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Su1240 Short and Long-Term Outcomes of Endoscopic Resection for Superficial Non-Ampullary Duodenal Epithelial Tumors
Abstracts
Su1239 Efficacy and Safety of a Novel Large-Bore Partially Covered Metallic Stent for Malignant GastrIC Outlet Obstruction: A Pilot Study Hyunsoo Chung*, Jun Chul Park, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee Yonsei Univeristy, Seoul, Seoul, Korea (the Republic of) Background: Improvements in stent patency and oral intake after stenting are important for the quality of life in patients with malignant gastric outlet obstruction (GOO). Therefore, we designed a new large-bore (24mm), one-side, partially covered metallic stent for malignant GOO. (Figure1). Aim: The aim of this study was to evaluate the clinical and technical efficacy and the safety of a large-bore partially covered metallic stent for malignant GOO. Patients and Methods: Fifteen patients with malignant gastric outlet obstruction received palliative treatment with largebore partially covered metallic stent. Technical success rate, 4 and 8-week stent patency rate and clinical success rate were investigated. Results: Sixteen stents were successfully placed in all 15 patients. Stent patency rate was 93.3% (14/15) and 77.8% (7/9) in 4 weeks and 8 weeks, respectively. One proximal migration and 1 proximal tumor overgrowth occurred in 22 and 41 days after stenting. The median GOOSS score was significantly higher after than before stent placement (2 [range 2-3] vs. 0 [range 0-1]; P < .001). Solid food intake (GOOSS 2-3) was tolerable in 46.7 % (7/ 15), 66.7 % (10/15) and 60.0 % (9/15) of the patients by 1, 4 and 8 weeks. Conclusion: Large-bore, one-side, partially covered metallic stent were effective and safe for malignant GOO in this pilot study with favorable short-term stent patency rates and significant improvement of oral intake in a majority of patients. Further comparative studies are needed to elucidate the role of this new stent.
Clinical outcomes Technical success, % (no./total no.) GOOSS score, median (range) Pre-procedure Post-procedure, 4 weeks Post-procedure, 8 weeks Stent length, mm 80 100 120 8-week stent patency rate, % (no./total no.) Stent failure, % (no./total no.) Overgrowth Migration
100 (16/16) 0 (0-1) 2 (2-3) 2 (2-3) 1 11 5 77.8 (7/9) 11.1 (1/9) 11.1 (1/9)
Su1240 Short and Long-Term Outcomes of Endoscopic Resection for Superficial Non-Ampullary Duodenal Epithelial Tumors Yuko Hara*1, Kenichi Goda1, Akira Dobashi1, Kazuki Sumiyama1, Hisao Tajiri1, Takehiro Mitsuishi2, Shinichi Hirooka2, Masahiro Ikegami2 1 Department of Endoscopy, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan; 2Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan Background and Objective: Endoscopic resection (ER) is a challenging technique for the treatment of superficial non-ampullary duodenal epithelial tumors (SNADETs), and the treatment outcomes of ER for SNADETs remain unknown because of the low incidence rate of these tumors. The present study aimed to analyze the clinical outcomes of ER for SNADETs and to evaluate the feasibility of this technique for the treatment of SNADETs. Patients and Methods: The study included 107 consecutive patients with 119 SNADETs, who underwent ER (endoscopic mucosal resection [EMR] or endoscopic submucosal dissection [ESD]) between April 2004 and December 2014. We assessed the curability and complications associated with ER for SNADETs and the post-ER tumor recurrence rate. Results: Of the 119 SNADETs, 110 were treated with EMR (92.4%) and 9 were treated with ESD (7.6%). Additionally, 17, 73, 18, and 11 SNADETs were located in the 1st, 2nd, 3rd, and 4th portions of the duodenum, respectively. The median tumor diameter was 13 mm (range, 4–55 mm). The macroscopic types were elevated (n Z 23, 19.3%), flat-elevated (n Z 54, 45.4%), and flat-depressed tumors (n Z 42, 35.3%). Histologically, of the 119 SNADETs, 38 involved low-grade dysplasia (31.9%), 34 involved high-grade dysplasia (28.6%), and 47 were adenocarcinomas (39.5%), which were all mucosal carcinomas. In tumors treated with EMR, the en bloc resection rate was 89.1% (98/110) and the complete en bloc resection rate (negative vertical and lateral margins) was 69.1% (75/110). In tumors treated with ESD, the en bloc resection rate was 100% (9/9) and the complete en bloc resection rate was 66.7% (6/9). Regarding complications, delayed bleeding after ESD was noted in 1 case, perforations during ESD were noted in 3 cases, and delayed perforations after ESD were noted in 2 cases. Only one of the 5 cases of perforation needed emergency surgery. There were 3 cases of local recurrence less than 12 months after treatment (2 cases of piecemeal EMR and 1 case of EMR with unclear margins). In 79 cases which followed more than 12 months after treatment, the median follow-up period was 27 months (range, 12–131 months) ,and there was no case of local recurrence during the follow-up period. No recurrence was noted in 81 cases involving complete en bloc resections, which were followed after ER regardless of the follow-up period. Conclusion: ER might be feasible for the treatment of SNSDETs. The clinical outcomes were good; however, strict follow-up endoscopy is needed after piecemeal or histologically incomplete EMR. Furthermore, ESD might be technically challenging.
Su1241 Polidocanol Injection Therapy for Small-Bowel Hemangioma Using Double-Balloon Endoscopy Atsushi Igawa*1, Shiro Oka1, Shinji Tanaka1, Sayoko Kunihara2, Makoto Nakano2, Kazuaki Chayama2 1 Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan; 2Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan Background and Aim: A small-bowel hemangioma is rare, but it often causes active bleeding. Surgical resection is the standard treatment for small-bowel hemangiomas. We previously reported the usefulness of polidocanol injection (PDI) in the treatment of oozing from the stomach, colon and small-bowel angioectasia. The present study aims to evaluate the clinical usefulness of PDI using double-balloon endoscopy (DBE) in the treatment of small-bowel hemangiomas. Patients and Methods: We retrospectively analyzed data from 12 obscure gastrointestinal bleeding (OGIB) patients with 39 small-bowel hemangiomas, who were treated with PDI using DBE at Hiroshima University Hospital between August 2007 and March 2014. The lesions were divided into the following 2 groups according to their size: Group A (size <10 mm; 20 lesions) and Group B (size 10 mm; 18 lesions). We compared the clinical characteristics of the patients and outcomes of PDI using DBE for small-bowel hemangiomas (locations of the lesions, treatment duration, number of injections per lesion, amount of polidocanol used per lesion, re-bleeding rate and complications) between the two groups. Additionally, in order to standardize the amount of PDI, the total amount of polidocanol according to lesion size was calculated. We evaluated the lesions using capsule endoscopy or DBE 3–6 months after treatment, and all patients were followed up a minimum of 1 year. Results: This study included 6 men and 6 women with OGIB (mean age, 62 years). The mean lowest hemoglobin level was 6.7 1.8 g/dL. Of the 12 patients, 6 (50%) needed blood transfusion. The median follow-up period was 65 months (range, 12–91 months). The locations of the lesions and treatment duration were not significantly different between the 2 groups. The number of injections and amount of polidocanol used per lesion were significantly higher in Group B than in Group A (p < 0.05 and p < 0.01, respectively). Re-bleeding occurred in only 1 lesion (9%; diameter, 10 mm), and was conservatively managed with additional PDI. The final hemostasis rate was 100% (12/12), and the complication rate related to PDI was 0% (0/12). The contribution ratio between the lesion size and amount of polidocanol showed a correlation (r Z 0.77). The optimal amount of polidocanol for a small-bowel hemangioma was determined as 0.2 ml/m. Conclusions: PDI using DBE is easy to perform, safe, and effective for the treatment of small-bowel hemangiomas.
www.giejournal.org
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB323
Su1239 Efficacy and Safety of a Novel Large-Bore Partially Covered Metallic Stent for Malignant GastrIC Outlet Obstruction: A Pilot Study Hyunsoo Chung*, Jun Chul Park, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee Yonsei Univeristy, Seoul, Seoul, Korea (the Republic of) Background: Improvements in stent patency and oral intake after stenting are important for the quality of life in patients with malignant gastric outlet obstruction (GOO). Therefore, we designed a new large-bore (24mm), one-side, partially covered metallic stent for malignant GOO. (Figure1). Aim: The aim of this study was to evaluate the clinical and technical efficacy and the safety of a large-bore partially covered metallic stent for malignant GOO. Patients and Methods: Fifteen patients with malignant gastric outlet obstruction received palliative treatment with largebore partially covered metallic stent. Technical success rate, 4 and 8-week stent patency rate and clinical success rate were investigated. Results: Sixteen stents were successfully placed in all 15 patients. Stent patency rate was 93.3% (14/15) and 77.8% (7/9) in 4 weeks and 8 weeks, respectively. One proximal migration and 1 proximal tumor overgrowth occurred in 22 and 41 days after stenting. The median GOOSS score was significantly higher after than before stent placement (2 [range 2-3] vs. 0 [range 0-1]; P < .001). Solid food intake (GOOSS 2-3) was tolerable in 46.7 % (7/ 15), 66.7 % (10/15) and 60.0 % (9/15) of the patients by 1, 4 and 8 weeks. Conclusion: Large-bore, one-side, partially covered metallic stent were effective and safe for malignant GOO in this pilot study with favorable short-term stent patency rates and significant improvement of oral intake in a majority of patients. Further comparative studies are needed to elucidate the role of this new stent.
Clinical outcomes Technical success, % (no./total no.) GOOSS score, median (range) Pre-procedure Post-procedure, 4 weeks Post-procedure, 8 weeks Stent length, mm 80 100 120 8-week stent patency rate, % (no./total no.) Stent failure, % (no./total no.) Overgrowth Migration
100 (16/16) 0 (0-1) 2 (2-3) 2 (2-3) 1 11 5 77.8 (7/9) 11.1 (1/9) 11.1 (1/9)
Su1240 Short and Long-Term Outcomes of Endoscopic Resection for Superficial Non-Ampullary Duodenal Epithelial Tumors Yuko Hara*1, Kenichi Goda1, Akira Dobashi1, Kazuki Sumiyama1, Hisao Tajiri1, Takehiro Mitsuishi2, Shinichi Hirooka2, Masahiro Ikegami2 1 Department of Endoscopy, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan; 2Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan Background and Objective: Endoscopic resection (ER) is a challenging technique for the treatment of superficial non-ampullary duodenal epithelial tumors (SNADETs), and the treatment outcomes of ER for SNADETs remain unknown because of the low incidence rate of these tumors. The present study aimed to analyze the clinical outcomes of ER for SNADETs and to evaluate the feasibility of this technique for the treatment of SNADETs. Patients and Methods: The study included 107 consecutive patients with 119 SNADETs, who underwent ER (endoscopic mucosal resection [EMR] or endoscopic submucosal dissection [ESD]) between April 2004 and December 2014. We assessed the curability and complications associated with ER for SNADETs and the post-ER tumor recurrence rate. Results: Of the 119 SNADETs, 110 were treated with EMR (92.4%) and 9 were treated with ESD (7.6%). Additionally, 17, 73, 18, and 11 SNADETs were located in the 1st, 2nd, 3rd, and 4th portions of the duodenum, respectively. The median tumor diameter was 13 mm (range, 4–55 mm). The macroscopic types were elevated (n Z 23, 19.3%), flat-elevated (n Z 54, 45.4%), and flat-depressed tumors (n Z 42, 35.3%). Histologically, of the 119 SNADETs, 38 involved low-grade dysplasia (31.9%), 34 involved high-grade dysplasia (28.6%), and 47 were adenocarcinomas (39.5%), which were all mucosal carcinomas. In tumors treated with EMR, the en bloc resection rate was 89.1% (98/110) and the complete en bloc resection rate (negative vertical and lateral margins) was 69.1% (75/110). In tumors treated with ESD, the en bloc resection rate was 100% (9/9) and the complete en bloc resection rate was 66.7% (6/9). Regarding complications, delayed bleeding after ESD was noted in 1 case, perforations during ESD were noted in 3 cases, and delayed perforations after ESD were noted in 2 cases. Only one of the 5 cases of perforation needed emergency surgery. There were 3 cases of local recurrence less than 12 months after treatment (2 cases of piecemeal EMR and 1 case of EMR with unclear margins). In 79 cases which followed more than 12 months after treatment, the median follow-up period was 27 months (range, 12–131 months) ,and there was no case of local recurrence during the follow-up period. No recurrence was noted in 81 cases involving complete en bloc resections, which were followed after ER regardless of the follow-up period. Conclusion: ER might be feasible for the treatment of SNSDETs. The clinical outcomes were good; however, strict follow-up endoscopy is needed after piecemeal or histologically incomplete EMR. Furthermore, ESD might be technically challenging.
Su1241 Polidocanol Injection Therapy for Small-Bowel Hemangioma Using Double-Balloon Endoscopy Atsushi Igawa*1, Shiro Oka1, Shinji Tanaka1, Sayoko Kunihara2, Makoto Nakano2, Kazuaki Chayama2 1 Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan; 2Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan Background and Aim: A small-bowel hemangioma is rare, but it often causes active bleeding. Surgical resection is the standard treatment for small-bowel hemangiomas. We previously reported the usefulness of polidocanol injection (PDI) in the treatment of oozing from the stomach, colon and small-bowel angioectasia. The present study aims to evaluate the clinical usefulness of PDI using double-balloon endoscopy (DBE) in the treatment of small-bowel hemangiomas. Patients and Methods: We retrospectively analyzed data from 12 obscure gastrointestinal bleeding (OGIB) patients with 39 small-bowel hemangiomas, who were treated with PDI using DBE at Hiroshima University Hospital between August 2007 and March 2014. The lesions were divided into the following 2 groups according to their size: Group A (size <10 mm; 20 lesions) and Group B (size 10 mm; 18 lesions). We compared the clinical characteristics of the patients and outcomes of PDI using DBE for small-bowel hemangiomas (locations of the lesions, treatment duration, number of injections per lesion, amount of polidocanol used per lesion, re-bleeding rate and complications) between the two groups. Additionally, in order to standardize the amount of PDI, the total amount of polidocanol according to lesion size was calculated. We evaluated the lesions using capsule endoscopy or DBE 3–6 months after treatment, and all patients were followed up a minimum of 1 year. Results: This study included 6 men and 6 women with OGIB (mean age, 62 years). The mean lowest hemoglobin level was 6.7 1.8 g/dL. Of the 12 patients, 6 (50%) needed blood transfusion. The median follow-up period was 65 months (range, 12–91 months). The locations of the lesions and treatment duration were not significantly different between the 2 groups. The number of injections and amount of polidocanol used per lesion were significantly higher in Group B than in Group A (p < 0.05 and p < 0.01, respectively). Re-bleeding occurred in only 1 lesion (9%; diameter, 10 mm), and was conservatively managed with additional PDI. The final hemostasis rate was 100% (12/12), and the complication rate related to PDI was 0% (0/12). The contribution ratio between the lesion size and amount of polidocanol showed a correlation (r Z 0.77). The optimal amount of polidocanol for a small-bowel hemangioma was determined as 0.2 ml/m. Conclusions: PDI using DBE is easy to perform, safe, and effective for the treatment of small-bowel hemangiomas.
www.giejournal.org
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB323