Thermal Ablation of Mucosal Defect Margins Reduces Adenoma Recurrence After Colonic Endoscopic Mucosal Resection

1. Download high-res image (484KB)
2. Download full-size image

     

Oral Erythromycin Accelerates Impaired Gastrointestinal Motility After Endoscopic Mucosal Resection

Gastrointestinal motility may be impaired after endoscopic mucosal resection of gastric lesions. We investigated whether oral erythromycin could improve motility. Twenty patients were divided randomly into groups that received oral omeprazole with or without erythromycin. Motility was recorded overnight at 3 days before and 4 days after endoscopic resection using a microtransducer probe. In the group without erythromycin, gastric phase III activity decreased significantly after endoscopic resection, while it was increased significantly by erythromycin (P < 0.01). After resection, there were significantly more gastric phase III events in the erythromycin group (P < 0.05). The interval between the start of the evening meal and the initial gastric phase III activity was significantly prolonged after resection, while this interval was significantly shortened by erythromycin (P < 0.05). The gastric phase III cycle length was also significantly shortened by erythromycin (P < 0.05). Postprandial and fasting gastrointestinal motility were impaired after endoscopic resection, and postprandial as well as fasting motility were improved by oral erythromycin.     

Endoscopic Resection of Ampullary Adenomas: Complications and Outcomes

Aim  

Ampullary adenomas have the potential to progress from benign to malignant lesions. Endoscopic ampullectomy as curative therapy has gained credibility as a safe and effective alternative to surgical resection. This study was designed to assess outcomes of endoscopic resection of ampullary neoplasms at a single center.     

Endoscopic Ultrasonographic Assessment of Gastric Polyps and Endoscopic Mucosal Resection

Gastric polyps refer to a heterogeneous group of epithelial- and subepithelial-based lesions that vary in histology and malignant potential. Although many gastric polyps have characteristic endoscopic appearances, their diagnosis, classification, and potential for malignant transformation are based on histologic evaluation. Therefore, all types of gastric polyps should be biopsied during the incident endoscopy. Mucosal-based polyps include fundic gland polyps, hyperplastic polyps, adenomatous polyps, and hamartomatous polyps. Inflammatory fibroid polyps may endoscopically appear similar to mucosal-based polyps but actually arise from the submucosa. Certain types of polyps are associated with genetic syndromes or potential precancerous conditions (gastric intestinal metaplasia and chronic atrophic gastritis). If dysplasia is present and the polyp is ??2?cm or symptomatic, the polyp should be endoscopically resected with the aim of en bloc resection. There are limited data on the use of adjunctive endoscopic ultrasound (EUS) in the evaluation of mucosal-based gastric polyps, and therefore, is not routinely employed in the management of these lesions. EUS is recommended for the evaluation of gastric subepithelial lesions.     

Clinical Evaluation of Endoscopic Gastric Mucosal Resection

Abstract: Endoscopic gastric mucosal resection (EGMR), by which a large specimen can be obtained, has been developed for the diagnosis and treatment of the borderline lesion (B. L.) or early gastric cancer (EGC), since biopsy specimens obtained by conventional techniques are too small to make an accurate diagnosis in number of cases. Thirty-eight lesions in 35 cases (26 lesions in 23 cases with B. L. and 12 lesions in 12 cases with EGC) were resected for the purpose of treatment by EGMR, and 24 lesions (6 submucosal tumors, 3 B. L. s, 14 cases of EGC and 1 malignant lymphoma) for the purpose of diagnosis. By means of histological examination of the bite biopsy specimens following EGMR, twenty-three lesions in 26 cases (89%) with a B. L. and 8 in 12 cases (67%) with EGC for treatment by EGMR were found to have been completely resected. After further histological examination of EGMR specimens obtained for diagnosis, one out of 3 B. L. s was diagnosed as EGC (IIa) and the others as bengin lesions. Out of 14 EGC cases, 6 were diagnosed as carcinoma, 3 as B. L. s and 5 as benign lesions. In Group III lesions obtained by conventional endoscopic biopsy, 8 out of 40 lesions (20%) were defined as EGC, 28 lesions (70%) as a B. L. and 4 lesions (10%) as benign lesions respectively by means of histological examination of the EGMR specimens. Although obvious side effects were observed in 4 cases, these patients could be treated by endoscopic management or drug therapy. It can be concluded that EGMR, by which large specimens can be obtained, is a useful procedure for the purpose of diagnosing and treating gastric mucosal lesions without causing major risk.