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Colorectal endoscopic submucosal dissection from a Westernperspective:Today's promises and future challenges

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World Journal of Gastrointestinal Endoscopy 2016年第2期8卷 40-55页

作者： JoséCarlos Marín-Gabriel Gloria Fernández-Esparrach JoséDíaz-Tasende Alberto Herreros de Tejada Department of Gastroenterology Endoscopy UnitHigh Risk GI Cancer Clinici+12Hospital Universitario“12 de Octubre”28041 MadridSpain Department of Gastroenterology Endoscopy UnitCIBEREHDIDIBAPSHospital ClínicUniversidad de Barcelona08036 BarcelonaSpain Department of Gastroenterology IDIPHIMHospital Universitario Puerta de HierroMajadahonda28222 MadridSpai

Over the last few years, endoscopic submucosal dissection(ESD) has shown to be effective in the management of early colorectal neoplasms, particularly in Asian countries where the technique was born. In the Western world, its implementation has been slow and laborious. In this paper, the indications for ESD, its learning model, the available methods to predict the presence of deep submucosal invasion before the procedure and the published outcomes from Asia and Europe will be reviewed. Since ESD has several limitations in terms of learning achievement in the West, and completion of the procedure for the first cases is difficult in our part of the world, a short review on colorectal assisted ESD has been included. Finally, other endoscopic and surgical treatment modalities that are in competition with colorectal ESD will be summarized.

关键词：《世界胃肠内镜杂志》中刊英文版

Gastrotomy closure with a new tissue anchoring device:A porcine survival study

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World Journal of Gastroenterology 2011年第13期17卷 1732-1738页

作者： Carlos Guarner-Argente Henry Córdova Graciela Martínez-Pallí Ricard Navarro-Ripoll Antonio Rodríguez-d’Jesús Cristina Rodríguez de Miguel Mireia Beltrán Gloria Fernández-Esparrach Endoscopy Unit Hospital Clínic CIBERehd Barcelona 08026 Spain Anesthesiology Department Hospital Clínic CIBERehd Barcelona 08026 Spain

AIM: To evaluate the feasibility, reproducibility and efficacy of a new tissue anchoring device in a porcine survival model. METHODS: Gastrotomies were performed using a needle-knife and balloon dilator in 10 female Yorkshire pigs weighing 30-35 kg. Gastric closure was attempted using a new tissue anchoring device. The tightness of the closure was confirmed by means of air insufflation and the ability to maintain gastric distension with stability in peritoneal pressure measured with a Veress needle. All animals were monitored daily for signs of peritonitis and sepsis over 14 d. During necropsy, the peritoneal cavity and the gastric access site were examined.RESULTS: Transgastric access, closure and 14 d survival was achieved in all pigs. The mean closure time was 18.1 ± 19.2 min and a mean of 2.1 ± 1 devices were used. Supplementary clips were necessary in 2 cases. The closure time was progressively reduced (24.8 ± 13.9 min in the first 5 pigs vs 11.4 ± 5.9 min in the last 5, P = NS). At necropsy, the gastric access site was correctly closed in all cases with all brace-bars present. One device was misplaced in the mesocolon. Minimal adhesions were observed in 3 pigs and signs of mild peritonitis and adhesions in one. CONCLUSIONS: The use of this new tissue anchoring device in porcine stomachs is feasible, reproducible and effective and requires a short learning curve.

关键词：锚固装置组织封闭猪闭合时间设备使用胃扩张锚定装置

rate of adverse events of gastroduodenal snare polypectomy for non-flat polyp is low: A prospective and multicenter study

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World Journal of Gastroenterology 2017年第47期23卷 8405-8414页

作者： Henry Córdova Lidia Argüello Carme Loras Antonio Naranjo Rodríguez Faust Riu Pons Joan B Gornals David Nicolás-Pérez Xavier Andújar Murcia Luis Hernández Santos Santolaria Carles Leal Carles Pons Enrique Pérez-Cuadrado-Robles Orlando García-Bosch Michel Papo Berger José Luis Ulla Rocha Cristina Sánchez-Montes Gloria Fernández-Esparrach Endoscopy Unit.Institut de Malalties Digestives Hospital ClínicIDIBAPSCIBERehdUniversitat de Barcelona Digestive Endoscopy Unit Digestive Diseases DepartmentGastrointestinal Endoscopy Research GroupIISLa Fe Polytechnic University Hospital Hospital Universitari Mútua de Terrassa CIBERehd Hospital Reina Sofía Hospital Del Mar Hospital Universitari de Bellvitge IDIBELLUniversitat de BarcelonaHospitalet de Llobregat Hospital Universitario de Canarias Hospital Santos Reyes Aranda de Duero Hospital San Jorge Consorci Hospitalari de Vic Universitat de Vic Hospital de Viladecans Hospital Morales Meseguer Hospital Moisès Broggi Sant Joan Despí Hospital Joan XXIII Complejo Hospitalario de Pontevedra

AIM To evaluate the rate of adverse events(AEs) during consecutive gastric and duodenal polypectomies in several Spanish centers. METHODS Polypectomies of protruded gastric or duodenal polyps ≥ 5 mm using hot snare were prospectively included. Prophylactic measures of hemorrhage were allowed in predefined cases. AEs were defined and graded according to the lexicon recommended by the American Society for Gastrointestinal Endoscopy. Patients were followed for 48 h, one week and 1 mo after theprocedure. RESULTS308 patients were included and a single polypectomy was performed in 205. Only 36(11.7%) were on prior anticoagulant therapy. Mean polyp size was 15 ± 8.9 mm(5-60) and in 294 cases(95.4%) were located in the stomach. Hemorrhage prophylaxis was performed in 219(71.1%) patients. Nine patients presented AEs(2.9%), and 6 of them were bleeding(n = 6, 1.9%)(in 5 out of 6 AE, different types of endoscopic treatment were performed). Other 24 hemorrhagic episodes could be managed without any change in the outcome of the endoscopy and, consequently, were considered incidents. We did not find any independent risk factor of bleeding.CONCLUSION Gastroduodenal polypectomy using prophylactic measures has a rate of AEs small enough to consider this procedure a safe and effective method for polyp resection independently of the polyp size and location.

关键词： Polypectomy Bleeding Adverse events Protruded polyps Gastroduodenal Foregut

Adjuvant therapy sparing in rectal cancer achieving complete response after chemoradiation

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World Journal of Gastroenterology 2014年第42期20卷 15820-15829页

作者： Xabier García-Albéniz Rosa Gallego Ralf Dieter Hofheinz Gloria Fernández-Esparrach Juan Ramón Ayuso-Colella Josep Antoni Bombí Carles Conill Miriam Cuatrecasas Salvadora Delgado Angels Ginés Rosa Miquel Mario Pagés Estela Pineda Verónica Pereira Aarón Sosa Oscar Reig Iván Victoria Luis Feliz Antonio María de Lacy Antoni Castells Iris Burkholder Andreas Hochhaus Joan Maurel Department of Epidemiology Harvard School of Public Health Department of Medical Oncology Hospital Clínic ICMHO IDIBAPS CIBEREHD University of Barcelona Interdisciplinary Tumor Center Mannheim and Ⅲ Medical Clinic University Hospital Mannheim University of Heidelberg Department of Gastroenterology Endoscopy Unit Hospital Clínic ICMDiM IDIBAPS CIBEREHD University of Barcelona Department of Radiology Hospital Clínic CDI IDIBAPS University of Barcelona Department of Pathology Hospital Clínic IDIBAPS University of Barcelona Department of Radiation Oncology Hospital Clínic ICMHO University of Barcelona Department of Gastrointestinal Surgery Hospital Clínic ICMDiM IDIBAPS CIBEREHD University of Barcelona Department of Gastroenterology Hospital Clínic ICMDiM IDIBAPS CIBEREHD University of Barcelona Department of Nursing and Health University of Applied Sciences of the Saarland Department for Hematology and Oncology Clinic for Internal Medicine Ⅱ Jena University Hospital

AIM:To evaluate the long-term results of conventional chemoradiotherapy and laparoscopic mesorectal excision in rectal adenocarcinoma patients without adjuvant therapy.METHODS:Patients with biopsy-proven adenocarcinoma of the rectum staged cT3-T4 by endoscopic ultrasound or magnetic resonance imaging received neoadjuvant continuous infusion of 5-fluorouracil for five weeks and concomitant radiotherapy.Laparoscopic surgery was planned after 5-8 wk.Patients diagnosed with ypT0N0 stage cancer were not treated with adjuvant therapy according to the protocol.Patients with ypT1-2N0 or ypT3-4 or N+were offered 5-fluorouracil-based adjuvant treatment on an individual basis.An external cohort was used as a reference for the findings.RESULTS:One hundred and seventy six patients were treated with induction chemoradiotherapy and 170underwent total mesorectal excision.Cancer staging of ypT0N0 was achieved in 26/170(15.3%)patients.After a median follow-up of 58.3 mo,patients withypT0N0 had five-year disease-free and overall survival rates of 96%(95%CI:77-99)and 100%,respectively.We provide evidence about the natural history of patients with localized rectal cancer achieving a complete response after preoperative chemoradiation.The inherent good prognosis of these patients will have implications for clinical trial design and care of patients.CONCLUSION:Withholding adjuvant chemotherapy after complete response following standard neoadjuvant chemoradiotherapy and laparoscopic mesorectal excision might be safe within an experienced multidisciplinary team.

关键词： Exercise Follow-up Gastrointestinal dis-eases Irri