Background and study aims ESD in the colon is more challenging technically than in other locations. Here, we report the first comparative case series of colon ESD using a systematic countertraction strategy using two clips and a rubber band. Patients and methods Retrospective comparative study of classic versus countertraction colon ESD performed in colon ESD cases collected prospectively at Lyon Edouard Herriot Hospital and Limoges University Hospital from January 2016 until December 2017. Results The study included 192 cases (control = 76, countertraction = 116). Countertraction using the double clip and rubber band technique versus the control group resulted in a significant decrease in the procedure time (94.7 vs. 117 min; P = 0.004) and significant increases in procedure speed (28.2 vs. 16.7 mm2/min; P < 0.0001), en bloc resection rate (95.7 % vs. 76.3 %, P < 0.0001), and R0 resection rate (78.5 % vs. 64.5 %, P = 0.04).At an individual operator point of view, results varied between operators but the double clip countertraction strategy significantly increased the en bloc resection rate, R0 resection rate, and speed of dissection for each of the 4 operators. Conclusion Systematic countertraction using a double clip and rubber band facilitates colon ESD. This strategy should become the standard for colon ESD.
K E Y W O R D S : baboon syndrome, case report, cutaneous adverse drug reaction, nefopam, pristinamycin, secnidazole, systemic allergic dermatitis In 1984, Andersen et al 1 introduced the term "baboon syndrome" to describe a systemic contact dermatitis characterized by exanthema with involvement of the buttocks and flexure regions after the systemic absorption of a contact allergen (nickel, mercury, or ampicillin) in a sensitized patient. The rash looked like the red buttocks of a baboon. In 1983, Nakayama et al 2 published a report of 15 patients with symmetrical erythema predominantly on major flexural sites, which occurred 1 or 2 days after the breaking of a mercury thermometer. The non-contact allergic variant of baboon syndrome is also referred to as symmetrical drug-related intertriginous and flexural exanthema (SDRIFE).Since 1984, $100 cases of baboon syndrome or SDRIFE have been reported. We report 3 cases of SDRIFE, 1 each caused by pristinamycin, secnidazole, and nefopam. 3 CASE REPORTSCase 1. A 60-year-old man presented with an erythematosquamous rash of the inguinal and axillary folds and gluteal area ( Figure 1). He had been treated with candesartan for many years. He had recently been diagnosed with a bronchial infection, and was prescribed pristinamycin. The cutaneous rash appeared 2 days later. The results of laboratory tests were within normal limits, except for a mild biological inflammatory syndrome probably attributable to the infection. Histopathological analyses of a skin biopsy showed an orthokeratotic epidermis without keratinocytic necrosis, discrete spongiosis, and a lymphocytic infiltrate of the dermis with some eosinophils ( Figure S1).The clinical and histopathological signs confirmed the diagnosis of SDRIFE caused by pristinamycin, which was discontinued. The skin lesions completely regressed within 7 days. Two months later, the patient was patch tested with pristinamycin 30% pet. and 30% aq. on the back and in an inguinal fold. The results were negative on day (D) 2 and D3. The patient refused an oral provocation test. Case 2. A 44-year-old woman was treated with secnidazole for vaginitis caused by Trichomonas vaginalis. After 2 days, she developed a pruritic eczema-like eruption in the axillary, inguinal and submammary folds, with no other signs (Figure S2). She denied taking any other medication, and had a history of maculopapular exanthema caused by metronidazole and acetylsalicylic acid. Secnidazole was stopped, and topical betamethasone treatment was initiated. The lesions resolved within 4 days. SDRIFE caused by secnidazole was diagnosed, and patch tests were performed with secnidazole 30% pet. and 30% aq. These gave negative results on D2 on the back and in 1 affected area (breast), but a positive reaction on D4 on the breast (+), although the result remained negative on the back. Metronidazole and secnidazole may potentially cross-react, because both are sulfonamides.Case 3. A 68-year-old woman was referred with an erythematous Vrash of the buttocks, perineum, and axillary f...
Use of the tunnel + clip strategy to treat oesophageal ESD is effective and safe, even when performed by physicians with little prior experience. It is thus possible to standardise ESD of superficial oesophageal neoplasms and increase the velocity of dissection. Our procedure will encourage the use of oesophageal ESD in Western countries.
Background Endoscopic mucosal resection (EMR) with snare is the recommended technique to resect non-invasive colorectal neoplastic lesions between 10 and 30 mm in diameter. The objective of EMR is to resect completely the neoplastic tissue en bloc and preferably with free margins (R0), avoiding recurrences. Anchoring the tip of the snare in the submucosa is a technical trick that allows snare sliding to be reduced and larger pieces to be caught. The aim of the present study was to evaluate the effectiveness and safety of anchoring-EMR (A-EMR). Methods This was a retrospective analysis of A-EMR procedures for lesions of diameter between 10 and 30 mm (endoscopic evaluation) performed consecutively in four French centers between May 2017 and January 2018. A-EMR was routinely performed for all EMR using Olympus conventional snares (10 or 25 mm). The primary outcome was evaluation of the proportion of R0 resections. Results A total of 141 A-EMR procedures were performed by 10 operators. Mean lesion size was 19.8 mm. Anchoring was feasible in 96.5 % of cases. There were 81.6 % en bloc resections and 70.2 % R0 resections, with the percentage of procedures decreasing with increasing lesion size (82.8 % < 20 mm, 55.3 % 21 – 30 mm, and 50.0 % > 30 mm, P = 0.002). Complete perforations closed endoscopically occurred in 3/141 cases (2.1 %); none occurred in lesions < 20 mm in size (0 /87). Conclusion The A-EMR technique appears to be promising with a high proportion of R0 for lesions of 10 – 20 mm in size without any perforations. It could also offer an alternative to endoscopic submucosal dissection (ESD), or to hybrid techniques to reach R0 for lesions between 20 and 30 mm in size.
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