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Doeller B, Hirnschall N, Fichtenbaum M, Nguyen PM, Varsits R, Findl O. A Randomized Study of the Impact of a Corneal Pre-Cut During Cataract Surgery on Wound Architecture and Corneal Astigmatism. Ophthalmol Ther 2021; 10:313-20. [PMID: 33709325 DOI: 10.1007/s40123-021-00339-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/23/2021] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION The aim of the current study was to assess the effect of a 600-µm corneal pre-cut on wound architecture and its impact on surgically induced astigmatism. The images were acquired intraoperatively and postoperatively with high-resolution spectral-domain optical coherence tomography (SD-OCT). METHODS This study included patients scheduled for cataract surgery. Preoperatively, optical biometry and corneal topography were performed (IOL Master 500 and Atlas 9000, both Carl Zeiss Meditec AG, Germany). The first eye randomly received a 600-µm corneal pre-cut during cataract surgery, or a single-plane stab-incision and the second eye received the other incision technique. Incision architecture was assessed intraoperatively using a continuous intraoperative optical coherence tomography (iOCT) device (ReScan 700, Carl Zeiss Meditec AG, Germany) at three time points: after the incision, after irrigation/aspiration and after intraocular lens (IOL) implantation. Additionally, OCT (Spectralis, Heidelberg Engineering, Germany) measurements were performed 1 h, 1 week and 1 month postoperatively. RESULTS Forty eight eyes of 24 patients were analysed. The pre-cut group and the stab-incision group had a significant decrease in wound thickness from the 1-h to the 1-week measurement (p = 0.022 and p = 0.001). Corneal astigmatism showed a vector difference from preoperatively to the 1-week measurement of 0.48 D (SD, ± 0.27) in the stab incision group and 0.49 D (SD, ± 0.24) in the stab incision group. No significant differences were found between the groups. CONCLUSION To our knowledge, this was the first study which compared the wound alterations in pre-cut and stab-incision groups. TRIAL REGISTRATION NCT02155270.
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Sato Y, Ozawa SI, Yasuda H, Kato M, Kiyokawa H, Yamashita M, Matsuo Y, Yamamoto H, Itoh F. Tip-in endoscopic mucosal resection for large colorectal sessile polyps. Surg Endosc 2020; 35:1820-1826. [PMID: 32356110 DOI: 10.1007/s00464-020-07581-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/18/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tip-in endoscopic mucosal resection (EMR) is a modified EMR technique using which en bloc resection of large colorectal sessile polyps can be performed; however, its usefulness for colorectal sessile polyps of > 20 mm has not been reported. This study examined treatment outcomes of tip-in and conventional EMR for large colorectal sessile polyps of ≥ 20 mm. METHODS This was a retrospective case-control study conducted at a single tertiary center in Japan. Subjects included those with large colorectal sessile polyps of ≥ 20 mm, excluding pedunculated-type polyps, who underwent endoscopic resection between January 2010 and January 2019. The primary outcome was endoscopic treatment outcomes when using tip-in and conventional EMR, and the secondary outcome was the local recurrence rate after endoscopic treatment. RESULTS Forty-three colorectal lesions were treated using tip-in EMR and 83 using conventional EMR. Tip-in EMR had a significantly higher en bloc resection rate (90.7% vs. 69.8.%), and significantly shorter treatment duration (6.64 ± 0.64 min vs. 10.47 ± 0.81 min) than conventional EMR. However, for lesions > 30 mm, en bloc resection rate was 50.0% and 52.6% for tip-in and conventional EMR, respectively, indicating no significant difference. Perforation rates with tip-in and conventional EMR were 4.6% and 3.6%, respectively, indicating no significant difference. Local recurrence was examined in 80 cases who were followed up for > 6 months after endoscopic resection; recurrence rate was 0% and 7.0% in tip-in and conventional EMR cases, respectively, without significance difference. CONCLUSIONS Tip-in EMR showed high en-block resection rate, particularly in polyps of < 30 mm, and no residual tumor was found. This technique is a potential endoscopic treatment alternative for large colorectal sessile polyps of ≥ 20 mm.
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Affiliation(s)
- Yoshinori Sato
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Sugao Street 2-16-1, Miyamae-ku, Kawasaki-shi, Kanagawa, 216-8511, Japan.
| | - Shun-Ichiro Ozawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Sugao Street 2-16-1, Miyamae-ku, Kawasaki-shi, Kanagawa, 216-8511, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Yokohama City Seibu Hospital, Yashi-cho 1197-1, Asahi-ku, Yokohama-shi, Kanagawa, 241-0811, Japan
| | - Hiroshi Yasuda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Sugao Street 2-16-1, Miyamae-ku, Kawasaki-shi, Kanagawa, 216-8511, Japan
| | - Masaki Kato
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Sugao Street 2-16-1, Miyamae-ku, Kawasaki-shi, Kanagawa, 216-8511, Japan
| | - Hirofumi Kiyokawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Sugao Street 2-16-1, Miyamae-ku, Kawasaki-shi, Kanagawa, 216-8511, Japan
| | - Masaki Yamashita
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Sugao Street 2-16-1, Miyamae-ku, Kawasaki-shi, Kanagawa, 216-8511, Japan
| | - Yasumasa Matsuo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Sugao Street 2-16-1, Miyamae-ku, Kawasaki-shi, Kanagawa, 216-8511, Japan
| | - Hiroyuki Yamamoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Sugao Street 2-16-1, Miyamae-ku, Kawasaki-shi, Kanagawa, 216-8511, Japan
| | - Fumio Itoh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Sugao Street 2-16-1, Miyamae-ku, Kawasaki-shi, Kanagawa, 216-8511, Japan
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Chen Q, Jin P, Ji X, Du H, Lu J. Management of difficult or failed biliary access in initial ERCP: A review of current literature. Clin Res Hepatol Gastroenterol 2019; 43:365-372. [PMID: 30314736 DOI: 10.1016/j.clinre.2018.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/16/2018] [Accepted: 09/10/2018] [Indexed: 02/04/2023]
Abstract
Selective bile duct cannulation is the prerequisite for all endoscopic biliary therapeutic interventions, but this cannot always be achieved easily. Despite advances and new developments in endoscopic accessories, selective biliary access fails in 5%-15% of cases, even in expert high volume centers. Various techniques - such as double-guidewire induced cannulation, pre-cut papillotomy or transpancreatic sphincterotomy with or without placement of a pancreatic stent - have been used to improve cannulation success rates. Repeated and prolonged attempts at cannulation increase the risk of pancreatitis. Repeating the ERCP within a few days after initial failed pre-cut is a successful strategy and should be tried before contemplating more invasive, alternative interventions such as percutaneous-endoscopic or endoscopic ultrasound guided rendezvous procedure, percutaneous transhepatic or surgical intervention. However, standard guidelines or sequential protocol has not been existed up to now. In certain circumstances, there are unique clinical indications for which invasive, alternative interventions should be preferred. We present and discuss the methods that can be used in difficult or failed initial ERCP, therefore to provide practical advice for endoscopists, especially those who are inexperienced.
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Affiliation(s)
- Qinghai Chen
- Department of Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300000, PR China.
| | - Peng Jin
- Department of Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300000, PR China.
| | - Xiaoyan Ji
- Department of Emergency Ward, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300000, PR China
| | - Haiwei Du
- Department of Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300000, PR China
| | - Junhua Lu
- Department of Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300000, PR China
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