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7075 A new technique for endoscopic polipectomy of the colon.
7075 A NEW TECHNIQUE FOR ENDOSCOPIC POLIPECTOMY OF THE COLON. Marcelo Averbach, Paulo A. Correa, Renato Hassegawa, Raul Cutait, Kiyoshi Hashiba, Hosp Sirio Libanes, Sao Paulo, Brazil. Bleeding is one of the most important complications of endoscopic polipectomy. It may occur during the procedure or some hours or days later. The risk of bleeding is greater in some patients due to the size or shape of the lesion, its location, association of any kind of coagulation disturbance, drugs used by the patient, etc. The aim of this study is to describe a new polipectomy technique (for pedunculated polyps), with previous ligation of the polyp pedicle, using a pre tied and pre cut loop to avoid post polipectomy hemorrhage. During colonoscopy a metallic guide with a loop is passed through the biopsy channel and applied to the pedicle of the polyp. This loop is made using a nylon string where a Roeder knot is previously applied. The fixed limb of this line is partially sectioned, in order to permit its rupture after the knot is firmly tied. Right after that, a conventional polipectomy with a wire snare is performed above the loop ligation. So far, we have used this technique in only five patients with no complications. We believe that this new technique may represent an important help to avoid major bleeding in selected patients.
7077 THROUGH-THE-SCOPE STENT (TTSS) FOR OBSTRUCTIVE NON-ESOPHAGEAL GASTROINTESTINAL TUMORS. Angus Cw Chan, Danny Wh Lee, Enders Kw Ng, Kar L. Leung, Simon Kh Wong, Bonita Kb Law, James Yw Lau, Sydney Sc Chung, Dept of Surg, The Chinese Univ of Hong Kong, Hong Kong, Hong Kong. Background: Endoscopic stenting for duodenal or colorectal obstruction is often more difficult due to the excessive looping of the deployment system inside the dilated stomach or tortuous axis in rectosigmoid colon. Throughthe-scope stent has the advantage of putting the stent via the working channel of the endoscope. We reported our results on through-the-scopestent (TTSS) in palliating obstructive non-esophageal gastrointestinal tumors. Materials and Methods: From Sept 98 to Aug 99, 10 patients (6 male: 4 female, mean age 64, range 35-88) received TTSS for relieving gastrointestinal obstruction. The procedure was performed under intravenous sedation and fluoroscopy. Enteral Wallstents (Schnieder, US Stent Division, USA) with a diameter of 20 or 22mm and 60 or 90mm length were used and delivered over a guidewire through the flexible endoscope with an operating channel of at least 3.7mm. Results: All stents were successfully deployed. The locations of the obstruction were: recto-sigmoid: in 3; descending colon: in 1; antral-pyloric in 3 and duodenum: in 3. All colonic stents relieved the bowel obstruction. Of these 4 colonic stents, one patient required second endoscopy to remove the stent because of persistent tenesmus and bleeding, and one patient received curative surgery for the tumor 2 weeks after stenting. For gastric outlet obstruction, the mean dysphagia score improved from 3.5 to 2 (p=0.02) after stenting. The mean survival and symptom free period was 7.25 weeks (range 0.5 to 16 weeks). One patient required another endoscopy to stop bleeding from tumor overgrowth. Conclusion: TTSS is safe and feasible. It offered a minimal invasive way to palliate obstruction in non-esophageal tumors.
7076 UNSEDATED PERORAL ULTRATHIN VIDEOENDOSCOPYASSISTED DELIVERY OF AN ESOPHAGEAL MANOMETRY CATHETER. G. Balachandar, R. Chennupati, B. Badejo, E. Trowers, Texas Tech Univ Health Sci Ctr, Lubbock, TX. Unsedated endoscopy with an ultrathin scope has several potential advantages over conventional endoscopy due to avoidance of adverse side effects and morbidity associated with sedation. Less intensive patient monitoring and less expense may be additional benefits. We report the first case of an unsedated peroral ultrathin vidco-endoscopy assisted delivery of an esophageal manometry catheter. Case Report: A 77-year-old male was referred for esophageal manometry by his surgeon prior to revision of a Nissen fundoplication which he had undergone two years previously for a large hiatus hernia and gastroesophageal reflux symptoms. A recent upper gastrointestinal series showed that the large hiatus hernia was still present and questionable upper esophegeal dysmotility was also reported. The patient’s complaints of epigastric fullness and inability to take a deep breath were similar to what he had experienced before the fundoplication. The manometry catheter could not be advanced beyond 40 cm from the incisors presumably due to inability to pass through the hiatus hernia. A few days later an unsedated peroral endoscopy using the ultrathin (6 mm in diameter) videoendoscope (Pentax Ultraslim videogastroscope, EG1840, Orangeburg, N.Y.) was performed to guide the manometry catheter into the stomach. A pediatric gastroscope snare was passed through the ultrathin scope to hold the tip of the manometry catheter. Then both the ultrathin endoscope with attached manometry catheter were passed under direct vision into the stomach and the catheter was subsequently disengaged by opening the snare. The patient tolerated the procedure well. Conclusion: This is the first report of an sedated peroral ultrathin videoendoscopy-assisted delivery of an esophageal catheter. This case is an example of how unsedated ultrathin video-endoscopy is a potentially useful technique that can assist in the delivery of diagnostic and/or therapeutic devices.
7078 TRIAL STUDY ON ENDOSCOPIC MUCOSAL RESECTION (EMR) USING A NEWLY DESIGNED SNARE WITH INJECTED NEEDLE CATHETER - PRELIMINARY STUDY. Joo Young Cho, Chang Beom Ryu, Su Jin Hong, Jin Oh Kim, Joon Seong Lee, Moon Sung Lee, Chan Sup Shim, Institute for Digest Research, Soon Chun Hyang Univ, Seoul, South Korea. Backgrounds: The number of early gastric cancer treated by EMR is increasing. Although there are several different techniques for EMR, the principles of all techniques are based on the combination of endoscopic injection technique and snare polypectomy technique. But, various EMR techniques have some disadvantages such as morphologic change of lesion due to saline injection and long procedure time. Methods: We manufactured a newly designed snare with injected needle catheter in EMR. In this randomized trial we performed EMR group using a newly designed snare with injected needle catheter on 12 patients who had gastric flat adenoma, early gastric cancer and compared the results with the group of conventional EMR on 16 patients in the aspects of the time required during EMR and procedure related complications. Results: Mean time for EMR procedure was 3.25 ± 1.15 min(01’35-08’25) and 8.15 ± 2.35 min(02’27-25’35) in EMR group using a newly designed snare with injected needle catheter and conventional EMR group, respectively.(P<0.05) No serious complications occurred in both groups. Conclusions: The newly designed snare with injected needle catheter may be considered as a new relatively simple, safe, and easy technique in EMR. However, further clinical evaluation and more technical improvements in a newly designed snare with injected needle catheter will be needed.
VOLUME 51, NO. 4, PART 2, 2000
GASTROINTESTINAL ENDOSCOPY
AB261
7077 THROUGH-THE-SCOPE STENT (TTSS) FOR OBSTRUCTIVE NON-ESOPHAGEAL GASTROINTESTINAL TUMORS. Angus Cw Chan, Danny Wh Lee, Enders Kw Ng, Kar L. Leung, Simon Kh Wong, Bonita Kb Law, James Yw Lau, Sydney Sc Chung, Dept of Surg, The Chinese Univ of Hong Kong, Hong Kong, Hong Kong. Background: Endoscopic stenting for duodenal or colorectal obstruction is often more difficult due to the excessive looping of the deployment system inside the dilated stomach or tortuous axis in rectosigmoid colon. Throughthe-scope stent has the advantage of putting the stent via the working channel of the endoscope. We reported our results on through-the-scopestent (TTSS) in palliating obstructive non-esophageal gastrointestinal tumors. Materials and Methods: From Sept 98 to Aug 99, 10 patients (6 male: 4 female, mean age 64, range 35-88) received TTSS for relieving gastrointestinal obstruction. The procedure was performed under intravenous sedation and fluoroscopy. Enteral Wallstents (Schnieder, US Stent Division, USA) with a diameter of 20 or 22mm and 60 or 90mm length were used and delivered over a guidewire through the flexible endoscope with an operating channel of at least 3.7mm. Results: All stents were successfully deployed. The locations of the obstruction were: recto-sigmoid: in 3; descending colon: in 1; antral-pyloric in 3 and duodenum: in 3. All colonic stents relieved the bowel obstruction. Of these 4 colonic stents, one patient required second endoscopy to remove the stent because of persistent tenesmus and bleeding, and one patient received curative surgery for the tumor 2 weeks after stenting. For gastric outlet obstruction, the mean dysphagia score improved from 3.5 to 2 (p=0.02) after stenting. The mean survival and symptom free period was 7.25 weeks (range 0.5 to 16 weeks). One patient required another endoscopy to stop bleeding from tumor overgrowth. Conclusion: TTSS is safe and feasible. It offered a minimal invasive way to palliate obstruction in non-esophageal tumors.
7076 UNSEDATED PERORAL ULTRATHIN VIDEOENDOSCOPYASSISTED DELIVERY OF AN ESOPHAGEAL MANOMETRY CATHETER. G. Balachandar, R. Chennupati, B. Badejo, E. Trowers, Texas Tech Univ Health Sci Ctr, Lubbock, TX. Unsedated endoscopy with an ultrathin scope has several potential advantages over conventional endoscopy due to avoidance of adverse side effects and morbidity associated with sedation. Less intensive patient monitoring and less expense may be additional benefits. We report the first case of an unsedated peroral ultrathin vidco-endoscopy assisted delivery of an esophageal manometry catheter. Case Report: A 77-year-old male was referred for esophageal manometry by his surgeon prior to revision of a Nissen fundoplication which he had undergone two years previously for a large hiatus hernia and gastroesophageal reflux symptoms. A recent upper gastrointestinal series showed that the large hiatus hernia was still present and questionable upper esophegeal dysmotility was also reported. The patient’s complaints of epigastric fullness and inability to take a deep breath were similar to what he had experienced before the fundoplication. The manometry catheter could not be advanced beyond 40 cm from the incisors presumably due to inability to pass through the hiatus hernia. A few days later an unsedated peroral endoscopy using the ultrathin (6 mm in diameter) videoendoscope (Pentax Ultraslim videogastroscope, EG1840, Orangeburg, N.Y.) was performed to guide the manometry catheter into the stomach. A pediatric gastroscope snare was passed through the ultrathin scope to hold the tip of the manometry catheter. Then both the ultrathin endoscope with attached manometry catheter were passed under direct vision into the stomach and the catheter was subsequently disengaged by opening the snare. The patient tolerated the procedure well. Conclusion: This is the first report of an sedated peroral ultrathin videoendoscopy-assisted delivery of an esophageal catheter. This case is an example of how unsedated ultrathin video-endoscopy is a potentially useful technique that can assist in the delivery of diagnostic and/or therapeutic devices.
7078 TRIAL STUDY ON ENDOSCOPIC MUCOSAL RESECTION (EMR) USING A NEWLY DESIGNED SNARE WITH INJECTED NEEDLE CATHETER - PRELIMINARY STUDY. Joo Young Cho, Chang Beom Ryu, Su Jin Hong, Jin Oh Kim, Joon Seong Lee, Moon Sung Lee, Chan Sup Shim, Institute for Digest Research, Soon Chun Hyang Univ, Seoul, South Korea. Backgrounds: The number of early gastric cancer treated by EMR is increasing. Although there are several different techniques for EMR, the principles of all techniques are based on the combination of endoscopic injection technique and snare polypectomy technique. But, various EMR techniques have some disadvantages such as morphologic change of lesion due to saline injection and long procedure time. Methods: We manufactured a newly designed snare with injected needle catheter in EMR. In this randomized trial we performed EMR group using a newly designed snare with injected needle catheter on 12 patients who had gastric flat adenoma, early gastric cancer and compared the results with the group of conventional EMR on 16 patients in the aspects of the time required during EMR and procedure related complications. Results: Mean time for EMR procedure was 3.25 ± 1.15 min(01’35-08’25) and 8.15 ± 2.35 min(02’27-25’35) in EMR group using a newly designed snare with injected needle catheter and conventional EMR group, respectively.(P<0.05) No serious complications occurred in both groups. Conclusions: The newly designed snare with injected needle catheter may be considered as a new relatively simple, safe, and easy technique in EMR. However, further clinical evaluation and more technical improvements in a newly designed snare with injected needle catheter will be needed.
VOLUME 51, NO. 4, PART 2, 2000
GASTROINTESTINAL ENDOSCOPY
AB261