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Tu1191 Safety and Technical Feasibility of Endoscopic Placement of Esophageal Self- Expandable Metal Stents Without the Aid of Fluoroscopy
Abstracts
should be on targeted intervention to improve treatment outcomes in patients of lower socio-economic status with EC.
Figure showing rising rates in terms of percentage change from 1992-1995 to 2010-2012 of different indices related to race and socio-economic health disparity in patient of esophageal adenocarcinoma (left panel) and squamous cell cancer (right panel).
Tu1190 Minimum Criteria of Narrow Band Imaging Magnification Endoscopy for the Detection of Superficial Esophageal Squamous Cell Carcinoma: A Randomized Controlled Trial Akira Dobashi*1, Kenichi Goda1, Kazuki Sumiyama1, Yuko Hara1, Shinichi Hirooka2, Shigeharu Hamatani2, Masahiro Ikegami2, Hisao Tajiri1 1 Endoscopy, The Jikei University School of Medicine, Tokyo, Japan; 2 Pathology, The Jikei University School of Medicine, Tokyo, Japan Background and Aim: The diagnostic accuracy of Narrow Band Imaging magnification endoscopy (NBI-ME) for superficial esophageal squamous cell carcinoma (SESCC), including high-grade intraepithelial neoplasia, has been reported to be significantly higher than that of white light endoscopy (WLE). NBI-ME is, however, a time-consuming procedure and not widely used, because it necessitates assessment of many NBI-ME findings (total Z 6; 4 pertaining to the morphological changes in the intraepithelial papillary capillary loop [IPCL], and 2 other NBI-ME features as follows: dilatation, tortuosity, caliber change, various shapes [VS], increase in the number of IPCL [INI], and intervascular background coloration). According to our randomized controlled trial data, we created the minimum criteria consisting of VS and INI by using stepwise statistical methods. The preliminary study showed that the minimum criteria include diagnostic performance comparable to that of the conventional criteria that consisted of the 4 morphological changes of IPCL. This study aimed to validate the real-time diagnostic utility of NBI-ME, as compared to WLE, according to the minimum criteria. Patients and Methods: Two experts randomly examined 170 patients with a history of head and neck cancer or SESCCs. One endoscopist performed WLE, and the other performed NBI-ME using a dual focus scope (DFS; Olympus Corporation, Tokyo, Japan). Endoscopically biopsied specimens were obtained from a suspected SESCC lesion during WLE, or from a brownish area (diameter, >5 mm) during NBI. As controls, biopsy specimens from a normal mucosal site near the suspected SESCC lesion were obtained. The endoscopists evaluated the lesions for the 6 NBI-ME findings. The primary endpoint was to evaluate the real-time detection rates of SESCC by WLE and NBI-ME according to the minimum criteria. The secondary endpoint was to assess the diagnostic performance of the 2 endoscopic techniques. Results: Of 156 suspected SESCC lesions, 77 were histologically diagnosed as SESCC. The detection rates for SESCC by NBI-ME according to the minimum criteria were significantly higher than those by WLE (90.9% vs. 50.6%, P < 0.01). The area under the receiver operating characteristic curve based on the minimum and conventional criteria did not differ significantly (0.92, 95% confidence interval [CI] Z 0.88–0.96 and 0.91, 95% CI Z 0.87–0.95, respectively). Conclusion: Our results show that the minimum criteria-based NBI-ME diagnosis of SESCC using a DFS has clinical utility and may be applied in routine practice.
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Tu1191 Safety and Technical Feasibility of Endoscopic Placement of Esophageal Self- Expandable Metal Stents Without the Aid of Fluoroscopy Shreyas Saligram*1, Diego Lim2, Luis pena1, Mark Friedman1, Cynthia L. Harris1, Jason B. Klapman1 1 GI, Moffitt Cancer Center, Tampa, FL; 2Internal Medicine, Kansas University Medical Center, Kansas City, KS Background: Endoscopic placement of Esophageal Self-expandable Metal Stents (SEMS) has become the gold standard for treatment of malignant dysphagia. Other indications include benign esophageal conditions like management of dysphagia secondary to anastomotic strictures, treatment of tracheo-esophageal fistulas and post- surgical esophageal leaks. Traditionally, esophageal stents have been placed with the aid of fluoroscopy. At our institution, we have been placing SEMS without the aid of fluoroscopy. Our aim was to evaluate the safety and feasibility of direct endoscopic placement of esophageal SEMS. Methods: A retrospective review was performed to identify all patients who underwent esophageal SEMS from January 2010 to June 2015 in our institution. Medical records were reviewed to obtain information on demographic, clinical and outcome data. Placement of all SEMS was accomplished under direct endoscopic visualization without fluoroscopy. When the indication was for benign or malignant stricture, all attempts to traverse the stricture were made to document the exact length of the stricture. The exact size of the stent chosen depended on length of the lesion and the lumen diameter with the goal of choosing a stent length with proximal end 2 cms above and distal end 2 cms below the lesion. Misplacement of the stent during the procedure that required removal of the stent and placement of another new stent was considered as a failed procedure. Adverse events due to SEMS placement that occurred in the first 48 hours of the procedure were documented. Results: A total of 172 patients underwent 280 procedures for SEMS placement. Mean age was 66 years (IQR 33-94; SD +/- 9). The majority of patients were male 132 (77%).The most common indication for SEMS placement was stricture in 248 (88%) of the procedures. The indications for which SEMS was placed and its related complications are shown in Table 1. The mean location of stricture was at 30cm (IQR 16-46; SD +/- 6.5) and the mean length of the stricture was 5.2cm (IQR 1-25; SD +/- 3.6). Initial dilation of the stricture prior to stent placement was performed in 111/280(40%) of cases. The mean length of SEMS was 90cm (IQR 40-120) and diameter was 15mm (IQR 10-22). A total of 29 (10%) patients had more than one stent placed to bridge the stricture. Number of patients who had periprocedure SEMS misplacement was 8 (3%). However, only 4 (1.5%) patients needed to have a new stent placed during the same procedure. In the remainder of the patients with misplacement, the stent could be repositioned during the procedure without the need for a new stent. Conclusion: Based on our experience, esophageal SEMS can be placed accurately and safely under direct endoscopic visualization without the aid of fluoroscopy. The technique simplifies the procedure and allows stent placement to be performed in any endoscopy room. Table 1. Indications for SEMS placement with associated complications Indication Adenocarcinoma cancer recurrence post surgery Anastamotic leak Anastamotic stricture Benign stricture Bronchoesophageal fistula Perforation Stricture due to squamous cell carcinoma Stricture due to adenocarcinoma Stricture due to external compression Stricture due to radiation therapy Tracheoesophageal fistula Total
Procedures-n (%)
Stent Misplacement-n (%)
6 (2.1)
1 (0.4)
2 (0.7) 47 (16.8) 1 (0.4) 2 (0.7) 5 (1.8) 28 (10) 155 (55.4) 10 (3.6) 1 (0.4) 23 (8.2) 280
0 1 (0.4) 0 0 0 1 (0.4) 4 (1.5) 1 (0.4) 0 0 8 (3)
Tu1192 Comparative Study of Esophageal Stent and Percutaneous Gastrostomy for Dysphagia Caused By Esophageal Cancer Ji Hye Jung*, Sun Hwa Kim, Inseub Shin, Yang Won Min, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Jae J. Kim Department of Medicine, Samsung Medical Center, Seoul, Gangnam-Gu, Korea (the Republic of) Background/Aim: Esophageal stent and percutaneous gastrostomy have been the common treatment method for patients with dysphagia caused by esophageal cancer. This study aimed to compare the prognosis of patients receiving esophageal stent and those receiving gastrostomy. Method: We retrospectively reviewed a total of 151 esophageal cancer patients who received either esophageal stent (stent group) or gastrostomy (gastrostomy group) for initial treatment procedure for
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB569
should be on targeted intervention to improve treatment outcomes in patients of lower socio-economic status with EC.
Figure showing rising rates in terms of percentage change from 1992-1995 to 2010-2012 of different indices related to race and socio-economic health disparity in patient of esophageal adenocarcinoma (left panel) and squamous cell cancer (right panel).
Tu1190 Minimum Criteria of Narrow Band Imaging Magnification Endoscopy for the Detection of Superficial Esophageal Squamous Cell Carcinoma: A Randomized Controlled Trial Akira Dobashi*1, Kenichi Goda1, Kazuki Sumiyama1, Yuko Hara1, Shinichi Hirooka2, Shigeharu Hamatani2, Masahiro Ikegami2, Hisao Tajiri1 1 Endoscopy, The Jikei University School of Medicine, Tokyo, Japan; 2 Pathology, The Jikei University School of Medicine, Tokyo, Japan Background and Aim: The diagnostic accuracy of Narrow Band Imaging magnification endoscopy (NBI-ME) for superficial esophageal squamous cell carcinoma (SESCC), including high-grade intraepithelial neoplasia, has been reported to be significantly higher than that of white light endoscopy (WLE). NBI-ME is, however, a time-consuming procedure and not widely used, because it necessitates assessment of many NBI-ME findings (total Z 6; 4 pertaining to the morphological changes in the intraepithelial papillary capillary loop [IPCL], and 2 other NBI-ME features as follows: dilatation, tortuosity, caliber change, various shapes [VS], increase in the number of IPCL [INI], and intervascular background coloration). According to our randomized controlled trial data, we created the minimum criteria consisting of VS and INI by using stepwise statistical methods. The preliminary study showed that the minimum criteria include diagnostic performance comparable to that of the conventional criteria that consisted of the 4 morphological changes of IPCL. This study aimed to validate the real-time diagnostic utility of NBI-ME, as compared to WLE, according to the minimum criteria. Patients and Methods: Two experts randomly examined 170 patients with a history of head and neck cancer or SESCCs. One endoscopist performed WLE, and the other performed NBI-ME using a dual focus scope (DFS; Olympus Corporation, Tokyo, Japan). Endoscopically biopsied specimens were obtained from a suspected SESCC lesion during WLE, or from a brownish area (diameter, >5 mm) during NBI. As controls, biopsy specimens from a normal mucosal site near the suspected SESCC lesion were obtained. The endoscopists evaluated the lesions for the 6 NBI-ME findings. The primary endpoint was to evaluate the real-time detection rates of SESCC by WLE and NBI-ME according to the minimum criteria. The secondary endpoint was to assess the diagnostic performance of the 2 endoscopic techniques. Results: Of 156 suspected SESCC lesions, 77 were histologically diagnosed as SESCC. The detection rates for SESCC by NBI-ME according to the minimum criteria were significantly higher than those by WLE (90.9% vs. 50.6%, P < 0.01). The area under the receiver operating characteristic curve based on the minimum and conventional criteria did not differ significantly (0.92, 95% confidence interval [CI] Z 0.88–0.96 and 0.91, 95% CI Z 0.87–0.95, respectively). Conclusion: Our results show that the minimum criteria-based NBI-ME diagnosis of SESCC using a DFS has clinical utility and may be applied in routine practice.
www.giejournal.org
Tu1191 Safety and Technical Feasibility of Endoscopic Placement of Esophageal Self- Expandable Metal Stents Without the Aid of Fluoroscopy Shreyas Saligram*1, Diego Lim2, Luis pena1, Mark Friedman1, Cynthia L. Harris1, Jason B. Klapman1 1 GI, Moffitt Cancer Center, Tampa, FL; 2Internal Medicine, Kansas University Medical Center, Kansas City, KS Background: Endoscopic placement of Esophageal Self-expandable Metal Stents (SEMS) has become the gold standard for treatment of malignant dysphagia. Other indications include benign esophageal conditions like management of dysphagia secondary to anastomotic strictures, treatment of tracheo-esophageal fistulas and post- surgical esophageal leaks. Traditionally, esophageal stents have been placed with the aid of fluoroscopy. At our institution, we have been placing SEMS without the aid of fluoroscopy. Our aim was to evaluate the safety and feasibility of direct endoscopic placement of esophageal SEMS. Methods: A retrospective review was performed to identify all patients who underwent esophageal SEMS from January 2010 to June 2015 in our institution. Medical records were reviewed to obtain information on demographic, clinical and outcome data. Placement of all SEMS was accomplished under direct endoscopic visualization without fluoroscopy. When the indication was for benign or malignant stricture, all attempts to traverse the stricture were made to document the exact length of the stricture. The exact size of the stent chosen depended on length of the lesion and the lumen diameter with the goal of choosing a stent length with proximal end 2 cms above and distal end 2 cms below the lesion. Misplacement of the stent during the procedure that required removal of the stent and placement of another new stent was considered as a failed procedure. Adverse events due to SEMS placement that occurred in the first 48 hours of the procedure were documented. Results: A total of 172 patients underwent 280 procedures for SEMS placement. Mean age was 66 years (IQR 33-94; SD +/- 9). The majority of patients were male 132 (77%).The most common indication for SEMS placement was stricture in 248 (88%) of the procedures. The indications for which SEMS was placed and its related complications are shown in Table 1. The mean location of stricture was at 30cm (IQR 16-46; SD +/- 6.5) and the mean length of the stricture was 5.2cm (IQR 1-25; SD +/- 3.6). Initial dilation of the stricture prior to stent placement was performed in 111/280(40%) of cases. The mean length of SEMS was 90cm (IQR 40-120) and diameter was 15mm (IQR 10-22). A total of 29 (10%) patients had more than one stent placed to bridge the stricture. Number of patients who had periprocedure SEMS misplacement was 8 (3%). However, only 4 (1.5%) patients needed to have a new stent placed during the same procedure. In the remainder of the patients with misplacement, the stent could be repositioned during the procedure without the need for a new stent. Conclusion: Based on our experience, esophageal SEMS can be placed accurately and safely under direct endoscopic visualization without the aid of fluoroscopy. The technique simplifies the procedure and allows stent placement to be performed in any endoscopy room. Table 1. Indications for SEMS placement with associated complications Indication Adenocarcinoma cancer recurrence post surgery Anastamotic leak Anastamotic stricture Benign stricture Bronchoesophageal fistula Perforation Stricture due to squamous cell carcinoma Stricture due to adenocarcinoma Stricture due to external compression Stricture due to radiation therapy Tracheoesophageal fistula Total
Procedures-n (%)
Stent Misplacement-n (%)
6 (2.1)
1 (0.4)
2 (0.7) 47 (16.8) 1 (0.4) 2 (0.7) 5 (1.8) 28 (10) 155 (55.4) 10 (3.6) 1 (0.4) 23 (8.2) 280
0 1 (0.4) 0 0 0 1 (0.4) 4 (1.5) 1 (0.4) 0 0 8 (3)
Tu1192 Comparative Study of Esophageal Stent and Percutaneous Gastrostomy for Dysphagia Caused By Esophageal Cancer Ji Hye Jung*, Sun Hwa Kim, Inseub Shin, Yang Won Min, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Jae J. Kim Department of Medicine, Samsung Medical Center, Seoul, Gangnam-Gu, Korea (the Republic of) Background/Aim: Esophageal stent and percutaneous gastrostomy have been the common treatment method for patients with dysphagia caused by esophageal cancer. This study aimed to compare the prognosis of patients receiving esophageal stent and those receiving gastrostomy. Method: We retrospectively reviewed a total of 151 esophageal cancer patients who received either esophageal stent (stent group) or gastrostomy (gastrostomy group) for initial treatment procedure for
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB569