Management of Adverse Events of Submucosal Endoscopy

Different behavior of electrosurgical currents between air and saline immersion therapeutic endoscopy

Impedance and voltage of monopolar currents are directly related. By replacing air with saline solution, a change in behavior of these currents are achieved in endoscopy, resulting in a desired coagulation effect. However, the underlying electrophysical mechanisms of this effect remain poorly explained. This investigation assessed the relationship between the electrical parameters and the surrounding environment for three high-voltage monopolar coagulation currents commonly used for therapeutic endoscopy. Six consecutive applications per setting and per environment were performed with dissection knife on porcine kidney. When transitioning from air to saline immersion, a 99% decrease in impedance was observed for all current settings tested (AirRange: 4400-8150 Ω, SalineRange: 64-71 Ω; p < 0.01 for all settings). This resulted in a 52-78% reduction in peak voltage (AirRange: 920-1165 V, SalineRange: 257-499 V; p < 0.01 for all settings), and a 237-2030% increase in power delivered (AirRange: 3-19 W, SalineRange: 50-117 W; p < 0.01 for all settings). The dramatic decrease in impedance results in a sharp reduction of voltage, explaining the coagulation effect observed when passing from air to saline-immersion therapeutic endoscopy.

The clinical efficacy of "water-jet" hemostasis in gastrointestinal endoscopic submucosal dissection

Objective

This study aims to evaluate the safety and efficacy of "water-jet" hemostasis during endoscopic submucosal dissection.

Methods

In this prospective single-arm clinical study, 10 patients aged 18-60 years with gastric or intestinal mucosal lesions who were admitted to Fujian Medical University Xiamen Humanity Hospital (Xiamen, P. R. China) between June 2022 and June 2023 and met the absolute indications for endoscopic treatment were finally analyzed. The primary outcomes of this study are the incidence rates of adverse events and R0 resection, and the secondary outcomes are length of hospital stay and short- and long-term outcomes.

Results

Successful hemostasis was achieved in all the included cases. In one case, the "water-jet" hemostasis failed to stop bleeding in one blood vessel, so the hemostatic forceps were used instead. No adverse events occurred in all cases. Pathologic results showed R0 resection in all samples.

Conclusion

The "water-jet" method is safe and feasible for hemostasis in endoscopic submucosal dissection.

Early Rectal Cancer and Local Excision: A Narrative Review

A rise in the incidence of early rectal cancer consequent to bowel-screening programs around the world and an increase in the incidence in young adults has led to a growing interest in organ-sparing treatment options. The rectum, being the most distal portion of the large intestine, is a fertile ground for local excision techniques performed with endoscopic or surgical techniques. Moreover, the advancement in endoscopic optical evaluation and the better definition of imaging techniques allow for a more precise local staging of early rectal cancer. Although the local treatment of early rectal cancer seems promising, in clinical practice, a significant number of patients who could benefit from local excision techniques undergo total mesorectal excision (TME) as the first approach. All relevant prospective clinical trials were identified through a computer-assisted search of the PubMed, EMBASE, and Medline databases until January 2024. This review is dedicated to endoscopic and surgical local excision in the treatment of early rectal cancer and highlights its possible role in current and future clinical practice, taking into account surgical completion techniques and chemoradiotherapy.