Tissue band ligation followed by snare resection (band and snare): a new technique for tissue acquisition in the esophagus

Fleischer, David E.; Wang, G.Q.; Dawsey, Sanford M.; Tio, T. L.; Newsome, Joseph T.; Kidwell, Jean; Prifti, Skerdi

doi:10.1016/s0016-5107(96)70233-x

Cited by 94 publications

(39 citation statements)

References 7 publications

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“…En nuestro trabajo llama la atención el elevado porcentaje de perforaciones que contrasta con las comunicadas por grupos con gran experiencia (4,(12)(13)(14)(15)17,18). La primera razón que podría explicar en parte esta frecuencia de perforación es que la pared del esófago en el animal de experimentación es de menor grosor, puesto que no tiene carcinoma.…”

Section: Discussionunclassified

“…La primera razón que podría explicar en parte esta frecuencia de perforación es que la pared del esófago en el animal de experimentación es de menor grosor, puesto que no tiene carcinoma. Sin embargo el grosor del esófago con displasia (asociada a esófago de Barrett ) no debe ser mayor que el esófago "sano" y hay amplia experiencia sin perforación en MB para tratamiento de la displasia de alto grado (4,15,17).…”

Section: Discussionunclassified

“…La última técnica consiste en la colocación de una banda de las utilizadas en el tratamiento de varices esofágicas, y posteriormente se realiza la resección. Esta última técnica, la mucosectomía con banda (MB), se ha realizado con diferentes modelos de ligadores multibanda, tanto en el estómago como en el esó-fago y se ha descrito realizando el corte por encima y también por debajo de la banda (4,(6)(7)(8)(9)(12)(13)(14)(15)(16)(17)(18)(19).…”

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Riesgo de perforación en la mucosectomía esofágica con banda: estudio experimental con dos modelos de ligadores

Vázquez-Iglesias

Alonso-Aguirre

Centeno

et al. 2007

Rev. esp. enferm. dig.

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INTRODUCCIÓNLa mucosectomía es el foco de atención de varios equipos de trabajo que la consideran un método seguro y eficaz para el tratamiento de algunos tumores del aparato digestivo. Principalmente se ha utilizado en carcinomas precoces y adenomas planos en esófago y estó-Riesgo de perforación en la mucosectomía esofágica con banda: estudio experimental con dos modelos de ligadores RESUMENObjetivo: en los últimos años se han publicado varios trabajos que encuentran la mucosectomía con banda (MB) como un méto-do seguro para el tratamiento de algunos tumores esofágicos, gás-tricos y colorrectales. Hemos realizado este estudio en animales de experimentación (cerdos) para comparar la seguridad de la MB en esófago, con dos modelos de ligadores multibanda, ya que muchos centros sólo disponen de estos modelos de ligadores comercializados para la ligadura de varices esofágicas.Métodos: se utilizaron 8 cerdos en los que se realizaron 23 resecciones esofágicas sin inyección previa. Se hicieron 10 resecciones con el modelo Six Shooter Saeed y 13 resecciones con el modelo Speedband Superview Super 7. También se comparó la técnica realizando el corte aleatoriamente por debajo o por encima de la banda.Resultados: se produjeron 5 perforaciones, todas con el modelo Speedband. Del total de casos en los que se utilizó este modelo se perforaron el 38,5% frente a ninguna de las intervenciones con el modelo Six Shooter, lo que alcanzó significación estadística (p = 0,046). No hubo deferencias estadísticamente significativas en la frecuencia de perforación, entre realizar el corte por debajo o por encima de la banda.Conclusiones: MB esofágica realizada con el modelo Speedband sin inyección previa, da lugar a perforación en un porcentaje elevado de casos en el animal de experimentación. Se precisan más estudios para establecer si la inyección previa incrementa la seguridad de la técnica con este modelo de ligador.Palabras clave: Riesgo de perforación. Etudio experimental. Modelo de ligador. ABSTRACTObjective: endoscopic mucosal resection with ligation (EMRL) is considered an efficient, safe method for the treatment of some esophageal, gastric and colorectal tumors. We conducted this study using a porcine model in order to compare the safety of esophageal EMRL with two multiband ligation systems, since many centers only use these ligator models in EMRL (commercialized for varix ligation).Methods: eight pigs were used, which were submitted to 23 esophageal resections without previous injection. Ten resections were conducted using the Six Shooter Saeed model, and 13 resections used the Speedband Superview Super 7 model. The technique was also compared by making random cuts either above or below the band.Results: five perforations occurred, all of them using the Speedband model. This represents 38.5% of total in the Speedband model group. No perforation occurred when using the Six Shooter model (p = 0.046). On the contrary, no significant differences were found regarding frequency of perforation when cutting above or below the band.Co...

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Riesgo de perforación en la mucosectomía esofágica con banda: estudio experimental con dos modelos de ligadores

Vázquez-Iglesias

Alonso-Aguirre

Centeno

et al. 2007

Rev. esp. enferm. dig.

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“…An alternative is to use a band-and-snare method in which the target lesion is banded using a specialized EMR device. Following banding the lesion is resected using a snare [Fleischer et al 1996]. In a prospective randomized trial, no significant differences were observed between these two techniques with regard to the maximum diameter or calculated area of the resected specimens [May et al 2003].…”

Section: Endoscopic Mucosal Resectionmentioning

confidence: 99%

Review: Diagnosis and management of Barrett’s esophagus for the endoscopist

Garud

Keilin

Cai

et al. 2010

Therap Adv Gastroenterol

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In Barrett's esophagus, the stratified squamous epithelium lining the esophagus is replaced by specialized intestinal-type columnar epithelium. The prevalence of Barrett's esophagus has ranged from 0.9% to 4.5%. The rate of progression from Barrett's esophagus to esophageal adenocarcinoma is 0.5% per patient-year. Proton-pump inhibitors are the mainstay of symptom control in Barrett's patients. Nondysplastic Barrett's and Barrett's with low-grade dysplasia (LGD) are typically managed by periodic surveillance. Radiofrequency ablation is being evaluated as a modality for managing nondysplastic Barrett's and Barrett's with LGD. The options for the management of Barrett's patients with high-grade dysplasia (HGD) include endoscopic therapy, surgery, and intensive surveillance until biopsy reveals adenocarcinoma. Endoscopic therapy involves endoscopic mucosal resection (EMR) and ablation. More aggressive techniques such as endoscopic submucosal dissection and larger segment endoscopic mucosal resection are under study. In this review, we discuss the diagnosis and management of Barrett's esophagus. The recommendations from the major gastroenterologic societies and the current and investigational endoscopic modalities for the management of Barrett's esophagus with and without dysplasia are reviewed.

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“…A variation of this method is the use of bands instead of an injection solution, and this method is best for the treatment of esophageal lesions. 10 Following injection, the 'lift and cut' method involves the use of a grasper to pull the lesion from the muscolaris propria. The 'lift and cut' method was the first EMR technique, but because of complexity, the 'suck and cut' method is now used more widely.…”

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Endoscopy: From Diagnosis to Therapeutics

Benson

Mizrahi²

2015

Gastro Open J

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Two decades ago, gastroenterologists used endoscopy for the diagnosis of Gastrointestinal (GI) lesions, thereby helping surgeons to localize lesion that necessitated resection and treatment with surgery. Today, the gastroenterology field has advanced beyond the diagnostic era and now, a large number of GI lesions can be treated via endoluminal procedures performed by the gastroenterologist with no need for surgical intervention.In recent years, the improvement of endoscopic imaging and tools, such as snares, clips and needles which can be delivered through the endoscope channel, have helped to change the field of gastroenterology. This allowed for the development and advancement of Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD). The pioneers of EMR and ESD were from Japan and the first articles describing these techniques were published in the 1990s. 1,2Two classification systems are used for describing GI lesions to be considered for EMR and ESD. One system is the Japanese classification 3 and the second is the Paris system, which was proposed in 2002. 4 The Japanese classification was originally developed for early gastric cancer management, but it can be applied to lesions throughout the GI tract. Once lesions are classified, EMR can be performed in different GI locations, including the esophagus, stomach, colon and rectum. When lesions are more complex and beyond the mucosa, ESD can be performed with careful dissection.Endoscopic ultrasound (EUS) may be useful in deciding whether to perform EMR or ESD. EUS can aid in determining the penetration of the tumor to layers beyond the mucosa when the lesion is localized in proximal parts of the colon. If the lesion cannot be reached by a regular EUS endoscope special high frequency mini-probes may be used through the colonoscope working channel.Two methods are used in performing EMR. The first method is 'suck and cut' and the second method is 'lift and cut'. Both usually begin with a submucosal injection prior to resection of the lesion the suc and cut method may be used also without submucosal injection especially when being performed in the esophagus. The injection is used to expand the submucosa, separating the deeper muscolaris propria from the more superficial mucosa and submucosa layers. Several solutions may be used as the injectate. These include normal saline with or without diluted epinephrine, hypertonic saline, dextrose solution, sodium hyaluronate, fibrinogen combination, glycerol, and fructose solutions all of those may be mixture with methylene blue depend on the preference of the endoscopist.5-8 Conio, et al. compared the solutions and showed that the disappearing time of normal saline is approximately 3 minutes with or without epinephrine, while the disappearing times of 50% dextrose and 10% glycerol and hyaluronic acid solutions were 4.7, 4.2 and 22 minutes respectively. 9After injection, one of the two resection methods can be applied. The 'suck and cut'

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Tissue band ligation followed by snare resection (band and snare): a new technique for tissue acquisition in the esophagus

Cited by 94 publications

References 7 publications

Riesgo de perforación en la mucosectomía esofágica con banda: estudio experimental con dos modelos de ligadores

Riesgo de perforación en la mucosectomía esofágica con banda: estudio experimental con dos modelos de ligadores

Review: Diagnosis and management of Barrett’s esophagus for the endoscopist

Endoscopy: From Diagnosis to Therapeutics

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