The use of a self-assembling peptide gel for stricture prevention in the esophagus after endoscopic submucosal dissection: a U.S. multicenter prospective study (with video).

BACKGROUND AND AIMS: Postoperative stricture is a serious common adverse event after extensive endoscopic submucosal dissection (ESD) in the esophagus. Self-assembling peptide (SAP) gel has been shown to promote tissue healing and re-epithelialization. The aim of this study was to evaluate the effect of the SAP gel for esophageal stricture prevention after ESD. METHODS: This was a multicenter prospective study of patients who underwent esophageal ESD followed by SAP gel application between March 2022 and December 2023. Patients were included if the ESD mucosal defect involved ≥50% of the circumference of the esophagus. High-risk cases were defined as mucosal defects ≥75% of the circumference. Stricture was defined as the inability to pass an endoscope ≥8.9 mm in diameter or a narrow-caliber lumen in a patient with symptoms. RESULTS: A total of 43 patients (median age, 71 years; 81.4% male) underwent ESD (median resected specimen size, 50 mm) during the study period. SAP gel (median, 3 mL) was successfully applied in all cases (median time, 4 minutes). In aggregate, stricture occurred in 20.9% (9 of 43) of the cases. Stricture developed in 30.8% of the high-risk cases: 80% (4 of 5) after circumferential ESD and 19% (4 of 21) in those with defects ≥75% but <100% of the circumference. All cases of stricture resolved with endoscopic treatment. Three cases (6.9%) of postoperative bleeding occurred and were adequately managed endoscopically. CONCLUSIONS: We show that SAP gel application was easy, quick, and associated with a relatively low stricture rate comparable to other prophylactic methods. Additional comparative studies are needed to corroborate these preliminary findings.

Medicina defensiva en Guatemala: resultados de una encuesta exploratoria entre cirujanos / Defensive medicine in Guatemala: results of an exploratory questionnaire among surgeons

Introducción: la medicina defensiva ha surgido como una práctica creciente, debido al temor reclamos y demandas de los pacientes. Las especialidades quirúrgicas se consideran un grupo de riesgo, por lo que se supone que la medicina defensiva sea practicada en mayor grado entre sus miembros. este trabajo tuvo como objetivo determinar , si, entre los cirujanos de Guatemala se practica medicina defensiva. Material y métodos: se presenta un estudio observacional, transversal y descriptivo de naturaleza exploratoria. Se tomó como muestra a los miembros activos...

Uso de coagulación electrotérmica bipolar (LIGASUREtm) en cirugía tiroidea: presentación de una serie de prospectiva de casos / Use of bipolar electrothermal coagulation (LIGASUREtm) in thyroid surgery: presentation of a prospective case series

Introducción: el trabajo que se presenta tuvo como propósito establecer si el uso del sistema Ligasture tm es confiable y seguro para el manejo de los pedículos vasculares en cirugía tiroidea y si su uso modifica el índice de complicaciones. Material y métodos: se presenta una serie prospectiva de pacientes operados por padecimientos tiroideos benignos y malignos...