1
|
Guardiola JJ, Rex DK, Thompson CC, Mosko J, Ryou M, Peetermans J, Rousseau MJ, von Renteln D. A new through-the-scope clip with anchor prongs is safe and successful for a variety of endoscopic uses. Endosc Int Open 2024; 12:E812-E817. [PMID: 38911014 PMCID: PMC11192586 DOI: 10.1055/a-2330-9803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/15/2024] [Indexed: 06/25/2024] Open
Abstract
Background and study aims Endoscopic through-the-scope clips (TTSC) are used for hemostasis and closure. We documented the performance of a new TTSC with anchor prongs. Patients and methods We conducted a prospective case series of the new TTSC in 50 patients with an indication for endoscopic clipping at three hospitals in the United States and Canada. Patients were followed for 30 days after the index procedure. Outcomes included defect closure and rate of serious adverse events (SAEs) related to the device or procedure. Results Fifty patients had 56 clipping procedures. Thirty-four procedures were clipping after endoscopic mucosal resection (EMR) in the colon (33) or stomach (1), 16 after polypectomy, two for hemostasis of active bleeding, and one each for fistula closure, per-oral endoscopic myotomy mucosal closure, or anchoring a feeding tube. Complete defect closure was achieved in 32 of 33 colon EMR defects and 21 of 22 other defects. All clips were placed per labeled directions for use. In 41 patients (82.0%), prophylaxis of delayed bleeding was reported as an indication for endoscopic clipping. There were three instances of delayed bleeding. There were no device-related SAEs. The only technical difficulty was one instance of premature clip deployment. Conclusions A novel TTSC with anchor prongs showed success in a range of defect closures, an acceptable safety profile, and low incidence of technical difficulties.
Collapse
Affiliation(s)
- John J. Guardiola
- Divsion of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, United States
| | - Douglas K. Rex
- Divsion of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, United States
| | - Christopher C. Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, United States
| | - Jeffrey Mosko
- Gastroenterology, St Michael's Hospital, Toronto, Canada
| | - Marvin Ryou
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, United States
| | | | | | | |
Collapse
|
2
|
Yang D, Xiao Y, Draganov PV. Novel devices for third-space endoscopy procedures. Dig Endosc 2024; 36:521-532. [PMID: 37737067 DOI: 10.1111/den.14690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/18/2023] [Indexed: 09/23/2023]
Abstract
Third-space endoscopy (TSE) is a subspecialty in interventional endoscopy that exploits the submucosa as a working space for the management of various gastrointestinal diseases. Over recent years, TSE has emerged as a viable alternative to surgery for the treatment of various conditions. The rapid dissemination and adoption of TSE has been largely supported by the advent of novel devices aimed to improve the efficacy and safety of these procedures. In this article, we review some of the recent developments in TSE devices and provide our initial experience with these instruments in clinical practice.
Collapse
Affiliation(s)
- Dennis Yang
- Center for Interventional Endoscopy, AdventHealth, Orlando, USA
| | - Yasi Xiao
- Center for Interventional Endoscopy, AdventHealth, Orlando, USA
| | - Peter V Draganov
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, USA
| |
Collapse
|
3
|
Yang D, Hasan MK, Bani Fawwaz B, Farooq A, Zhang Y, Khan HM, Brar TS, Singh S, Viana A, Singh G, Kadkhodayan K, Arain MA, Cosgrove N, Jain D, Inayat I, Singh C. Quantification of interstitial cells of Cajal and fibrosis during gastric per-oral endoscopic myotomy and its association with clinical outcomes. Endosc Int Open 2024; 12:E585-E592. [PMID: 38654965 PMCID: PMC11039041 DOI: 10.1055/a-2290-0502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/04/2024] [Indexed: 04/26/2024] Open
Abstract
Background and study aims Alterations to interstitial cells of Cajal (ICC) and collagen fibrosis have been implicated in the pathogenesis of gastroparesis. We aimed to evaluate the feasibility and safety of pyloric muscle sampling during gastric peroral endoscopic myotomy (G-POEM) and the association between pyloric ICC density and degree of fibrosis with clinical outcomes. Patients and methods This was a single-center prospective study of gastroparetic patients who underwent G-POEM and intraprocedural pyloric muscle biopsies between January 2022 and April 2023. ICC count was estimated using CD117 stain and trichome for collagen fibrosis. Clinical response to G-POEM was defined as an improvement of ≥ 1 point on the Gastroparesis Cardinal Symptom Index. Results Fifty-six patients (median age 60 years, 71.4% women) underwent G-POEM (100% technical success; 71.4% clinical response). ICC depletion (< 10/high-power field) and fibrosis were encountered in 70.4% and 75% of the cases, respectively. There was no difference in mean ICC count between G-POEM responders vs. non-responders (7±3.6 vs. 7.7±3.3; P = 0.9). There was no association between ICC density or degree of fibrosis with the etiology of gastroparesis, duration of symptoms, gastric emptying rate, or pyloric impedance planimetry. Patients who did not respond to G-POEM had a significantly higher degree of moderate/severe fibrosis when compared with those who responded (81.3% vs. 25%; P = 0.0002). Conclusions Pyloric muscle biopsies during G-POEM was feasible and safe. ICC depletion and pyloric muscle fibrosis are common in gastroparetic patients. The degree of fibrosis may be related to pyloric dysfunction and clinical response to G-POEM. Additional studies are needed to confirm these results.
Collapse
Affiliation(s)
- Dennis Yang
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | | | | | - Aimen Farooq
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
- Internal Medicine, AdventHealth Central Florida, Orlando, United States
| | - Yiyang Zhang
- Statistics, AdventHealth Central Florida, Orlando, United States
| | - Hafiz M Khan
- Gastroenterology and Hepatology, Staten Island University Hospital, Staten Island, United States
| | - Tony S Brar
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Sanmeet Singh
- Gastroenterology, AdventHealth Central Florida, Orlando, United States
| | - Artur Viana
- Gastroenterology, AdventHealth Central Florida, Orlando, United States
| | - Gurdeep Singh
- Medicine, AdventHealth Central Florida, Orlando, United States
| | - Kambiz Kadkhodayan
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Mustafa A Arain
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Natalie Cosgrove
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Deepanshu Jain
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Irteza Inayat
- Gastroenterology, AdventHealth Central Florida, Orlando, United States
| | | |
Collapse
|
4
|
D'Souza LS, Yang D, Diehl D. AGA Clinical Practice Update on Endoscopic Full-Thickness Resection for the Management of Gastrointestinal Subepithelial Lesions: Commentary. Gastroenterology 2024; 166:345-349. [PMID: 38108671 DOI: 10.1053/j.gastro.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023]
Abstract
DESCRIPTION Subepithelial lesions of the gastrointestinal tract are not encountered uncommonly during routine endoscopy. There has been remarkable progress in the development of endoscopic options for the resection of subepithelial lesions, including full-thickness resection. The purpose of this American Gastroenterological Association (AGA) Clinical Practice Update (CPU) is to describe the various techniques for endoscopic full-thickness resection and to facilitate their appropriate application in the management of subepithelial lesions. METHODS This CPU was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPUC and external peer review through standard procedures of Gastroenterology.
Collapse
Affiliation(s)
- Lionel S D'Souza
- Department of Gastroenterology and Hepatology, Stony Brook University Hospital, Stony Brook, New York.
| | - Dennis Yang
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida
| | - David Diehl
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania
| |
Collapse
|
5
|
Mohammed A, Gonzaga ER, Hasan MK, Saeed A, Friedland S, Bilal M, Sharma N, Jawaid S, Othman M, Khalaf MA, Hwang JH, Viana A, Singh S, Hayat M, Cosgrove ND, Jain D, Arain MA, Kadkhodayan KS, Yang D. Low delayed bleeding and high complete closure rate of mucosal defects with the novel through-the-scope dual-action tissue clip after endoscopic resection of large nonpedunculated colorectal lesions (with video). Gastrointest Endosc 2024; 99:83-90.e1. [PMID: 37481003 DOI: 10.1016/j.gie.2023.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/05/2023] [Accepted: 07/17/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND AND AIMS Complete closure after endoscopic resection of large nonpedunculated colorectal lesions (LNPCLs) can reduce delayed bleeding but is challenging with conventional through-the-scope (TTS) clips alone. The novel dual-action tissue (DAT) clip has clip arms that open and close independently of each other, facilitating tissue approximation. We aimed to evaluate the rate of complete closure and delayed bleeding with the DAT clip after endoscopic resection of LNPCLs. METHODS This was a multicenter prospective cohort study of all patients who underwent defect closure with the DAT clip after EMR or endoscopic submucosal dissection (ESD) of LNPCLs ≥20 mm from July 2022 to May 2023. Delayed bleeding was defined as a bleeding event requiring hospitalization, blood transfusion, or any intervention within 30 days after the procedure. Complete closure was defined as apposition of mucosal defect margins without visible submucosal areas <3 mm along the closure line. RESULTS One hundred seven patients (median age, 64 years; 42.5% women) underwent EMR (n = 63) or ESD (n = 44) of LNPCLs (median size, 40 mm; 74.8% right-sided colon) followed by defect closure. Complete closure was achieved in 96.3% (n = 103) with a mean of 1.4 ± .6 DAT clips and 2.9 ± 1.8 TTS clips. Delayed bleeding occurred in 1 patient (.9%) without requiring additional interventions. CONCLUSIONS The use of the DAT clip in conjunction with TTS clips achieved high complete defect closure after endoscopic resection of large LNPCLs and was associated with a .9% delayed bleeding rate. Future comparative trials and formal cost-analyses are needed to validate these findings. (Clinical trial registration number: NCT05852457.).
Collapse
Affiliation(s)
- Abdul Mohammed
- Division of Gastroenterology and Hepatology, AdventHealth, Orlando, Florida, USA
| | | | - Muhammad K Hasan
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - Ahmed Saeed
- Kansas City Gastroenterology and Hepatology Physicians Group, Kansas City, Missouri, USA
| | - Shai Friedland
- Department of Gastroenterology, Stanford University School of Medicine, Stanford, California, USA; VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Mohammad Bilal
- The University of Minnesota/Minneapolis VA Medical Center, Minneapolis, Minnesota, USA
| | - Neil Sharma
- Division of Interventional Oncology and Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, Indiana, USA
| | - Salmaan Jawaid
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA
| | - Mohamed Othman
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA
| | - Mai Ahmed Khalaf
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA
| | - Joo Ha Hwang
- Department of Gastroenterology, Stanford University School of Medicine, Stanford, California, USA
| | - Artur Viana
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - Sanmeet Singh
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - Maham Hayat
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - Natalie D Cosgrove
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - Deepanshu Jain
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - Mustafa A Arain
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | | | - Dennis Yang
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| |
Collapse
|
6
|
Nasir A, Ding H, Bai Q, Hu B. Novel through-the-scope dual-action tissue clip for mucosal defect closure after endoscopic resection of large nonpedunculated colorectal lesions: a strong stimulus for multinational collaboration. Gastrointest Endosc 2024; 99:132-133. [PMID: 38097305 DOI: 10.1016/j.gie.2023.07.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 07/23/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Abdul Nasir
- Medical Research Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huanfei Ding
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qian Bai
- Medical Research Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bowen Hu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
7
|
Jawaid S, Othman M, Keihanian T, Hasan MK, Yang D. Use of a novel dual-action traction device to facilitate endoscopic submucosal dissection. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:224-225. [PMID: 37303706 PMCID: PMC10251433 DOI: 10.1016/j.vgie.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Video 1Use of a novel dual-action traction device to facilitate endoscopic submucosal dissection.
Collapse
Affiliation(s)
- Salmaan Jawaid
- Department of Medicine, Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas
| | - Mohamed Othman
- Department of Medicine, Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas
| | - Tara Keihanian
- Department of Medicine, Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas
| | - Muhammad K Hasan
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida
| | - Dennis Yang
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida
| |
Collapse
|