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Sa1523 Endoscopic Resection of Large Sporadic Non-Ampullary Duodenal Polyps- Efficacy and Long-Term Recurrence
Abstracts
Sa1523 Endoscopic Resection of Large Sporadic Non-Ampullary Duodenal Polyps- Efficacy and Long-Term Recurrence Udayakumar Navaneethan*, Vennisvasanth Lourdusamy, Dennisdhilak Lourdusamy, Dhruv Mehta, Preethi GK. Venkatesh, Madhusudhan R. Sanaka Gastroenterology, The Cleveland Clinic, Cleveland, OH Background: Endoscopic resection is an alternative to surgery for removal of large duodenalpolyps. There is limited data on the safety, efficacy, and long term recurrence data afterendoscopic resection of sporadic, non-ampullary, large duodenal polyps. Objective: Our aim was to evaluate the safety and short term outcomes of the endoscopicremoval of the large sporadic duodenal polyps and to determine long-term risk of recurrence and factors predicting recurrence on follow-up. Methods: Patients with large (O 10 mm) sporadic nonampullary duodenal polyps whounderwent endoscopic resection from 2001 to 2012 at the Cleveland Clinic. Patients underwent endoscopic polypectomy, and argon plasma coagulation. The main outcome measurements were complete polypectomy, complications, short and longterm recurrence. Results: A total of 54 patients were included. The mean patient age was 66.4 years. Themean polyp size was 15.1 mm 5.4 mm. Most polyps (NZ48, 88.9%) were sessile polyps. The median follow-up time was 10.8 (range 0.5-120) months. Most lesions were located inthe second part of the duodenum (NZ41, 75.9%). Adenomas were found in 46 (85.2%) oflesions overall. Tubular adenoma was the most common histology type found in 33 cases(71.7%). Tubulovillous and villous was found in 12(26.1%) and 1(2.2%) cases respectively. On follow-up, 50 (92.6%) achieved complete resection with tumor free margins postresection. The 30-day risk of major complications was 5.6% (NZ3), 1 with perforation and 2with delayed bleeding. Recurrence was documented in 29% (NZ16) of patients. Allrecurrences were managed endoscopically except for one patient who required surgery. The recurrence rate was higher for patients who had villous component in their adenomas compared to those with tubular alone (p Z 0.03). Conclusions: Endoscopic resection is effective for treating large duodenal adenomas. Adenomas with villous features are more likely to recur. Almost all recurrences can bemanaged endoscopically.
Sa1524 Correlation of Healing Type of Gastric Ulceration and Recurrence in Gastric Neoplastic Lesions After Endoscopic Submucosal Dissection Seok Reyol Choi* Dong- A University, Busan, Republic of Korea Background: Endoscopic submucosal dissection (ESD) is common treatment modality for gastric neoplasm, especially early gastric cancer. However, compared to surgical resection, local recurrence can be problem. We investigated correlation between recurrence after ESD and risk factors, especially about healing types of lesion. Methods: The patients who had gastric neoplasm, were enrolled between April 2010 and January 2012. We performed endoscopy at 1st, 6th, 12th months to investigate the local recurrence. We also examined the risk factors of recurrence, for example, age, location, tumor size, diagnosis, and healing type of lesion and divided into 3 groups; hypertrophic polypoid, scar and nodular lesion for healing. Results: We enrolled 293 patients and couldn’t find significant correlation between sex, age, size, location of tumor, and diagnosis with recurrence. Healing types of lesions were 9 hypertrophic polypoids (6.4%), 122 scars (86.5%), 10 nodular lesions (7.1%). 8 patients were recurred, including 1 hypertrophic polypoid, 2 scars, 5 nodular lesions. And nodular changes were statistically significant healing type correlated with recurrence (pZ0.000). Conclusion: Although most common healing type was scar, most type of recurrence was nodular lesion. Therefore, we should perform endoscopy with biopsy more carefully, when the lesion has nodular change after ESD.
Sa1525 Preliminary Results of Endoscopic Submucosal Tunnel Dissection for Gastric Submucosal Tumors Originated From Muscularis Propria Ho Kim*1, Jung Wan Choe1, Moon Kyung Joo1, Beom Jae Lee1, Jong-Jae Park1, Jae Seon Kim1, Young-Tae Bak1, Hoon Jai Chun1, Sang Woo Lee1, You-Jin Jang2 1 Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea; 2Surgery, Korea University College of Medicine, Seoul, Republic of Korea Objective: Resection of submucosal tumors (SMTs) would aid in establishing the diagnosis and may be curative. Although ESD is regarded recently as minimally invasive resection methods for SMTs, it can be associated with the complications of strictures and perforations. But endoscopic submucosal tunnel dissection (ESTD) can maintain the gastrointestinal tract mucosa integrity and be closed more easily by endoclips compared with ESD. So, we aim to present the effectiveness and safety of a novel ESTD method for resection of gastrointestinal SMTs originating from the muscularis propria (MP). Patients and Methods: In 8 patients who presented with a
AB244 GASTROINTESTINAL ENDOSCOPY Volume 79, No. 5S : 2014
gastric SMT, we underwent submucosal tunnelling endoscopic resection under general anesthesia from Jan. 2011 to Jan. 2013. A submucosal tunnel was endoscopically created by starting approximately 4cm distant to the lesion. After careful submucosal dissection of the tumor from the surrounding submucosal tissue and the unaffected MP layer, the SMTs were completely removed by the technique of endoscopic submucosal dissection or full thickness resection including serosa layer. The mucosal entrance of the tunnel was closed using endoclips after the tumor was removed. Results: SMTs had a mean size of 21.1mm (range 17-25mm); 4 were located in the antrum, 3 in the body and 1 in the cardia. SMT resection was successful in all patients with en-bloc resection 100% rate. (6 lesions affected the deep MP, so complete MP and serosa resection with intentional peritoneal perforation was performed; 2 lesions affected the superficial MP for a partial MP resection). The average procedure time was 66.1 minutes (range 40-80minutes). The endoscopic procedure was converted into laparoscopic surgery in three patients among 6 patients with peritoneal perforation. Two patients had lost the full thickness resected sample in the peritoneal space. Abdominal pain and distension persisted and low grade fever developed in the other one. The other five patients had no any complications such as delayed hemorrhage and chronic fistula after then. No residual tumor or tumor recurrence were detected during the follow-up period (mean: 4.5 months, range: 3-9 months). Pathological diagnoses of these tumors were low risk gastrointestinal stromal tumors(6/8), a schwannoma (1/8), and a etopic pancreas (1/8). Conclusion: In this study, ESTD is feasible endoscopic procedure to remove submucosal tumors originating from the muscularis propria layer in stomach.
Sa1526 Newly Found Polyps After Removal of Diminutive Colorectal Polyps: Cold SNARE Polypectomy vs. Conventional Polypectomy Akira Horiuchi*, Yoshiko Nakayama Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan Background: Colonoscopic polypectomy is used for treatment of colorectal polyps. There are limited data comparing polyp recurrence between cold snare polypectomy (CSP) and conventional polypectomy (CP) for colonoscopic resection of diminutive colorectal polyps. Objective: The aim of this study was to evaluate the rate of newly found polyp after CSP and CP and the predictive factors. Methods: This was a retrospective case-control study at a single municipal hospital. Patients undergoing CSP or CP for diminutive colorectal polyps included in the previous study (Digestion 2011; 84:78-81) were enrolled. New polyps were defined as polyps found at follow-up colonoscopy within 3 years after CSP or CP. Predictive factors for newly found polyps were assessed by multivariate analysis using logistic regression. Results: A total of 72 patients (female 22, mean age 68) with 184 polyps were included. Eighty-nine polyps (mean size + SD, 5.3+2 mm) were resected with CSP and 95 polyps (mean size 5.5+6 mm) were resected with CP. There were each 12 new polyps following both CSP and CP. The rate of new polyps was similar (i.e., CSP vs. CP: (13.5% vs. 12.6%, PZ0.86). Multivariate analysis revealed that the removal of R4 polyps was an independent predictor associated with new polyps (odds ratio: 7.8, 95% confidence interval: 2.1-32, PZ0.0022) (Table). Conclusions: The recurrence of polyps (e.g., a likely measure of completeness of polypectomy) was similar after CSP and CP for the endoscopic removal of diminutive polyps. Because of the simplicity and lower complications CSP is the preferable method for resection of diminutive colorectal polyps.
Multivariate analysis of variables affecting newly found polyps in all patients who underwent polypectomy Variables Conventional vs. Cold Number, O4 vs. !3 Size (mm), O6 vs. !5 Location, left vs. right Shape, flat vs. sessile
Odds ratio
95%CI
P value
1.2 7.8 0.50 1.2 0.52
0.34-4.6 2.1-32 0.097-2.1 0.32-4.4 0.023-4.5
0.76 0.0022 0.34 0.82 0.59
CI, confidence interval
Sa1527 Long-Term Outcomes of Non-Curative Endoscopic Resection of Early Gastric Cancer Eun Ran Kim1, Hye Mi Jung*1, Byung-Hoon Min1, Kyoung-Mee Kim2, Yang Won Min1, Jun Haeng Lee1, Poong-Lyul Rhee1, Jong Chul Rhee1, Jae J. Kim1 1 Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Seoul, Republic of Korea; 2Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Background and Aims: We evaluated the clinical characteristics and long-term outcomes of patients undergoing non-curative endoscopic resection for early gastric
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Sa1523 Endoscopic Resection of Large Sporadic Non-Ampullary Duodenal Polyps- Efficacy and Long-Term Recurrence Udayakumar Navaneethan*, Vennisvasanth Lourdusamy, Dennisdhilak Lourdusamy, Dhruv Mehta, Preethi GK. Venkatesh, Madhusudhan R. Sanaka Gastroenterology, The Cleveland Clinic, Cleveland, OH Background: Endoscopic resection is an alternative to surgery for removal of large duodenalpolyps. There is limited data on the safety, efficacy, and long term recurrence data afterendoscopic resection of sporadic, non-ampullary, large duodenal polyps. Objective: Our aim was to evaluate the safety and short term outcomes of the endoscopicremoval of the large sporadic duodenal polyps and to determine long-term risk of recurrence and factors predicting recurrence on follow-up. Methods: Patients with large (O 10 mm) sporadic nonampullary duodenal polyps whounderwent endoscopic resection from 2001 to 2012 at the Cleveland Clinic. Patients underwent endoscopic polypectomy, and argon plasma coagulation. The main outcome measurements were complete polypectomy, complications, short and longterm recurrence. Results: A total of 54 patients were included. The mean patient age was 66.4 years. Themean polyp size was 15.1 mm 5.4 mm. Most polyps (NZ48, 88.9%) were sessile polyps. The median follow-up time was 10.8 (range 0.5-120) months. Most lesions were located inthe second part of the duodenum (NZ41, 75.9%). Adenomas were found in 46 (85.2%) oflesions overall. Tubular adenoma was the most common histology type found in 33 cases(71.7%). Tubulovillous and villous was found in 12(26.1%) and 1(2.2%) cases respectively. On follow-up, 50 (92.6%) achieved complete resection with tumor free margins postresection. The 30-day risk of major complications was 5.6% (NZ3), 1 with perforation and 2with delayed bleeding. Recurrence was documented in 29% (NZ16) of patients. Allrecurrences were managed endoscopically except for one patient who required surgery. The recurrence rate was higher for patients who had villous component in their adenomas compared to those with tubular alone (p Z 0.03). Conclusions: Endoscopic resection is effective for treating large duodenal adenomas. Adenomas with villous features are more likely to recur. Almost all recurrences can bemanaged endoscopically.
Sa1524 Correlation of Healing Type of Gastric Ulceration and Recurrence in Gastric Neoplastic Lesions After Endoscopic Submucosal Dissection Seok Reyol Choi* Dong- A University, Busan, Republic of Korea Background: Endoscopic submucosal dissection (ESD) is common treatment modality for gastric neoplasm, especially early gastric cancer. However, compared to surgical resection, local recurrence can be problem. We investigated correlation between recurrence after ESD and risk factors, especially about healing types of lesion. Methods: The patients who had gastric neoplasm, were enrolled between April 2010 and January 2012. We performed endoscopy at 1st, 6th, 12th months to investigate the local recurrence. We also examined the risk factors of recurrence, for example, age, location, tumor size, diagnosis, and healing type of lesion and divided into 3 groups; hypertrophic polypoid, scar and nodular lesion for healing. Results: We enrolled 293 patients and couldn’t find significant correlation between sex, age, size, location of tumor, and diagnosis with recurrence. Healing types of lesions were 9 hypertrophic polypoids (6.4%), 122 scars (86.5%), 10 nodular lesions (7.1%). 8 patients were recurred, including 1 hypertrophic polypoid, 2 scars, 5 nodular lesions. And nodular changes were statistically significant healing type correlated with recurrence (pZ0.000). Conclusion: Although most common healing type was scar, most type of recurrence was nodular lesion. Therefore, we should perform endoscopy with biopsy more carefully, when the lesion has nodular change after ESD.
Sa1525 Preliminary Results of Endoscopic Submucosal Tunnel Dissection for Gastric Submucosal Tumors Originated From Muscularis Propria Ho Kim*1, Jung Wan Choe1, Moon Kyung Joo1, Beom Jae Lee1, Jong-Jae Park1, Jae Seon Kim1, Young-Tae Bak1, Hoon Jai Chun1, Sang Woo Lee1, You-Jin Jang2 1 Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea; 2Surgery, Korea University College of Medicine, Seoul, Republic of Korea Objective: Resection of submucosal tumors (SMTs) would aid in establishing the diagnosis and may be curative. Although ESD is regarded recently as minimally invasive resection methods for SMTs, it can be associated with the complications of strictures and perforations. But endoscopic submucosal tunnel dissection (ESTD) can maintain the gastrointestinal tract mucosa integrity and be closed more easily by endoclips compared with ESD. So, we aim to present the effectiveness and safety of a novel ESTD method for resection of gastrointestinal SMTs originating from the muscularis propria (MP). Patients and Methods: In 8 patients who presented with a
AB244 GASTROINTESTINAL ENDOSCOPY Volume 79, No. 5S : 2014
gastric SMT, we underwent submucosal tunnelling endoscopic resection under general anesthesia from Jan. 2011 to Jan. 2013. A submucosal tunnel was endoscopically created by starting approximately 4cm distant to the lesion. After careful submucosal dissection of the tumor from the surrounding submucosal tissue and the unaffected MP layer, the SMTs were completely removed by the technique of endoscopic submucosal dissection or full thickness resection including serosa layer. The mucosal entrance of the tunnel was closed using endoclips after the tumor was removed. Results: SMTs had a mean size of 21.1mm (range 17-25mm); 4 were located in the antrum, 3 in the body and 1 in the cardia. SMT resection was successful in all patients with en-bloc resection 100% rate. (6 lesions affected the deep MP, so complete MP and serosa resection with intentional peritoneal perforation was performed; 2 lesions affected the superficial MP for a partial MP resection). The average procedure time was 66.1 minutes (range 40-80minutes). The endoscopic procedure was converted into laparoscopic surgery in three patients among 6 patients with peritoneal perforation. Two patients had lost the full thickness resected sample in the peritoneal space. Abdominal pain and distension persisted and low grade fever developed in the other one. The other five patients had no any complications such as delayed hemorrhage and chronic fistula after then. No residual tumor or tumor recurrence were detected during the follow-up period (mean: 4.5 months, range: 3-9 months). Pathological diagnoses of these tumors were low risk gastrointestinal stromal tumors(6/8), a schwannoma (1/8), and a etopic pancreas (1/8). Conclusion: In this study, ESTD is feasible endoscopic procedure to remove submucosal tumors originating from the muscularis propria layer in stomach.
Sa1526 Newly Found Polyps After Removal of Diminutive Colorectal Polyps: Cold SNARE Polypectomy vs. Conventional Polypectomy Akira Horiuchi*, Yoshiko Nakayama Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan Background: Colonoscopic polypectomy is used for treatment of colorectal polyps. There are limited data comparing polyp recurrence between cold snare polypectomy (CSP) and conventional polypectomy (CP) for colonoscopic resection of diminutive colorectal polyps. Objective: The aim of this study was to evaluate the rate of newly found polyp after CSP and CP and the predictive factors. Methods: This was a retrospective case-control study at a single municipal hospital. Patients undergoing CSP or CP for diminutive colorectal polyps included in the previous study (Digestion 2011; 84:78-81) were enrolled. New polyps were defined as polyps found at follow-up colonoscopy within 3 years after CSP or CP. Predictive factors for newly found polyps were assessed by multivariate analysis using logistic regression. Results: A total of 72 patients (female 22, mean age 68) with 184 polyps were included. Eighty-nine polyps (mean size + SD, 5.3+2 mm) were resected with CSP and 95 polyps (mean size 5.5+6 mm) were resected with CP. There were each 12 new polyps following both CSP and CP. The rate of new polyps was similar (i.e., CSP vs. CP: (13.5% vs. 12.6%, PZ0.86). Multivariate analysis revealed that the removal of R4 polyps was an independent predictor associated with new polyps (odds ratio: 7.8, 95% confidence interval: 2.1-32, PZ0.0022) (Table). Conclusions: The recurrence of polyps (e.g., a likely measure of completeness of polypectomy) was similar after CSP and CP for the endoscopic removal of diminutive polyps. Because of the simplicity and lower complications CSP is the preferable method for resection of diminutive colorectal polyps.
Multivariate analysis of variables affecting newly found polyps in all patients who underwent polypectomy Variables Conventional vs. Cold Number, O4 vs. !3 Size (mm), O6 vs. !5 Location, left vs. right Shape, flat vs. sessile
Odds ratio
95%CI
P value
1.2 7.8 0.50 1.2 0.52
0.34-4.6 2.1-32 0.097-2.1 0.32-4.4 0.023-4.5
0.76 0.0022 0.34 0.82 0.59
CI, confidence interval
Sa1527 Long-Term Outcomes of Non-Curative Endoscopic Resection of Early Gastric Cancer Eun Ran Kim1, Hye Mi Jung*1, Byung-Hoon Min1, Kyoung-Mee Kim2, Yang Won Min1, Jun Haeng Lee1, Poong-Lyul Rhee1, Jong Chul Rhee1, Jae J. Kim1 1 Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Seoul, Republic of Korea; 2Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Background and Aims: We evaluated the clinical characteristics and long-term outcomes of patients undergoing non-curative endoscopic resection for early gastric
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