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Mo1650 Full-Thickness Endoscopic Resection of Gastrointestinal Cancer: From Animal Experiments to Humans
Abstracts
underwent standard white light endoscopic screening. Then, after staining the tissue with topical proflavine (0.01%), VFI was performed. Each site was biopsied and analyzed by a single, expert gastrointestinal pathologist. From 65 VFI sites, 10 images and 8 videos were used in a fifteen-minute training set to teach four novice and two experienced gastroenterologists to distinguish between normal tissue and neoplasia. Following training, a test set of 40 mixed videos was given to each gastroenterologist in a blinded fashion. Videos ranged from 2-16 seconds and could be viewed for up to 30 seconds; responses were examined for individual accuracy and interobserver variability.Novice users identified neoplasias with a mean sensitivity of 83% (95% CI 65-99%) and a mean specificity of 82% (95% CI 62-99%). In comparison, experienced gastroenterologists achieved a mean sensitivity of 75% and a mean specificity of 84%. Finally, kappa values for interobserver variability were 0.56 for experts, 0.58 for non-experts, and 0.58 overall.After brief training, gastroenterologists with no prior experience using VFI were proficient in distinguishing benign metaplasia from neoplastic tissue, attaining accuracy measures comparable to those of experienced gastroenterologists. While further prospective evaluation needs to be performed, this study suggests that VFI shows promising accuracy and, in particular, good specificity. And given that imaging is performed with topical proflavine, the same contrast used for confocal imaging, VFI may become a bridge between white light and confocal endoscopy.
lesions) were observed by both ME-BLI and ME-NBI before the endoscopic submucosal dissection (ESD). Written informed consent was obtained from all the patients. Results: The absence or the presence of demarcation line (absent: present) was able to be determined by NBI (4: 81) and BLI (2: 83). Similarly, the endoscopic findings (absent: irregular: regular) of MV pattern and MS pattern were diagnosed by NBI (MV 0:82:3, MS 21:47:17) and BLI (MV 2:81:2, MS 6:62: 17) respectively. According to the ‘VS classification’, an irregular MV pattern and/ or an irregular MS pattern together with a clear demarcation line are characteristic for early gastric carcinoma. With these criteria, the correct diagnostic ratio of NBI and BLI were 94.1% and 95.3% respectively (statistically not significant). Interestingly, ME-BLI was able to detect irregular MS pattern in 75% of lesions that showed absent MS pattern detected by ME-NBI (statistically significant). Conclusion: For the observation of early gastric cancer, ME-BLI can detect MV and MS pattern at the same level of ME-NBI. Additionally, ME-BLI can detect minute mucosal pattern in greater detail compared to ME-NBI. Further study is necessary to establish the diagnostic standard of early gastric cancer using ME-BLI.
ME-BLI is superior than ME-NBI in the detection of MS pattern.
Mo1650 Full-Thickness Endoscopic Resection of Gastrointestinal Cancer: From Animal Experiments to Humans Joseph R. Armengol2, Monder Abusuboh Abadia2, Joan Dot-Bach2, Jordi Armengol Bertroli2, Miquel Masachs Peracaula2, Anna Benages Curell2, Jose C. Salord2, Sergey Kantsevoy*1 1 Institute for Digestive Health and Liver Disease, Mercy Medical Center, Baltimore, MD; 2Digestive Endoscopy, Vall D’Hebron University Hospital, Barcelona, Spain
Mo1649 The Efficacy of a Novel Blue LASER Imaging System for the Diagnosis of Early Gastric Cancers; a Prospective Single Center Open Trial Nobuaki Yagi*, Yuji Naito, Osamu Dohi, Naohisa Yoshida, Kazuhiro Kamada, Kazuhiro Katada, Kazuhiko Uchiyama, Tomohisa Takagi, Osamu Handa, Hideyuki Konishi, Toshikazu Yoshikawa Molecular gastroenterology and hepatology, kyoto prefectural university of medicine, Kyoto, Japan Background: It has been reported that the image enhanced endoscopy, such as magnifying endoscopy with narrow band imaging (ME-NBI) is useful for the diagnosis of early gastric cancers. Recently, a new endoscope system having two kinds of diode LASER was developed by FUJIFILM Corporation. It has the narrow-band light observation function without a customized optical filter. By controlling the power of the 2 lasers, we can choose 2 images; white light image and BLI image. Although the magnifying endoscopy with BLI light (ME-BLI) is useful for acquiring mucosal surface information, no study has been performed to examine the accuracy of ME-BLI compared to ME-NBI in the diagnosis of early gastric cancers. Aims & Methods: In this prospective open trial in single center (Kyoto Prefectural University of Medicine), we aimed to clarify the feasibility of ME-BLI compared to ME-NBI for the diagnosis of early gastric cancers, using the VS classification (microvascular pattern [MV] and microsurface pattern [MS]) as previously reported by Yao K. et al. (Endoscopy. 2009;41). 81 patients (male: 58, female: 23; Mean age: 70 years old) with early gastric cancer who were diagnosed between September 2011 and August 2012 were enrolled. A total of 85 early gastric cancers (protruded type 39 lesions, depressed type 46
Background: Transition of Natural Orifice Translumenal Endoscopic Surgery (NOTES) from animal lab to clinical practice in humans for many years was hindered by lack of reliable closure of the translumenal entry site into the peritoneal cavity. Aim: To study technical feasibility and safety of full-thickness colonic and gastric resections in a live porcine model and the first clinical experience of NOTES full-thickness organ wall resections in humans. Methods: We performed endoscopic full-thickness resections of gastric and colonic wall in nine 50-kg domestic pigs. After resection the defects in GI tract wall were sutured with Overstitch endoscopic suturing device (Apollo Endosurgery Inc, Austin, TX). Three animals were sacrificed post procedure. Six animals were survived for 14 days and subsequently sacrificed for postmortem examination. Then we performed 2 human cases: 1. Purely endoscopic full-thickness resection of actively bleeding colon cancer. 2. Purely endoscopic full-thickness resection of large gastro-intestinal stromal tumor (GIST). Results: Large (3-5 cm) full-thickness endoscopic resections of gastric (3 animals) and colonic (6 animals) wall were easily achieved using hook knife, IT-knife and polypectomy snare (all made by Olympus, Tokyo, Japan). Suturing with the Overstitch endoscopic suturing device was technically easy and achieved airtight closure of the GI tract in all animals. Postmortem examination revealed good full-thickness healing of the GI tract wall at the sites of resection.After gaining significant experience in endoscopic suturing we performed full-thickness endoscopic resection of actively bleeding colon cancer located at hepatic flexure. The cancer was 2x4 cm and could not be lifted with submucosal injection of normal saline. After endoscopic resection, 4x6 cm full-thickness defect in colonic wall was completely closed with continuous suture line. The patient had no pain post procedure and was discharged home in 3 days. Follow-up endoscopy in 3, 6 and 12 months revealed good healing of colonic wall without any residual cancer or strictures. Then we performed endoscopic resection of 2x5 cm gastric stromal tumor. Resulting full-thickness defect was completely closed with 2 endoscopic sutures. Follow-up endoscopy in 45 days revealed complete healing of the gastric wall defect without any residual GIST tumor. Conclusion: Endoscopic full-thickness resections of GI tract tumors can potentially become another valuable alternative to laparoscopy and open surgery.
AB458 GASTROINTESTINAL ENDOSCOPY Volume 77, No. 5S : 2013
www.giejournal.org
underwent standard white light endoscopic screening. Then, after staining the tissue with topical proflavine (0.01%), VFI was performed. Each site was biopsied and analyzed by a single, expert gastrointestinal pathologist. From 65 VFI sites, 10 images and 8 videos were used in a fifteen-minute training set to teach four novice and two experienced gastroenterologists to distinguish between normal tissue and neoplasia. Following training, a test set of 40 mixed videos was given to each gastroenterologist in a blinded fashion. Videos ranged from 2-16 seconds and could be viewed for up to 30 seconds; responses were examined for individual accuracy and interobserver variability.Novice users identified neoplasias with a mean sensitivity of 83% (95% CI 65-99%) and a mean specificity of 82% (95% CI 62-99%). In comparison, experienced gastroenterologists achieved a mean sensitivity of 75% and a mean specificity of 84%. Finally, kappa values for interobserver variability were 0.56 for experts, 0.58 for non-experts, and 0.58 overall.After brief training, gastroenterologists with no prior experience using VFI were proficient in distinguishing benign metaplasia from neoplastic tissue, attaining accuracy measures comparable to those of experienced gastroenterologists. While further prospective evaluation needs to be performed, this study suggests that VFI shows promising accuracy and, in particular, good specificity. And given that imaging is performed with topical proflavine, the same contrast used for confocal imaging, VFI may become a bridge between white light and confocal endoscopy.
lesions) were observed by both ME-BLI and ME-NBI before the endoscopic submucosal dissection (ESD). Written informed consent was obtained from all the patients. Results: The absence or the presence of demarcation line (absent: present) was able to be determined by NBI (4: 81) and BLI (2: 83). Similarly, the endoscopic findings (absent: irregular: regular) of MV pattern and MS pattern were diagnosed by NBI (MV 0:82:3, MS 21:47:17) and BLI (MV 2:81:2, MS 6:62: 17) respectively. According to the ‘VS classification’, an irregular MV pattern and/ or an irregular MS pattern together with a clear demarcation line are characteristic for early gastric carcinoma. With these criteria, the correct diagnostic ratio of NBI and BLI were 94.1% and 95.3% respectively (statistically not significant). Interestingly, ME-BLI was able to detect irregular MS pattern in 75% of lesions that showed absent MS pattern detected by ME-NBI (statistically significant). Conclusion: For the observation of early gastric cancer, ME-BLI can detect MV and MS pattern at the same level of ME-NBI. Additionally, ME-BLI can detect minute mucosal pattern in greater detail compared to ME-NBI. Further study is necessary to establish the diagnostic standard of early gastric cancer using ME-BLI.
ME-BLI is superior than ME-NBI in the detection of MS pattern.
Mo1650 Full-Thickness Endoscopic Resection of Gastrointestinal Cancer: From Animal Experiments to Humans Joseph R. Armengol2, Monder Abusuboh Abadia2, Joan Dot-Bach2, Jordi Armengol Bertroli2, Miquel Masachs Peracaula2, Anna Benages Curell2, Jose C. Salord2, Sergey Kantsevoy*1 1 Institute for Digestive Health and Liver Disease, Mercy Medical Center, Baltimore, MD; 2Digestive Endoscopy, Vall D’Hebron University Hospital, Barcelona, Spain
Mo1649 The Efficacy of a Novel Blue LASER Imaging System for the Diagnosis of Early Gastric Cancers; a Prospective Single Center Open Trial Nobuaki Yagi*, Yuji Naito, Osamu Dohi, Naohisa Yoshida, Kazuhiro Kamada, Kazuhiro Katada, Kazuhiko Uchiyama, Tomohisa Takagi, Osamu Handa, Hideyuki Konishi, Toshikazu Yoshikawa Molecular gastroenterology and hepatology, kyoto prefectural university of medicine, Kyoto, Japan Background: It has been reported that the image enhanced endoscopy, such as magnifying endoscopy with narrow band imaging (ME-NBI) is useful for the diagnosis of early gastric cancers. Recently, a new endoscope system having two kinds of diode LASER was developed by FUJIFILM Corporation. It has the narrow-band light observation function without a customized optical filter. By controlling the power of the 2 lasers, we can choose 2 images; white light image and BLI image. Although the magnifying endoscopy with BLI light (ME-BLI) is useful for acquiring mucosal surface information, no study has been performed to examine the accuracy of ME-BLI compared to ME-NBI in the diagnosis of early gastric cancers. Aims & Methods: In this prospective open trial in single center (Kyoto Prefectural University of Medicine), we aimed to clarify the feasibility of ME-BLI compared to ME-NBI for the diagnosis of early gastric cancers, using the VS classification (microvascular pattern [MV] and microsurface pattern [MS]) as previously reported by Yao K. et al. (Endoscopy. 2009;41). 81 patients (male: 58, female: 23; Mean age: 70 years old) with early gastric cancer who were diagnosed between September 2011 and August 2012 were enrolled. A total of 85 early gastric cancers (protruded type 39 lesions, depressed type 46
Background: Transition of Natural Orifice Translumenal Endoscopic Surgery (NOTES) from animal lab to clinical practice in humans for many years was hindered by lack of reliable closure of the translumenal entry site into the peritoneal cavity. Aim: To study technical feasibility and safety of full-thickness colonic and gastric resections in a live porcine model and the first clinical experience of NOTES full-thickness organ wall resections in humans. Methods: We performed endoscopic full-thickness resections of gastric and colonic wall in nine 50-kg domestic pigs. After resection the defects in GI tract wall were sutured with Overstitch endoscopic suturing device (Apollo Endosurgery Inc, Austin, TX). Three animals were sacrificed post procedure. Six animals were survived for 14 days and subsequently sacrificed for postmortem examination. Then we performed 2 human cases: 1. Purely endoscopic full-thickness resection of actively bleeding colon cancer. 2. Purely endoscopic full-thickness resection of large gastro-intestinal stromal tumor (GIST). Results: Large (3-5 cm) full-thickness endoscopic resections of gastric (3 animals) and colonic (6 animals) wall were easily achieved using hook knife, IT-knife and polypectomy snare (all made by Olympus, Tokyo, Japan). Suturing with the Overstitch endoscopic suturing device was technically easy and achieved airtight closure of the GI tract in all animals. Postmortem examination revealed good full-thickness healing of the GI tract wall at the sites of resection.After gaining significant experience in endoscopic suturing we performed full-thickness endoscopic resection of actively bleeding colon cancer located at hepatic flexure. The cancer was 2x4 cm and could not be lifted with submucosal injection of normal saline. After endoscopic resection, 4x6 cm full-thickness defect in colonic wall was completely closed with continuous suture line. The patient had no pain post procedure and was discharged home in 3 days. Follow-up endoscopy in 3, 6 and 12 months revealed good healing of colonic wall without any residual cancer or strictures. Then we performed endoscopic resection of 2x5 cm gastric stromal tumor. Resulting full-thickness defect was completely closed with 2 endoscopic sutures. Follow-up endoscopy in 45 days revealed complete healing of the gastric wall defect without any residual GIST tumor. Conclusion: Endoscopic full-thickness resections of GI tract tumors can potentially become another valuable alternative to laparoscopy and open surgery.
AB458 GASTROINTESTINAL ENDOSCOPY Volume 77, No. 5S : 2013
www.giejournal.org