Endoscopic mucosal resection

Hwang, Joo Ha; Konda, Vani J.; Dayyeh, Barham K. Abu; Chauhan, Shailendra S.; Enestvedt, Brintha K.; Fujii-Lau, Larissa L.; Komanduri, Sri; Maple, John T.; Murad, Faris; Pannala, Rahul; Thosani, Nirav; Banerjee, Subhas

doi:10.1016/j.gie.2015.05.001

Cited by 160 publications

(94 citation statements)

References 108 publications

(153 reference statements)

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“…Directed marginal ablation will likely become the new addition to the armamentarium of EMR skills, which already includes recognizing pit patterns and morphology, applying the right electrocautery setting, controlling of bleeding, treating perforation, and mastering clipping. [11][12][13] Such skills will ensure that EMR of large colorectal polyps will be as effective and safe as possible, emphasizing the need for complex polyp resections to be done by adequately trained endoscopists.…”

Section: Is Ablation Of the Endoscopic Mucosal Resection Margin The Nmentioning

confidence: 99%

Is Ablation of the Endoscopic Mucosal Resection Margin the New Standard for Colorectal Polyps?

Renteln

Pohl

2019

Gastroenterology

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Section: Is Ablation Of the Endoscopic Mucosal Resection Margin The Nmentioning

confidence: 99%

Is Ablation of the Endoscopic Mucosal Resection Margin the New Standard for Colorectal Polyps?

Renteln

Pohl

2019

Gastroenterology

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“…The stages of colon cancer are determined by the extent of spread through the layers of the bowel wall and whether the localized tumour has spread to lymph nodes or distant organs. The surgical removal of colon polyps or cancers based on conventional techniques may lead to two of the most important post‐surgery complications, bleeding and perforation . In this study we demonstrate the relevance of ultrafast laser in colon tissue resection for minimal perforation or thermal damage.…”

Section: Introductionmentioning

confidence: 56%

Preclinical evaluation of porcine colon resection using hollow core negative curvature fibre delivered ultrafast laser pulses

Mohanan

Beck

West

et al. 2019

Journal of Biophotonics

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Ultrashort pulse lasers offer great promise for tissue resection with exceptional precision and minimal thermal damage. Surgery in the bowel requires high precision and minimal necrotic tissue to avoid severe complications such as perforation. The deployment of ultrashort lasers in minimally invasive or endoscopic procedures has been hindered by the lack of suitable optical fibres for high peak powers. However, recent developments of hollow core microstructured fibres provide potential for delivery of such pulses throughout the body. In this study, analysis of laser ablation via a scanning galvanometer on a porcine colon tissue model is presented. A thermally damaged region (<85 μm) and fine depth control of ablation using the pulse energies 46 and 33 μJ are demonstrated. It is further demonstrated that such pulses suitable for precision porcine colon resection can be flexibly delivered via a hollow core negative curvature fibre (HC-NCF) and again ablation depth can be controlled with a thermally damaged region <85 μm. Ablation volumes are comparable to that of early stage lesions in the inner lining of the colon. This study concludes that the combination of ultrashort pulses and flexible fibre delivery via HC-NCF present a viable route to new minimally invasive surgical procedures. K E Y W O R D S negative curvature fibre, plasma-mediated ablation, porcine colon, thermal necrosis, ultrafast laser surgery

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“…They also have less time constraints on their endoscopy schedule due to longer blocks of time per case and have access to anesthesia support during their procedures, which has been shown to positively impact the success of advanced endoscopic procedures [3, 22]. There is no formal recommendation in the ASGE core curriculum as to which providers should perform these EMR, but we believe that formally defining specialist endoscopists could potentially have healthcare policy implications and merits further study [2, 12, 13]. …”

Section: Discussionmentioning

confidence: 99%

Specialist Endoscopists Are Associated with a Decreased Risk of Incomplete Polyp Resection During Endoscopic Mucosal Resection in the Colon

et al. 2017

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Background Endoscopic experience is known to correlate with outcomes of endoscopic mucosal resection (EMR), particularly complete resection of the polyp tissue. Whether specialist endoscopists can protect against incomplete polypectomy in the setting of known risk factors for incomplete resection (IR) is unknown. Aims We aimed to characterize how specialist endoscopists may help to mitigate the risk of IR of large sessile polyps. Methods This is a retrospective cohort study of patients who underwent EMR at the University of Michigan from January 1, 2006, to November 15, 2015. The primary outcome was endoscopist-reported polyp tissue remaining at the end of the initial EMR attempt. Specialist endoscopists were defined as endoscopists who receive tertiary referrals for difficult colonoscopy cases and completed at least 20 EMR colonic polyp resections over the study period. Results A total of 257 patients with 269 polyps were included in the study. IR occurred in 40 (16%) cases. IR was associated with polyp size ≥ 40 mm [adjusted odds ratio (aOR) 3.31, 95% confidence interval (CI) 1.38–7.93], flat/laterally spreading polyps (aOR 2.61, 95% CI 1.24–5.48), and difficulty lifting the polyp (aOR 11.0, 95% CI 2.66–45.3). A specialist endoscopist performing the initial EMR was protective against IR, even in the setting of risk factors for IR (aOR 0.13, 95% CI 0.04–0.41). Conclusions IR is associated with polyp size ≥ 40 mm, flat and/or laterally spreading polyps, and difficulty lifting the polyp. A specialist endoscopist initiating the EMR was protective of IR.

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Endoscopic mucosal resection

Cited by 160 publications

References 108 publications

Is Ablation of the Endoscopic Mucosal Resection Margin the New Standard for Colorectal Polyps?

Is Ablation of the Endoscopic Mucosal Resection Margin the New Standard for Colorectal Polyps?

Preclinical evaluation of porcine colon resection using hollow core negative curvature fibre delivered ultrafast laser pulses

Specialist Endoscopists Are Associated with a Decreased Risk of Incomplete Polyp Resection During Endoscopic Mucosal Resection in the Colon

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