Endoscopic resection with ligation using a multi-band mucosectomy system in Barrett’s esophagus with high-grade dysplasia and intramucosal carcinoma

Abstract

Abstract:Background: Endoscopic therapy for early neoplasia in Barrett's esophagus (BE) is evolving. Endoscopic resection has an increasing role. We wanted to evaluate the safety and efficacy of multi-band ligation/resection [ER-L] without pre-injection in BE with high-grade dysplasia [HGD] and intramucosal carcinoma [IMCA]. Methods: A cohort of 65 consecutive patients from a single academic medical center, who underwent ER-L as part of endoscopic eradication therapy for BE with HGD/IMCA were studied. ER-L was performed after endoscopic mapping and endoscopic ultrasound (EUS). Subsequently, adjunctive ablative therapies including photodynamic therapy, argon plasma coagulation and radiofrequency ablation were applied to achieve complete eradication of all BE. Thereafter biopsy surveillance was performed per protocol. All patients were prescribed a proton-pump inhibitor. Main outcome measurements: Change in histopathological stage; eradication of BE and HGD/IMCA; adverse events. Results: The median number of ER-L applications in each session was 4 (range 16) and the mean total number of ER-L sessions was 1.5. Compared with prior forceps biopsy, histopathology from the ER-L specimen changed in 24 (37.5%, p ¼ <0.0001). With median follow-up of 15 months (range 842), complete and durable BE eradication was achieved with ER-L alone in 36 (60%) and the remainder with adjunctive ablation therapies. There were nine complications (four (6%) acute bleeding, five (7.5%) strictures, zero perforations). Conclusions: ER-L without submucosal (SM) pre-injection is safe and effective when applied selectively for eradication of BE with HGD/IMCA. There is significant change in pathological stage after ER-L conferring a diagnostic and staging advantage. ER-L may be used adjunctively with ablation therapies.

Use of an over-the-scope clipping device: multicenter retrospective results of the first U.S. experience (with videos)

“…Recently, the OTSC device has been used in an animal model to perform full-thickness resection in the colon by using a clip-and-cut technique, 36 similar to the band ligation and cut technique used for EMR 37 and resection of subepithelial lesions. 38 In one of our patients, we resected a subepithelial lesion in a similar fashion, and deeper lesions may be resectable with this technique.…”

Comparison of the clinical value of multi-band mucosectomy versus endoscopic mucosal resection for the treatment of patients with early-stage esophageal cancer

“…In 2007, MBM was compared with EMR in a retrospective study, and proved to be safer and have better curative resection rate in early-stage gastroesophageal neoplasia (8). This conclusion was confirmed by the subsequent studies by Bhat et al (15) and Herrero et al (16). In a previous study (n=72), the cap technique with submucosal injection and the ligation technique without submucosa injection were found to be similar with respect to efficacy and safety in endoscopic resections of early-stage esophageal cancers (17).…”

Lycorine hydrochloride inhibits metastatic melanoma cell‐dominant vasculogenic mimicry

“…Malignant melanoma cells can form tumor blood vessels through vasculogenic mimicry (Maniotis et al., 1999; Hess et al., 2007; Bhat et al., 2009; Helfrich and Schadendorf, 2011). However, cells also produce various growth factors to promote tumor angiogenesis.…”

“…Aggressive and metastatic melanomas are rich in tumor vasculature (Bhat et al., 2009; Marneros, 2009). Accumulated evidence has indicated that malignant melanoma cells not only produce various angiogenic factors to promote tumor angiogenesis through ingrowth of the tumor’s vasculature from pre‐existing blood vessels, but also directly form tumor vasculature via tumor vasculogenic mimicry, by which tumor cells line up to form functional blood vessels, independent of vascular endothelial cells (Maniotis et al., 1999; Hess et al., 2007; Bhat et al., 2009; Helfrich and Schadendorf, 2011). Thus, vasculogenic melanoma cells and genes may be rational targets for anti‐melanoma therapy.…”

“…Emerging evidence has shown that traditional Chinese medicines are useful in treating various cancers and as new adjuvant chemotherapy to enhance the efficacy of chemotherapy and reduce side effects and resistance of cancer chemotherapies. Malignant melanoma usually has an abundant vasculature and metastatic melanoma cells actively participate in tumor vasculogenic mimicry (Maniotis et al., 1999; Hess et al., 2007; Bhat et al., 2009). For these reasons, we explored novel anti‐melanoma agents from traditional Chinese medicinal herbs using the vasculogenic and metastatic melanoma cell line C8161 as a model.…”