Short term effects of anti-reflux mucosectomy for proton pump inhibitor dependent gastroesophageal reflux disease / 中华消化内镜杂志

Clinical data of 26 patients with proton pump inhibitor dependent gastroesophageal reflux disease (GERD) who underwent anti-reflux mucosectomy (ARMS) in Nanjing Drum Tower Hospital from July 2017 to December 2020 were reviewed, and the GERD questionnaire (GERD-Q) score, the short-form reflux-qual (RQS) score, esophageal motility and 24 h esophageal pH parameters before and after ARMS were compared. With a median follow-up period of 18.4 months (6-27 months), 23 (88.5%) patients reported symptomatic improvement and 15 (57.7%) patients discontinued the use of proton pump inhibitors. After ARMS, the mean scores of GERD-Q (6.23 VS 13.19, P=0.004) and RQS (26.67 VS 10.98, P<0.001) were significantly improved, the mean DeMeester score (10.69 VS 53.15, P<0.001), the mean acid exposure time percentage (3.56% VS 9.92%, P<0.001) and the mean number of acid reflux episodes (36.9 VS 139.9, P=0.001) were lower, and the mean rest pressure at lower esophageal sphincter (LES) (25.19 mmHg VS 13.63 mmHg, P<0.001) and the mean distal contractile integral (1 819.15 mmHg·s·cm VS 1 007.67 mmHg·s·cm, P<0.001) were significantly increased compared with those before surgery. ARMS has significant short-term efficacy in the treatment of proton pump inhibitor dependent GERD, which can effectively improve reflux symptoms and life quality of patients, and strengthen the rest pressure of LES and peristalsis of the esophageal body.

Adenoma velloso de esófago en la mucosa ectópica gástrica: reporte de un caso / Villous adenoma of the esophagus in ectopic gastric mucosa: A case report

Resumen Introducción: Los adenomas vellosos son lesiones del tubo digestivo con tendencia alta a la malignidad. Su ubicación en parches de mucosa gástrica ectópica en el esófago cervical determina una presentación atípica de interés tanto clínico como patológico. Objetivo: Presentar un caso de adenoma velloso en la mucosa gástrica ectópica del esófago cervical. Métodos: Describir el caso de un paciente con diagnóstico de adenoma velloso y realizar una revisión de la literatura disponible hasta el momento. Resultados: Se identificó mediante un estudio histopatológico un adenoma tubulovelloso con displasia de bajo grado, cuya ubicación endoscópica era un parche de mucosa ectópica gástrica en el esófago cervical. Conclusiones: La ubicación de los adenomas vellosos en el esófago cervical puede predisponer al desarrollo de lesiones neoplásicas. La evaluación detallada de este segmento, con técnicas como la cromoendoscopia digital de alta definición, permiten la detección temprana de estas lesiones y su oportuna intervención.

Abstract Introduction: Villous adenomas are lesions of the digestive tract with a high tendency to malignancy. Its location in ectopic gastric mucosa patches in the cervical esophagus is an atypical presentation of clinical and pathological interest. Objective: To present a case of villous adenoma in ectopic gastric mucosa of the cervical esophagus. Methods: A case study of a patient with a diagnosis of villous adenoma is presented, as well as a review of the current literature. Results: A tubulovillous adenoma with low-grade dysplasia was identified by histopathological study. Its endoscopic location was a gastric ectopic mucosa patch in the cervical esophagus. Conclusions: The location of villous adenomas in the cervical esophagus may predispose to the development of neoplastic lesions. Detailed evaluation of this segment using techniques, such as high-definition digital chromoendoscopy, would allow for early detection and treatment of these lesions.

Clinical evaluation of endoscopic anti-reflux mucosectomy for gastroesophageal reflux disease / 中华消化内镜杂志

Objective To assess the efficacy and safety of the endoscopic anti-reflux mucosectomy for gastroesophageal reflux disease. Methods Data of 18 patients with gastroesophageal reflux disease who underwent endoscopic anti-reflux mucosectomy at the First Affiliated Hospital of ZhengZhou University from December 2015 to July 2018 were retrospectively studied. The therapeutic effects ( improvement of heartburn and reflux symptoms, 24 h esophageal pH monitoring) and complications were analyzed. Results Anti-reflux mucosectomy was performed successfully in all patients with successful rate of 100％. ESD was performed in 8 cases and EMR in 10 cases. 24 h esophageal pH monitoring results showed that the Demeester score, the time percentage of pH < 4, total reflux events and reflux times of pH < 4 with time longer than 5 minutes after treatment were significantly lower than those before treatment (20. 16±9. 12 VS 74. 16±20. 03, (2. 70±0. 88)％ VS (6. 42±1. 37)％, 43. 78±19. 68 VS 156. 56±41. 22, 2. 89±1. 68 VS 9. 89±2. 95, all P<0. 05) . No bleeding, perforation or infection was observed after the procedure. During a follow-up period of 3-34 months, symptom relief rate was 89％ (16/18). A tightened cardiac was noted in 18 cases and recovery of mucosal damage was found in 16 patients. Conclusion Anti-reflux mucosectomy is safe, effective and easy to operate for gastroesophageal reflux disease.

Clinical evaluation of endoscopic anti-reflux mucosectomy for gastroesophageal reflux disease / 中华消化内镜杂志

Objective@#To assess the efficacy and safety of the endoscopic anti-reflux mucosectomy for gastroesophageal reflux disease.@*Methods@#Data of 18 patients with gastroesophageal reflux disease who underwent endoscopic anti-reflux mucosectomy at the First Affiliated Hospital of ZhengZhou University from December 2015 to July 2018 were retrospectively studied. The therapeutic effects (improvement of heartburn and reflux symptoms, 24 h esophageal pH monitoring) and complications were analyzed.@*Results@#Anti-reflux mucosectomy was performed successfully in all patients with successful rate of 100%. ESD was performed in 8 cases and EMR in 10 cases.24 h esophageal pH monitoring results showed that the Demeester score, the time percentage of pH < 4, total reflux events and reflux times of pH < 4 with time longer than 5 minutes after treatment were significantly lower than those before treatment (20.16±9.12 VS 74.16±20.03, (2.70±0.88)% VS (6.42±1.37)%, 43.78±19.68 VS 156.56±41.22, 2.89±1.68 VS 9.89±2.95, all P<0.05). No bleeding, perforation or infection was observed after the procedure. During a follow-up period of 3-34 months, symptom relief rate was 89% (16/18). A tightened cardiac was noted in 18 cases and recovery of mucosal damage was found in 16 patients.@*Conclusion@#Anti-reflux mucosectomy is safe, effective and easy to operate for gastroesophageal reflux disease.

Clinical study of endoscopic multiband mucosectomy and endoscopic submucosal dissection in the treatment of colorectal submucosal tumors under the guidance of ultrasound endoscopy / 中国综合临床

Objective To explore the therapeutic effect and safety of endoscopic multi-band mucosetomy (EMBM) and endoscopic submucosal dissection(ESD) for colorectal submucosal tumors under the guidance of ultrasound endoscopy. Methods From January 2013 to June 2016,the clinical data of sixty patients with colorectal submucosal tumors in Center People's Hospital of Tengzhou who received either EMBM (32 cases) or ESD ( 28 cases) were included in this retrospective study. The complete resection rate, average diameter of resection lesion, operative time, complications and recurrence rate of two groups were compared. Results The complete resection rate of EMBM groups was 96. 9%(31/ 32),the complete resection rate of ESD groups was 96. 4%(27/ 28),there was no statistically significant difference between the two groups (χ2 = 0. 07,P= 0. 812). The average diameter of was ESD group (12. 3±2. 6) mm,significantly greater than that of EMBM group ((9. 1± 2. 2) mm) (P = 0. 038),and the mean operation time of EMBM group was (20. 5 ±5. 1) min,which was significantly less than that of ESD group ( (36. 8±4. 5) min) (P = 0. 008),and the percentage of perforation in EMBM group was 0,significantly lower than that of ESD group (10. 7%(3/ 28))(χ2 = 6. 37, P = 0. 013). The severe bleeding rate of EMBM group was 3. 1% (1/ 32),which was significantly lower than that in ESD group(14. 3%(4/ 28)) (χ2 = 4. 89, P = 0. 021) . After 6-12 months of follow-up,no recurrence or distant metastasis was found in EMBM or ESD group. Conclusion EMBM and ESD are safe and effective for colorectal submucosal tumors,However the average diameter of the lesion was larger in EMBM group than that in ESD group.

Comparison of the effect of endoscopic multi-band mucosectomy and endoscopic mucosal resection for colorectal submucosal tumors / 中国基层医药

Objective@#To compare the therapeutic effect and safety of endoscopic multi-band mucosetomy (EMBM) and endoscopic mucosal resection (ESMR) in the treatment of colorectal submucosal tumors.@*Methods@#From January 2012 to June 2014, the clinical data of 40 patients with colorectal submucosal tumors in Tengzhou Central People′s Hospital were divided into EMBM group (22 cases) and ESMR group(18 cases) according to different treatment method.The complete resection rate, operation time and complications were compared between the two groups.@*Results@#The complete resection rate of the EMBM group was 95.45%, which of the ESMR group was 94.44%, the difference between the two groups was not statistically significant (χ2=0.273, P>0.05). The operation time was shorter in the EMBM group[(31.3.5±4.0)min]than that in the ESMR group[(47.2±4.5)min), t=-15.194, P<0.05]. The incidence rate of hemorrhage in the EMBM group was 9.0%, which was significantly lower than 33.3% in the ESMR group (χ2=3.952, P<0.05). There was no statistically significant difference between the two groups in the incidence of postoperative colorectal stricture (P>0.05). All the patients were followed up for 3~24 months after operation, and no local recurrence occurred.@*Conclusion@#EMBM is safe and effective for colorectal submucosal tumors and the complications are less.

Mucosectomía endoscópica por coloproctólogos. Resultados iniciales / Endoscopic mucosal resection by coloproctologists. initial results

ANTECEDENTES: La detección y resección de lesiones colónicas plipoideas, sésiles y planas, previene el desarrollo de cáncer de colon. La mucosectomía endoscópica ha surgido en 1970 como un procedimiento alternativo para el tratamiento de éstas lesiones y, en la actualidad, es considerado el procedimiento de elección, pudiendo evitar procedimientos quirúrgicos mayores. OBJETIVO: Evaluar los resultados y complicaciones de la técnica de mucosectomía realizada por cirujanos coloproctólogos. Con revisión de indicaciones y limitaciones de la técnica. MATERIAL Y MÉTODO: Se realizó un análisis descriptivo, retrospectivo y observacional de pacientes tratados con técnica de mucosectomía endoscópica en el Servicio de Coloproctología del Hospital Británico de Bs. As., desde junio de 2010 a junio 2015. Se aplicó la técnica de “elevación y corte” en lesiones polipoideas mayores a 1 cm. Se realizó la resección en bloque para aquellas lesiones de hasta 3 cm y, para aquellas mayores a los 3 cm, se utilizó la resección por técnica de piecemeal. Se evaluaron complicaciones y resultados según la técnica empleada al igual que tasa de recidiva, realizando en todos los casos seguimiento con control endoscópico. RESULTADOS: Se analizaron un total de 41 casos (25 mujeres y 16 hombres) realizándose un procedimiento por paciente. La edad promedio fue de 65,8 años (38-83 años) y el tamaño promedio de las lesiones de 20,3 mm (10 – 50 mm). Se realizó resección en bloque en 19 pacientes (representando el46,3% de nuestra serie) y logrando resección endoscópica y anatomopatológica completa en todos ellos. En tanto se empleó técnica de piecemeal en los 22 pacientes restantes (53,6%). La tasa de complicaciones en nuestra serie fue del 7,3% (3/41). El seguimiento promedio fue de 14,4 meses (2 – 48 meses) y la tasa global de recidiva local fue de 9,75%...

BACKGROUND: Detection and resection of colonic lesions polypoid sessile and flat, prevents the development of colon cancer. Endoscopic mucosal resection has emerged in 1970 as an alternative method for the treatment of these lesions and, at present it is considered the procedure of choice, being able to avoid major surgical procedures. Objectives evaluation of the results and complications of the technique mucosectomy by colorectal surgeons. Review of indications and limitations of the technique. MATERIAL AND METHODS: Descriptive, retrospective and observational analysis of patients treated with endoscopic mucosal resection technique in the Coloproctology Service of the British Hospital of Buenos Aires, from June 2010 to June 2015. Technique of "lift and cut" was used in polypoid lesions greater than 1 cm. The bloc resection is used for those injuries up to 3 cm, and the piecemeal resection technique was used for those older than 3 cm. Complications and results were evaluated according to the technique as recurrence rate , performing tracking in all cases with endoscopic control. RESULTS: forty one cases (25 women and 16 men) performing a procedure per patient were analyzed. The average age was 65.8 years (38-83 years) and the average lesion size of 20.3 mm (10-50 mm). The average age was 65.8 years (38-83 years) and the average lesion size of 20.3 mm (10-50 mm). Resection was performed in 19 patients block (representing the 46.3 % of our series) and achieving endoscopic resection and pathologic complete in all. Piecemeal technique was used in the remaining 22 patients (53.6 %). The complication rate in our series was 7.3% (3/41). Mean follow-up was 14.4 months (2-48 months) and overall local recurrence rate was 9.75%...

The efficacy and safety analysis for endoscopic multi-band mucosectomy in the treatment of early esophageal cancer and intraepithelial neoplasia / 中国医师进修杂志

Objective To investigate the safety and efficacy of endoscopic multi-band mucosectomy (EMBM) in the treatment of early esophageal cancer and intraepithelial neoplasia.Methods A retrospective analysis was made on the clinical data of 34 cases diagnosed with early esophageal cancer and intraepithelial neoplasia.All the patients accepted EMBM.The therapeutic effects and safety were summarized.Results A total of 34 patients with 36 lesions were successfully completed in the treatment of one session.The entire biopsy specimen was tested by pathological examination.High-grade intraepithelial neoplasia in 24 lesions,low-grade intraepithelial neoplasia in 4 lesions,intramucosal cancer in 6 lesions,a submucosal shallow cancer and a submucosal deep cancer were diagnosed.Clamps electric coagulation hemostasis was used during the operation in 2 bleeding cases.No delayed postoperative bleeding,subcutaneous emphysema and esophageal perforation happened.Two cases appeared esophageal stenosis after EMBM.Bougienage were used to relieve dysphagia.One case confirmed with deep submucosal lymphovascular invasion accepted surgery later in department of thoracic surgery.No local recurrence and metastasis were found in the other 33 cases during the 6-24 months of follow-up time.Conclusions EMBM is a minimally invasive,safe and effective method for the treatment of early esophageal cancer and intraepithelial neoplasia.EMBM is worthy of promotion.

Efficacy and safety of the duette multiband mucosectomy for esophageal submucosal tumors / 中华消化内镜杂志

Objective To investigate clinical efficacy and safety of endoscopic multiband mucosec-tomy(EMBM)for esophageal submucosal tumors(SMTs).Methods Data of 51 patients with SMTs diag-nosed between Jan 2012 and Aug 2014 were retrospectively studied.Of the 51 patients,33 patients(34 le-sions)received EMBMand 18 patients received endoscopic submucosal resection(ESMR).The operation success rates,complete resection rates,procedure time,complications and the follow-up of group EMBMand group ESMR were compared.Results All of 51 cases had successful endoscopic treatment with no perfora-tion,infection or obvious bleeding.Follow-up showed no recurrence after operation.Compared with group ESMR,group EMBM had higher complete resection rate [97.1% (33 /34)VS 61.1% (11 /18 ),P =0.010],shorter operation time[(6.3 ±1.8)min VS (21.4 ±3.8)min,P =0.001]and lower complication rate[6.1%(2 /33)VS 27.8%(5 /18),P =0.024].Conclusion EMBM is simple,safe and effective for treating SMTs originating from muscularis mucosa or submucosa which are less than 2.0 cm in diameter.

Clinical efficacy of multi-band mucosectomy for high-grade esophageal intraepithelial neoplasia / 中华消化外科杂志

Objective To investigate the efficacy and safety of multi-band mucosectomy (MBM) for the treatment of high-grade intraepithelial neoplasia.Methods The clinical data of 24 patients with high-grade esophageal intraepithelial neoplasia who were admitted to the Henan Honliv Hospital from April 2011 to October 2012 were retrospectively analyzed.All the 24 patients received MBM,and the operation time,resection of the lesion and complications were observed.All the patients were followed up with gastroscopy at postoperative 1,3,6,12 months.The follow-up was ended in April 2013.Results A total of 26 lesions in 24 patients were resected successfully by MBM (2 patients received MBM twice).The mean operation time was 42 minutes.The mean length of the lesions was 3.1 cm (range,0.8-6.0 cm),and it occupied 3/4 of the circumference of the esophagus to the maximum.The mean number of the band used was 4 (range,1-6).During the operation,bleeding was occurred in 4 patients,and they were cured by hot biopsy forceps.No perforation of the esophagus was detected.The results of post-MBM pathological examination showed that 22 patients were with severe atypical hyperplasia,and 2 were with carcinoma in situ.During the follow-up of 6-24 months,22 patients were cured,and esophageal stricture occurred in 1 patient at post-MBM 1 month,and the symptoms were successfully relieved by endoscopic balloon dilatation.Neoplasia recurrence was observed in 1 patient (2 lesions were resected twice) at post-MBM 3 months,and he received surgical treatment.Histopathological diagnosis showed that he had esophageal squamous cell carcinoma.No stricture or neoplasia was detected by gastroscopy at postoperative month 12.Conclusions MBM is a relatively safe and effective endoscopic technique for the treatment of high-grade esophageal intraepithelial neoplasia.The resection range should not be blindly extended.For patients whose lesions are beyond 3/4 of the circumference of the esophagus in width or with multiple lesions which can not be resected by MBM at one time,MBM should be applied cautiously to avoid esophageal stricture and recurrence.

Clinical value of multiband mucosectomy for the treatment of early esophageal cancer and precancerous lesions / 中华消化外科杂志

Objective To investigate the clinical value of multiband mucosectomy (MBM) for the treatment of early esophageal cancer and precancerous lesions.Methods The clinical data of 43 patients with early esophageal cancer or precancerous lesions (including 13 cases of early esophageal cancer and 30 cases of precancerous lesion) who were admitted to the Tengzhou Central People's Hospital from January 2010 to January 2011 were retrospectively analyzed.A total of 51 lesions were confirmed by preoperative endoscopy and mucosal biopsy,and then were treated by MBM.Results A total of 52 MBM procedures were carried out,and 180 lesions were resected.The sizes of the lesions ranged from 10 mm × 8 mm to 25 mm × 23 mm,and the mean operation time was (37 ± 5)minutes.The complete resection rate was 92.2％ (47/51).The submucosal layer of 1 patient was invaded by squamous cell carcinoma postoperatively,and the patient was treated by operation;1 patient wth squamous epithelium carcinoma was treated by radiotherapy at 2 weeks after MBM ; the other 2 lesions were treated by argon plasma coagulation (APC).Four lesions with bleeding were detected during 52 MBM procedures,and no esophageal perforation was detected during MBM.Early complications consisted of delayed bleeding (1 patient,cured by APC) and slight esophageal stenosis (1 patient,recovered at postoperative month 6).The accurate rate of pathological examinations was 51.0％ (26/51).Forty-three patients were followed up for 1 year,3 patients with tumor recurrence were treated by MBM or APC.No death occurred during the followup.Conclusion MBM is a safe and effective technique for the treatment of early esophageal cancer and precancerous lesions.

Rabbit gastric ulcer models: comparison and evaluation of acetic acid-induced ulcer and mucosectomy-induced ulcer / 한국실험동물학회지

In this study, we examined rabbit gastric ulcer models that can serve as more clinically relevant models. Two types of ulcer model were studied: acetic acid-induced ulcers (AAU) and mucosal resection-induced ulcers (MRU). For AAU, rabbit gastric mucosa was exposed by median laparotomy and treated with bottled acetic acid. MRU was examined as a model for endoscopic mucosal resection (EMR). Normal saline was injected into the submucosal layer and the swollen mucosa was resected with scissors. Endoscopic mucosal resection (EMR) is frequently performed for treatment of early gastric cancers. This procedure inevitably leads to ulcers and bleeding. Bleeding control is the major concern in endoscopic mucosectomy, and some endoscopic hemostatic agents are currently under clinical and preclinical studies. MRU was developed as a model for these induced ulcers and the evaluation of the healing process. The clinical relevancy of those models was compared with that of rat models. Progressive healing was observed for 7 days based on histology. Rabbit models demonstrate round, deep ulcers with clear margins and well-defined healing stages that were difficult to define in rat models.

Endoscopic resection using the new duette multiband mucosectomy kit for esophageal disease / 中国癌症杂志

Background and purpose:Endoscopic treatment is a promising therapeutic option for superifcial lesions throughout the gastrointestinal tract, this study was aimed to evaluate the efficacy of endoscopic resection (ER) using the new Duette multiband mucosectomy kit (DT-6) on treating esophageal disease. Methods:Since Jun. 2011, ER using DT-6 has been performed on 100 patients in a tertiary medical center. Data from those who have been followed up for over 6 months was analyzed. ER and esophagectomy were compared on treating high grade dysplasia (HGD) lesions and early esophageal cancer. Results:From Jun. 2011 to Jan. 2012, a total of 32 patients with esophageal lesions underwent 34 ER using DT-6 (22 male and 10 female, mean age 59.0 years, range 25 to 83 years). There were (3.4±1.0) specimen resected per operation, and the average greatest diameter was (11.8±2.7)mm. Intraoperative blood loss was (5.45±1.47)mL. The median follow-up period was 8.2 months with a 100%half-year-follow-up rate. Except one pneumothorax occurred during one endoscopic submucosal dissection (ESD), no other complications happened. When Comparing ER and esophagectomy on treating HGD and early esophageal cancer, ER showed advantages in terms of operation time, intraoperative blood loss, hospital stay and complications. Conclusion:ER using DT-6 is safe, simple, minimally invasive and effective for esophageal disease. Prospective study and long follow-up are needed to compare endoscopic resection and esophagectomy for HGD and early esophagus cancer.

Safety and efficacy of endoscopic multiband mucosectomy for early esophageal carcinoma and intraepithelial neoplasia / 中华消化内镜杂志

Objective To study the effectiveness of endoscopic multiband mucosectomy ( EMBM ) for early cancer and precancerous lesions of the esophagus. Methods From August 2007 to December 2011,EMBM was performed on 46 patients (25 males and 21 females) with the average age of 59.0 (35-82) yr.All lesions were margined under NBI,with 2 to 13 cm in diameter (median 4 cm),and occupying at most two-third of the circumference of the esophagus.Of 46 patients,41 (89.1％ ) accepted deep sedation by intravenous injection of propofol.All patients were followed up with endoscopy at 1,6,12 months after the operation.Results A total of 48 lesions were resected completely by EMBM with 1-11 processes.During the procedure,controllable bleeding occurred in 3 cases and micro-perforation occurred in 1,which was cured by metal clip.Histopathological diagnoses revealed 3 cases of intramucosal squamous carcinoma,19 high grade intraepithelial neoplasia,17 low grade intraepithelial neoplasia,and 7 inflammatory hyperplasia.No recurrence was found during the follow-up of 1 to 53 months.Conclusion EMBM is effective and safe for the treatment of early cancer and precancerous lesions of the esophagus.Appropriate indication and manipulation can decrease complication occurrence.

Study of anal function after ileal pouch anal anastomosis with modified double-stapled mucosectomy / 国际外科学杂志

Objective To evaluate the long-term functional outcome after ileal pouch anal anastomosis with modified double-stapled technique.Methods From January 2002 to March 2011,forty-five patients underwent ileal pouch anal anastomosis with modified double-stapled technique.The clinical data of these patients were reviewed.The postoperative anal function was assessed by Kirwan classification and Oresland pouch-specific function score.Results During the median follow-up of 65 months,2 patients with malignant adenomatous polyps died,2 patients were diagnosed dysplasia by biopsy,4 patients developed mild to moderate anastomotic narrowing,1 patient developed persistent anastomotic stricture needing surgical intervention,16 patients developed at least 1 episode of pouchitis.There was no incontinence in these patients,and the median functional Oresland score was 6,3 and 2 after 1 year,2.5 years and 5 years respectively.Conclusion The functional results of ileal pouch anal anastomosis with modified double-stapled technique are promising,with no incontinence in our patients.

Multi-band mucosectomy for early esophageal cancer and precancerous lesions / 中华消化内镜杂志

Objective To evaluate the safety and efficacy of multi-band mucosectomy (MBM) for early esophageal cancer and precancerous lesions.Methods Data of 28 patients with early esophageal cancer or precancerous lesions undergoing MBM were reviewed in regarding of procedure complications and follow-up results.Results A total of 32 lesions were resected successfully by MBM in one session,with mean procedure time of 28.3 minutes.The mean diameter of specimens was 12mm.No residual neoplasm was found at the base of any resected specimens.The post-MBM pathological findings consisted of 2 cases of intramucosal cancer,1 case of submucosal cancer,and 25 cases of moderate-severe dysplasia.No perforation,delayed hemorrhage or subcutaneous emphysema occurred.Intraoperative bleeding occurred in 23 cases,including 3 cases of pulsatile bleeding,which were controlled with metal clip,and 20 cases of minor bleeding which were managed with APC or halted automatically at the end of procedure.Chest pain after the procedure occurred in 5 cases and were relieved soon.The patient with submucosal cancer underwent subsequent surgical resection,with no residual cancer in surgical specimen or lymph node metastasis.Twenty seven other cases were followed up endoscopically for 2-12 months.Esophageal stricture occurred in 2 cases,and were successfully relieved by dilatation with stent or bougienage.No recurrent lesion or metastasis were revealed.Conclusion MBM is a relatively safe and effective endoscopic technique for treatment of early esophageal intramucosal cancer and precancerous lesions,but further studies are needed to evaluate the long-term results.

Stapled Mucosectomy: An Alternative Technique for the Removal of Retained Rectal Mucosa after Ileal Pouch-Anal Anastomosis

Restorative proctocolectomy (RPC), when performed with a stapled ileal pouch-anal anastomosis (IPAA), allows the retention of the rectal mucosa above the dentate line and can result in disease persistence or recurrence, as well as neoplastic lesions in patients with ulcerative colitis (UC). We report the case of a patient with chronic UC who underwent staple mucosectomy, which is an alternative technique that evolved from stapled hemorrhoidopexy, rather than more traditional procedures. The patient had undergone laparoscopic RPC with a stapled IPAA 2 cm above the dentate line and a temporary loop ileostomy. Because the histopathology showed low-grade dysplasia in the proximal rectum, stapled mucosectomy with a 33-mm circular stapler kit at the time of ileostomy closure was scheduled. Following the application of a purse-string suture 1 cm above the dentate line, the stapler was inserted with its anvil beyond the purse-string and was fired. The excised rectal tissue was checked to ensure that it was a complete cylindrical doughnut. Histopathology of the excised tissue showed chronic inflammation. There were no complications during a follow-up period of 5 months. Because it preserves the normal rectal mucosal architecture and avoids a complex mucosectomy surgery, stapled mucosectomy seems to be a technically feasible and clinically acceptable alternative to the removal of rectal mucosa retained after RPC.

Mucosectomía en cáncer gástrico incipiente: consideraciones acerca de la indicación, complejidad del procedimiento, valor y técnica del estudio histopatológico / Mucosectomy in early gastric cancer: considerations on indication, complexity of the procedure, importance and technique of the histopatological analysis

We report a case of a 59 year-old male presenting with upper gastrointestinal symptoms characterized by epigastric pain. Endoscopic biopsies were diagnostic of adenoma with high-grade dysplasia and focal mucosal invasion by well-differentiated intestinal type adenocarcinoma, which is successfully treated with mucosectomy. We discuss indications for this technique and prognostic factors associated with the macroscopic classification, histological type, size and depth of cancer invasion.

Se presenta caso de paciente masculino de 59 años con sintomatología digestiva alta caracterizada epigastralgia. Las biopsias endoscópicas son diagnósticas de lesión de tipo adenoma con displasia de alto grado y foco de invasión mucosa por Adenocarcinoma bien diferenciado de tipo intestinal, el cual es tratado exitosamente con mucosectomía. Se discuten indicaciones de ésta técnica y factores pronóstico asociados con la clasificación macroscópica, tipo histológico, diámetro de la lesión y profundidad de invasión cancerosa.

Mucosectomía rectal con engrapadora sola y combinada con otros procedimientos quirúrgicos anorrectales: análisis multivariado de los factores que afectan el resultado clínico / Stapled rectal mucosectomy alone and in combination with other surgical anorectal procedures: multivariate analysis of factors affecting clinical outcome

Objetivo: Comparar el resultado clínico de la mucosectomía rectal con engrapadora (MRE) sola y de la MRE combinada con esfinterotomía y con plastia anal de colgajos cutáneos, y examinar qué factores influyen sobre las complicaciones y la satisfacción del paciente. Material y métodos: Se incluyeron pacientes con enfermedad hemorroidal grados II a IV sometidos a MRE sola o en combinación con otros procedimientos. Se analizaron las complicaciones posoperatorias, resolución de síntomas y grado de satisfacción. Resultados: 241 pacientes consecutivos con seguimiento mínimo de un año se dividieron en tres grupos: MRE sola (n = 187), MRE combinada con esfinterotomía (n = 31) y MRE combinada con plastia de colgajos (n = 23). Los pacientes con MRE con esfinterotomía presentaron un porcentaje de complicaciones mayor que el resto (32 versus 12.8 % y 13 %, respectivamente, p = 0.02). La MRE con esfinterotomía se asoció con mayor riesgo de complicaciones que la MRE sola (RM = 3.5, IC 95 % = 1.4-8.7); la inclusión exclusiva de epitelio columnar en la zona resecada se asoció con menor riesgo de complicaciones que cuando se incluyó además epitelio transicional (RM = 0.4, IC 95 % = 0.2-0.8). La resolución de síntomas preoperatorios en la mayor parte de los pacientes fue > 80 % en los tres grupos. No hubo asociación de complicaciones o del tipo de procedimiento con el grado de satisfacción. Cuando el porcentaje de síntomas resueltos fue < 80 % se asoció con grado bajo o intermedio de satisfacción (p < 0.001). Conclusiones: La resolución de los síntomas preoperatorios con los tres procedimientos es similar. La MRE con esfinterotomía tiene mayor riesgo de complicaciones. El grado de satisfacción se asocia con la resolución de los síntomas preoperatorios.

BACKGROUND: We undertook this study to compare the clinical outcome of stapled rectal mucosectomy (SRM) alone and in combination with sphincterotomy and cutaneous flap anoplasty and to determine the influence of factors related to complications and patient satisfaction. METHODS: Patients with second- to fourth-degree hemorrhoids who underwent SRM alone or in combination with other anorectal procedures were included. Postoperative complications, symptom resolution and patient satisfaction were analyzed. RESULTS: Two hundred forty one patients with a minimum follow-up of 1 year were divided into three groups: SRM alone (n = 187), SRM combined with sphincterotomy (n = 31) and SRM combined with cutaneous flap anoplasty (n = 23). Patients with SRM with sphincterotomy showed a higher complication rate than the other groups (32 vs. 12.8% and 13%, respectively, p = 0.02). SRM combined with sphincterotomy was associated with a higher rate of complications (OR = 3.5; 95% CI = 1.4-8.7). SRM alone with low mucosal resection was associated with a lower complications rate (OR = 0.4, 95% CI = 0.2-0.8). Resolution of preoperative symptoms was >80% among the three groups. There was no association between complications and type of procedure with satisfaction level. Resolution of symptoms <80% was associated with low/intermediate level of satisfaction (p <0.001). CONCLUSIONS: Resolution of preoperative symptoms is similar among the three groups. SRM combined with sphincterotomy has a higher risk of complications. The satisfaction level is associated with resolution of preoperative symptoms.