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Cocomazzi F, Carparelli S, Labarile N, Capogreco A, Gentile M, Maselli R, Dhar J, Samanta J, Repici A, Hassan C, Perri F, Facciorusso A. Is there a best choice of equipment for colorectal endoscopic submucosal dissection? Expert Rev Med Devices 2024:1-17. [PMID: 38829122 DOI: 10.1080/17434440.2024.2364022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 05/31/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION Endoscopic submucosal dissection (ESD) is a widely used technique to remove early neoplastic lesions. It was primarily used in the initial days to treat gastric lesions, but recently, the horizon of this endoscopic procedure has expanded, which has allowed us to manage other technically more complex locations, such as the colorectum. AREAS COVERED There has been an exponential growth regarding the wide range of devices available in the market for performing colorectal ESD. As a result, the aim of this review is to highlight the indication of this endoscopic technique, which device is best suited for which indication, as well as future trajectories in this field. EXPERT OPINION Although some devices have proven to be more advantageous than others in this area, very often the choice is still subjective, which is commonly attributed to individual preferences and experience. However, an accurate knowledge of the available tools and their functioning, with their pros and cons, is fundamental for any endoscopist venturing into the field of third space endoscopy. In this way, one can choose which device best suits a particular situation, along with simultaneously having the wealth of knowledge related to therapeutic armamentarium at our disposal in the endoscopy suite.
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Affiliation(s)
- Francesco Cocomazzi
- Gastroenterology and Endoscopy Unit, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - Sonia Carparelli
- Gastroenterology and Endoscopy Unit, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - Nunzia Labarile
- Department of Gastroenterology, National Institute of Gastroenterology - IRCCS "Saverio de Bellis" - Castellana Grotte, Bari, Italy
| | - Antonio Capogreco
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS - Rozzano, Rozzano, Italy
| | - Marco Gentile
- Gastroenterology and Endoscopy Unit, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - Roberta Maselli
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS - Rozzano, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University - Rozzano, Foggia, Italy
| | - Jahnvi Dhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alessandro Repici
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS - Rozzano, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University - Rozzano, Foggia, Italy
| | - Cesare Hassan
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS - Rozzano, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University - Rozzano, Foggia, Italy
| | - Francesco Perri
- Gastroenterology and Endoscopy Unit, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Foggia, Italy
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2
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Nabi Z, Reddy DN. Endoscopic full thickness resection: techniques, applications, outcomes. Expert Rev Gastroenterol Hepatol 2024:1-13. [PMID: 38779710 DOI: 10.1080/17474124.2024.2357611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Endoscopic full-thickness resection (EFTR) represents a pivotal advancement in the minimally invasive treatment of gastrointestinal lesions, offering a novel approach for the management of lesions previously deemed challenging or unreachable through conventional endoscopic techniques. AREAS COVERED This review discusses the development, methodologies, applications, and clinical outcomes associated with EFTR, including exposed and device-assisted EFTR (DA-EFTR), the integration of endoscopic mucosal resection (EMR) with EFTR in hybrid techniques, and the collaborative approach between laparoscopic and endoscopic surgery (LECS). It encapsulates a comprehensive analysis of the various EFTR techniques tailored to specific lesion characteristics and anatomical locations, underscoring the significance of technique selection based on the lesion's nature and situational context. EXPERT OPINION/COMMENTARY The review underscores EFTR's transformative role in expanding therapeutic horizons for gastrointestinal tumors, emphasizing the importance of technique selection tailored to the unique attributes of each lesion. It highlights EFTR's capacity to facilitate organ-preserving interventions, thereby significantly enhancing patient outcomes and reducing procedural complications. EFTR is a cornerstone in the evolution of gastrointestinal surgery, marking a significant leap forward in the pursuit of precision, safety, and efficacy in tumor management.
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Affiliation(s)
- Zaheer Nabi
- Asian institute of Gastroenterology, Hyderabad
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3
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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.
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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
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Agnihotri A, Mitsuhashi S, Holmes I, Kamal F, Chiang A, Loren DE, Kowalski TE, Schlachterman A, Kumar AR. Randomized trial of gastric and colorectal endoscopic submucosal dissection defect closure comparing a novel through-the-scope suturing system with an over-the-scope suturing system (with video). Gastrointest Endosc 2024; 99:237-244.e1. [PMID: 37536633 DOI: 10.1016/j.gie.2023.07.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/16/2023] [Accepted: 07/23/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND AIMS Mucosal closure adds time but reduces adverse events associated with endoscopic submucosal dissection (ESD). We aimed to assess the closure time (CT), technical success, and cost-effectiveness between a novel through-the-scope helix tack suture system (TTSS) and the over-the-scope suturing system (OTSS). METHODS In this single-center, prospective, randomized trial, all patients undergoing ESD with anticipated closure were randomized 1:1 to TTSS (study group) or OTSS (control group). Primary outcomes were CT and overall CT (OCT; CT + setup time). Secondary outcomes were rates of technical success, adverse events, and cost-effectiveness. RESULTS Forty patients were randomized to OTSS (n = 20) or TTSS (n = 20). OTSS and TTSS groups were similar with respect to age, gender, proportion of colorectal polyps, proximal colon polyps, and mean size of the resected specimen (40.9 mm vs 40.4 mm). The mean CT was 18.4 minutes for OTSS and 23.3 minutes for TTSS (P = .36). The mean OCT was 32 minutes for OTSS and 39.5 minutes for TTSS (P = .36). Closure with a primary device was successful in 17 cases (85%) with OTSS and 18 cases (90%) with TTSS (P = .63). No closure-related intraprocedural adverse events or delayed perforations were noted. Mean cost of closure was significantly lower in the TTSS group for lesions <35 mm (P = .008). CONCLUSIONS TTSS was not found to be superior to OTSS with respect to CT and technical and clinical success for closure of gastric and colorectal ESD defects. TTSS is more cost-effective for closure of lesions <35 mm. (Clinical trial registration number: NCT04925271.).
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Affiliation(s)
- Abhishek Agnihotri
- Division of Gastroenterology, Bayhealth Medical Center, Dover, Delaware, USA
| | - Shuji Mitsuhashi
- Division of Gastroenterology & Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ian Holmes
- Division of Gastroenterology, The Oregon Clinic, Portland, Oregon, USA
| | - Faisal Kamal
- Division of Gastroenterology & Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Austin Chiang
- Division of Gastroenterology & Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - David E Loren
- Division of Gastroenterology & Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Thomas E Kowalski
- Division of Gastroenterology & Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alexander Schlachterman
- Division of Gastroenterology & Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Anand R Kumar
- Division of Gastroenterology & Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Albouys J, Montori Pina S, Boukechiche S, Albéniz E, Vidal G, Legros R, Dahan M, Lepetit H, Pioche M, Schaefer M, Geyl S, Carrier P, Loustaud-Ratti V, Valgueblasse V, Brule C, Rodrigues R, Enguita German M, Jacques J. Risk of delayed bleeding after colorectal endoscopic submucosal dissection: the Limoges Bleeding Score. Endoscopy 2024; 56:110-118. [PMID: 37816392 DOI: 10.1055/a-2189-0807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
BACKGROUND Clinically significant delayed bleeding (CSDB) is a frequent, and sometimes severe, adverse event after colorectal endoscopic submucosal dissection (ESD). We evaluated risk factors of CSDB after colorectal ESD. METHODS We analyzed a prospective registry of 940 colorectal ESDs performed from 2013 to 2022. The incidence of bleeding was evaluated up to 30 days. Risk factors for delayed bleeding were evaluated by multivariate logistic regression. A Korean scoring model was tested, and a new risk-scoring model was developed and internally validated. RESULTS CSDB occurred in 75 patients (8.0%). The Korean score performed poorly in our cohort, with a receiver operating characteristic (ROC) curve of 0.567. In the multivariate analysis, risk factors were age ≥75 years (odds ratio [OR] 1.63; 95%CI 0.97-2.73; 1 point), use of antithrombotics (OR 1.72; 95%CI 1.01-2.94; 1 point), rectal location (OR 1.51; 95%CI 0.92-2.48; 1 point), size >50 mm (OR 3.67; 95%CI 2.02-7.14; 3 points), and American Society of Anesthesiologists (ASA) score of III or IV (OR 2.26; 95%CI 1.32-3.92; 2 points). The model showed fair calibration and good discrimination, with an area under the ROC curve of 0.751 (95%CI 0.690-0.812). The score was used to define two groups of patients, those with low-medium risk (0 to 4 points) and high risk (5 to 8 points) for CSDB (respective bleeding rates 4.1% and 17.5%). CONCLUSION A score based on five simple and meaningful variables was predictive of CSDB.
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Affiliation(s)
- Jérémie Albouys
- Hépato-gastro-entérology, Hopital Dupuytren, Limoges, France
| | - Sheyla Montori Pina
- Gastrointestinal Endoscopy Research Unit, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | | | - Eduardo Albéniz
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
- Gastroenterology Department, Hospital Universitario de Navarra (HUN), Navarrabiomed, Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | - Guillaume Vidal
- Hépato-gastro-entérologie, Hospital Dupuytren, Limoges, France
| | - Romain Legros
- Hépato-gastro-entérologie, Hospital Dupuytren, Limoges, France
| | - Martin Dahan
- Hépato-gastro-entérologie, Hospital Dupuytren, Limoges, France
| | - Hugo Lepetit
- Hépato-gastro-entérologie, Hospital Dupuytren, Limoges, France
| | | | - Marion Schaefer
- Hépato-gastro-entérology, Nancy University Hospital, Nancy, France
| | - Sophie Geyl
- Hépato-gastro-entérologie, Hospital Dupuytren, Limoges, France
| | - Paul Carrier
- Hépato-gastro-entérologie, Hospital Dupuytren, Limoges, France
| | | | | | | | | | - Monica Enguita German
- Methodology Unit, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | - Jérémie Jacques
- Hépato-gastro-entérologie, Hospital Dupuytren, Limoges, France
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Canakis A, Dawod SM, Dawod E, Simons M, Di Cocco B, Westerveld DR, Trasolini RP, Berzin TM, Marshall CA, Abdelfattah AM, Marya NB, Smallfield GB, Kaspar M, Campos GM, Skef W, Kedia P, Smith TA, Aihara H, Moyer MT, Sampath K, Mahadev S, Carr-Locke DL, Sharaiha RZ. Efficacy, Feasibility, and Safety of the X-Tack Endoscopic HeliX Tacking System: A Multicenter Experience. J Clin Gastroenterol 2024:00004836-990000000-00261. [PMID: 38277501 DOI: 10.1097/mcg.0000000000001977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/04/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND AND AIMS The application of endoscopic suturing has revolutionized defect closures. Conventional over-the-scope suturing necessitates removal of the scope, placement of the device, and reinsertion. A single channel, single sequence, through-the-scope suturing device has been developed to improve this process. This study aims to describe the efficacy, feasibility, and safety of a through-the-scope suturing device for gastrointestinal defect closure. METHODS This was a retrospective multicenter study involving 9 centers of consecutive adult patients who underwent suturing using the X-Tack Endoscopic HeliX Tacking System (Apollo Endosurgery). The primary outcomes were technical success and long-term clinical success. Secondary outcomes included adverse events, recurrence, and reintervention rates. RESULTS In all, 56 patients (mean age 53.8, 33 women) were included. Suturing indications included fistula repair (n=22), leak repair (n=7), polypectomy defect closure (n=12), peroral endoscopic myotomy (POEM) site closure (n=7), perforation repair (n=6), and ulcers (n=2). Patients were followed at a mean duration of 74 days. Overall technical and long-term clinical success rates were 92.9% and 75%, respectively. Both technical and clinical success rates were 100% for polypectomies, POEM-site closures, and ulcers. Success rates were lower for the repair of fistulas (95.5% technical, 54.5% clinical), leaks (57.1%, 28.6%), and perforations (100%, 66.7%). No immediate adverse events were noted. CONCLUSION This novel, through-the-scope endoscopic suturing system, is a safe and feasible method to repair defects that are ≤3 cm. The efficacy of this device may be better suited for superficial defects as opposed to full-thickness defects. Larger defects will need more sutures and probably a double closure technique to provide a reinforcement layer.
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Affiliation(s)
- Andrew Canakis
- Department of Gastroenterology, University of Maryland Medical Center, Baltimore, MD
| | - Sanad Maher Dawod
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
| | - Enad Dawod
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
| | - Malorie Simons
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
| | - Bianca Di Cocco
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
| | | | | | - Tyler M Berzin
- Department of Gastroenterology, Beth Israel Deaconess Medical Center, Boston
| | | | | | - Neil B Marya
- Department of Gastroenterology, UMass Memorial Medical Center, Worcester, MA
| | - George B Smallfield
- Department of Gastroenterology, Virginia Commonwealth University, Richmond, VA
| | - Matthew Kaspar
- Department of Gastroenterology, Virginia Commonwealth University, Richmond, VA
| | - Guilherme M Campos
- Department of Gastroenterology, Virginia Commonwealth University, Richmond, VA
| | - Wasseem Skef
- Department of Gastroenterology, Loma Linda University Medical Center, Loma Linda, CA
| | - Prashant Kedia
- Department of Gastroenterology, Methodist Dallas Medical Center, Dallas, TX
| | - Terrence A Smith
- Department of Gastroenterology, Vanderbilt University Medical Center, Nashville, TN
| | - Hiroyuki Aihara
- Department of Gastroenterology, Brigham and Women's Hospital
| | - Matthew T Moyer
- Department of Gastroenterology, Penn State Health Milton S Hershey Medical Center. Hershey, PA
| | - Kartik Sampath
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
| | - Srihari Mahadev
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
| | - David L Carr-Locke
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
| | - Reem Z Sharaiha
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
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Kim YI, Khalaf MA, Keihanian T, Salmaan J, Othman MO. Ambulatory Endoscopic Submucosal Dissection for Gastrointestinal Neoplasms: Trends and Associated Factors in the United States. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00001-6. [PMID: 38184097 DOI: 10.1016/j.cgh.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 12/10/2023] [Accepted: 12/15/2023] [Indexed: 01/08/2024]
Abstract
Endoscopic submucosal dissection (ESD) is a minimally invasive treatment for superficial gastrointestinal (GI) cancers.1,2 ESD practice is expanding significantly in the United States and Western countries. This is attributed to a shorter hospital stay, better quality of life, and fewer adverse events compared with surgery. In the United States, ESD usually is performed and managed in an outpatient setting (ambulatory ESD) or with an overnight hospital stay. This practice is in contrast to Eastern Asian countries, where 3 to 5 days of hospital stay is a routine process for observation after ESD. A Swedish study showed that patients with well-selected colorectal neoplasms (median tumor size, 37 mm) could be managed safely in an outpatient setting after ESD.3 A North American multicenter ESD study also reported that ambulatory ESD was safe and feasible in selected cases (noninvasive cancers, no adverse events, high-volume endoscopists with short procedure time).4 However, procedural and technical aspects that enable safe outpatient management of patients after ESD need to be investigated.
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Affiliation(s)
- Young-Il Kim
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Mai A Khalaf
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Tropical Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Tara Keihanian
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Jawaid Salmaan
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Mohamed O Othman
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
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8
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Geyl S, Albouys J, Schaefer M, Jacques J. Should colorectal endoscopic submucosal dissection defects be closed just because we can? Endoscopy 2023; 55:977. [PMID: 37757800 DOI: 10.1055/a-2077-5034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Affiliation(s)
- Sophie Geyl
- Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Jérémie Albouys
- Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Marion Schaefer
- Service d'Hépato-gastro-entérologie, CHU Nancy, Nancy, France
| | - Jérémie Jacques
- Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
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Jia L, Shi Y. Using a through-the-scope tack and suture system in patients with gastrointestinal wall defects: an alternative option beyond endoscopic clipping. Endoscopy 2023; 55:973. [PMID: 37757796 DOI: 10.1055/a-2085-5594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Affiliation(s)
- Lijun Jia
- Department of Anesthesiology and Perioperative Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yang Shi
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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10
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Ullah S, Ali FS, Ostovan M, Liu BR. Helix tack-and-suture device for mucosal defect closure following colorectal endoscopic submucosal dissection: is it ready for global adoption? Endoscopy 2023; 55:780. [PMID: 37499653 DOI: 10.1055/a-2046-5159] [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] [Indexed: 07/29/2023]
Affiliation(s)
- Saif Ullah
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Faisal S Ali
- Gastroenterology, Hepatology, and Nutrition Department, University of Texas Health Science Center at Houston, Texas, United States
| | - Maral Ostovan
- School of International Education and School of Stomatology, Zhengzhou University, Zhengzhou, China
| | - Bing-Rong Liu
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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