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Sa1528 Efficacy and Curability of Retroflexion−Assisted EMR(R-EMR) for Large LSTS in Low Rectum
Abstracts
cancer (EGC) and investigated the incidence and patterns of recurrence in patients who underwent non-curative endoscopic resection without additional treatment for differentiated EGC. Patients and Methods: We performed a retrospective review of prospectively and consecutively collected database of differentiated EGCs undergone noncurative endoscopic resection without additional treatment for EGCs from April 2000 to June 2011. Results: A total of 345 patients underwent noncurative endoscopic resection for 347 differentiated EGCs. Patients without additional treatment tended to be older (median age 70 years vs. 63 years, p!0.01). They underwent additional surgery in 232 EGCs, additional ER in 12 EGCs, and additional APC in 7 EGCS. Ninety six patients (97 EGCS) didn’t undergo additional treatment. Among 29 EGCs with positive resection margin, seven EGCs revealed remained lesion in the follow up endoscopic biopsy. Among 97 EGCs without additional treatment, extragastric recurrence occurred in five EGC cases at mean 32 months (range 25-40 months), and all of them initially had lymphovascular invasion (LVI) or deep submucosal (SM) invasion (Figure 1). Among 250 EGCs with additional treatment, extragastric recurrence occurred only in one case at 20 months after additional surgery. The median follow up period was 32 months (range 0-99.7 months). The overall 5-year survival rate was 94.7 % in the no additional treatment group and 97.8% in the additional treatment group. Of 347 patients, nine patients died during follow up period. Among them, two patients died of stomach cancer. Conclusions: Recurrence rates was higher in patients without additional treatment than in patients with additional surgery (6.2% vs. 0.4%). Recurrence mainly occurred in patients with lymphovascular invasion (LVI) and submucosal (SM) invasion. Therefore additional treatment should be considered in patients with LVI and SM invasion among patients undergone noncurative endoscopic resection for EGC. The overall survival rates between patients with and without additional surgery after non-curative endoscopic resection for EGC were not significantly different. Therefore, in elderly patients at high risk for surgery, conservative strategy with intensive surveillance could be considered.
A, Observation of reversal endoscopy in rectum, the inferior margin of the tumor was adjacent to the pectinate line; B, NBI observation showed the surface of the tumor with villus granular structure; C, After R-EMR,the tumor was resected completely and themuscularis vessel without injury; D, Gross observation of the operative specimen after R-EMR; E, The low-power pathological findings of the specimen resected by salvage R-EMR indicate adenoma; (hematoxylin and eosin stain); F,12 months after the R-EMR resection, there was forming asmooth scar of the resection ulcer base. Sa1529 Effectiveness of Cleaning Flexible Gastrointestinal Endoscopes LúCia H. Tomiato*, Claudio S. Coy Gastrocenter, Unicamp, Campinas, Brazil
Sa1528 Efficacy and Curability of RetroflexionLAssisted EMR(R-EMR) for Large LSTS in Low Rectum Yang Haiyun, Deng Lijuan, Li Aimin, Yan Qun, Zhong Jietao, Wan Tianmo, Zhou Dan, Liu Side* Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China Background: The low rectal large laterally spreading tumor(O3 cm) from the pectinate line within 2 cm, is difficult to completly resected by either conventional EMR or TEM, which usually needs to choose the surgical operation (Mile ’s operation). Objective: To describe efficacy and curability of retroflexion assisted EMR(R-EMR) for large LSTs in low rectum. Design: Retrospective study. Setting: Tertiary referral academic gastroenterology unit. Patients: Sixty two patients who were referred to R-EMR treatment for large LSTs in low rectum between April 2004 and December 2008. Intervention: R-EMR or EMR was used. Curative surgical resection was used in cases that invasive cancer was confirmed by pathological examination. Main Outcome Measurements: Technical success, rate of complete resection, complications, length of procedure and recurrence. Results: For the treatment of R-EMR in 18 cases, the average time was 46.411.2 minutes; 16 in 18 patients with first or secondary R-EMR treatment had reached both elimination of lesion and maintaining the physiological entirety of anal, in which cases the preserving the cure rate was 88.8%. One case comfired as invasive cancer (cancer SM) by postoperative pathology was referred to additional surgical radical treatment (5.6%); One patient need abdominoperineal operation due to residual tumor(5.6%). Complications: The maximum hemorrhage of all 18 cases was 160 ml and one need anal mirror assisted suture(5.6%). None of 18 patients had perforation. Limitations: Retrospective design and limited cases at a single center. Conclusions: R-EMR is feasible and could be an effective option for the treatment of large LSTs in low rectum.
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Background: Successful reprocessing is dependent on adequate cleaning prior High Level Disinfection. If cleaning is inadequate, residual organic debris consisting of microorganisms and patient secretions may remain on surface and within channels. It is difficult to clean endoscopes because it is hard to see what is inside their channels. One approach that has recently been adapted to monitor flexible endoscopes is the use of adenosine triphosphate (ATP) as a measure of cleaning adequacy. Using the ATP evaluation makes it possible to evaluate the cleaning of the endoscope because it measures the level of proteins found in the rinsed water from its channels. The ATP indicates the amount of organic macrobiotic contamination. The test is based on bioluminescent reaction; the more ATP there is the more light is produced and with it higher relative light unit (RLU) values. Controlling the ATP dose can be used as an adequate method for controlling the reprocessing of endoscopes which in return will reduce the risk of infection. Objective: Evaluate cleaning procedures with Adenosine Triphosfate bioluminescence method. Compare the ATP values of gastroscopes, colonoscopes and duodenoscopes after manual cleaning. Method: We collected samples from gastrocopes, colonoscopes and duodenoscopes after manually cleaning the endoscopes by injecting 20 mLs of reverse osmosis water with syringe in the air/water and biopsy channels in sterile cubes. The cleaning protocol used was immersion in heated enzymatic detergent as instructed by manufacturer; three times brushing of internal channels; reverse osmosis water rinsing with 200 mLs per channel. We followed the manufacturer s instructions and measured the results by detecting ATP using 3M’s bioluminescent Clean-Trace ATP Test. We use the manual cleaning benchmarks for flexible endoscope channels as established by Alfa et al. If manual cleaning has been adequate, then there should be ! 200 RLUs by the Clean Trace ATP test. To estimate the effectiveness of the cleaning we used the median and its intervels of confidence of 95%. Results: The results we found using the median were 566.50 RLU for gastroscopes, 43.50 RLU for colonoscopes and 125 RLU duodenoscopes. Conclusion: Values found in colonoscopes and duodenoscopes are correspondent to the manual cleaning benchmarks for flexible endoscopes . New studies should be done to evaluate the high levels values found in gastroscopes.
Sa1530 Safety of Endoscopy Following Acute Coronary Syndrome: a Systematic Review Alastair Dorreen*1, Sarvenaz Moosavi2, Myriam Martel3, Alan N. Barkun2,3 1 Department of Internal Medicine, McGill University, Jewish General Hospital, Montreal, QC, Canada; 2Gastroenterology, McGill University, The Montreal General Hospital, GI Division, Montreal, QC, Canada; 3 Epidemiology and Biostatistics and Occupational Health, McGill University Health Center, Montreal, QC, Canada Aims: The safety of endoscopy shortly after an acute coronary syndrome (ACS) has been poorly characterized. Following ACS, patients are at increased risk of cardiopulmonary sequelae, which may be compounded by the physiologic stress
Volume 79, No. 5S : 2014 GASTROINTESTINAL ENDOSCOPY AB245
cancer (EGC) and investigated the incidence and patterns of recurrence in patients who underwent non-curative endoscopic resection without additional treatment for differentiated EGC. Patients and Methods: We performed a retrospective review of prospectively and consecutively collected database of differentiated EGCs undergone noncurative endoscopic resection without additional treatment for EGCs from April 2000 to June 2011. Results: A total of 345 patients underwent noncurative endoscopic resection for 347 differentiated EGCs. Patients without additional treatment tended to be older (median age 70 years vs. 63 years, p!0.01). They underwent additional surgery in 232 EGCs, additional ER in 12 EGCs, and additional APC in 7 EGCS. Ninety six patients (97 EGCS) didn’t undergo additional treatment. Among 29 EGCs with positive resection margin, seven EGCs revealed remained lesion in the follow up endoscopic biopsy. Among 97 EGCs without additional treatment, extragastric recurrence occurred in five EGC cases at mean 32 months (range 25-40 months), and all of them initially had lymphovascular invasion (LVI) or deep submucosal (SM) invasion (Figure 1). Among 250 EGCs with additional treatment, extragastric recurrence occurred only in one case at 20 months after additional surgery. The median follow up period was 32 months (range 0-99.7 months). The overall 5-year survival rate was 94.7 % in the no additional treatment group and 97.8% in the additional treatment group. Of 347 patients, nine patients died during follow up period. Among them, two patients died of stomach cancer. Conclusions: Recurrence rates was higher in patients without additional treatment than in patients with additional surgery (6.2% vs. 0.4%). Recurrence mainly occurred in patients with lymphovascular invasion (LVI) and submucosal (SM) invasion. Therefore additional treatment should be considered in patients with LVI and SM invasion among patients undergone noncurative endoscopic resection for EGC. The overall survival rates between patients with and without additional surgery after non-curative endoscopic resection for EGC were not significantly different. Therefore, in elderly patients at high risk for surgery, conservative strategy with intensive surveillance could be considered.
A, Observation of reversal endoscopy in rectum, the inferior margin of the tumor was adjacent to the pectinate line; B, NBI observation showed the surface of the tumor with villus granular structure; C, After R-EMR,the tumor was resected completely and themuscularis vessel without injury; D, Gross observation of the operative specimen after R-EMR; E, The low-power pathological findings of the specimen resected by salvage R-EMR indicate adenoma; (hematoxylin and eosin stain); F,12 months after the R-EMR resection, there was forming asmooth scar of the resection ulcer base. Sa1529 Effectiveness of Cleaning Flexible Gastrointestinal Endoscopes LúCia H. Tomiato*, Claudio S. Coy Gastrocenter, Unicamp, Campinas, Brazil
Sa1528 Efficacy and Curability of RetroflexionLAssisted EMR(R-EMR) for Large LSTS in Low Rectum Yang Haiyun, Deng Lijuan, Li Aimin, Yan Qun, Zhong Jietao, Wan Tianmo, Zhou Dan, Liu Side* Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China Background: The low rectal large laterally spreading tumor(O3 cm) from the pectinate line within 2 cm, is difficult to completly resected by either conventional EMR or TEM, which usually needs to choose the surgical operation (Mile ’s operation). Objective: To describe efficacy and curability of retroflexion assisted EMR(R-EMR) for large LSTs in low rectum. Design: Retrospective study. Setting: Tertiary referral academic gastroenterology unit. Patients: Sixty two patients who were referred to R-EMR treatment for large LSTs in low rectum between April 2004 and December 2008. Intervention: R-EMR or EMR was used. Curative surgical resection was used in cases that invasive cancer was confirmed by pathological examination. Main Outcome Measurements: Technical success, rate of complete resection, complications, length of procedure and recurrence. Results: For the treatment of R-EMR in 18 cases, the average time was 46.411.2 minutes; 16 in 18 patients with first or secondary R-EMR treatment had reached both elimination of lesion and maintaining the physiological entirety of anal, in which cases the preserving the cure rate was 88.8%. One case comfired as invasive cancer (cancer SM) by postoperative pathology was referred to additional surgical radical treatment (5.6%); One patient need abdominoperineal operation due to residual tumor(5.6%). Complications: The maximum hemorrhage of all 18 cases was 160 ml and one need anal mirror assisted suture(5.6%). None of 18 patients had perforation. Limitations: Retrospective design and limited cases at a single center. Conclusions: R-EMR is feasible and could be an effective option for the treatment of large LSTs in low rectum.
www.giejournal.org
Background: Successful reprocessing is dependent on adequate cleaning prior High Level Disinfection. If cleaning is inadequate, residual organic debris consisting of microorganisms and patient secretions may remain on surface and within channels. It is difficult to clean endoscopes because it is hard to see what is inside their channels. One approach that has recently been adapted to monitor flexible endoscopes is the use of adenosine triphosphate (ATP) as a measure of cleaning adequacy. Using the ATP evaluation makes it possible to evaluate the cleaning of the endoscope because it measures the level of proteins found in the rinsed water from its channels. The ATP indicates the amount of organic macrobiotic contamination. The test is based on bioluminescent reaction; the more ATP there is the more light is produced and with it higher relative light unit (RLU) values. Controlling the ATP dose can be used as an adequate method for controlling the reprocessing of endoscopes which in return will reduce the risk of infection. Objective: Evaluate cleaning procedures with Adenosine Triphosfate bioluminescence method. Compare the ATP values of gastroscopes, colonoscopes and duodenoscopes after manual cleaning. Method: We collected samples from gastrocopes, colonoscopes and duodenoscopes after manually cleaning the endoscopes by injecting 20 mLs of reverse osmosis water with syringe in the air/water and biopsy channels in sterile cubes. The cleaning protocol used was immersion in heated enzymatic detergent as instructed by manufacturer; three times brushing of internal channels; reverse osmosis water rinsing with 200 mLs per channel. We followed the manufacturer s instructions and measured the results by detecting ATP using 3M’s bioluminescent Clean-Trace ATP Test. We use the manual cleaning benchmarks for flexible endoscope channels as established by Alfa et al. If manual cleaning has been adequate, then there should be ! 200 RLUs by the Clean Trace ATP test. To estimate the effectiveness of the cleaning we used the median and its intervels of confidence of 95%. Results: The results we found using the median were 566.50 RLU for gastroscopes, 43.50 RLU for colonoscopes and 125 RLU duodenoscopes. Conclusion: Values found in colonoscopes and duodenoscopes are correspondent to the manual cleaning benchmarks for flexible endoscopes . New studies should be done to evaluate the high levels values found in gastroscopes.
Sa1530 Safety of Endoscopy Following Acute Coronary Syndrome: a Systematic Review Alastair Dorreen*1, Sarvenaz Moosavi2, Myriam Martel3, Alan N. Barkun2,3 1 Department of Internal Medicine, McGill University, Jewish General Hospital, Montreal, QC, Canada; 2Gastroenterology, McGill University, The Montreal General Hospital, GI Division, Montreal, QC, Canada; 3 Epidemiology and Biostatistics and Occupational Health, McGill University Health Center, Montreal, QC, Canada Aims: The safety of endoscopy shortly after an acute coronary syndrome (ACS) has been poorly characterized. Following ACS, patients are at increased risk of cardiopulmonary sequelae, which may be compounded by the physiologic stress
Volume 79, No. 5S : 2014 GASTROINTESTINAL ENDOSCOPY AB245