RESUMEN
Background/Aims@#Endoscopic resection (ER) for superficial non-ampullary duodenal epithelial tumors (SNADETs) is challenging. Conventional endoscopic mucosal resection (CEMR) is also problematic due to the anatomical features of the duodenum. We compared the safety and efficacy of underwater endoscopic mucosal resection (UEMR) with those of CEMR through a retrospective analysis. @*Methods@#Altogether, 44 consecutive patients with 46 SNADETs underwent ER (18 CEMR cases and 28 UEMR cases) between January 2016 and October 2019. We investigated the proportions of en bloc resection, R0 resection, complications, resection time, and total procedure time and compared the outcomes of patients from the CEMR group with those of patients from the UEMR group. @*Results@#The median tumor size was 8.0 mm (range, 2.0–20.0 mm). The UEMR group showed a higher proportion of en bloc resection (96.4% vs. 72.2%, p<0.05) and significantly lower median resection time and total procedure time (4 min vs. 9.5 min, p<0.05 and 13 min vs. 19 min, p<0.05; respectively) than the CEMR group. No complications were observed. However, two patients treated with piecemeal resection in the CEMR group had residual tumors. @*Conclusions@#UEMR is a feasible therapeutic option for SNADETs. It can be recommended as a standard treatment.
RESUMEN
Background/Aims@#Endoscopic resection (ER) for superficial non-ampullary duodenal epithelial tumors (SNADETs) is challenging. Conventional endoscopic mucosal resection (CEMR) is also problematic due to the anatomical features of the duodenum. We compared the safety and efficacy of underwater endoscopic mucosal resection (UEMR) with those of CEMR through a retrospective analysis. @*Methods@#Altogether, 44 consecutive patients with 46 SNADETs underwent ER (18 CEMR cases and 28 UEMR cases) between January 2016 and October 2019. We investigated the proportions of en bloc resection, R0 resection, complications, resection time, and total procedure time and compared the outcomes of patients from the CEMR group with those of patients from the UEMR group. @*Results@#The median tumor size was 8.0 mm (range, 2.0–20.0 mm). The UEMR group showed a higher proportion of en bloc resection (96.4% vs. 72.2%, p<0.05) and significantly lower median resection time and total procedure time (4 min vs. 9.5 min, p<0.05 and 13 min vs. 19 min, p<0.05; respectively) than the CEMR group. No complications were observed. However, two patients treated with piecemeal resection in the CEMR group had residual tumors. @*Conclusions@#UEMR is a feasible therapeutic option for SNADETs. It can be recommended as a standard treatment.
RESUMEN
A 47-year-old man suffered an idiopathic esophageal rupture and an emergency operation was performed. Postoperative CT revealed an aortic dissection at the level of the infra-renal aorta and the right common iliac artery. The maximum diameter of the aorta was 3.0cm, and that of the right common iliac artery was 2.5cm with a patent false lumen. The operation was done using the right extra-peritoneal approach. When the infra-renal aorta was clamped and opened, the false lumen was located on the right anterior wall of the aorta. There were 3 communicating holes presumably being the points of entry or re-entry. A bifurcation Dacron graft was put into the aorta and the bilateral iliac artery. His postoperative course was good and he was discharged on the 15th day after surgery. In this case, since the patient had no history of severe pain except for the time of esophageal rupture, the localized abdominal aortic dissection was suspected to have simultaneously occurred with the idiopathic esophageal rupture.
RESUMEN
A 63-year-old man was admitted due to acute congestive heart failure. Transesophageal echocardiography demonstrated quadricuspid aortic valve malformation with concomitant severe aortic regurgitation. The valve was replaced by a 21mm Edward-MIRA and the postoperative course was uneventful. Although quadricuspid aortic valve is a rare anomaly, its potential for severe valve failure in adulthood should not be neglected.