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Mo1532 Feasibility and Usefullness of Application of Oxidized Cellulose (Surgicell) to Treat and Prevent Hemorrhage After Large Endosocpic Colorectal Resections
Abstracts
Mo1532 Feasibility and Usefullness of Application of Oxidized Cellulose (Surgicell) to Treat and Prevent Hemorrhage After Large Endosocpic Colorectal Resections Seiichiro Abe*1,2, Ivan Jovanovic2, Helmut Neumann2, Yutaka Saito1, Monkemuller Klaus2 1 Endoscopy, National Cancer Center, Tokyo, Japan; 2Basil I. Hirschowitz Endoscopic Center of Excellence, University of Alabama, Birmingham, AL Background: The most common complication of endoscopic resection (ER) of large colorectal polyps is bleeding, especially in patients who must continue anticoagulation medications for thrombophilic or cardiovascular disorders. Oxidized cellulose (OC) mesh (SurgicellÒ) is a well-known and widely available surgical hemostatic agent. OC, which has bactericidal activity, exerts its effect as a tissue-apposing device. OC is used to stop bleeding from liver lacerations, gynecological surgery and in neurosurgical interventions. Therefore, it use in endoluminal GI interventions is appealing. Aim: To evaluate the feasibility of endoscopic application of OC and the hemostatic efficacy after endoscopic resection (endoscopic submucosal dissection or piecemeal endoscopic mucosal resection). Materials and Methods: Retrospective, observational, open label, single-center study of patients undergoing endoscopic resection of large rectal and rectosigmoid lesions. After the colorectal epithelial neoplasm removed, OC was applied onto the submucosal surface using one of two methods: a) anoscope or cap-assisted delivery. In both techniques, a hemoclip was advanced through the working channel of the scope and 10 x 10 to 20 x 20 mm large pieces of the OC were grasped with the clip and then delivered and attached to the wound. Results: A total of 12 patients (8 male, 4 female, mean age 64, range 48 to 87) underwent endoscopic resection (ESD, nZ8 or piecemeal EMR, nZ4) of large rectum or rectosigmoid lesions with either primary intent of complete resection or debulking (in the case of large mucin-secreting rectal tumors). All patients were on anticoagulants and/or antiplatelet agents. The mean size of the lesions was 40 mm, range 30 to 120 mm. An endoscopic R0 was achieved in 75%. (50.0%) underwent the SurgicellÒ application. During follow-up period there were no rectal bleeding episodes or adverse events, despite patients continuing on anticoagulant therapy. Conclusions: OC can be successfully applied to large resection sites using the capassisted or anoscope techniques. OC effectively decreases hemorrhage and prevents post-endoscopic resection bleeding. Thus, this feasibility study suggests that OC may be a valuable tool to provide hemostasis and prevent bleeding after ESD. Now prospective and randomized studies are warranted.
Mo1533 Endoscopic Treatment of Large Esophageal Diverticula Using a Magnetic Anastomosis Device: Report of Three Cases Simon Bouchard*, Vincent Huberty, Daniel Blero, Jacques M. Deviere Gastroenterology, Erasme Hospital, Anderlecht, Belgium Introduction: Symptoms of esophageal diverticula can be particularly disabilitating, especiallyin patients with large diverticula. Nowadays, Zenker’s Diverticulum can be treated byflexible endoscopy. Aim: Magnets could possibly have a role in treating patients with large esophageal diverticula bycreating a magnetic compression anastomosis between the base of the diverticulum and theesophagus and allowing full marsupialization by completing the section of the septum. Methods: A first magnet is mounted on a catheter and advanced over a guidewire intothe stomach. The endoscope is introduced in the esophagus with the second magnet alreadyattached at the tip of the endoscope. After this magnet has been placed at the base of thediverticulum, the magnet in the stomach is slowly pulled back under fluoroscopic and endoscopicguidance until the two magnets mate. The magnets are then left in place for 7-14 days to allowtime for a complete magnetic compression anastomosis to occur. During a second endoscopic procedure, the magnets are removed. A large communicationbetween the base of the diverticulum and the esophagus is now visible. Using a diathermicblade, the septum between the diverticulum and the esophagus is progressively cut, thus completingthe diverticulotomy. Results: The first patient had a Zenker’s diverticulum unsuccessfully treated with three endoscopicsessions. Then a magnetic compression anastomosis was performed and a partial section of theseptum between the diverticulum and the esophagus was done. One week later, the magnetswere retrieved from the base of the diverticulum and the remaining septum was cut. A bariumswallow performed a month later demonstrated complete passage of barium in the stomach. The second patient had a longstanding history of a large mid-esophageal pulsion diverticulum. During an initial EGD, magnets were successfully placed. 10 days later, the magnets were easilyretrieved and the remaining septum was cut. One month later, the patient presented a completeresolution of symptoms and is still asymptomatic at 5 months.Our last patient had a 10-month history of retrosternal discomfort associated with developmentof dysphagia. A barium swallow revealed a large 4 cm deep diverticulum of the loweresophagus. During an initial endoscopic procedure, the magnets were placed. 13 days later,another gastroscopy showed the magnets-induced communication.
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The magnets were retrievedand the remaining septum was completely cut. One month later, the dysphagia has significantlyimproved. Conclusions: We reported the first series of patients with esophageal diverticula treated bycreation of a magnetic compression anastomosis followed by an endoscopic diverticulotomy. This approach seems promising for the treatment of selected patients with large esophagealdiverticula.
Endoscopic view of the final position of the two magnets, with one magnet at the base of the diverticulum and the other at the opposite side of the septum, in the esophagus
Ten days following their endoscopic placement, the magnets have joined together and migrated into the diverticulum.
Volume 81, No. 5S : 2015 GASTROINTESTINAL ENDOSCOPY AB455
Mo1532 Feasibility and Usefullness of Application of Oxidized Cellulose (Surgicell) to Treat and Prevent Hemorrhage After Large Endosocpic Colorectal Resections Seiichiro Abe*1,2, Ivan Jovanovic2, Helmut Neumann2, Yutaka Saito1, Monkemuller Klaus2 1 Endoscopy, National Cancer Center, Tokyo, Japan; 2Basil I. Hirschowitz Endoscopic Center of Excellence, University of Alabama, Birmingham, AL Background: The most common complication of endoscopic resection (ER) of large colorectal polyps is bleeding, especially in patients who must continue anticoagulation medications for thrombophilic or cardiovascular disorders. Oxidized cellulose (OC) mesh (SurgicellÒ) is a well-known and widely available surgical hemostatic agent. OC, which has bactericidal activity, exerts its effect as a tissue-apposing device. OC is used to stop bleeding from liver lacerations, gynecological surgery and in neurosurgical interventions. Therefore, it use in endoluminal GI interventions is appealing. Aim: To evaluate the feasibility of endoscopic application of OC and the hemostatic efficacy after endoscopic resection (endoscopic submucosal dissection or piecemeal endoscopic mucosal resection). Materials and Methods: Retrospective, observational, open label, single-center study of patients undergoing endoscopic resection of large rectal and rectosigmoid lesions. After the colorectal epithelial neoplasm removed, OC was applied onto the submucosal surface using one of two methods: a) anoscope or cap-assisted delivery. In both techniques, a hemoclip was advanced through the working channel of the scope and 10 x 10 to 20 x 20 mm large pieces of the OC were grasped with the clip and then delivered and attached to the wound. Results: A total of 12 patients (8 male, 4 female, mean age 64, range 48 to 87) underwent endoscopic resection (ESD, nZ8 or piecemeal EMR, nZ4) of large rectum or rectosigmoid lesions with either primary intent of complete resection or debulking (in the case of large mucin-secreting rectal tumors). All patients were on anticoagulants and/or antiplatelet agents. The mean size of the lesions was 40 mm, range 30 to 120 mm. An endoscopic R0 was achieved in 75%. (50.0%) underwent the SurgicellÒ application. During follow-up period there were no rectal bleeding episodes or adverse events, despite patients continuing on anticoagulant therapy. Conclusions: OC can be successfully applied to large resection sites using the capassisted or anoscope techniques. OC effectively decreases hemorrhage and prevents post-endoscopic resection bleeding. Thus, this feasibility study suggests that OC may be a valuable tool to provide hemostasis and prevent bleeding after ESD. Now prospective and randomized studies are warranted.
Mo1533 Endoscopic Treatment of Large Esophageal Diverticula Using a Magnetic Anastomosis Device: Report of Three Cases Simon Bouchard*, Vincent Huberty, Daniel Blero, Jacques M. Deviere Gastroenterology, Erasme Hospital, Anderlecht, Belgium Introduction: Symptoms of esophageal diverticula can be particularly disabilitating, especiallyin patients with large diverticula. Nowadays, Zenker’s Diverticulum can be treated byflexible endoscopy. Aim: Magnets could possibly have a role in treating patients with large esophageal diverticula bycreating a magnetic compression anastomosis between the base of the diverticulum and theesophagus and allowing full marsupialization by completing the section of the septum. Methods: A first magnet is mounted on a catheter and advanced over a guidewire intothe stomach. The endoscope is introduced in the esophagus with the second magnet alreadyattached at the tip of the endoscope. After this magnet has been placed at the base of thediverticulum, the magnet in the stomach is slowly pulled back under fluoroscopic and endoscopicguidance until the two magnets mate. The magnets are then left in place for 7-14 days to allowtime for a complete magnetic compression anastomosis to occur. During a second endoscopic procedure, the magnets are removed. A large communicationbetween the base of the diverticulum and the esophagus is now visible. Using a diathermicblade, the septum between the diverticulum and the esophagus is progressively cut, thus completingthe diverticulotomy. Results: The first patient had a Zenker’s diverticulum unsuccessfully treated with three endoscopicsessions. Then a magnetic compression anastomosis was performed and a partial section of theseptum between the diverticulum and the esophagus was done. One week later, the magnetswere retrieved from the base of the diverticulum and the remaining septum was cut. A bariumswallow performed a month later demonstrated complete passage of barium in the stomach. The second patient had a longstanding history of a large mid-esophageal pulsion diverticulum. During an initial EGD, magnets were successfully placed. 10 days later, the magnets were easilyretrieved and the remaining septum was cut. One month later, the patient presented a completeresolution of symptoms and is still asymptomatic at 5 months.Our last patient had a 10-month history of retrosternal discomfort associated with developmentof dysphagia. A barium swallow revealed a large 4 cm deep diverticulum of the loweresophagus. During an initial endoscopic procedure, the magnets were placed. 13 days later,another gastroscopy showed the magnets-induced communication.
www.giejournal.org
The magnets were retrievedand the remaining septum was completely cut. One month later, the dysphagia has significantlyimproved. Conclusions: We reported the first series of patients with esophageal diverticula treated bycreation of a magnetic compression anastomosis followed by an endoscopic diverticulotomy. This approach seems promising for the treatment of selected patients with large esophagealdiverticula.
Endoscopic view of the final position of the two magnets, with one magnet at the base of the diverticulum and the other at the opposite side of the septum, in the esophagus
Ten days following their endoscopic placement, the magnets have joined together and migrated into the diverticulum.
Volume 81, No. 5S : 2015 GASTROINTESTINAL ENDOSCOPY AB455