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Sa1538 Salvage Endoscopic Resection of Scarred Polyps After Failed Previous Endoscopic Resection Attempt: Sense Study
Abstracts
05/2004 und 03/2014 141 cases of EGC were treated by ESD in a European tertiary referral center. En bloc resection rate, R0 resection rate and recurrence rates were assessed prospectively. Results: ESD was possible in 137/141 cases. In 4/141 cases ESD had to be stopped due to non-lifting or perforation. En bloc resection was possible in 121/137 (88,3%). 28 lesions corresponded to guideline criteria of which 23 were resected R0 (82,1%) , 1 was Rx and 4 could not be resected en bloc. 109 lesions corresponded to expanded criteria with an R0 resection rate of 78/109 (71,6%), 7 Rx, 12 could not be resected en bloc and 12 were not resected R0 (6,4%, 11% and 11% respectively). Within the entity of EC lesions R0 resection rate was 77,5% (62/80) when lesions showed one expanded criterium, 63,6% (14/22) when lesions showed two and 28,6% (2/7) when lesions showed three expanded criteria. When lesions size O20mm was the only expanded criterium R0 resection rate was 74,2% (49/66). After R0 resection local recurrence was observed in 1 GC lesion but none in EC lesions. Conclusion: ESD in EGC provides high rates of curative resections in lesions among guideline criteria which cannot be reached in lesions meeting expanded criteria. Nevertheless the majority of EC lesions can be treated curatively by ESD with no higher risk of recurrence, especially if lesion size is the defining character.
Sa1537 Factors Associated With Outcomes in Endoscopic Submucosal Dissection of Gastric Cardia Tumors Tae Wook Kim*, Dong Hun Shin, Chul Hong Park, Byeong Gu Song, Joong Keun Kim, Kyung Lim Hwang, Dong Uk Kim, Geun Am Song, Gwang Ha Kim, Bong Eun Lee, Dong Hoon Baek, Hye Kyung Jeon Busan National University School of Medicine, Busan, Korea (the Republic of) Background and Study Aims: Tumors of the gastric cardia are among the most technically difficult lesions to remove by endoscopic submucosal dissection (ESD). The aims of this study were to evaluate the therapeutic outcomes of ESD in gastric cardia tumors according to clinicopathologic characteristics, and to assess the predictive factors for incomplete resection. Patients and Methods: We conducted a retrospective cohort study of 82 patients with adenomas and early cancers of the gastric cardia that underwent ESD between January 2006 and December 2013 at the Pusan National University Hospital. Therapeutic outcomes of ESD and procedure-related complications were analyzed. Results: En bloc resection, complete resection, and curative resection rates were 87%, 79%, and 66%, respectively. Deep submucosal invasion was the most common cause of noncurative resection in the cases in which complete resection was achieved. On multivariate analyses, hemispheric distribution (anterior hemisphere; odds ratio 4.808) and depth of tumor invasion (submucosal cancer; odds ratio 22.056) were independent factors associated with incomplete resection. The rates of procedure-related bleeding, perforation, and stenosis were 6%, 1%, and 0%, respectively; none of the complications required surgical intervention. Conclusions: ESD is a safe, effective, and feasible treatment for gastric cardia tumors. However, complete resection rate decreases for tumors that are located in the anterior hemisphere or have deep submucosal invasion.
Sa1538 Salvage Endoscopic Resection of Scarred Polyps After Failed Previous Endoscopic Resection Attempt: Sense Study Fergus Chedgy*, Rupam Bhattacharyya, Kesavan Kandiah, Gaius R. Longcroft-Wheaton, Pradeep Bhandari Endoscopy, Queen Alexandra Hospital, Portsmouth, Portsmouth, United Kingdom
Sa1536 Spiral snare Resection and Hybrid Endoscopic Mucosal Ablation: a Comparison of Outcomes After Piecemeal Resection/Ablation Zacharias P. Tsiamoulos*, Rameshshanker Rajaratnam, Timothy R. Elliott, Leonidas A. Bourikas, Mayur Garg, Henning Spranger, Iosif Beintaris, Arun Rajendran, Brian P. Saunders Wolfson Unit for Endoscopy, St Mark, London, United Kingdom Introduction: Incomplete endoscopic removal of colorectal polyps causes severe submucosal fibrosis, making subsequent endoscopic resection challenging. Two approaches to removal of recurrent polyp over a scarred submucosa or to polyps with inherent submucosal fibrosis such as NG-LST’s are either to use a stiff braided snare which helps capture tissue or to firstly snare as much tissue as possible using a conventional snare and then destroy tissue over the centre of the scar with high power APC preceded by submucosal injection (Endoscopic Mucosal Ablation, EMA). Methods: A prospective database (Jan 2010-Aug 2012) was used to identify large (O2cm) colorectal polyps removed in a piecemeal fashion using either hybrid EMR/EMA technique or spiral snare EMR (SS-EMR, Olympus, Keymed, UK) at our tertiary referral centre. Patient/polyp/technique-related details and short/ long term endoscopic surveillance data were retrieved and analysed (chi-square/ Fischer’s). The aim of this study was to compare the safety, technical success and recurrence between each group (group A - hybrid EMR/EMA, group B - SS-EMR). Results: This study enrolled 56 patients in group A and 48 patients in group B. Median polyp size was 3cm (range 2-8cm) for group A and 5cm (2-15cm) for group B. The majority (64.28%) of polyps in group A had previous failed polypectomy attempts compared to only 27% of polyps in group B. There was no difference in time taken to complete the procedure between the groups (mean time for group A 36min vs group B- 39 minutes). Procedural bleeding (A vs B were 7.1% vs 18.8% p Z 0.13) and delayed bleeding (A vs B were 19.6% vs 37.5%, p Z 0.05) were more common in group B. There were no peforations in either group. Two (4.2%) patients in SS-EMR group developed post polypectomy syndrome and needed brief hospital admission. Four (7.1%) patients in hybrid EMR/EMA cohort developed delayed bleeding requiring admission for transfusion; all made an uneventful recovery. There was no significant difference in polyp recurrence at 24 months between the groups (A vs B 12.5% vs 8.3%, pZ0.44). No patients have required surgery to date. Conclusions: Spiral snare resection and hybrid mucosal resection/ ablation modalities are both safe and feasible to eradicate recurrent fibrotic colorectal polyps. Delayed bleeding overall is significantly lower when using the hybrid resection/ablation technique though may be more severe when it does occur. Medium term outcomes appear similar in both groups with acceptable levels of endoscopically manageable recurrence.
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Background and Aims: Current standard of care for recurrent/residual polyps after previous endoscopic resection is surgery. This study analyses the outcomes of salvage endoscopic resection of polyps with severe scarring following a previously failed endoscopic resection. Methods: Prospective cohort study of patients referred to a Tertiary-centre for resection of scarred polyps with failed previous endoscopic resection attempts. Resection techniques: ESD knife & Snare combination (Knife Assisted Resection, KAR) or Snare & APC assisted resection (SAR). Results: We identified 64 consecutive patients referred to us following a previously failed endoscopic resection attempt. All these patients had severely scarred polyps which were being considered for surgery at the local centre. The mean polyp size 46mm (20-150mm). 83% were left-sided and 17% right-sided. 67% of resections were performed by KAR with mean polyp size 50mm. 33% of resections were by SAR with mean polyp size 38mm. Referral to surgery: 2/64 for technically difficult so no attempt made, 5/64 for cancer. Endoscopic follow up & cure: mean follow up of 3 years, 94% overall cure rate which was the same for left and right sided lesions as well as KAR and SAR. The only complication was bleeding seen in 3 patients (4.6%).Had all 64 patients been sent for surgery the total cost would have been £343,224. The total cost of the endoscopic approach, including the cost of patients requiring surgery, was £149,820 representing an average cost saving of £3021.94 per patient. Conclusion: Severely scarred polyps due to failed previous endoscopic mucosal resection attempts can be successfully treated by experts. The techniques of KAR and SAR are equally effective when used for appropriate polyps. The complication rate is low. Recurrence after first salvage resection can be treated successfully with further endoscopic resection. Surgery can be avoided in most patients and an endoscopic approach is very cost effective. We would therefore, advocate an aggressive endoscopic resection strategy over surgery when dealing with severely scarred polyps.
Sa1539 Endoscopic Resection of Giant Colorectal Adenomas Greater Than 8 CM - Lessons From a Tertiary Referral Practice Amyn Haji*, Bu Hayee Dept of Endoscopy, King’s College Hospital, London, United Kingdom Background and Aims: Patients with large sessile colorectal polyps can be technically challenging to resect endoscopically and have been subject to colorectal resection in the United Kingdom and in several centres in the Western world. Surgery can be associated with significant morbidity and mortality particularly in the elderly and in patients with rectal lesions. Our aims were to determine the safety and efficacy of endoscopic resection of large colorectal lesions at a tertiary referral unit. Methods: All patients with colorectal polyps greater than or equal to 8 cm deemed suitable for endoscopic resection were included in the study. Patients underwent magnification colonoscopy after dye spraying with 0.4% indigo carmine under midazolam sedation after oral bowel preparation. Snares were utilized for endoscopic mucosal piecemeal resection (EMR) and the Fuji flush knife for endoscopic submucosal dissection
Volume 81, No. 5S : 2015 GASTROINTESTINAL ENDOSCOPY AB253
05/2004 und 03/2014 141 cases of EGC were treated by ESD in a European tertiary referral center. En bloc resection rate, R0 resection rate and recurrence rates were assessed prospectively. Results: ESD was possible in 137/141 cases. In 4/141 cases ESD had to be stopped due to non-lifting or perforation. En bloc resection was possible in 121/137 (88,3%). 28 lesions corresponded to guideline criteria of which 23 were resected R0 (82,1%) , 1 was Rx and 4 could not be resected en bloc. 109 lesions corresponded to expanded criteria with an R0 resection rate of 78/109 (71,6%), 7 Rx, 12 could not be resected en bloc and 12 were not resected R0 (6,4%, 11% and 11% respectively). Within the entity of EC lesions R0 resection rate was 77,5% (62/80) when lesions showed one expanded criterium, 63,6% (14/22) when lesions showed two and 28,6% (2/7) when lesions showed three expanded criteria. When lesions size O20mm was the only expanded criterium R0 resection rate was 74,2% (49/66). After R0 resection local recurrence was observed in 1 GC lesion but none in EC lesions. Conclusion: ESD in EGC provides high rates of curative resections in lesions among guideline criteria which cannot be reached in lesions meeting expanded criteria. Nevertheless the majority of EC lesions can be treated curatively by ESD with no higher risk of recurrence, especially if lesion size is the defining character.
Sa1537 Factors Associated With Outcomes in Endoscopic Submucosal Dissection of Gastric Cardia Tumors Tae Wook Kim*, Dong Hun Shin, Chul Hong Park, Byeong Gu Song, Joong Keun Kim, Kyung Lim Hwang, Dong Uk Kim, Geun Am Song, Gwang Ha Kim, Bong Eun Lee, Dong Hoon Baek, Hye Kyung Jeon Busan National University School of Medicine, Busan, Korea (the Republic of) Background and Study Aims: Tumors of the gastric cardia are among the most technically difficult lesions to remove by endoscopic submucosal dissection (ESD). The aims of this study were to evaluate the therapeutic outcomes of ESD in gastric cardia tumors according to clinicopathologic characteristics, and to assess the predictive factors for incomplete resection. Patients and Methods: We conducted a retrospective cohort study of 82 patients with adenomas and early cancers of the gastric cardia that underwent ESD between January 2006 and December 2013 at the Pusan National University Hospital. Therapeutic outcomes of ESD and procedure-related complications were analyzed. Results: En bloc resection, complete resection, and curative resection rates were 87%, 79%, and 66%, respectively. Deep submucosal invasion was the most common cause of noncurative resection in the cases in which complete resection was achieved. On multivariate analyses, hemispheric distribution (anterior hemisphere; odds ratio 4.808) and depth of tumor invasion (submucosal cancer; odds ratio 22.056) were independent factors associated with incomplete resection. The rates of procedure-related bleeding, perforation, and stenosis were 6%, 1%, and 0%, respectively; none of the complications required surgical intervention. Conclusions: ESD is a safe, effective, and feasible treatment for gastric cardia tumors. However, complete resection rate decreases for tumors that are located in the anterior hemisphere or have deep submucosal invasion.
Sa1538 Salvage Endoscopic Resection of Scarred Polyps After Failed Previous Endoscopic Resection Attempt: Sense Study Fergus Chedgy*, Rupam Bhattacharyya, Kesavan Kandiah, Gaius R. Longcroft-Wheaton, Pradeep Bhandari Endoscopy, Queen Alexandra Hospital, Portsmouth, Portsmouth, United Kingdom
Sa1536 Spiral snare Resection and Hybrid Endoscopic Mucosal Ablation: a Comparison of Outcomes After Piecemeal Resection/Ablation Zacharias P. Tsiamoulos*, Rameshshanker Rajaratnam, Timothy R. Elliott, Leonidas A. Bourikas, Mayur Garg, Henning Spranger, Iosif Beintaris, Arun Rajendran, Brian P. Saunders Wolfson Unit for Endoscopy, St Mark, London, United Kingdom Introduction: Incomplete endoscopic removal of colorectal polyps causes severe submucosal fibrosis, making subsequent endoscopic resection challenging. Two approaches to removal of recurrent polyp over a scarred submucosa or to polyps with inherent submucosal fibrosis such as NG-LST’s are either to use a stiff braided snare which helps capture tissue or to firstly snare as much tissue as possible using a conventional snare and then destroy tissue over the centre of the scar with high power APC preceded by submucosal injection (Endoscopic Mucosal Ablation, EMA). Methods: A prospective database (Jan 2010-Aug 2012) was used to identify large (O2cm) colorectal polyps removed in a piecemeal fashion using either hybrid EMR/EMA technique or spiral snare EMR (SS-EMR, Olympus, Keymed, UK) at our tertiary referral centre. Patient/polyp/technique-related details and short/ long term endoscopic surveillance data were retrieved and analysed (chi-square/ Fischer’s). The aim of this study was to compare the safety, technical success and recurrence between each group (group A - hybrid EMR/EMA, group B - SS-EMR). Results: This study enrolled 56 patients in group A and 48 patients in group B. Median polyp size was 3cm (range 2-8cm) for group A and 5cm (2-15cm) for group B. The majority (64.28%) of polyps in group A had previous failed polypectomy attempts compared to only 27% of polyps in group B. There was no difference in time taken to complete the procedure between the groups (mean time for group A 36min vs group B- 39 minutes). Procedural bleeding (A vs B were 7.1% vs 18.8% p Z 0.13) and delayed bleeding (A vs B were 19.6% vs 37.5%, p Z 0.05) were more common in group B. There were no peforations in either group. Two (4.2%) patients in SS-EMR group developed post polypectomy syndrome and needed brief hospital admission. Four (7.1%) patients in hybrid EMR/EMA cohort developed delayed bleeding requiring admission for transfusion; all made an uneventful recovery. There was no significant difference in polyp recurrence at 24 months between the groups (A vs B 12.5% vs 8.3%, pZ0.44). No patients have required surgery to date. Conclusions: Spiral snare resection and hybrid mucosal resection/ ablation modalities are both safe and feasible to eradicate recurrent fibrotic colorectal polyps. Delayed bleeding overall is significantly lower when using the hybrid resection/ablation technique though may be more severe when it does occur. Medium term outcomes appear similar in both groups with acceptable levels of endoscopically manageable recurrence.
www.giejournal.org
Background and Aims: Current standard of care for recurrent/residual polyps after previous endoscopic resection is surgery. This study analyses the outcomes of salvage endoscopic resection of polyps with severe scarring following a previously failed endoscopic resection. Methods: Prospective cohort study of patients referred to a Tertiary-centre for resection of scarred polyps with failed previous endoscopic resection attempts. Resection techniques: ESD knife & Snare combination (Knife Assisted Resection, KAR) or Snare & APC assisted resection (SAR). Results: We identified 64 consecutive patients referred to us following a previously failed endoscopic resection attempt. All these patients had severely scarred polyps which were being considered for surgery at the local centre. The mean polyp size 46mm (20-150mm). 83% were left-sided and 17% right-sided. 67% of resections were performed by KAR with mean polyp size 50mm. 33% of resections were by SAR with mean polyp size 38mm. Referral to surgery: 2/64 for technically difficult so no attempt made, 5/64 for cancer. Endoscopic follow up & cure: mean follow up of 3 years, 94% overall cure rate which was the same for left and right sided lesions as well as KAR and SAR. The only complication was bleeding seen in 3 patients (4.6%).Had all 64 patients been sent for surgery the total cost would have been £343,224. The total cost of the endoscopic approach, including the cost of patients requiring surgery, was £149,820 representing an average cost saving of £3021.94 per patient. Conclusion: Severely scarred polyps due to failed previous endoscopic mucosal resection attempts can be successfully treated by experts. The techniques of KAR and SAR are equally effective when used for appropriate polyps. The complication rate is low. Recurrence after first salvage resection can be treated successfully with further endoscopic resection. Surgery can be avoided in most patients and an endoscopic approach is very cost effective. We would therefore, advocate an aggressive endoscopic resection strategy over surgery when dealing with severely scarred polyps.
Sa1539 Endoscopic Resection of Giant Colorectal Adenomas Greater Than 8 CM - Lessons From a Tertiary Referral Practice Amyn Haji*, Bu Hayee Dept of Endoscopy, King’s College Hospital, London, United Kingdom Background and Aims: Patients with large sessile colorectal polyps can be technically challenging to resect endoscopically and have been subject to colorectal resection in the United Kingdom and in several centres in the Western world. Surgery can be associated with significant morbidity and mortality particularly in the elderly and in patients with rectal lesions. Our aims were to determine the safety and efficacy of endoscopic resection of large colorectal lesions at a tertiary referral unit. Methods: All patients with colorectal polyps greater than or equal to 8 cm deemed suitable for endoscopic resection were included in the study. Patients underwent magnification colonoscopy after dye spraying with 0.4% indigo carmine under midazolam sedation after oral bowel preparation. Snares were utilized for endoscopic mucosal piecemeal resection (EMR) and the Fuji flush knife for endoscopic submucosal dissection
Volume 81, No. 5S : 2015 GASTROINTESTINAL ENDOSCOPY AB253