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Abstract
PURPOSE OF REVIEW Gastric intestinal metaplasia (GIM) is an attractive target for surveillance and treatment as it can progress to gastric adenocarcinoma (GAC). Yet, GIM remains a challenging area for clinicians as most patients do not progress to cancer, and there are conflicting data regarding the benefits of surveillance and therapy. This review aims to summarize recently published GIM surveillance guidelines, to discuss, which patients with GIM may benefit from treatment, and to review pivotal and recent literature on GIM therapy. RECENT FINDINGS Guidelines published by American, British, and European gastroenterology societies do not recommend universal surveillance, but do suggest endoscopic surveillance in patients with risk factors for progression to GAC. Although light examination for at least 7 min and mapping biopsies may increase yield for dysplasia and GAC. In randomized trials, Helicobacter pylori eradication reduced risk of dysplasia and cancer. In GIM with visible dysplasia and early-stage GAC, endoscopic resection improves quality of life without reducing survival compared with surgery. Endoscopic ablation therapies have shown promise for invisible or extensive dysplasia. SUMMARY Endoscopic resection is appropriate for visible dysplasia and early-stage GAC without high-risk features that persists despite H. pylori eradication therapy. Prospective studies are needed to assess the utility of endoscopic ablation in GIM.
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Affiliation(s)
- Thaer Abdelfattah
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University
- Division of Gastroenterology and Hepatology, McGuire VA Medical Center, Richmond, Virginia, USA
| | - Omer Shahab
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University
- Division of Gastroenterology and Hepatology, McGuire VA Medical Center, Richmond, Virginia, USA
| | - Tilak U Shah
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University
- Division of Gastroenterology and Hepatology, McGuire VA Medical Center, Richmond, Virginia, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Song Y, Feng Y, Sun LH, Zhang BJ, Yao HJ, Qiao JG, Zhang SF, Zhang P, Liu B. Role of argon plasma coagulation in treatment of esophageal varices. World J Clin Cases 2021; 9:521-527. [PMID: 33553390 PMCID: PMC7829739 DOI: 10.12998/wjcc.v9.i3.521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/02/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
With the development of endoscopic therapy, argon plasma coagulation (APC) has been widely used by endoscopists. It has many advantages, such as simple to operate, low cost, and minimal invasiveness. Because of its capability of lesion ablation and hemostasis, APC has several indications in the gastrointestinal tract. One of them is esophageal varices. The aim of this review is to summarize the research on APC in this field to provide a reference for clinical practice.
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Affiliation(s)
- Ying Song
- Department of Gastroenterology, Xi’an Gaoxin Hospital, Xi'an 710032, Shaanxi Province, China
| | - Yuan Feng
- Department of Gastroenterology, Xi’an Gaoxin Hospital, Xi'an 710032, Shaanxi Province, China
| | - Li-Hui Sun
- Department of Gastroenterology, Xi’an Gaoxin Hospital, Xi'an 710032, Shaanxi Province, China
| | - Bo-Jiang Zhang
- Department of Gastroenterology, Xi’an Gaoxin Hospital, Xi'an 710032, Shaanxi Province, China
| | - Hong-Juan Yao
- Department of Gastroenterology, Xi’an Gaoxin Hospital, Xi'an 710032, Shaanxi Province, China
| | - Jing-Gui Qiao
- Department of Gastroenterology, Xi’an Gaoxin Hospital, Xi'an 710032, Shaanxi Province, China
| | - Shu-Fen Zhang
- Department of Gastroenterology, Xi’an Gaoxin Hospital, Xi'an 710032, Shaanxi Province, China
| | - Ping Zhang
- Department of Clinical Medical Affair, Erbe China Ltd., Shanghai 200336, China
| | - Bin Liu
- Department of Clinical Medical Affair, Erbe China Ltd., Shanghai 200336, China
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Esaki M, Haraguchi K, Akahoshi K, Tomoeda N, Aso A, Itaba S, Ogino H, Kitagawa Y, Fujii H, Nakamura K, Kubokawa M, Harada N, Minoda Y, Suzuki S, Ihara E, Ogawa Y. Endoscopic mucosal resection vs endoscopic submucosal dissection for superficial non-ampullary duodenal tumors. World J Gastrointest Oncol 2020; 12:918-930. [PMID: 32879668 PMCID: PMC7443844 DOI: 10.4251/wjgo.v12.i8.918] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 07/03/2020] [Accepted: 07/19/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The selection of endoscopic treatments for superficial non-ampullary duodenal epithelial tumors (SNADETs) is controversial.
AIM To compare the efficacy and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for SNADETs.
METHODS We retrospectively analyzed the data of patients with SNADETs from a database of endoscopic treatment for SNADETs, which included eight hospitals in Fukuoka, Japan, between April 2001 and October 2017. A total of 142 patients with SNADETs treated with EMR or ESD were analyzed. Propensity score matching was performed to adjust for the differences in the patient characteristics between the two groups. We analyzed the treatment outcomes, including the rates of en bloc/complete resection, procedure time, adverse event rate, hospital stay, and local or metastatic recurrence.
RESULTS Twenty-eight pairs of patients were created. The characteristics of patients between the two groups were similar after matching. The EMR group had a significantly shorter procedure time and hospital stay than those of the ESD group [median procedure time (interquartile range): 6 (3-10.75) min vs 87.5 (68.5-136.5) min, P < 0.001, hospital stay: 8 (6-10.75) d vs 11 (8.25-14.75) d, P = 0.006]. Other outcomes were not significantly different between the two groups (en bloc resection rate: 82.1% vs 92.9%, P = 0.42; complete resection rate: 71.4% vs 89.3%, P = 0.18; and adverse event rate: 3.6% vs 17.9%, P = 0.19, local recurrence rate: 3.6% vs 0%, P = 1; metastatic recurrence rate: 0% in both). Only one patient in the ESD group underwent emergency surgery owing to intraoperative perforation.
CONCLUSION EMR has significantly shorter procedure time and hospital stay than ESD, and provides acceptable curability and safety compared to ESD. Accordingly, EMR for SNADETs is associated with lower medical costs.
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Affiliation(s)
- Mitsuru Esaki
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 8128582, Japan
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 1738610, Japan
| | - Kazuhiro Haraguchi
- Department of Gastroenterology, Hara-Sanshin Hospital, Fukuoka 8120033, Japan
| | - Kazuya Akahoshi
- Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 8208502, Japan
| | - Naru Tomoeda
- Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka 8108564, Japan
| | - Akira Aso
- Department of Gastroenterology, Kitakyushu Municipal Medical Center, Kitakyushu 8020077, Japan
| | - Soichi Itaba
- Department of Gastroenterology, Kyushu Rosai Hospital, Kitakyushu 8000296, Japan
| | - Haruei Ogino
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 8128582, Japan
| | - Yusuke Kitagawa
- Department of Internal Medicine, Saiseikai Fukuoka General Hospital, Fukuoka 8100001, Japan
| | - Hiroyuki Fujii
- Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center, Koga 81103195, Japan
| | - Kazuhiko Nakamura
- Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center, Koga 81103195, Japan
| | - Masaru Kubokawa
- Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 8208502, Japan
| | - Naohiko Harada
- Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka 8108564, Japan
| | - Yosuke Minoda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 8128582, Japan
| | - Sho Suzuki
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 1738610, Japan
| | - Eikichi Ihara
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 8128582, Japan
- Department of Gastroenterology and Metabolism, Graduate School of Medicine Sciences, Kyushu University, Fukuoka 8128582, Japan
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 8128582, Japan
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Filis K, Galyfos G, Sigala F, Zografos G. Utilization of low-temperature helium plasma (J-Plasma) for dissection and hemostasis during carotid endarterectomy. J Vasc Surg Cases Innov Tech 2020; 6:152-5. [PMID: 32154472 DOI: 10.1016/j.jvscit.2020.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/20/2020] [Indexed: 02/05/2023]
Abstract
Herein we report nine cases of carotid endarterectomy in which we used a cold atmospheric helium plasma device (J-Plasma; Apyx Medical Corporation, Clearwater, Fla). Although clinical reports are limited, experimental data indicate that this technology could be used for dissection and coagulation during surgery, yielding limited adjacent tissue damage. As a result, it could be extremely useful in procedures like carotid endarterectomy that necessitate careful dissection and coagulation with limited damage of adjacent neurovascular structures.
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