initial hemostasis was achieved in 83% of patients. Rebleeding occurred in 28.3% of patients within 30 days. The median OS after initial hemostasis was lower in patients with rebleeding than in those without rebleeding (2.7 and 3.9 months, respectively, P=0.02). There were no significant differences in disease status and rebleeding rates among patients with partial response or stable disease (n=4), progressive disease (n=64), and first diagnosis of disease (n=38). Univariate and multivariate analyses (P=0.038 and 0.034, respectively) revealed that transfusion of ≥5 units of RBCs was a significant risk factor for rebleeding. Conclusions Despite favorable success rates of endoscopic hemostasis for bleeding associated with gastric cancer, the 30-day rebleeding rate was 28.3% and the median OS was significantly lower in patients with rebleeding than in those without rebleeding. Massive transfusion (≥5 units of RBCs) was the only significant risk factor for rebleeding. Patients with bleeding associated with AGC who have undergone massive transfusion should be observed closely following endoscopic hemostasis. Further research on approaches to reduce rebleeding rate and prevent death is needed.
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Affiliation(s)
- In Ji Song
- Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ju Kim
- Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Departtment of Medicine, Yonsei University Graduate School, Seoul, Korea
| | - Ji Ae Lee
- Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Chul Park
- Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Kwan Shin
- Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Kil Lee
- Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Chan Lee
- Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyunsoo Chung
- Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Departtment of Medicine, Yonsei University Graduate School, Seoul, Korea
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18
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Niekamp A, Sheth RA, Kuban J, Avritscher R, Ganguli S. Palliative Embolization for Refractory Bleeding. Semin Intervent Radiol 2017; 34:387-397. [PMID: 29249863 DOI: 10.1055/s-0037-1608862] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Bleeding is a common and often challenging complication of malignancy. Etiologies of hemorrhage in this patient population vary, and bleeding may present as an acute, life-threatening emergency or a chronic, low-volume blood loss. For patients with advanced malignancies, interventions to manage bleeding must be balanced by the patient's life expectancy and quality of life. As such, minimally invasive procedures such as transarterial embolization are useful therapeutic options in appropriately selected patients. There is a rich history of palliative transarterial embolization for refractory bleeding in cancer patients. This technique was first applied in the 1970s and has since become an established treatment tool for malignancy-related bleeding throughout the body. While the preponderance of published data comprised case reports and small retrospective studies, the use of embolization continues to expand as experience grows and techniques are refined. In this review, we summarize the literature and provide our perspective on embolization for refractory bleeding in cancer patients.
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Affiliation(s)
- Andrew Niekamp
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Rahul A Sheth
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Joshua Kuban
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Rony Avritscher
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Suvranu Ganguli
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Neri A, Marrelli D, Voglino C, Di Mare G, Ferrara F, Marini M, Roviello F. Recurrence after surgery in esophago-gastric junction adenocarcinoma: Current management and future perspectives. Surg Oncol 2016; 25:355-363. [PMID: 27916166 DOI: 10.1016/j.suronc.2016.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 02/07/2023]
Abstract
Recurrent esophago-gastric junction adenocarcinoma is not a rare event and its correct management is still debated. Many approaches for the treatment of these patients exist, but only few studies compare the different techniques. Most of the studies are retrospectives series and describe the experiences of single institutions in the treatment of recurrent esophageal and esophago-gastric junction cancers. Nowadays surgery is still the main and only curative treatment. Other alternative palliative therapies could be endoscopic stent placement and balloon dilation, photodynamic therapy, thermal tumor ablation (laser photoablation and Argon plasma coagulation), radiation therapy and brachytherapy, and chemotherapy. The aim of this review is to investigate the different rates, patterns and timings of recurrence of this tumor, and to explain the various approaches used for the treatment of recurrent esophago-gastric junction cancer.
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Affiliation(s)
- Alessandro Neri
- Department of Medicine, Surgery and Neurosciences - Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci - Policlinico "Le Scotte" 53100, Siena, Italy
| | - Daniele Marrelli
- Department of Medicine, Surgery and Neurosciences - Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci - Policlinico "Le Scotte" 53100, Siena, Italy
| | - Costantino Voglino
- Department of Medicine, Surgery and Neurosciences - Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci - Policlinico "Le Scotte" 53100, Siena, Italy.
| | - Giulio Di Mare
- Department of Medicine, Surgery and Neurosciences - Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci - Policlinico "Le Scotte" 53100, Siena, Italy
| | - Francesco Ferrara
- Department of Medicine, Surgery and Neurosciences - Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci - Policlinico "Le Scotte" 53100, Siena, Italy
| | - Mario Marini
- Department of Medicine, Surgery and Neurosciences - Unit of Gastroenterology and Digestive Endoscopy, University of Siena, Viale Bracci - Policlinico "Le Scotte" 53100, Siena, Italy
| | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences - Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci - Policlinico "Le Scotte" 53100, Siena, Italy
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20
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Abstract
Topical hemostatic agents and powders are an emerging modality in the endoscopic management of upper and lower gastrointestinal bleeding. This systematic review demonstrates the effectiveness and safety of these agents with special emphasis on TC-325 and Ankaferd Blood Stopper. The unique noncontact/nontraumatic application, ability to cover large areas of bleed, and ease of use make these hemostatic agents an attractive option in certain clinical situations, such as massive bleeding with poor visualization, salvage therapy, and diffuse bleeding from luminal malignancies.
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21
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Evans JA, Chandrasekhara V, Chathadi KV, Decker GA, Early DS, Fisher DA, Foley K, Hwang JH, Jue TL, Lightdale JR, Pasha SF, Sharaf R, Shergill AK, Cash BD, DeWitt JM. The role of endoscopy in the management of premalignant and malignant conditions of the stomach. Gastrointest Endosc 2015; 82:1-8. [PMID: 25935705 DOI: 10.1016/j.gie.2015.03.1967] [Citation(s) in RCA: 169] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 03/19/2015] [Indexed: 02/07/2023]
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22
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Martins BC, Wodak S, Gusmon CC, Safatle-Ribeiro AV, Kawaguti FS, Baba ER, Pennacchi CM, Lima MS, Ribeiro U, Maluf-Filho F. Argon plasma coagulation for the endoscopic treatment of gastrointestinal tumor bleeding: A retrospective comparison with a non-treated historical cohort. United European Gastroenterol J 2015; 4:49-54. [PMID: 26966522 DOI: 10.1177/2050640615590303] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/14/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The endoscopic use of argon plasma coagulation (APC) to achieve hemostasis for upper gastrointestinal tumor bleeding (UGITB) has not been adequately evaluated in controlled trials. This study aimed to evaluate the efficacy of APC for the treatment of upper gastrointestinal bleeding from malignant lesions. METHODS Between January and September 2011, all patients with UGITB underwent high-potency APC therapy (up to 70 Watts). This group was compared with a historical cohort of patients admitted between January and December 2010, when the endoscopic treatment of bleeding malignancies was not routinely performed. Patients were stratified into two categories, grouping the Eastern Cooperative Oncology Group (ECOG) performance status scale: Category I (ECOG 0-2) patients with a good clinical status and Category II (ECOG 3-4) patients with a poor clinical status. RESULTS Our study had 25 patients with UGITB whom underwent APC treatment and 28 patients whom received no endoscopic therapy. The clinical characteristics of the groups were similar, except for endoscopic active bleeding, which was more frequently detected in APC group. We had 15 patients in the APC group whom had active bleeding, and initial hemostasis was obtained in 11 of them (73.3%). In the control group, four patients had active bleeding. There were no differences in 30-day re-bleeding (33.3% in the APC group versus 14.3% in the control group; p = 0.104) and 30-day mortality rates (20.8% in the APC group, versus 42.9% in the control group; p = 0.091). When patients were categorized according to their ECOG status, we found that APC therapy had no impact in re-bleeding and mortality rates (Group I: APC versus no endoscopic treatment: re-bleeding p = 0.412, mortality p = 0.669; Group II: APC versus no endoscopic treatment: re-bleeding p = 0.505, mortality p = 0.580). Hematemesis and site of bleeding located at the esophagus or duodenum were associated with a higher 30-day mortality. CONCLUSIONS Endoscopic hemostasis of UGITB with APC has no significant impact on 30-day re-bleeding and mortality rates, irrespective of patient performance status.
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Affiliation(s)
- Bruno Costa Martins
- Endoscopy Division, Cancer Institute, University of São Paulo, São Paulo, Brazil
| | - Stephanie Wodak
- Endoscopy Division, Cancer Institute, University of São Paulo, São Paulo, Brazil
| | - Carla C Gusmon
- Endoscopy Division, Cancer Institute, University of São Paulo, São Paulo, Brazil
| | | | | | - Elisa Ryoka Baba
- Endoscopy Division, Cancer Institute, University of São Paulo, São Paulo, Brazil
| | | | - Marcelo Simas Lima
- Endoscopy Division, Cancer Institute, University of São Paulo, São Paulo, Brazil
| | - Ulysses Ribeiro
- Endoscopy Division, Cancer Institute, University of São Paulo, São Paulo, Brazil
| | - Fauze Maluf-Filho
- Endoscopy Division, Cancer Institute, University of São Paulo, São Paulo, Brazil
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Sheibani S, Kim JJ, Chen B, Park S, Saberi B, Keyashian K, Buxbaum J, Laine L. Natural history of acute upper GI bleeding due to tumours: short-term success and long-term recurrence with or without endoscopic therapy. Aliment Pharmacol Ther 2013; 38:144-50. [PMID: 23710797 DOI: 10.1111/apt.12347] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 04/03/2013] [Accepted: 05/04/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Scant information is available regarding patients with upper gastrointestinal bleeding (UGIB) from tumours. AIM To determine the presentation, endoscopic findings, treatment and outcomes in patients with UGIB from malignant tumours and identify risk factors associated with rebleeding. METHODS Consecutive patients who were hospitalised with haematemesis, melena or haematochezia and underwent upper endoscopy were identified retrospectively by reviewing an endoscopy database. Patients with UGIB due to biopsy-proven malignant tumours were studied. RESULTS Tumours were the source of bleeding in 106 (5%) of 2,166 patients with UGIB. Tumours were oesophageal in 17 (16%), gastric in 77 (73%) and duodenal in 12 (11%). At presentation, 84 (79%) did not have known cancer previously, and 79 (75%) had metastatic disease. Seventy-seven (73%) received transfusions at index hospitalisation. At endoscopy, 32 (30%) had active bleeding (31 oozing, 1 spurting). Among actively bleeding patients, haemostasis was achieved in 12 (86%) of 14 receiving endoscopic therapy and all 18 not receiving endoscopic treatment. Hospitalisation for rebleeding occurred in 50 (49%) of 103 at a median of 30 days (3-885). On multivariate analysis, age ≤60 years (OR = 2.49, 95% CI 1.06-5.81) and haemodynamic instability (OR = 2.42, 95% CI 1.08-5.46) were associated with rebleeding. CONCLUSIONS Patients presenting with tumour-associated UGIB have substantial blood loss, with three-quarters requiring transfusion at presentation. Initial haemostasis occurs in almost all patients, with or without endoscopic therapy, but rebleeding requiring repeat hospitalisation occurs in approximately half the patients and is more common in patients who are ≤60 years of age and have haemodynamic instability at presentation.
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Affiliation(s)
- S Sheibani
- Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, CA, USA
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24
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Koh KH, Kim K, Kwon DH, Chung BS, Sohn JY, Ahn DS, Jeon BJ, Kim SH, Kim IH, Kim SW, Lee SO, Lee ST, Kim DG. The successful endoscopic hemostasis factors in bleeding from advanced gastric cancer. Gastric Cancer 2013; 16:397-403. [PMID: 23053826 DOI: 10.1007/s10120-012-0200-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 09/07/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND When patients with advanced gastric cancer experience active bleeding, gastroenterologists normally choose between two treatment modalities, endoscopic hemostasis and transarterial embolization (TAE). In patients with advanced gastric cancer with bleeding, the predictive factors for endoscopic hemostatic failure are still unknown. Thus, the purpose of this study was to evaluate predictive factors for endoscopic hemostasis failure and to differentiate which hemostasis procedure is more effective for advanced gastric cancer with bleeding. METHODS We reviewed the medical records of patients who were diagnosed with advanced gastric cancer and acute non-variceal gastric bleeding from January 2006 to August 2011. Forty-five patients were enrolled in this study and they were divided into a group of 14 patients who had experienced successful endoscopic hemostasis and a group of 31 patients who had had unsuccessful hemostasis with the first endoscopy and then underwent TAE. RESULTS Lesion size and bleeding condition of Forrest class 1a or 1b were statistically significant predictive factors for endoscopic hemostatic failure (P = 0.023 and P = 0.017, respectively). On multivariate logistic regression analysis, size (lesion >2 cm) was a significant predictive factor for endoscopic hemostatic failure [adjusted odds ratio (aOR) 8.056; 95% confidence interval (CI) 1.329-48.846]. CONCLUSIONS We determined that small bleeding lesions (<2 cm) and exposed vessels in the bleeding site with gastric cancer indicated that endoscopic hemostasis would be an effective hemostatic modality to choose. Particularly, in the opposite condition, the presence of large bleeding lesions (>2 cm) and non-exposed vessel bleeding with a tumor, endoscopic hemostasis failure is predicted and TAE could be recommended.
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Affiliation(s)
- Kang Hun Koh
- Department of Internal Medicine, Research Institute for Medical Science, Chonbuk National University College of Medicine, 634-18 Geumam-dong, Dukjin-ku, Jeonju, Jeonbuk, 561-712, Korea
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Green S, Bhandari P, DeCaestecker J, Barr H, Ragunath K, Jankowski J, Singh R, Longcroft-Wheaton G, Bennett C. Endoscopic therapies for the prevention and treatment of early esophageal neoplasia. Expert Rev Gastroenterol Hepatol 2011; 5:731-43. [PMID: 22017700 DOI: 10.1586/egh.11.80] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Esophageal cancers have traditionally been diagnosed late and prognosis has been dire. For many years the only real treatment option was esophagectomy with substantial morbidity and mortality. This situation has now changed dramatically. Improvements have been achieved in surgical outcomes and there is an array of new effective treatment options now available, particularly for the increasing proportion diagnosed with early-stage disease. Minimally invasive endoscopic therapies can now prevent, cure or palliate esophageal cancers. This article aims to investigate the role and evidence base for these new therapeutic options.
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Affiliation(s)
- Susi Green
- St Mark's Hospital, Northwick Park, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.
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Rupinski M, Zagorowicz E, Regula J, Fijuth J, Kraszewska E, Polkowski M, Wronska E, Butruk E. Randomized comparison of three palliative regimens including brachytherapy, photodynamic therapy, and APC in patients with malignant dysphagia (CONSORT 1a) (Revised II). Am J Gastroenterol 2011; 106:1612-20. [PMID: 21670770 DOI: 10.1038/ajg.2011.178] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Because most esophageal cancers are diagnosed at an advanced stage, a majority of patients require palliative dysphagia treatment. Dysphagia severity and the need for repeated re-canalization procedures significantly affect patients' quality of life (QoL). The aim of this study was to establish whether combining argon plasma coagulation (APC) of the neoplastic esophageal tissue with another re-canalization method results in a longer dysphagia-free period compared with APC alone. METHODS We conducted a randomized trial in 93 patients with malignant dysphagia. Patients were followed until death. We compared three regimens of esophageal re-canalization; APC combined with high dose rate (HDR) brachytherapy, APC combined with photodynamic therapy (PDT), and APC alone. The primary outcome measure was the dysphagia-free period following randomization. Secondary measures were survival, QoL, treatment-associated complications, and treatment tolerance. A per-protocol analysis was carried out. RESULTS The time to first dysphagia recurrence was significantly different between each combination treatment group and the control group (overall test: P=0.006; HDR vs. control, log-rank P=0.002, PDT vs. control, log-rank P=0.036), but not different between the combination groups (HDR vs. PDT, log-rank P=0.36). The median time to first dysphagia recurrence was 88, 59, and 35 days in the HDR, PDT, and control groups, respectively. There was no difference in overall survival between the study groups (P=0.27). No deaths, perforations, hemorrhages, or fistula formations were attributed to treatment. The only major complication was fever, occurring in three PDT patients. Minor complications were observed significantly more often in the combination treatment groups and included pain in both groups, transient dysphagia worsening, and skin sensitivity in the PDT group. The QoL 30 days after treatment in the HDR group was significantly better than in the other groups. CONCLUSIONS In patients with inoperable esophageal cancer, palliative combination treatment of dysphagia with APC and HDR or PDT was significantly more efficient than APC alone, and was safe and well tolerated. APC combined with HDR resulted in fewer complications and better QoL than APC with PDT or APC alone (CONSORT 1b).
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Affiliation(s)
- Maciej Rupinski
- Gastroenterology Department, Medical Center for Postgraduate Education and Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
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Gan S, Watson DI. New endoscopic and surgical treatment options for early esophageal adenocarcinoma. J Gastroenterol Hepatol 2010; 25:1478-84. [PMID: 20796143 DOI: 10.1111/j.1440-1746.2010.06421.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Although the outcome for advanced stage esophageal cancer is poor, the early detection and treatment of early stage disease is usually associated with a much better outcome. Until recently, esophagectomy has been the treatment of choice in fit patients. However, morbidity is significant, and this has encouraged the development of newer endoscopic treatments that preserve the esophagus. These techniques include ablation and mucosal resection. Promising results are described, and endoscopic methods might provide a reasonable alternative for the treatment of early esophageal cancer. However, follow-up remains short and endoscopic treatment does not deal with potential lymphatic spread. Hence, careful selection is required. Minimally invasive techniques for esophageal resection have also been shown to be feasible, although there is only limited evidence that they reduce postoperative morbidity. Better data are still required to demonstrate improved outcomes from endoscopic treatment and minimally invasive esophagectomy.
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Affiliation(s)
- Susan Gan
- Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
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Park JC, Lee SK, Seo JH, Kim YJ, Chung H, Shin SK, Lee YC. Predictive factors for local recurrence after endoscopic resection for early gastric cancer: long-term clinical outcome in a single-center experience. Surg Endosc 2010; 24:2842-9. [PMID: 20428894 DOI: 10.1007/s00464-010-1060-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2009] [Accepted: 03/19/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Endoscopic resection is widely accepted as the primary treatment for early gastric cancer (EGC) without lymph node metastasis. A new and refined technique, endoscopic submucosal dissection (ESD), may prove to be more effective; however, incomplete resection and local recurrence present ongoing concerns. We sought to determine the clinicopathological features associated with local recurrence in patients with EGC following endoscopic resection. METHODS We enrolled in this study 239 EGC patients treated by endoscopic resection between January 2002 and January 2008. RESULTS Fifty EGC lesions were treated by conventional endoscopic mucosal resection (EMR group) and 189 EGC lesions were treated by ESD (ESD group). During the follow-up period (mean = 30.3 months), the rates for en bloc resection and complete resection (defined as en bloc resection with negative resection margin) were 64% (32/50) and 60% (30/50), respectively, in the EMR group, and 86.8% (164/189) and 79.9% (151/189), respectively, in the ESD group. We observed seven local recurrences in the ESD group, though only one with complete resection by ESD had a local recurrence. The EMR group showed a significantly higher recurrence rate than did the ESD group (18% vs. 3.7%, respectively, p < 0.001). Incomplete resection significantly increased local recurrence risk, and larger tumor size and use of EMR increased the risk for incomplete resection. Most lesions (3/4) treated with additional argon plasma coagulation for an initial recurrence had recurred again. CONCLUSIONS Despite the potential advantages in treating EGC with ESD, a risk for local recurrence remains. All patients treated with EMR, even with curative resection, and those with incomplete resection after ESD require conscientious surveillance for local recurrence. Furthermore, a large prospective study will be required to determine the best treatment modality for local recurrence.
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Affiliation(s)
- Jun Chul Park
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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30
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Kähler GF, Szyrach MNI, Hieronymus A, Grobholz R, Enderle MD. Investigation of the thermal tissue effects of the argon plasma coagulation modes "pulsed" and "precise" on the porcine esophagus, ex vivo and in vivo. Gastrointest Endosc 2009; 70:362-8. [PMID: 19500786 DOI: 10.1016/j.gie.2008.11.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Accepted: 11/25/2008] [Indexed: 01/09/2023]
Abstract
BACKGROUND Argon plasma coagulation (APC) is a monopolar, noncontact, thermal procedure that is widely used in therapeutic endoscopy. Systematic investigations of the tissue damage ex vivo and in vivo with the new, second-generation APC modes are lacking. OBJECTIVE The aim of this study is to compare the tissue effects of the pulsed effect 2 and precise APC modes. DESIGN AND SETTING Ex vivo and in vivo animal model. SUBJECTS This study involved 3 explanted porcine esophagi and 8 pigs under general anesthesia. INTERVENTION APC application on 3 explanted esophagi and during esophagoscopy. MAIN OUTCOME MEASUREMENTS The tissue effect was subjected to histological and statistical investigation. RESULTS In vivo, a well known type of superficial tissue damage (type A) of the tunica mucosa and a new injury pattern (type B) limited to the tunica muscularis, were found. Ex vivo, only type A injuries were seen. Thermal injury of the tunica muscularis was significantly lower with precise APC compared with pulsed APC in vivo. The pulsed effect 2 shows a positive correlation between the penetration depth and the power (r = 0.38, P < .0002) or application time for the highest power setting used (40 W, r = 0.77, P < .0001). This correlation could not be detected with precise APC because of its very superficial tissue effect. LIMITATIONS This was an animal study. The distance of the APC probe to the esophagus may have varied between applications in vivo. CONCLUSION Thermal damage by APC of the esophageal tunica muscularis seems to be underestimated ex vivo. The extent of tissue injury was significantly lower with precise APC than with pulsed APC, indicating that precise APC may be suitable for the treatment of particularly thermosensitive, thin-wall anatomy.
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Affiliation(s)
- Georg F Kähler
- Section Endoscopy, Surgical University Hospital Mannheim, Mannheim, Germany.
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Nomura T, Miyashita M, Makino H, Okawa K, Katsuta M, Tajiri T. Argon plasma coagulation for a patient with locoregional failure after definitive chemoradiotherapy for esophageal carcinoma: a case report. J NIPPON MED SCH 2009; 75:280-3. [PMID: 19023167 DOI: 10.1272/jnms.75.280] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Patients who undergo definitive chemoradiotherapy (CRT) face a risk of residual resistant disease or disease recurrence at the primary site; therefore, salvage treatment may be required. An optimum strategy to minimize these risks clearly needs to be established. Argon plasma coagulation (APC) is a safe and convenient procedure now applied widely for therapeutic endoscopy. In this report we describe the successful use of APC over 6 years for the treatment of recurrent esophageal cancer after CRT. A 61-year-old Japanese man underwent CRT for a thoracic esophageal cancer. Pathological examination before CRT revealed a well-differentiated squamous cell carcinoma. Locoregional failure was observed 2 years after CRT, and an initial APC treatment was performed. The patient has now undergone APC ablation 7 times with no postoperative complications. No metastasis to lymph nodes or to other organs has been detected during the last 6 years. The usefulness of APC as a salvage treatment for locoregional failure after definitive CRT has not been established. In our experience, salvage APC is the best treatment option for some patients.
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Affiliation(s)
- Tsutomu Nomura
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan.
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Lee HJ, Shin JH, Yoon HK, Ko GY, Gwon DI, Song HY, Sung KB. Transcatheter arterial embolization in gastric cancer patients with acute bleeding. Eur Radiol 2008; 19:960-5. [PMID: 18987861 DOI: 10.1007/s00330-008-1216-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 08/26/2008] [Accepted: 09/22/2008] [Indexed: 01/18/2023]
Abstract
The safety and clinical effectiveness of transcatheter arterial embolization for bleeding associated with unresectable gastric cancer was evaluated. Twenty-three patients with bleeding from unresectable gastric cancer underwent transcatheter arterial embolization. Of the 23 patients, eight showed signs of active bleeding, such as contrast extravasation or pseudoaneurysm, seven showed only tumor staining, and the remaining eight patients showed negative angiographic findings. All embolization procedures were successful without procedure-related complications. In all eight active bleeding patients, immediate hemostasis was achieved. The overall clinical success rate was 52% (12/23). Recurrent bleeding within 1 month occurred in one (8%) in 12 patients with initial clinical success. One patient showed partial splenic infarction after embolization of the splenic artery for active bleeding from the short gastric artery. Overall 30-day mortality rate was 43% (10/23). The median overall survival period was 38 days. In patients with bleeding from unresectable gastric cancer, transcatheter arterial embolization was found to be safe and effective for achieving immediate hemostasis for active bleeding. Although the clinical success rate was not high, the recurrent bleeding rate was low at 1 month post procedure.
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Affiliation(s)
- Hyun Joo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
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Auroux J, Roblin X, Germain E, Berthelet O, Bichard P. Une utilisation peu usuelle mais efficace du plasma d’argon : la section des prothèses métalliques expansives. ACTA ACUST UNITED AC 2008; 32:118-22. [DOI: 10.1016/j.gcb.2008.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Surgical Emergencies. Oncology 2007. [DOI: 10.1007/0-387-31056-8_73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Manner H, May A, Rabenstein T, Pech O, Nachbar L, Enderle MD, Gossner L, Ell C. Prospective evaluation of a new high-power argon plasma coagulation system (hp-APC) in therapeutic gastrointestinal endoscopy. Scand J Gastroenterol 2007; 42:397-405. [PMID: 17354121 DOI: 10.1080/00365520600898130] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study was to prospectively evaluate a new high-power argon plasma coagulation system (hp-APC) in therapeutic gastrointestinal (GI) endoscopy. MATERIAL AND METHODS From February to June 2005, 216 patients (167 M (77.3%), mean age 66 years) underwent treatment with hp-APC in a total of 275 sessions. Main indications were additive ablation therapy in Barrett's esophagus, palliative treatment of esophageal cancer, gastric polyps/carcinomas, angiodysplasias, Zenker's diverticula, and duodenal adenomas. The new hp-APC device (VIO 300 D with APC 2) was used (15-120 W) in upper GI endoscopy, push-enteroscopy, and double-balloon enteroscopy. RESULTS The mean number of treatment sessions required was 1.7 (1-5). For palliative tumor ablation in the esophagus, the number of sessions was 2.3 (1-5). Minor complications (pain, dysphagia, neuromuscular irritation, asymptomatic gas accumulation in the intestinal wall) were observed in 29/216 patients (13.4%). Major complications (perforation, stenosis occurred) in 2 patients (0.9%). CONCLUSIONS Hp-APC appears to be safe and effective in the treatment of various GI condition using different types of endoscopes including double-balloon enteroscopy. Because of the low number of treatment sessions required, hp-APC could be used as an alternative to Nd:YAG laser treatment in tumor debulking.
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Affiliation(s)
- Hendrik Manner
- Department of Internal Medicine II, HSK Wiesbaden, Wiesbaden, Germany.
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Nomura T, Miyashita M, Makino H, Maruyama H, Katsuta M, Kashiwabara M, Takahashi K, Sasajima K, Yamashita K, Tajiri T. Argon Plasma Coagulation for the Treatment of Superficial Esophageal Carcinoma. J NIPPON MED SCH 2007; 74:163-7. [PMID: 17507793 DOI: 10.1272/jnms.74.163] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIMS Recently, endoscopic mucosal resection (EMR) has become the first choice of treatment for superficial esophageal cancer without metastasis. However, EMR is not safe for all patients. Argon plasma coagulation (APC) is a noncontact electrocoagulation technique that creates tissue damage. The risk of bleeding may be lower with APC than with EMR. Therefore, we selected APC for the treatment of patients with superficial esophageal cancer who could not undergo EMR. The aim of the present study was to describe these cases and analyze the results of this treatment. PATIENTS AND METHODS Ten patients with superficial esophageal cancer underwent APC at our institution from February 2001 through January 2002. None of the patients could undergo EMR because of complications. Ablation was performed using an APC probe (ERBE APC probe; ERBE Elektromedizin, Tübingen, Germany), a high-frequency electrosurgical generator (ERBE ICC200), and an argon delivery unit (ERBE APC 300). All patients had uneventful recoveries. RESULTS No incidents of bleeding from the ablated lesion or infection occurred. Oral intake was resumed on the day after treatment. The mean duration of the procedure was 20 minutes (range, 10 to 40 minutes). Disease recurred in two patients. Two patients died of laryngeal cancer and liver failure, respectively. CONCLUSION APC is a safe and easy to perform procedure, but the effect of therapy is inferior to that of EMR in terms of the complete resection of the lesion. In conclusion, APC should be limited to cases of superficial esophageal cancer without metastasis in which EMR has been deemed difficult.
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Affiliation(s)
- Tsutomu Nomura
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
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Nakamura S, Mitsunaga A, Konishi H, Oi I, Shiratori K, Suzuki S. LONG-TERM FOLLOW UP OF GASTRIC ANTRAL VASCULAR ECTASIA TREATED BY ARGON PLASMA COAGULATION. Dig Endosc 2006. [DOI: 10.1111/j.1443-1661.2006.00592.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Abstract
Bleeding occurs in up to 10% of patients with advanced cancer. It can present in many different ways. This article provides a qualitative review of treatment options available to manage visible bleeding. Local modalities, such as hemostatic agents and dressings, radiotherapy, endoscopic ligation and coagulation, and transcutaneous arterial embolization, are reviewed in the context of advanced cancer, as are systemic treatments such as vitamin K, vasopressin/desmopressin, octreotide/somatostatin, antifibrinolytic agents (tranexamic acid and aminocaproic acid), and blood products. Considerations at the end of life are described.
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Affiliation(s)
- Jose Pereira
- Department of Oncology, University of Calgary, Palliative Care Office, Room 710, South Tower, Foothills Medical Centre, 1403-29th Avenue NW, Calgary, Alberta, T2N 2T9, Canada.
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Affiliation(s)
- David Mitton
- Department of Surgery, Royal Hallamshire Hospital, Sheffield, United Kingdom
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Martínez Cerezo FJ, Garreta J, Miralbés M. [Endoscopic resection with polypectomy snare and argon plasma coagulation in early gastric adenocarcinoma in a patient at high surgical risk]. GASTROENTEROLOGIA Y HEPATOLOGIA 2004; 27:411-3. [PMID: 15461940 DOI: 10.1016/s0210-5705(03)70489-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report a patient at high surgical risk with an early gastric adenocarcinoma. Due to the size of the tumor, endoscopic mucosal resection alone was not feasible and consequently a combination of endoscopic resection with polypectomy snare and argon plasma coagulation was applied. Four years later the patient remains asymptomatic.
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Cheng AWK, Chiu PWY, Chan PCM, Lam SH. Endoscopic Hemostasis for Bleeding Gastric Stromal Tumors by Application of Hemoclip. J Laparoendosc Adv Surg Tech A 2004; 14:169-71. [PMID: 15245670 DOI: 10.1089/1092642041255522] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In the past, numerous reports have advocated primary surgical resection as a treatment of choice for bleeding gastric stromal tumors (GIST). There were scarce reports on primary hemostasis with endoscopic therapy. We encountered two patients who presented to our unit with acute bleeding from gastric fundal stromal tumor, in whom we were able to achieved successful endoscopic hemostasis with hemoclip therapy. We describe the management of these cases and reviewed the current management strategies in bleeding gastric stromal tumor.
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Affiliation(s)
- Anthony Wing Kay Cheng
- Department of Surgery and Endoscopy Center, United Christian Hospital, Hong Kong S. A. R., China
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Abstract
Most of the patients with advanced gastric cancer have incurable disease at presentation and require palliative treatment to reduce symptoms as vomiting, nausea and inability to eat. Treatment options are palliative surgery and endoscopic techniques. Insertion of self-expanding metal stents is nowadays a well-established method of treating biliary and esophageal strictures and is also effective in gastric tumors. The indication and application technique are described in this review. In addition, enteral nutrition is indicated if the gastrointestinal tract functions but swallowing or mastication is compromised by disease or if it is needed to pass an obstructed area, especially in gastric tumor patients. This article reviews the enteral nutrition techniques and their clinical value for patients with advanced gastric cancer.
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Affiliation(s)
- A J Dormann
- Department of Medicine, Krankenhaus Holwelde, Koln, Germany.
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Affiliation(s)
- John J Vargo
- Department of Gastroenterology and Hepatology, The Cleveland Clinic Foundation, Ohio 44195, USA
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Abstract
Esophageal cancer remains one of the leading causes of cancer death worldwide. Patients generally present with progressive dysphagia, malnutrition, and weight loss. The diagnosis commonly involves radiologic studies and conventional esophagogastroduodenoscopy. Advances in endoscopic evaluation have allowed early detection of premalignant and malignant lesions. These techniques include chromoscopy, which can be performed in conjunction with high-resolution/magnification endoscopy, and fluorescent endoscopy. Such techniques as endoscopic ultrasound with dedicated echoendoscopes or high-frequency probes, positron emission tomography, optical coherence tomography, endoscopic magnetic resonance imaging, and tactile sensing may complement conventional imaging by CT to enhance staging accuracy. Because the majority of patients present with incurable disease at the time of diagnosis, nonsurgical approaches to their management have evolved. These include endoscopic mucosal resection, stenting, tumor ablation, and palliative chemoradiotherapy. The ablative techniques include argon plasma coagulator therapy, laser, and photodynamic therapy. For patients with early malignancies of the esophagus who are not surgical candidates, such techniques may be used with curative intent.
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Affiliation(s)
- Darius Sorbi
- Division of Gastroenterology and Hepatology, Mayo Clinic Scottsdale, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA.
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Affiliation(s)
- E Medina
- Servicio de Patología Digestiva, Hospital General Universitario de Valencia, Spain
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Abstract
In Western countries, many esophageal diseases result from uncontrolled gastroesophageal reflux. Treatments for Barrett esophagus, peptic strictures, and esophageal adenocarcinoma still account for a large portion of the esophageal interventions performed by therapeutic endoscopists. In addition to continued refinements in the treatment of these sequelae, new endoscopic therapies have emerged to treat gastroesophageal reflux disease itself. This article reviews the available literature on new endoscopic antireflux procedures along with other advances that give the endoscopist unprecedented options in the treatment of esophageal diseases.
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Affiliation(s)
- Drew B Schembre
- University of Washington, Virginia Mason Medical Center, Seattle, Washington 98111, USA.
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Ginsberg GG, Barkun AN, Bosco JJ, Burdick JS, Isenberg GA, Nakao NL, Petersen BT, Silverman WB, Slivka A, Kelsey PB. The argon plasma coagulator: February 2002. Gastrointest Endosc 2002; 55:807-10. [PMID: 12024132 DOI: 10.1016/s0016-5107(02)70408-2] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
Esophageal and gastric malignancies are common worldwide. Less than half are amenable to curative treatment at the time of diagnosis because of advanced or metastatic disease. Palliation is often required for symptoms, such as dysphagia, gastrointestinal bleeding, aspiration caused by tracheoesophageal fistula, nausea and emesis secondary to gastric outlet obstruction, and malnutrition. This article reviews the gastric outlet obstruction, and malnutrition. This article reviews the medical, endoscopic, and surgical options for palliative treatment.
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Affiliation(s)
- Carla L Nash
- Gastroenterology-Nutrition Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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