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Background and Aims: Endoscopic resection of lesions involving the appendiceal orifice (AO) remains a challenge. We aim to report the outcomes of full-thickness resection device (FTRD) for the resection of appendiceal lesions and identify factors associated with the occurrence of appendicitis. Methods: This is a retrospective study at 18 tertiary-care centers (12 U.S., Canada 1, 5 Europe) between 11/2016 and 8/2020. Consecutive patients who underwent resection of AO lesions using the FTRD were included. The primary outcome was the rate of R0 margin resection in neoplastic lesions, defined as negative lateral and deep margins on post-resection histologic evaluation. Secondary outcomes included the rates of; technical success (en bloc resection), clinical success (technical success without need for further surgical interventions), post-resection appendicitis, and polyp recurrence. Results: A total of 66 patients (mean age 64 yr., 29 F) underwent resection of colonic lesions (mean size 14.5 (6.2) mm) involving the AO, with 40 (61%) deep extending into the appendiceal lumen. Technical success was achieved in 59/66 (89%) cases, out of which, 56 were found to be neoplastic lesions on post-resection pathology. Clinical success was achieved in 53/66 (80%). R0 resection was achieved in 52/56 (93%) cases. Out of the 58 patients of whom EFTR was completed and had no prior history of appendectomy, appendicitis was reported in 10 (17%) cases, with 6 (60%) requiring surgical appendectomies. Follow-up colonoscopy was completed in 41 cases with evidence of recurrence in 5 (12.2%). Conclusions: FTRD is a promising non-surgical alternative for resecting appendiceal lesions but appendicitis occurs in 1 out of 6 cases.

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Currently, endoscopic variceal ligation (EVL) monotherapy is the standard therapy for managing esophageal variceal hemorrhage. Patients generally need several sessions of endoscopy to achieve optimal variceal ablation, and the varices can recur afterward. Endoscopic injection sclerotherapy (EIS) is an older technique, associated with certain complications. This study aimed to evaluate the clinical efficacy of EVL alone versus combined EVL and EIS in the treatment of esophageal varices. This retrospective study included 84 patients, of which 40 patients were treated with EVL monotherapy and 44 patients were treated with combined EVL + EIS. The main outcomes were rebleeding rates, recurrence at six months, number of treatment sessions, length of hospital stay, cost of hospitalization, and procedural complications. At six months, the rebleeding rate and recurrence were significantly lower in the EVL + EIS group compared to the EVL group (2.3% versus 15.0%; and 9.1% versus 27.5%, respectively). The number of treatment sessions, length of hospital stay, and cost of hospitalization were significantly lower in the EVL + EIS group compared to those in the EVL group (2.3 ± 0.6 versus 3.2 ± 0.8 times; 14.5 ± 3.4 versus 23.5 ± 5.9 days; and 23918.6 ± 4220.4 versus 26165.2 ± 4765.1 renminbi, respectively). Chest pain was significantly lower in the EVL + EIS group compared to that in the EVL group (15.9% versus 45.0%). There were no statistically significant differences in the presence of fever or esophageal stricture in both groups. In conclusion, combined EVL + EIS showed less rebleeding rates and recurrence at six months and less chest pain and was more cost effective compared to EVL alone in the treatment of gastroesophageal varices.

Background and study aims The Full-Thickness Resection Device (FTRD) provides a novel treatment option for lesions not amenable to conventional endoscopic resection techniques. There are limited data on the efficacy and safety of FTRD for resection of upper gastrointestinal tract (GIT) lesions. Patients and methods This was an international multicenter retrospective study, including patients who had an endoscopic resection of an upper GIT lesion using the FTRD between January 2017 and February 2019. Results Fifty-six patients from 13 centers were included. The most common lesions were mesenchymal neoplasms (n = 23, 41 %), adenomas (n = 7, 13 %), and hamartomas (n = 6, 11 %). Eighty-four percent of lesions were located in the stomach, and 14 % in the duodenum. The average size of lesions was 14 mm (range 3 to 33 mm). Deployment of the FTRD was technically successful in 93 % of patients (n = 52) leading to complete and partial resection in 43 (77 %) and 9 (16 %) patients, respectively. Overall, the FTRD led to negative histological margins (R0 resection) in 38 (68 %) of patients. A total of 12 (21 %) mild or moderate adverse events (AEs) were reported. Follow-up endoscopy was performed in 31 patients (55 %), on average 88 days after the procedure (IQR 68–138 days). Of these, 30 patients (97 %) did not have any residual or recurrent lesion on endoscopic examination and biopsy, with residual adenoma in one patient (3 %). Conclusions Our results suggest a high technical success rate and an acceptable histologically complete resection rate, with a low risk of AEs and early recurrence for FTRD resection of upper GIT lesions.

INTRODUCTION: Fecal microbiota transplant (FMT) has been demonstrated to be an effective treatment option for recurrent C. difficile infections (RCDI) with minimal serious adverse reactions reported. Although the results of FMT for RCDI are promising, the screening process (for both donors and recipients) remains largely unregulated by the FDA. CASE DESCRIPTION/METHODS: A 19 y.o. male with a history of primary IgA deficiency, growth hormone deficiency, asthma, and ulcerative colitis presented to his gastroenterologist with his 3rd C. difficile infection in a 4 month period. FMT was performed via colonoscopy using commercially sourced stool. 10 days later, the patient presented to the ER with explosive bloody diarrhea, up to 20 BMs per day. He was also positive for leukocytopenia, tachycardia, intermittent subjective fevers, chills, night sweats, and abdominal cramping. Stool studies were positive for EPEC, ETEC, and Shiga toxin-producing E. coliO157:H7. Patient was not given antibiotics and received supportive care for 17 days until discharge. He has a good prognosis and has not experienced a recurrence of CDI since the FMT 3 months ago. Unbeknownst to his Gastroenterologist, the patient had a history of mostly asymptomatic, total primary IgA deficiency that was diagnosed in the Czech Republic. DISCUSSION: This appears to be the first reported instance of an individual with Primary IgA Deficiency undergoing FMT and also the first reported instance of FMT-introduced E. coli O157:H7 infection. The patient’s complete lack of IgA appears to be the main catalyst for his disastrous response to FMT. While barrier defects secondary to IBD and the concomitant use of immunosuppressive medications (Xeljanz and Entyvio) can increase susceptibility to infections, studies have shown FMT does not carry an increased risk of serious adverse effects in immunocompromised patients (including IBD patients on immunosuppressive therapy). This patient was not screened for immunodeficiencies prior to receiving FMT. The FDA has issued guidelines, but does not currently mandate which pathogens the stool must be screened for, or which comorbidities the recipient must be screened for. Given the understood importance of IgA in mucosal immunity against E. coli, and the outcome presented in this study, we suggest that rigorous screening of the recipient's medical history for immunodeficiency, and/or potentially running a basic Immunoglobulin panel, should be considered prior to performing FMT.

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