[Endoscopic prevention of bleeding during resection of mucous membrane neoplasms of hollow organs of gastrointestinal tract]

OBJECTIVE

To optimize endoscopic prevention of bleeding during resection of mucous membrane neoplasms of hollow organs of gastrointestinal tract and minimize the risk of intra- and postoperative complications.

MATERIAL AND METHODS. A S

Ystematic review and meta-analysis were made in accordance with the PRISMA recommendations. Statistical analysis was performed in Cohrane Review Manager ver. 5.4.

RESULTS. THERE ARE 3

Methods of endoscopic prevention of bleeding during polypectomy, i.e. 0.01% adrenaline injection, endoscopic clip placement and endoscopic polyp band ligation. Endoscopic polyp band ligation is characterized by minimum complication rate.

CONCLUSION

Endoscopic polyp band ligation is preferable due to minimum complication rate. If ligation is impossible, prophylactic clip placement may be performed. Adrenaline injection is the least effective method and may be used only if two above-mentioned methods are ineffective.

[Prevention of bleeding in polypectomy]

OBJECTIVE

To improve early treatment outcomes in patients with gastrointestinal polyps using a new device designed for prevention of bleeding during endoscopic minimally invasive polypectomy.

MATERIAL AND METHODS

A prospective trial included 35 patients with 36 colonic polyps (stalk diameter >5 mm). Polyp ligation procedure was performed using a novel device providing delivery and tightening the knot before polypectomy.

RESULTS

All polyps were successfully removed without any technical difficulties and exposed to histological examination. Mean age of patients was 64 years (52-81), mean dimension of polyps - 15.6 mm (10-40), mean thickness of stalk - 8 mm (5-12). There were no intraoperative and early postoperative complications. All patients were discharged after 2 postoperative days.

CONCLUSION

The proposed method for prevention of bleeding during polypectomy is simple, effective and safe for clinical practice.

Epidemiology, Diagnosis, Staging and Multimodal Therapy of Esophageal and Gastric Tumors

Gastric and esophageal tumors are diverse neoplasms that involve mucosal and submucosal tissue layers and include squamous cell carcinomas, adenocarcinomas, spindle cell neoplasms, neuroendocrine tumors, marginal B cell lymphomas, along with less common tumors. The worldwide burden of esophageal and gastric malignancies is significant, with esophageal and gastric cancer representing the ninth and fifth most common cancers, respectively. The approach to diagnosis and staging of these lesions is multimodal and includes a combination of gastrointestinal endoscopy, endoscopic ultrasound, and cross-sectional imaging. Likewise, therapy is multidisciplinary and combines therapeutic endoscopy, surgery, radiotherapy, and systemic chemotherapeutic tools. Future directions for diagnosis of esophageal and gastric malignancies are evolving rapidly and will involve advances in endoscopic and endosonographic techniques including tethered capsules, optical coherence tomography, along with targeted cytologic and serological analyses.

Endoscopic submucosal dissection versus endoscopic mucosal resection for colorectal tumors: a systematic review and meta-analysis

OBJECTIVE

To compare early (resection quality, complication rate, surgery time) and long-term (recurrence rate) outcomes of endoscopic submucosal dissection versus endoscopic mucosal resection.

MATERIAL AND METHODS

A systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. Data were analyzed using the Rewiew Manager 5.3 software.

RESULTS

The study included 8 manuscripts including 6 retrospective trials, 1 case-control and only 1 prospective study. These studies comprised the results of endoscopic resection of 1989 colonic tumors (EMR - 748, ESD - 1241). ESD is associated with higher incidence of en-bloc resection (OR 0.13; 95% CI 0.03 0.49; p=0.003) and R0 resection (OR 0.23; 95% CI 0.05 1.02; p=0.05) compared to EMR. Local recurrence rate is 13 times higher after EMR compared to ESD (OR 13.94; 95% CI 6.3 30.8; p=0.00001). However, ESD is followed by 4 times higher risk of colon wall perforation (OR 0.25; 95% CI 0.08 0.81; p=0.02).

CONCLUSION

ESD is more advisable regarding resection quality compared to EMR. However, higher incidence of perforations, surgery time and technical features of ESD do not allow us to unambiguously interpret the results of our meta-analysis and determine the optimal surgical approach.

The impact of flexible endoscopy in esophageal surgery

Achalasia and Treatment of esophageal Adenocarcinoma are commonly associated to surgical resection. Newer technologies in interventional endoscopy gave way to a substantial paradigm shift in the management of these conditions. In the case of achalasia, endoscopic myotomy is rapidly displacing Heller's myotomy as the gold standard in many centers. Early stage neoplasia in Barrett's esophagus (BE) comprising high-grade dysplasia (HGD), intramucosal and, in some cases, submucosal carcinoma is now being treated without the need of esophagectomy. This review presents a summary of the most relevant endoscopic techniques for both achalasia and esophageal cancer. Endoscopic advances in diagnostic and therapeutic arenas allow for minimally invasive therapies and organ preservation in most settings of achalasia and early stage neoplasia of the esophagus provided that the clinical setting and physician's expertise are prepared for this approach.