Search

Recent data show an increasing number of abdominal surgeries being performed for the treatment of nonmalignant colorectal polyps in the West but in settings where colorectal endoscopic submucosal dissection is not routinely performed. This study evaluated the number of nonmalignant colorectal lesions referred to surgical treatment in a tertiary cancer center that incorporated magnification chromoendoscopy and endoscopic submucosal dissection as part of the standard management of complex colorectal polyps.The study aimed to estimate the number of patients with nonmalignant colorectal lesions referred to surgical resection at our institution after the standardization of routine endoscopic submucosal dissection and to describe outcomes for patients undergoing colorectal endoscopic submucosal dissection.Single-center retrospective study from prospectively collected database of endoscopic submucosal dissections and colorectal surgeries performed between January 2016 and December 2019.Reference cancer center.Consecutive adult patients with complex nonmalignant colorectal polyps.Patients with nonmalignant colorectal polyps treated by endoscopic submucosal dissection or surgery (elective colectomy, rectosigmoidectomy, low anterior resection, or proctocolectomy).The primary outcome measure was the percentage of patients referred to colorectal surgery for non-malignant lesions.In the period, 1.1% of 825 colorectal surgeries were performed for nonmalignant lesions, and 97 complex polyps were endoscopically removed by endoscopic submucosal dissection. The en bloc, R0, and curative resection rates of endoscopic submucosal dissection were 91.7%, 83.5%, and 81.4%, respectively. The mean tumor size was 59 (SD 37.8) mm. Perforations during endoscopic submucosal dissection occurred in 3 cases, all treated with clipping. One patient presented with a delayed perforation 2 days after the endoscopic resection and underwent surgery. The mean follow-up period was 3 years, with no tumor recurrence in this cohort.Single-center retrospective study.A workflow that includes assessment of the lesions with magnification chromoendoscopy and resection through endoscopic submucosal dissection can lead to a very low rate of abdominal surgery for nonmalignant colorectal lesions. See Video Abstract at http://links.lww.com/DCR/C123.

Conventional endoscopic mucosal resection (CEMR) is the standard modality for removing non-pedunculated colorectal lesions. Underwater endoscopic mucosal resection (UEMR) has emerged as an alternative method. There are few comparative studies between these techniques, especially evaluating recurrence. Then, the purpose of this trial was to compare CEMR and UEMR for the resection of colorectal lesions with respect to efficacy, safety and recurrence rate.Randomized controlled trial of UEMR versus CEMR for naïve and non-pedunculated lesions measuring between 10 and 40 mm. The primary outcome was adenoma recurrence at 6 months after the resection. Secondary outcomes were technical success, en bloc resection and adverse events rates. Block randomization was used to assign patients. Tattooing was performed to facilitate localization of the scars and eventual recurrences. Endoscopic follow-up was scheduled at 6 months after the procedure. The sites of resections were examined with white light, Narrow-Band Imaging and conventional chromoscopy with indigo carmine followed by biopsies.One hundred and five patients with 120 lesions were included, with a mean size of 17.5 ± 7.1 (SD) mm. Sixty-one lesions were resected underwater and 59 by CEMR. The groups were similar at baseline, regarding age, gender, average size, or histological type. Lesions in the proximal colon in the conventional group corresponded to 83% and in the UEMR group to 67.8% (p=0.073). There was no difference between groups regarding success rate (one failure in each group) and en bloc resection rate (60.6% UEMR vs 54.2% CEMR, p = 0.48). Intra-procedure bleeding was observed in five conventional resections (8.5%) and two UEMRs (3.3%) (p = 0.27). There was no perforation or delayed hemorrhage in both groups. Recurrence rate was higher in the CEMR arm (15%) than in UEMR (2%) (p=0.031). Therefore, the relative risk of 6-month recurrence rate in the CEMR group was 7.5 fold higher (95% CI - 0.98 to 58.20) with a NNT of 7.7 (95% CI - 40.33 to 4.22). The higher recurrence rate in CEMR group persisted only for lesions measuring 21-40mm (35.7 vs. 0%, p=0.04).This study demonstrated that UEMR was associated with lower adenoma recurrence rate than CEMR. Both endoscopic techniques are effective and have similar rates of adverse events for the treatment of non-pedunculated colorectal lesions.

Background and study aims Esophageal squamous cell carcinoma (ESCC) is the most common secondary tumor in patients with head and neck squamous cell cancer (HNSCC). Currently, endoscopic submucosal dissection (ESD) is the preferred approach to manage superficial ESCC, however, it remains to be elucidated whether patients with HNSCC and early ESCC managed by ESD have different outcomes. Patients and methods We retrospectively analyzed esophageal ESD for early ESCC from September 2009 to September 2017 and the following variables: demographics, tumor and specimen size, Paris classification, location, en bloc and R0 resection rates, overall survival (OS) and adverse events (AEs). To reduce selection bias, propensity score matching was applied to compare the results. Results Eighty-nine ESDs were performed in 81 consecutive patients (47 with HNSCC and 34 without HNSCC). Patients with HNSCC who developed superficial ESCC were found to be younger and to refer a more frequent history of alcohol ingestion and smoking. There was no difference in lesion size, number of lesions, procedure time, en bloc resection rate, R0 resection rate, local recurrence and adverse event rate between the two groups. The histological depth of invasion for patients with HNSCC was significantly shallower before (P = 0.016) and after (P = 0.047) matching. The overall survival rate was similar in both groups. Conclusions Patients with HNSCC have earlier detection of ESCC, probably due to endoscopic screening. Previous history of chemoradiation and surgery for HNSCC does not affect procedure time, AEs and OS.

Gastric cancer is an aggressive disease with low long-term survival rates. An early diagnosis is essential to offer a better prognosis and curative treatment. Upper gastrointestinal endoscopy is the main tool for the screening and diagnosis of patients with gastric pre-neoplastic conditions and early lesions. Image-enhanced techniques such as conventional chromoendoscopy, virtual chromoendoscopy, magnifying imaging, and artificial intelligence improve the diagnosis and the characterization of early neoplastic lesions. In this review, we provide a summary of the currently available recommendations for the screening, surveillance, and diagnosis of gastric cancer, focusing on novel endoscopy imaging technologies.

INTRODUÇÃO: Pacientes com diagnóstico de carcinoma de células escamosas de cabeça e pescoço apresentam maior risco de desenvolver um segundo tumor primário, mais comumente no trato aerodigestivo alto. A principal justificativa para o rastreamento de carcinoma de esôfago nestes pacientes é detectar as displasias assintomáticas e as lesões precoces, para permitir um tratamento curativo e melhorar a sobrevida. Apesar desta recomendação, a efetividade do rastreamento endoscópico permanece incerta. O presente estudo teve como objetivo descrever o resultado do programa de rastreamento quanto a prevalência, fatores de risco associados, sobrevida e tratamento endoscópico da neoplasia precoce de esôfago. MÉTODOS: Análise retrospectiva de banco de dados coletados prospectivamente incluindo os pacientes portadores de CEC-CP submetidos à endoscopia digestiva alta de alta definição associada à cromoscopia no período de 2010 a 2018 em centro acadêmico terciário. RESULTADOS: 1888 pacientes foram incluídos. A prevalência de CEC esôfago foi de 7,9%. A maioria (77,8%) das lesões eram de aspecto superficial à endoscopia. Os fatores de risco associados foram tumores de cavidade oral e orofaringe e presença de displasia de baixo grau. As lesões de esôfago tratadas por dissecção endoscópica da submucosa foram estatisticamente de maior tamanho e tiveram maiores taxas de ressecção em bloco e ressecção curativa (R0), além de maior ocorrência de estenoses. A sobrevida foi mais curta no grupo em que a neoplasia de esôfago foi diagnosticada num estádio avançado. CONCLUSÃO: O rastreamento de câncer superficial de esôfago em pacientes com neoplasia de cabeça e pescoço é efetivo em melhorar a sobrevida e deve ser recomendado especialmente nos pacientes com câncer em orofaringe e cavidade oral, assim como naqueles com displasia de baixo grau no esôfago INTRODUCTION: Patients with head and neck squamous cell carcinoma (HNSCC) are at risk to develop a second primary tumor, most commonly in the upper aerodigestive tract. The main reason for screening esophageal carcinoma in these patients is to detect asymptomatic dysplasia and early cancer, thus allowing curative treatment and improving survival. Nevertheless, the effectiveness of endoscopic screening remains uncertain. The present study aimed to describe the results of the screening program regarding prevalence, associated risk factors, survival and endoscopic treatment of early esophageal cancer. METHODS: Retrospective analysis of a prospectively collected database including patients with HNSCC who had undergone high-definition endoscopy with chromoscopy between 2010 and 2018 in a tertiary academic center. RESULTS: 1,888 patients were included. The prevalence of esophageal SCC was 7.9%. The majority (77.8%) were superficial lesions. Tumors of the oral cavity and oropharynx and the presence of low-grade dysplasia were significant risk factors. The esophageal lesions treated by endoscopic submucosal dissection were statistically larger in size and had higher en bloc and RO resection rates, in addition to a higher occurrence of strictures. Survival significantly changed in the group in which the esophageal cancer was diagnosed at an advanced stage. CONCLUSION: Endoscopic screening in HNSCC is effective for improving mortality and should be recommended specially for patients with oropharynx and oral cavity cancers and for those with esophageal low-grade dysplasia

Background and study aims Patients with head and neck squamous cell carcinoma (HNSCC) are at risk of a second primary tumor in the gastrointestinal tract, most commonly in the esophagus. Screening these patients for esophageal carcinoma may help detect asymptomatic dysplasia and early cancer, thus allowing curative treatment and more prolonged survival, but the impact of endoscopic screening remains uncertain. Here we aimed to describe the long-term results of an esophageal SCC screening program in patients with head and neck cancer in terms of prevalence, associated risk factors, and survival. Patients and methods We performed an observational study of a prospectively collected database including patients with HNSCC who had undergone high-definition endoscopy with chromoscopy between 2010 and 2018 at a Brazilian tertiary academic center. Results The study included 1,888 patients. The esophageal SCC prevalence was 7.9 %, with the majority (77.8 %) being superficial lesions. Significant risk factors for esophageal high-grade dysplasia (HGD) and invasive cancer included tumors of the oral cavity and oropharynx and the presence of low-grade dysplasia (LGD). Overall survival (OS) was significantly shorter among patients in whom esophageal cancer was diagnosed at an advanced stage (P Conclusions Endoscopic screening for superficial esophageal neoplasia in patients with HNSCC improves esophageal cancer detection. Screening could potentially benefit patients with primary cancer located at the oropharynx or oral cavity. In addition, the detection of esophageal LGD indicates a need for endoscopic surveillance.

Background and study aims Endoscopic removal of biliary stones has high success rates, ranging between 85 % to 95 %. Nevertheless, some stones may be challenging and different endoscopic methods have evolved. Papillary large balloon dilation after sphincterotomy is a widely used technique with success rates ranging from 68 to 90 % for stones larger than 15 mm. Cholangioscopy allows performing lithotripsy under direct biliary visualization, either by laser or electrohydraulic waves, which have similar success rate (80 % – 90 %). However, there is no study comparing these 2 techniques. Patients and methods From April 2014 to June 2016, 100 patients were enrolled and randomized in 2 groups, using a non-inferiority hypothesis: cholangioscopy + electrohydraulic lithotripsy (group 1) and endoscopic papillary large balloon dilation (group 2). The main outcome was complete stone removal. Adverse events were documented. Mechanical lithotripsy was not performed. Failure cases had a second session with crossover of the methods. Results The mean age was 56 years. 74 (75.5 %) patients were female. The initial overall complete stone removal rate was 74.5 % (77.1 % in group 1 and 72 % in group 2, P > 0.05). After second session the overall success rate achieved 90.1 %. Procedure time was significantly lower in group 2, – 25.2 min (CI95 % – 12.48 to – 37.91). There were no significant differences regarding technical success rate, radiologic exposure and adverse events. Conclusion Single-operator cholangioscopy-guided lithotripsy and papillary large balloon dilation are effective and safe approaches for removing complex biliary stones.

Context Tissue sampling of renal masses is traditionally performed via the percutaneous approach or laparoscopicaly. The utility of endoscopic ultrasound to biopsy renal lesions it remains unclear and few cases have been reported. Objectives To evaluate the feasibility and outcome of endoscopic ultrasound fine needle aspiration of renal tumors. Methods Consecutive subjects undergoing attempted endoscopic ultrasound fine needle aspiration of a kidney mass after evaluation with computerized tomography or magnetic resonance. Results Ten procedures were performed in nine male patients (median age 54.7 years) on the right (n = 4) and left kidney (n = 4) and bilaterally (n = 1). Kidney masses (median diameter 55 mm ; range 13-160 mm) were located in the upper pole (n = 3), the lower pole (n = 2) and the mesorenal region (n = 3). In two cases, the mass involved more than one kidney region. Surgical resection confirmed renal cell carcinoma in six patients in whom pre-operative endoscopic ultrasound fine needle aspiration demonstrated renal cell carcinoma. No complications were reported. Conclusions Endoscopic ultrasound fine needle aspiration appears as a safe and feasible procedure with good results and minimal morbidity. Contexto A amostragem de tecido de massas renais é tradicionalmente realizada através da abordagem percutânea ou pelo método laparoscópico. A utilidade do ultrassom endoscópico para biópsia de lesões renais ainda não está clara e poucos casos foram relatados na literatura. Objetivos Avaliar a factibilidade e os resultados da biópsia de tumores renais guiada por ultrassom endoscópico. Métodos Trata-se de uma série retrospectiva de casos de biópsias ecoguiadas de massa renal após avaliação com tomografia computadorizada ou ressonância magnética. Resultados Dez procedimentos foram realizados em nove pacientes do sexo masculino (idade média de 54,7 anos), no rim direito (n = 4), esquerdo (n = 4) e bilateralmente (n = 1). Massas renais (diâmetro médio 55 mm; variando de 13 a 160 mm) localizadas no pólo superior (n = 3), inferior (n = 2) e na região mesorenal (n = 3). Em dois casos, a massa envolvida mais de uma região renal. A ressecção cirúrgica confirmou carcinoma de células renais em seis pacientes nos quais a biópsia ecoguiada pré-operatória demonstrava carcinoma de células renais. Não foram relatadas complicações. Conclusões A biópsia de massas renais guiadas por ultrassom endoscópico é um procedimento seguro e viável, com bons resultados e mínima morbidade.

Context Direct endoscopic visualization of biliopancreatic duct is certainly one of the greatest advances of therapeutic endoscopy. The use of a single-operator cholangioscopy platform (SpyGlass) is a promising technique in the evaluation of diseases such as indeterminate biliary stricture and giant choledocholitiasis. This is the first Brazilian case series using this technology. Methods We report a case series of 20 patients in whom SpyGlass was used with diagnostic and therapeutic intention. Results Most patients were female (60%) and the median age was 48 years (ranging from 14 to 94). Choledocholitiasis was the most common indication (12/20), and electrohydraulic lithotripsy was applied in eight (66%). Electrohydraulic lithotripsy was successful in seven (87.5%) patients. Partial stone fragmentation occurred in one patient with large stone causing stone-choledochal disproportion, which was conducted with biliary plastic stent placement and a second scheduled endoscopic approach in 3 months. In cases of undefined etiology of biliary strictures, it was possible to exclude malignancy due to direct visualization (7/8) or biopsy (1/8). One complication occurred (duodenal perforation) after papillary balloon dilation. Conclusion The use of SpyGlass demonstrated the benefits, especially in cases of large bile duct stones and indeterminate biliary strictures. Other potencial improvements such as reduction on radiation exposure should be confirmed in prospective studies. Contexto A visão endoscópica direta das vias biliopancreáticas é certamente um dos maiores avanços na endoscopia terapêutica. O uso da plataforma de colangioscopia de operador-único (SpyGlass) é uma técnica promissora na avaliação de afecções tais como estenoses de etiologia indefinida e coledocolitíase gigante. Essa é a primeira série de casos brasileira utilizando o método. Métodos Reportamos uma série de casos de 20 pacientes nos quais foi realizado Spyglass com objetivos diagnósticos e terapêuticos. Resultados A maioria dos pacientes era do sexo feminino (60%), com idade que variou de 14 a 94 anos (mediana de 48). Coledocolitíase foi a indicação mais comum (12/20) e litotripsia eletrohidráulica foi realizada em oito (66%). Litotripsia eletrohidráulica foi realizada com sucesso em sete (87,5%) pacientes. Fragmentação parcial dos cálculos ocorreu em um paciente com desproporção cálculo-coledociana, sendo conduzido com colocação de prótese plástica e reabordagem endoscópica programada em 3 meses. Nos casos de estenoses biliares de etiologia indeterminada, foi possível a exclusão de malignidade devido a visualização direta (7/8) ou biópsia (1/8). Uma complicação ocorreu (perfuração duodenal) após dilatação balonada da papila. Conclusão Foram demonstrados os benefícios do uso do Spyglass, principalmente nos casos de coledocolitíase gigante e estenoses biliares de etiologia indefinida. Outras potenciais vantagens como a redução da exposição à radiação deve ser confirmada em estudos prospectivos posteriores.

Abdominal pain is present in the vast majority of patients with chronic pancreatitis, being frequently debilitating. Celiac plexus block (CPB) is an interventional technique that can be considered to provide a temporary pain relief.To estimate the effectiveness and safeness of endoscopic-ultrasound (EUS) comparing with percutaneous-guided CBP in patients with pancreatic pain.A systematic review of English and non-English articles using MEDLINE, EMBASE, LILACS and COCHRANE (via BVS).Only randomized control trials (RCT) comparing the beneficial and harmful effects of EUS and percutaneous-guided celiac plexus block for managing pancreatic pain were included. Data was extracted and analyzed on variables including pain relief and related procedure complications.Two RCT met the inclusion criteria. Both studies assessed the primary outcome (reduction on pain score) and evaluated adverse effects. The drugs injected were the same; nevertheless percutaneous technique was guided by fluoroscopy in one study and by computer tomography (CT) in other. The results showed that the EUS-CPB group was more effective to reduce pain score after 4 weeks after the procedure, with risk of bias to do this affirmation. No statistical difference in pain relief at 1, 8 and 12 weeks and in complications rates.Based on this systematic review and meta-analysis, no statistically significant difference was noted in pain relief and complications for EUS and percutaneous - CPB.

Traditionally, treatment of renal lesions is indicated based only on imaging features. Although controversy exists about tissue sampling from small renal masses, renal biopsy is indicated in some cases. In this review, we discuss the rationale for endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and summarize the recent advances in this field, providing recommendations for the practicing clinician. The use of EUS-FNA appears to be a safe and feasible means of confirming or excluding malignancy. EUS allows assessment and biopsy of masses or lesions within both kidneys and related complications are rare. The main advantages of EUS-FNA are that it can be done as an outpatient procedure, with good results, minimal morbidity and a short hospital stay. Nevertheless, EUS-FNA of renal masses should be indicated only in selected cases, in which there is potential to decrease unnecessary treatment of small renal masses and to best select tumors for active surveillance and minimally invasive ablative therapies. Additionally, some renal lesions may be ineligible for EUS-guided biopsy because of anatomical limitations. EUS-FNA renal biopsy will probably be best applied to central anterior renal masses, while tumors on the posterior aspect of the kidney, percutaneous access will probably be superior.