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Case Report
A rare case of esophageal mucoepidermoid carcinoma successfully treated via endoscopic submucosal dissection
So Eun Jeun, Kyung Bin Kim, Bong Eun Lee, Gwang Ha Kim, Moon Won Lee, Dong Chan Joo
Received February 29, 2024  Accepted March 7, 2024  Published online June 18, 2024  
DOI: https://doi.org/10.5946/ce.2024.051    [Epub ahead of print]
AbstractAbstract PDFPubReaderePub
Esophageal mucoepidermoid carcinoma (EMEC) is a special subtype of esophageal malignancy, accounting for less than 1% of all cases of primary esophageal carcinoma. Pathologically, it consists of a mixture of adenocarcinoma and squamous cell carcinoma with mucin-secreting cells. Special staining for mucicarmine helps to diagnose EMEC. We present a rare case of EMEC successfully treated via endoscopic submucosal dissection (ESD). A 63-year-old man was referred to our tertiary hospital. On esophagogastroduodenoscopy, a 6-mm-sized subtle reddish depressed lesion was identified in the mid-esophagus. Diagnostic ESD was performed with a high suspicion of carcinoma. Histopathologic findings were consistent with EMEC which was confined to the lamina propria without lymphatic invasion. We plan to do a careful follow-up without administering adjuvant chemotherapy or radiotherapy. Due to the small volume of the lesion, establishing a diagnosis was difficult through forceps biopsy alone. However, by using ESD, we could confirm and successfully treat a rare case of early-stage EMEC.
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Systematic Review and Meta-analysis
Cryotherapy versus radiofrequency ablation in the treatment of dysplastic Barrett’s esophagus with or without early esophageal neoplasia: a systematic review and meta-analysis
Igor Logetto Caetité Gomes, Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Sérgio Barbosa Marques, Alexandre de Sousa Carlos, Beanie Conceição Medeiros Nunes, Bruno Salomão Hirsch, Guilherme Henrique Peixoto de Oliveira, Roberto Paolo Trasolini, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura
Clin Endosc 2024;57(2):181-190.   Published online January 17, 2024
DOI: https://doi.org/10.5946/ce.2023.065
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Radiofrequency ablation (RFA) is the first-line therapy for dysplastic Barrett’s esophagus (BE). Therefore, cryotherapy has emerged as an alternative treatment option. This study aimed to compare the efficacies of these two techniques based on the rates of complete eradication of intestinal metaplasia (CE-IM) and dysplasia (CE-D). Adverse events and recurrence have also been reported.
Methods
An electronic search was conducted using the Medline (PubMed), Embase, LILACS, and Google Scholar databases until December 2022. Studies were included comparing cryotherapy and RFA for treating dysplastic BE with or without early esophageal neoplasia. This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Results
Three retrospective cohort studies involving 627 patients were included. Of these, 399 patients underwent RFA, and 228 were treated with cryotherapy. There was no difference in CE-IM (risk difference [RD], –0.03; 95% confidence interval [CI], –0.25 to 0.19; p=0.78; I2=86%) as well as in CE-D (RD, –0.03; 95% CI, –0.15 to 0.09; p=0.64; I2=70%) between the groups. The absolute number of adverse events was low, and there was no difference in the recurrence rate.
Conclusions
Cryotherapy and RFA were equally effective in treating dysplastic BE, with or without early esophageal neoplasia.
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Reviews
Advanced endoscopic imaging for detection of Barrett’s esophagus
Netanel Zilberstein, Michelle Godbee, Neal A. Mehta, Irving Waxman
Clin Endosc 2024;57(1):1-10.   Published online January 5, 2024
DOI: https://doi.org/10.5946/ce.2023.031
AbstractAbstract PDFPubReaderePub
Barrett’s esophagus (BE) is the precursor to esophageal adenocarcinoma (EAC), and is caused by chronic gastroesophageal reflux. BE can progress over time from metaplasia to dysplasia, and eventually to EAC. EAC is associated with a poor prognosis, often due to advanced disease at the time of diagnosis. However, if BE is diagnosed early, pharmacologic and endoscopic treatments can prevent progression to EAC. The current standard of care for BE surveillance utilizes the Seattle protocol. Unfortunately, a sizable proportion of early EAC and BE-related high-grade dysplasia (HGD) are missed due to poor adherence to the Seattle protocol and sampling errors. New modalities using artificial intelligence (AI) have been proposed to improve the detection of early EAC and BE-related HGD. This review will focus on AI technology and its application to various endoscopic modalities such as high-definition white light endoscopy, narrow-band imaging, and volumetric laser endomicroscopy.

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  • Advancements in Barrett's esophagus detection: The role of artificial intelligence and its implications
    Sara Massironi
    World Journal of Gastroenterology.2024; 30(11): 1494.     CrossRef
  • 3,047 View
  • 223 Download
  • 1 Web of Science
  • 1 Crossref
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Role of linked color imaging for upper gastrointestinal disease: present and future
Sang Pyo Lee
Clin Endosc 2023;56(5):546-552.   Published online June 9, 2023
DOI: https://doi.org/10.5946/ce.2023.015
AbstractAbstract PDFPubReaderePub
Techniques for upper gastrointestinal endoscopy are advancing to facilitate lesion detection and improve prognosis. However, most early tumors in the upper gastrointestinal tract exhibit subtle color changes or morphological features that are difficult to detect using white light imaging. Linked color imaging (LCI) has been developed to overcome these shortcomings; it expands or reduces color information to clarify color differences, thereby facilitating the detection and observation of lesions. This article summarizes the characteristics of LCI and advances in LCI-related research in the upper gastrointestinal tract field.

Citations

Citations to this article as recorded by  
  • Upper gastrointestinal signs and symptoms: assessment, management and referral pathways
    Hasan Alsararatee
    Gastrointestinal Nursing.2024; 22(4): 192.     CrossRef
  • Endoscopic submucosal dissection for early gastric cancer: It is time to consider the quality of its outcomes
    Gwang Ha Kim
    World Journal of Gastroenterology.2023; 29(43): 5800.     CrossRef
  • 2,353 View
  • 203 Download
  • 1 Web of Science
  • 2 Crossref
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Original Articles
Endoscopic vacuum therapy for treatment of spontaneous and iatrogenic upper gastrointestinal defects
Kavea Panneerselvam, Jake S. Jacob, Ronald E. Samuel, Andy Tau, Gyanprakash A. Ketwaroo, Wasif M. Abidi, Robert J. Sealock
Clin Endosc 2023;56(6):754-760.   Published online May 9, 2023
DOI: https://doi.org/10.5946/ce.2022.177
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic vacuum therapy (EVT) can heal a variety of defects within the gastrointestinal (GI) tract via applying negative pressure, which reduces the defect size, aspirates the infected fluid, and promotes granulation tissue. Here we present our experience with EVT as it relates to both spontaneous and iatrogenic upper GI tract perforations, leaks, and fistulas.
Methods
This retrospective study was conducted at four large hospital centers. All patients who underwent EVT between June 2018 and March 2021 were included. Data on multiple variables were collected, including demographics, defect size and location, number and intervals of EVT exchanges, technical success, and hospital length of stay. Student t-test and the chi-squared test were used to analyze the data.
Results
Twenty patients underwent EVT. The most common defect cause was spontaneous esophageal perforation (50%). The most common defect location was the distal esophagus (55%). The success rate was 80%. Seven patients were treated with EVT as the primary closure method. The mean number of exchanges was five with a mean interval of 4.3 days between exchanges. The mean length of hospital stay was 55.8 days.
Conclusions
EVT is a safe and effective initial management option for esophageal leaks and perforations.

Citations

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  • Endoscopic vacuum therapy: management of upper gastrointestinal anastomotic leaks and esophageal perforations
    María de Armas Conde, Carmen Díaz-López , Vanessa Concepción-Martín, María Del Pilar Borque-Barrera
    Revista Española de Enfermedades Digestivas.2024;[Epub]     CrossRef
  • Management of fistulas in the upper gastrointestinal tract
    Maria Valeria Matteo, Maria Mihaela Birligea, Vincenzo Bove, Valerio Pontecorvi, Martina De Siena, Loredana Gualtieri, Federico Barbaro, Cristiano Spada, Ivo Boškoski
    Best Practice & Research Clinical Gastroenterology.2024; : 101929.     CrossRef
  • Endoscopic Vacuum Therapy of Upper Gastrointestinal Anastomotic Leaks: How to Deal with the Challenges (with Video)
    Laurent Monino, Tom G. Moreels
    Life.2023; 13(6): 1412.     CrossRef
  • 2,186 View
  • 138 Download
  • 1 Web of Science
  • 3 Crossref
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Bile acid sequestrants in poor healing after endoscopic therapy of Barrett’s esophagus
Lukas Welsch, Andrea May, Tobias Blasberg, Jens Wetzka, Elisa Müller, Myriam Heilani, Mireen Friedrich-Rust, Mate Knabe
Clin Endosc 2023;56(2):194-202.   Published online March 9, 2023
DOI: https://doi.org/10.5946/ce.2022.121
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic therapy for neoplastic Barrett’s esophagus (BE) has become the standard of care over the past two decades. In clinical practice, we regularly encounter patients who fail to achieve complete squamous epithelialization of the esophagus. Although the therapeutic strategies in the individual stages of BE, dysplasia, and esophageal adenocarcinoma are well studied and largely standardized, the problem of inadequate healing after endoscopic therapy is only marginally considered. This study aimed to shed light on the variables influencing inadequate wound healing after endoscopic therapy and the effect of bile acid sequestrants (BAS) on healing.
Methods
Retrospective analysis of endoscopically treated neoplastic BE in a single referral center.
Results
In 12.1% out of 627 patients, insufficient healing was present 8 to 12 weeks after previous endoscopic therapy. The average follow-up duration was 38.8±18.4 months. Complete healing was achieved in 13 patients already after intensifying proton pump inhibitor therapy. Out of 48 patients under BAS, 29 patients (60.4%) showed complete healing. An additional eight patients (16.7%) improved, but only partial healing was achieved. Eleven (22.9%) patients showed no response to BAS augmented therapy.
Conclusions
In cases of insufficient healing even under exhaustion of proton pump inhibitors, treatment with BAS can be an option as an ultimate healing attempt.

Citations

Citations to this article as recorded by  
  • Clinicians should be aware of proton pump inhibitor–related changes in the gastric mucosa
    Gwang Ha Kim
    Clinical Endoscopy.2024; 57(1): 51.     CrossRef
  • Seeking to understand non-responders to ablative therapy for dysplastic Barrett's esophagus
    Bryan G. Sauer
    Clinical Endoscopy.2023; 56(2): 180.     CrossRef
  • 2,624 View
  • 163 Download
  • 1 Web of Science
  • 2 Crossref
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Systematic Review and Meta-Analysis
Hybrid argon plasma coagulation in Barrett’s esophagus: a systematic review and meta-analysis
Sagar N. Shah, Nabil El Hage Chehade, Amirali Tavangar, Alyssa Choi, Marc Monachese, Kenneth J. Chang, Jason B. Samarasena
Clin Endosc 2023;56(1):38-49.   Published online January 30, 2023
DOI: https://doi.org/10.5946/ce.2022.179
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Patients with Barrett’s esophagus are at increased risk of developing esophageal adenocarcinoma. Endoscopic therapies aim to eradicate dysplastic and metaplastic tissues. Hybrid argon plasma coagulation (hybrid-APC) utilizes submucosal fluid injection to create a protective cushion prior to ablation that shields the submucosa from injury. We performed a pooled meta-analysis to evaluate the safety and efficacy of hybrid-APC.
Methods
We conducted a systematic search of major electronic databases in April 2022. Studies that included patients with dysplastic and non-dysplastic Barrett’s esophagus undergoing treatment with hybrid-APC were eligible for inclusion. Outcome measures included complete remission of intestinal metaplasia (CR-IM), stricture formation, serious adverse events, and number of sessions necessary to achieve CR-IM.
Results
Overall pooled CR-IM rate for patients undergoing hybrid-APC was 90.8% (95% confidence interval [CI], 0.872–0.939; I2=0%). Pooled stricture rate was 2.0% (95% CI, 0.005–0.042; I2=0%). Overall serious adverse event rate was 2.7% (95% CI, 0.007–0.055; I2=0%).
Conclusions
Results of the current meta-analysis suggest that hybrid-APC is associated with high rates of CR-IM and a favorable safety profile. Interpretation of these results is limited by the inclusion of retrospective cohort and case series data. Randomized controlled trials that standardize treatment and outcome evaluation protocols are necessary to understand how this treatment option is comparable to the current standards of care.

Citations

Citations to this article as recorded by  
  • Application of electrosurgery in gastrointestinal endoscopy

    Progress in Medical Devices.2024;[Epub]     CrossRef
  • Hybrid Argon Plasma Coagulation for Barrett’s Esophagus and for Colonic Mucosal Resection—A Systematic Review and Meta-Analysis
    Maria Manuela Estevinho, Rolando Pinho, João Carlos Silva, João Correia, Pedro Mesquita, Teresa Freitas
    Biomedicines.2023; 11(4): 1139.     CrossRef
  • Hybrid-APC treatment for gastric vascular ectasia of atypical location after failed radiofrequency ablation
    José Manuel Palma García, Raúl Honrubia López, Cristina Fernández de Castro, Carmen Comas Redondo
    Revista Española de Enfermedades Digestivas.2023;[Epub]     CrossRef
  • Thermal ablative therapies in the gastrointestinal tract
    Hendrik Manner
    Current Opinion in Gastroenterology.2023; 39(5): 370.     CrossRef
  • Endoscopic Management of Dysplastic Barrett’s Oesophagus and Early Oesophageal Adenocarcinoma
    Leonardo Henry Eusebi, Andrea Telese, Chiara Castellana, Rengin Melis Engin, Benjamin Norton, Apostolis Papaefthymiou, Rocco Maurizio Zagari, Rehan Haidry
    Cancers.2023; 15(19): 4776.     CrossRef
  • Critical Decision Making: Technical Aspects of Esophageal Ablation
    Felice Schnoll-Sussman
    Foregut: The Journal of the American Foregut Society.2023; 3(3): 314.     CrossRef
  • 2,897 View
  • 161 Download
  • 5 Web of Science
  • 6 Crossref
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Review
Role of artificial intelligence in diagnosing Barrett’s esophagus-related neoplasia
Michael Meinikheim, Helmut Messmann, Alanna Ebigbo
Clin Endosc 2023;56(1):14-22.   Published online January 17, 2023
DOI: https://doi.org/10.5946/ce.2022.247
AbstractAbstract PDFPubReaderePub
Barrett’s esophagus is associated with an increased risk of adenocarcinoma. Thorough screening during endoscopic surveillance is crucial to improve patient prognosis. Detecting and characterizing dysplastic or neoplastic Barrett’s esophagus during routine endoscopy are challenging, even for expert endoscopists. Artificial intelligence-based clinical decision support systems have been developed to provide additional assistance to physicians performing diagnostic and therapeutic gastrointestinal endoscopy. In this article, we review the current role of artificial intelligence in the management of Barrett’s esophagus and elaborate on potential artificial intelligence in the future.

Citations

Citations to this article as recorded by  
  • Endoskopische Therapie von Barrett-Neoplasien und Magenfrühkarzinomen
    Florian Berreth, Jan Peveling-Oberhag, Jörg G. Albert
    best practice onkologie.2024; 19(1-2): 28.     CrossRef
  • The Role of Screening and Early Detection in Upper Gastrointestinal Cancers
    Jin Woo Yoo, Monika Laszkowska, Robin B. Mendelsohn
    Hematology/Oncology Clinics of North America.2024; 38(3): 693.     CrossRef
  • Artificial intelligence in gastroenterology: where are we and where are we going?
    Laurence B Lovat
    Gastrointestinal Nursing.2024; 22(Sup3): S6.     CrossRef
  • As how artificial intelligence is revolutionizing endoscopy
    Jean-Francois Rey
    Clinical Endoscopy.2024; 57(3): 302.     CrossRef
  • Screening and Diagnostic Advances of Artificial Intelligence in Endoscopy
    Muhammed Yaman Swied, Mulham Alom, Obada Daaboul, Abdul Swied
    Innovations in Digital Health, Diagnostics, and Biomarkers.2024; 4(2024): 31.     CrossRef
  • Endoskopische Therapie von Barrett-Neoplasien und Magenfrühkarzinomen
    Florian Berreth, Jan Peveling-Oberhag, Jörg G. Albert
    Die Gastroenterologie.2023; 18(3): 186.     CrossRef
  • 2,528 View
  • 253 Download
  • 2 Web of Science
  • 6 Crossref
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Original Article
Epidemiology of early esophageal adenocarcinoma
Thuy-Van P. Hang, Zachary Spiritos, Anthony M. Gamboa, Zhengjia Chen, Seth Force, Vaishali Patel, Saurabh Chawla, Steven Keilin, Nabil F. Saba, Bassel El-Rayes, Qiang Cai, Field F. Willingham
Clin Endosc 2022;55(3):372-380.   Published online February 11, 2022
DOI: https://doi.org/10.5946/ce.2021.152
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic resection has become the preferred treatment approach for select early esophageal adenocarcinoma (EAC); however, the epidemiology of early stage disease has not been well defined.
Methods
Surveillance Epidemiology and End Results (SEER) data were analyzed to determine age-adjusted incidence rates among major epithelial carcinomas, including EAC, from 1973 to 2017. The percent change in incidence over time was compared according to tumor subtype. Early T-stage, node-negative EAC without metastasis was examined from 2004 to 2017 when precise T-stage data were available.
Results
The percent change in annual incidence from 1973 to 2017 was 767% for EAC. Joinpoint analysis showed that the average annual percent change in EAC from 1973 to 2017 was 5.11% (95% confidence interval, 4.66%–5.56%). The annual percent change appeared to plateau between 2004 and 2017; however, early EAC decreased from 2010 to 2017, with an annual percent change of -5.78%.
Conclusions
There has been a 7-fold increase in the incidence of EAC, which was significantly greater than that of the other major epithelial malignancies examined. More recently, the incidence of early EAC has been decreasing. Approximately one in five patients has node negative, potentially resectable early stage disease.

Citations

Citations to this article as recorded by  
  • Concise Commentary: It’s All Downhill from Here—How Diagnostic and Therapeutic Advances May Decrease the Incidence Rates of Gastroesophageal Junction and Esophageal Adenocarcinoma
    Anthony Gamboa, Rishi Naik
    Digestive Diseases and Sciences.2024; 69(1): 254.     CrossRef
  • Descriptive Epidemiology of Early-Onset Gastrointestinal Cancers in Iran, 2014-2018
    Mohammad Sadra Gholami Chahkand, Fatemeh Esmaeilpour Moallem, Fatemeh Ghasemi-Kebria, Reza Malekzadeh, Gholamreza Roshandel, Mohammad Taher
    Middle East Journal of Digestive Diseases.2024; 16(1): 28.     CrossRef
  • Epidemiologie der Adenokarzinome des Ösophagus und des ösophagogastralen Übergangs
    Sabine Luttmann, Andrea Eberle, Joachim Hübner
    Die Onkologie.2023; 29(6): 470.     CrossRef
  • Evaluation of Esophageal Dysphagia in Elderly Patients
    Khanh Hoang Nicholas Le, Eric E. Low, Rena Yadlapati
    Current Gastroenterology Reports.2023; 25(7): 146.     CrossRef
  • Histology Shift in Esophageal Cancer Between Biopsies and Resections After Neoadjuvant Therapy: A Pilot Study
    Tieying Hou, Zhaohai Yang, Qingzhao Zhang, Xuchen Zhang, Xiaoyan Liao, Jingmei Lin
    International Journal of Surgical Pathology.2023;[Epub]     CrossRef
  • Molecular Biology and Clinical Management of Esophageal Adenocarcinoma
    Shulin Li, Sanne Johanna Maria Hoefnagel, Kausilia Krishnawatie Krishnadath
    Cancers.2023; 15(22): 5410.     CrossRef
  • Progress in Clinical Management of Esophago-Jejunal Anastomotic Fistula with Total Gastrectomy for Adenocarcinoma of the Esophagogastric Junction
    天伟 赖
    Advances in Clinical Medicine.2023; 13(11): 17210.     CrossRef
  • Cranberry Proanthocyanidins Mitigate Reflux-Induced Transporter Dysregulation in an Esophageal Adenocarcinoma Model
    Yun Zhang, Katherine M. Weh, Bridget A. Tripp, Jennifer L. Clarke, Connor L. Howard, Shruthi Sunilkumar, Amy B. Howell, Laura A. Kresty
    Pharmaceuticals.2023; 16(12): 1697.     CrossRef
  • Lessons learned in clinical epidemiology of esophageal adenocarcinoma
    Hye Kyung Jung
    Clinical Endoscopy.2022; 55(3): 365.     CrossRef
  • 4,820 View
  • 268 Download
  • 5 Web of Science
  • 9 Crossref
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Case Report
Less invasive transoral resection of esophageal fibrovascular polyps: case reports
Janusz Włodarczyk, Tomasz Smęder
Clin Endosc 2022;55(5):683-687.   Published online December 6, 2021
DOI: https://doi.org/10.5946/ce.2021.144
AbstractAbstract PDFPubReaderePub
We report five patients treated for esophageal fibrovascular polyps using a minimally invasive technique. Esophageal fibrovascular polyps are benign pedunculated submucosal tumors of considerable size. The treated polyps size ranged from 1.5 to 13 cm. The polyps were removed by relocation to the oral cavity under endoscopic control. No perioperative complications occurred after the treatment. The follow-up of patients after surgery was 9–89 months, with no evidence of polyp recurrence. Thus, the described treatment is safe but requires experience with endoscopy as well as esophageal surgery.
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Focused Review Series: Endoscopic Management of Postoperative Gastrointestinal Complication: What’s New?
Current Status of Endoscopic Vacuum Therapy in the Management of Esophageal Perforations and Post-Operative Leaks
Imogen Livingstone, Lily Pollock, Bruno Sgromo, Sotiris Mastoridis
Clin Endosc 2021;54(6):787-797.   Published online November 16, 2021
DOI: https://doi.org/10.5946/ce.2021.240
AbstractAbstract PDFPubReaderePub
Esophageal wall defects, including perforations and postoperative leaks, are associated with high morbidity and mortality and pose a significant management challenge. In light of the high morbidity of surgical management or revision, in recent years, endoscopic vacuum therapy (EVT) has emerged as a novel alternative treatment strategy. EVT involves transoral endoscopic placement of a polyurethane sponge connected to an externalized nasogastric tube to provide continuous negative pressure with the intention of promoting defect healing, facilitating cavity drainage, and ameliorating sepsis. In the last decade, EVT has become increasingly adopted in the management of a diverse spectrum of esophageal defects. Its popularity has been attributed in part to the growing body of evidence suggesting superior outcomes and defect closure rates in excess of 80%. This growing body of evidence, coupled with the ongoing evolution of the technology and techniques of deployment, suggests that the utilization of EVT has become increasingly widespread. Here, we aimed to review the current status of the field, addressing the mechanism of action, indications, technique methodology, efficacy, safety, and practical considerations of EVT implementation. We also sought to highlight future directions for the use of EVT in esophageal wall defects.

Citations

Citations to this article as recorded by  
  • Multi-modality management of defects in the gastrointestinal tract: Where the endoscope meets the scalpel: Endoscopic vacuum therapy in the upper gastrointestinal tract
    Lisanne M.D. Pattynama, Wietse J. Eshuis, Stefan Seewald, Roos E. Pouw
    Best Practice & Research Clinical Gastroenterology.2024; : 101901.     CrossRef
  • Management of esophageal anastomotic leaks, a systematic review and network meta-analysis
    William Murray, Mathew G Davey, William Robb, Noel E Donlon
    Diseases of the Esophagus.2024;[Epub]     CrossRef
  • Management of an Aortoesophageal Fistula With Esophageal Endoluminal Wound Vacuum Therapy
    Antoine Nehme, Samuel Brown, Salman Zaheer, Alexander Leung
    Annals of Thoracic Surgery Short Reports.2024;[Epub]     CrossRef
  • Treatment of Esophageal-Pleural Fistula After Diverticulectomy Using Transluminal Vacuum Therapy in a Patient with HIV Infection
    M. A. Panasyuk, G. Yu. Aldaranov, V. N. Makhutov, E. G. Grigoriev
    Russian Sklifosovsky Journal "Emergency Medical Care".2024; 13(1): 156.     CrossRef
  • Successful Endoscopic Vacuum-Assisted Closure Therapy for Esophageal Perforation: A Case Report
    Jung Huh, Jinsun Yang, Seung Joo Kang, Hyoun Woo Kang, Hyeon Jong Moon, Su Hwan Kim, Bokyung Kim, Ji Won Kim, Kook Lae Lee, Yong Won Seong, Kwang Woo Kim
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2024; 24(2): 187.     CrossRef
  • VAC-Stent in the Treatment of Post-Esophagectomy Anastomotic Leaks: A New “Kid on the Block” Who Marries the Best of Old Techniques—A Review
    Giuseppe Dell’Anna, Lorella Fanti, Jacopo Fanizza, Rukaia Barà, Alberto Barchi, Ernesto Fasulo, Ugo Elmore, Riccardo Rosati, Vito Annese, Liboria Laterza, Lorenzo Fuccio, Francesco Azzolini, Silvio Danese, Francesco Vito Mandarino
    Journal of Clinical Medicine.2024; 13(13): 3805.     CrossRef
  • Homemade endoscopic vacuum therapy device for the management of transmural gastrointestinal defects
    Diogo Turiani Hourneaux de Moura, Bruno Salomão Hirsch, Thomas R. McCarty, Marcos Eduardo Lera dos Santos, Hugo Gonçalo Guedes, Guilherme Francisco Gomes, Flaubert Sena de Medeiros, Eduardo Guimarães Hourneaux de Moura
    Digestive Endoscopy.2023; 35(6): 745.     CrossRef
  • Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas: Basic principles and recommendations
    Victor Lira de Oliveira, Alexandre Moraes Bestetti, Roberto Paolo Trasolini, Eduardo Guimarães Hourneaux de Moura, Diogo Turiani Hourneaux de Moura
    World Journal of Gastroenterology.2023; 29(7): 1173.     CrossRef
  • Vacuum-Assisted Closure Treats Refractory Esophageal Leak in a Pediatric Patient
    Evan K Lin, Felicia Lee, Jasmin Cao, Christian Saliba, Vivian Lu, Raymond I Okeke, Justin Sobrino, Christopher Blewett
    Cureus.2023;[Epub]     CrossRef
  • Esophageal Perforation
    Kelly Fairbairn, Stephanie G. Worrell
    Thoracic Surgery Clinics.2023; 33(2): 117.     CrossRef
  • Endoscopic Treatment of Non-malignant Esophageal Perforation: Time to Go Vacuum?
    Diogo Turiani Hourneaux de Moura, Bruno Salomão Hirsch, Heli Clóvis de Medeiros Neto, Victor Lira de Oliveira, Alexandre Moraes Bestetti, Bruna Furia Buzetti Hourneaux de Moura, Mouen A. Khashab, Eduardo Guimarães Hourneaux de Moura
    Current Treatment Options in Gastroenterology.2023; 21(2): 95.     CrossRef
  • Prophylactic endoluminal vacuum therapy after major gastrointestinal surgery: a systematic review
    Olga Adamenko, Carlo Ferrari, Stefan Seewald, Jan Schmidt
    Updates in Surgery.2022; 74(4): 1177.     CrossRef
  • Endoscopic Management of Esophageal Cancer
    Christopher Paiji, Alireza Sedarat
    Cancers.2022; 14(15): 3583.     CrossRef
  • 4,790 View
  • 253 Download
  • 7 Web of Science
  • 13 Crossref
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Original Article
Endoscopic Management of Anastomotic Leakage after Esophageal Surgery: Ten Year Analysis in a Tertiary University Center
Nader El-Sourani, Sorin Miftode, Maximilian Bockhorn, Alexander Arlt, Christian Meinhardt
Clin Endosc 2022;55(1):58-66.   Published online October 14, 2021
DOI: https://doi.org/10.5946/ce.2021.099
AbstractAbstract PDFPubReaderePub
Background
/Aims: Anastomotic leakage after esophageal surgery remains a feared complication. During the last decade, management of this complication changed from surgical revision to a more conservative and endoscopic approach. However, the treatment remains controversial as the indications for conservative, endoscopic, and surgical approaches remain non-standardized.
Methods
Between 2010 and 2020, all patients who underwent Ivor Lewis esophagectomy for underlying malignancy were included in this study. The data of 28 patients diagnosed with anastomotic leak were further analyzed.
Results
Among 141 patients who underwent resection, 28 (19.9%) developed an anastomotic leak, eight (28.6%) of whom died. Thirteen patients were treated with endoluminal vacuum therapy (EVT), seven patients with self-expanding metal stents (SEMS) four patients with primary surgery, one patient with a hemoclip, and three patients were treated conservatively. EVT achieved closure in 92.3% of the patients with a large defect and no EVT-related complications. SEMS therapy was successful in clinically stable patients with small defect sizes.
Conclusions
EVT can be successfully applied in the treatment of anastomotic leakage in critically ill patients, while SEMS should be limited to clinically stable patients with a small defect size. Surgery is only warranted in patients with sepsis with graft necrosis.

Citations

Citations to this article as recorded by  
  • Placing vacuum sponges in esophageal anastomotic leaks — how we do it
    Florian Hentschel, Götz Mollenhauer, Björn Siemssen, Christoph Paasch, René Mantke, Stefan Lüth
    Langenbeck's Archives of Surgery.2024;[Epub]     CrossRef
  • Management of esophageal anastomotic leaks, a systematic review and network meta-analysis
    William Murray, Mathew G Davey, William Robb, Noel E Donlon
    Diseases of the Esophagus.2024;[Epub]     CrossRef
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  • RETRACTED ARTICLE: Changes in diagnosis and management of anastomotic leakage after esophagectomy for underlying malignancy reduce postoperative mortality and improve patient outcome
    Nader El-Sourani, Sorin Miftode, Achim Troja, Fadl Alfarawan, Maximilian Bockhorn
    European Surgery.2023; 55(2): 77.     CrossRef
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  • Endoscopic vacuum therapy significantly improves clinical outcomes of anastomotic leakages after 2-stage, 3-stage, and transhiatal esophagectomies
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    Laurent Monino, Tom G. Moreels
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    Chul-Hyun Lim
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  • 5,235 View
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Focused Review Series: Cutting Edge of Advanced Therapeutic Endoscopy
Role of Peroral Endoscopic Myotomy (POEM) in the Management of Esophageal Diverticula
Bogdan P. Miutescu, Sarah Khan, Shruti Mony, Mouen A. Khashab
Clin Endosc 2020;53(6):646-651.   Published online November 26, 2020
DOI: https://doi.org/10.5946/ce.2020.262
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Esophageal diverticula are uncommon; however, when present, they can cause symptoms of dysphagia, regurgitation, and chest pain. Based on location and pathophysiological characteristics, they are classified as pulsion- and traction-type diverticula. In the past, the open surgical approach was the only treatment available; however, in the past few decades, transoral incisionless approaches in the form of rigid and flexible endoscopy have gained popularity. Diverticular peroral endoscopic myotomy has emerged as an alternative treatment option. In this paper, we reviewed the role of peroral endoscopic myotomy as a treatment option for different types of esophageal diverticula. Although a safe and effective procedure, this novel submucosal tunneling technique for the treatment of esophageal diverticula requires further validation, and head-to-head comparisons between the different approaches for the treatment of esophageal diverticula are warranted.

Citations

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    Antonio Facciorusso, Daryl Ramai, Yervant Ichkhanian, Rena Yadlapati, Vito Annese, Sachin Wani, Mouen A. Khashab
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  • 6,218 View
  • 197 Download
  • 8 Web of Science
  • 7 Crossref
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Case Reports
Hybrid Peroral Endoscopic Myotomy for Achalasia with Prior Treatment Failure
In Kyung Yoo, Abdullah OzgurYeniova, Joo Young Cho
Clin Endosc 2021;54(1):127-130.   Published online April 2, 2020
DOI: https://doi.org/10.5946/ce.2020.013
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Achalasia is a neurodegenerative motility disorder caused by enteric neuron damage in the lower esophageal sphincter. Peroral endoscopic myotomy (POEM) is a standard treatment method for achalasia. Previous treatment modalities may affect the outcome of POEM as they cause submucosal fibrosis. We report a new technique called “hybrid POEM” for the treatment of patients with achalasia who had been previously treated with pneumatic balloon dilatation. We performed two techniques of POEM simultaneously, the standard POEM for the upper part of the submucosal tunnel and open POEM for the stenotic part of the esophagogastric junction. We dissected the mucosa and submucosa, and performed myotomy simultaneously. We overcame submucosal fibrosis of the esophagogastric junction, which was caused by the previous hybrid POEM treatment. The risks of mucosal incision and technical challenge of submucosal tunneling for the fibrotic area may be reduced by hybrid POEM.
  • 4,148 View
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Submucosal Tunneling Muscle Biopsy for Esophageal Motility Disorders: A Case Report
Aleksandr A. Smirnov, Maya M. Kiriltseva, Aleksandr N. Burakov, Maksim V. Maksimov, Anna V. Botina, Marina M. Saadulaeva, Nadezda V. Konkina
Clin Endosc 2020;53(3):370-373.   Published online August 20, 2019
DOI: https://doi.org/10.5946/ce.2019.109
AbstractAbstract PDFPubReaderePub
Submucosal tunneling endoscopic technique can be useful in obtaining esophageal muscle specimens in patients with esophageal motility disorders. Here, we describe the case of a patient with systemic sclerosis. Histological verification of the esophageal involvement in the pathological process was required for the treatment. There were no intra- and post- operational complications.

Citations

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  • Updates in the Field of Submucosal Endoscopy
    Tadateru Maehata, Yoshinori Sato, Yusuke Nakamoto, Masaki Kato, Akiyo Kawashima, Hirofumi Kiyokawa, Hiroshi Yasuda, Hiroyuki Yamamoto, Keisuke Tateishi
    Life.2022; 13(1): 104.     CrossRef
  • 4,416 View
  • 87 Download
  • 1 Web of Science
  • 1 Crossref
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Buried Barrett’s Esophagus with High-Grade Dysplasia after Radiofrequency Ablation
Joana Castela, Miguel Serrano, Susana Mão de Ferro, Daniela Vinha Pereira, Paula Chaves, António Dias Pereira
Clin Endosc 2019;52(3):269-272.   Published online October 5, 2018
DOI: https://doi.org/10.5946/ce.2018.124
AbstractAbstract PDFPubReaderePub
Radiofrequency ablation therapy is an effective endoscopic option for the eradication of Barrett’s esophagus that appears to reduce the risk of esophageal cancer. A concern associated with this technique is the development of subsquamous/buried intestinal metaplasia, whose clinical relevance and malignant potential have not yet been fully elucidated. Fewer than 20 cases of subsquamous neoplasia after the successful radiofrequency ablation of Barrett’s esophagus have been reported to date. Here, we describe a new case of subsquamous neoplasia (high-grade dysplasia) following radiofrequency ablation that was managed with endoscopic resection. Our experience suggests that a meticulous endoscopic inspection prior to and after radiofrequency ablation is fundamental to reduce the risk of buried neoplasia development.

Citations

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  • 6 Web of Science
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Focused Review Series: Updates on Capsule Endoscopy from Esophagus to Colon
Current and Future Use of Esophageal Capsule Endoscopy
Junseok Park, Young Kwan Cho, Ji Hyun Kim
Clin Endosc 2018;51(4):317-322.   Published online July 31, 2018
DOI: https://doi.org/10.5946/ce.2018.101
AbstractAbstract PDFPubReaderePub
Capsule endoscopy can be a diagnostic option for patients with esophageal diseases who cannot tolerate esophagogastroduodenoscopy.Functional modifications of the capsule allow for thorough examination of the esophagus. Esophageal capsule endoscopy has so farfailed to show sufficient performance to justify the replacement of traditional endoscopy for the diagnosis of esophageal diseasesbecause the esophagus has a short transit time and common pathologies appear near the esophagogastric junction. However,technological improvements are being introduced to overcome the limitations of capsule endoscopy, which is expected to become agood alternative to conventional endoscopy.

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Review
Quality Indicators in Barrett’s Esophagus: Time to Change the Status Quo
Samuel Han, Sachin Wani
Clin Endosc 2018;51(4):344-351.   Published online July 31, 2018
DOI: https://doi.org/10.5946/ce.2018.099
AbstractAbstract PDFPubReaderePub
The push for high quality care in all fields of medicine highlights the importance of establishing and adhering to quality indicators.In response, several gastrointestinal societies have established quality indicators specific to Barrett’s esophagus, which serve to createthresholds for performance while standardizing practice and guiding value-based care. Recent studies, however, have consistentlydemonstrated the lack of adherence to these quality indicators, particularly in surveillance (appropriate utilization of endoscopy andobtaining biopsies using the Seattle protocol) and endoscopic eradication therapy practices. These findings suggest that innovativeinterventions are needed to address these shortcomings in order to deliver high quality care to patients with Barrett’s esophagus.

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    Alexander T Reddy, Joshua P Lee, David A Leiman
    Diseases of the Esophagus.2024;[Epub]     CrossRef
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    Jamielyn DC Cruz, David Paculdo, Divya Ganesan, Meredith Baker, Rebecca J Critchley-Thorne, Nicholas J Shaheen, Sachin Wani, John W Peabody
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    Connor K. Wilson, Sara R. Frankowski, Susan C. Steelman, Issam Makhoul
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  • 102 Download
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Case Report
Magnifying Endoscopy for Esophageal Ectopic Sebaceous Glands
Mu Song Jeon, Gwang Ha Kim, Dong Young Jeong, Byeong Kyu Park, Moon Won Lee, So-Jeong Lee, Do Youn Park
Clin Endosc 2018;51(5):495-497.   Published online February 26, 2018
DOI: https://doi.org/10.5946/ce.2017.187
AbstractAbstract PDFPubReaderePub
Ectopic sebaceous glands are found very rarely in the esophagus; heretofore, several cases have been reported. The sebaceous gland is originally a source of an endodermal origin; however, there have been controversies regarding whether the origin of the esophageal ectopic sebaceous gland is ectodermal or endodermal. Ectopic sebaceous glands of the esophagus usually do not cause symptoms; thus, they are often found incidentally on endoscopy for routine health screening. Endoscopic findings are characterized by single or multiple yellow patches or nodular lesions of various sizes, sometimes with small central openings. We report two cases of esophageal ectopic sebaceous glands found incidentally during endoscopy with magnifying endoscopic findings. The lesions were in the mid-esophagus and lower esophagus, respectively, and both endoscopic findings were similar as multiple yellowish patches or plaques. Magnifying endoscopy revealed the openings of the excretory ducts surrounded by circular microvessels in both cases.

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    Dong Han Yeom, Han Seung Ryu
    Chonnam Medical Journal.2019; 55(3): 168.     CrossRef
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Review
Oroesophageal Fish Bone Foreign Body
Heung Up Kim
Clin Endosc 2016;49(4):318-326.   Published online July 26, 2016
DOI: https://doi.org/10.5946/ce.2016.087
AbstractAbstract PDFPubReaderePub
Fish bone foreign body (FFB) is the most frequent food-associated foreign body (FB) in adults, especially in Asia, versus meat in Western countries. The esophageal sphincter is the most common lodging site. Esophageal FB disease tends to occur more frequently in men than in women. The first diagnostic method is laryngoscopic examination. Because simple radiography of the neck has low sensitivity, if perforation or severe complications requiring surgery are expected, computed tomography should be used. The risk factors associated with poor prognosis are long time lapse after FB involvement, bone type, and longer FB (>3 cm). Bleeding and perforation are more common in FFB disease than in other FB diseases. Esophageal FB disease requires urgent treatment within 24 hours. However, FFB disease needs emergent treatment, preferably within 2 hours, and definitely within 6 hours. Esophageal FFB disease usually occurs at the physiological stricture of the esophagus. The aortic arch eminence is the second physiological stricture. If the FB penetrates the esophageal wall, a life-threatening aortoesophageal fistula can develop. Therefore, it is better to consult a thoracic surgeon prior to endoscopic removal.

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Case Report
Laser Imaging Facilitates Early Detection of Synchronous Adenocarcinomas in Patients with Barrett’s Esophagus
Chihiro Iwashita, Yoshimasa Miura, Hiroyuki Osawa, Takahito Takezawa, Yuji Ino, Masahiro Okada, Alan K. Lefor, Hironori Yamamoto
Clin Endosc 2017;50(1):81-86.   Published online May 9, 2016
DOI: https://doi.org/10.5946/ce.2016.027
AbstractAbstract PDFPubReaderePub
Barrett’s adenocarcinoma may occur in multiple sites, and recurrence and metachronous lesions are the major problems with endoscopic resection. Therefore, early detection of such lesions is ideal to achieve complete resection and obtain improved survival rates with minimally invasive treatment. Laser imaging systems allow multiple modalities of endoscopic imaging by using white light laser, flexible spectral imaging color enhancement (FICE), blue laser imaging (BLI), and linked color imaging even at a distant view. However, the usefulness of these modalities has not been sufficiently reported regarding Barrett’s adenocarcinoma. Here, we report on a patient with three synchronous lesions followed by one metachronous lesion in a long segment with changes of Barrett’s esophagus, all diagnosed with this new laser endoscopic imaging system and enhanced by using FICE and/or BLI with high contrast compared with the surrounding mucosa. Laser endoscopic imaging may facilitate the detection of malignancies in patients with early Barrett’s adenocarcinoma.

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Focused Review Series: Current Issues and Future Directions of Small Bowel Endoscopic Evaluation
Current Status and Research into Overcoming Limitations of Capsule Endoscopy
Won Gun Kwack, Yun Jeong Lim
Clin Endosc 2016;49(1):8-15.   Published online January 28, 2016
DOI: https://doi.org/10.5946/ce.2016.49.1.8
AbstractAbstract PDFPubReaderePub
Endoscopic investigation has a critical role in the diagnosis and treatment of gastrointestinal (GI) diseases. Since 2001, capsule endoscopy (CE) has been available for small-bowel exploration and is under continuous development. During the past decade, CE has achieved impressive improvements in areas such as miniaturization, resolution, and battery life. As a result, CE is currently a first-line tool for the investigation of the small bowel in obscure gastrointestinal bleeding and is a useful alternative to wired enteroscopy. Nevertheless, CE still has several limitations, such as incomplete examination and limited diagnostic and therapeutic capabilities. To resolve these problems, many groups have suggested several models (e.g., controlled CO2 insufflation system, magnetic navigation system, mobile robotic platform, tagging and biopsy equipment, and targeted drug-delivery system), which are in development. In the near future, new technological advances will improve the capabilities of CE and broaden its spectrum of applications not only for the small bowel but also for the colon, stomach, and esophagus. The purpose of this review is to introduce the current status of CE and to review the ongoing development of solutions to address its limitations.

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  • Colorectal cancer, screening and primary care: A mini literature review
    Athanasios Hadjipetrou, Dimitrios Anyfantakis, Christos G Galanakis, Miltiades Kastanakis, Serafim Kastanakis
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  • 250 Download
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Case Report
Esophageal Lymphoepithelioma-Like Carcinoma with Unique Daisy-Like Appearance
Sehmus Olmez, Alper Can, Alpaslan Yavuz, Umit Haluk İliklerden, Gulay Bulut
Clin Endosc 2015;48(6):549-552.   Published online November 30, 2015
DOI: https://doi.org/10.5946/ce.2015.48.6.549
AbstractAbstract PDFPubReaderePub
Due to differences in prognosis and management, it is important to subclassify esophageal carcinoma. Esophageal lymphoepithelioma-like carcinoma (LELC) is extremely rare, with only a few cases reported to date. Review of the literature revealed case reports describing lesions with similar histology. We present a 69-year-old man with a giant pedunculated-polypoid lesion of the esophagus shrinking the lumen. Endoscopic excision of the tumor was performed and final histopathological diagnosis was confirmed to be LELC. In contrast to a previous case with a more aggressive course and a recurrent lesion, our patient died of his disease within 8 months of diagnosis. Here we discuss the endoscopic and radiologic findings of the case and a review of the literature.

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  • Analysis of genetic profiling, pathomics signature, and prognostic features of primary lymphoepithelioma‐like carcinoma of the renal pelvis
    Bo Fan, Yuanbin Huang, Hongshuo Zhang, Tingyu Chen, Shenghua Tao, Xiaogang Wang, Shuang Wen, Honglong Wang, Zhe Lin, Tianqing Liu, Hongxian Zhang, Tao He, Xiancheng Li
    Molecular Oncology.2022; 16(20): 3666.     CrossRef
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    Kosuke Narumiya, Yosuke Yagawa, Kenji Kudo, Shinsuke Maeda, Yukinori Toyoshima, Kyohei Ogawa, Sho Izumika, Kimito Harada, Masayuki Itabashi, Harushi Osugi
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Review
Stricture Occurring after Endoscopic Submucosal Dissection for Esophageal and Gastric Tumors
Gwang Ha Kim, Sam Ryong Jee, Jae Young Jang, Sung Kwan Shin, Kee Don Choi, Jun Haeng Lee, Sang Gyun Kim, Jae Kyu Sung, Suck Chei Choi, Seong Woo Jeon, Byung Ik Jang, Kyu Chan Huh, Dong Kyung Chang, Sung-Ae Jung, Bora Keum, Jin Woong Cho, Il Ju Choi, Hwoon-Yong Jung, Korean ESD Study Group
Clin Endosc 2014;47(6):516-522.   Published online November 30, 2014
DOI: https://doi.org/10.5946/ce.2014.47.6.516
AbstractAbstract PDFPubReaderePub

Endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastric and esophageal cancer. Compared to endoscopic mucosal resection, ESD has the advantage of enabling en bloc removal of tumors regardless of their size. However, ESD can result in a large artificial ulcer, which may lead to a considerable deformity. Circumferential mucosal defects of more than three-fourths the esophageal circumference, long longitudinal mucosal defects (>30 mm), and lesions in the upper esophagus are significant risk factors for the development of post-ESD strictures of the esophagus. In the stomach, a circumferential mucosal defects more than three-fourths in extent and longitudinal mucosal defects >5 cm are risk factors of post-ESD stricture. If scheduled early, regular endoscopic balloon dilation is effective in controlling and preventing post-ESD stricture. Moreover, intralesional steroid injections or oral steroids can achieve remission of dysphagia or reduce the need for repeated endoscopic balloon dilation. However, further study is needed to improve the prevention of stricture formation.

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    Mike T. Wei, Shai Friedland
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    Seung Hyun Kim, Yong Seon Choi, Sang Kil Lee, Hanseul Oh, Seung Ho Choi
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    Woong Ki Lee, Byung Sun Kim, Min A Yang, So Hee Yun, Young Jae Lee, Ji Woong Kim, Jin Woong Cho
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    Eduard Jonas, Sebastian Sjöqvist, Peter Elbe, Nobuo Kanai, Jenny Enger, Stephan L Haas, Ammar Mohkles‐Barakat, Teruo Okano, Ryo Takagi, Takeshi Ohki, Masakazu Yamamoto, Makoto Kondo, Katrin Markland, Mei Ling Lim, Masayuki Yamato, Magnus Nilsson, Johan Pe
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Case Reports
Xanthoma of the Esophagus
Chang Seok Bang, Yeon Soo Kim, Gwang Ho Baik, Sang Hak Han
Clin Endosc 2014;47(4):358-361.   Published online July 28, 2014
DOI: https://doi.org/10.5946/ce.2014.47.4.358
AbstractAbstract PDFPubReaderePub

Xanthoma is an uncommon nonneoplastic lesion resulting from the accumulation of histiocytes. It predominantly shows cutaneous manifestations associated with dyslipidemia. However, xanthoma of the esophagus is extremely rare. To the best of our knowledge, only 14 cases have been reported thus far. The clinical significance of this lesion has not been established. However, this lesion should be distinguished grossly from ectopic sebaceous glands and small subepithelial tumors such as carcinoid and granular cell tumor. Moreover, signet ring cell carcinoma, which contains round cells with abundant cytoplasm and has similar histologic features to xanthoma, should be distinguished microscopically.

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    Yuan Fang, Zhi Wang, Yong Qiang Yang, Bei Wen Song, Wen Bin Gou
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    Xiao-Yun Yang, Kuang-I Fu, Yan-Ping Chen, Zhen-Wei Chen, Jing Ding
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    Seong Keun Lee, Chul Hong Park, Min Hee Jung
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    Ahmed Dirweesh, Muhammad Khan, Sumera Bukhari, Cheryl Rimmer, Robert Shmuts
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Primary Papillary Thyroid Carcinoma Diagnosed by Using Endoscopic Ultrasound with Fine Needle Aspiration
Ala Abdel Jalil, Fateh A. Elkhatib, Abdulah A. Mahayni, Amer A. Alkhatib
Clin Endosc 2014;47(4):350-352.   Published online July 28, 2014
DOI: https://doi.org/10.5946/ce.2014.47.4.350
AbstractAbstract PDFPubReaderePub

There is paucity in the literature on the use of endoscopic ultrasound (EUS) for evaluating the thyroid gland. We report the first case of primary papillary thyroid cancer diagnosed by using EUS and fine needle aspiration (FNA). A 66-year-old man underwent EUS for the evaluation of mediastinal lymphadenopathy. FNA of the lymph nodes showed benign findings. A hypoechoic mass was noted in the right lobe of the thyroid gland. Therefore, FNA was performed. The cytological results were consistent with primary papillary thyroid cancer.

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  • EUS of the neck: A comprehensive anatomical reference for the staging of head and neck cancer (with videos)
    Malay Sharma, Amit Pathak, Abid Shoukat, ChittapuramSrinivasan Rameshbabu, Sumit Goyal, Raghav Bansal, Rooby Hamza, Kshitij Charaya
    Endoscopic Ultrasound.2019; 8(4): 227.     CrossRef
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Review
Plastic and Biodegradable Stents for Complex and Refractory Benign Esophageal Strictures
Young Hee Ham, Gwang Ha Kim
Clin Endosc 2014;47(4):295-300.   Published online July 28, 2014
DOI: https://doi.org/10.5946/ce.2014.47.4.295
AbstractAbstract PDFPubReaderePub

Endoscopic stent placement is a well-accepted and effective alternative treatment modality for complex and refractory esophageal strictures. Among the currently available types of stents, the partially covered self-expanding metal stent (SEMS) has a firm anchoring effect, preventing stent migration and ensuring effective covering of a narrowed segment. However, hyperplastic tissue reaction driven by the uncovered mesh may prevent easy and safe stent removal. As an alternative, a fully covered SEMS decreases the recurrence of dysphagia caused by hyperplastic tissue ingrowth; however, it has a high migration rate. Likewise, although a self-expanding plastic stent (SEPS) reduces reactive hyperplasia, the long-term outcome is disappointing because of the high rate of stent migration. A biodegradable stent has the main benefit of not requiring stent removal in comparison with SEMS and SEPS. However, it still has a somewhat high rate of hyperplastic reaction, and the long-term outcome does not satisfy expectations. Up to now, the question of which type of stent should be recommended for the effective treatment of complex and refractory benign strictures has no clear answer. Therefore, the selection of stent type for endoscopic treatment should be individualized, taking into consideration the endoscopist's experience as well as patient and stricture characteristics.

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Original Article
Predictors of Esophageal Stricture Formation Post Endoscopic Mucosal Resection
Bashar Qumseya, Abraham M. Panossian, Cynthia Rizk, David Cangemi, Christianne Wolfsen, Massimo Raimondo, Timothy Woodward, Michael B. Wallace, Herbert Wolfsen
Clin Endosc 2014;47(2):155-161.   Published online March 31, 2014
DOI: https://doi.org/10.5946/ce.2014.47.2.155
AbstractAbstract PDFPubReaderePub
Background/Aims

Stricture formation is a common complication after endoscopic mucosal resection. Predictors of stricture formation have not been well studied.

Methods

We conducted a retrospective, observational, descriptive study by using a prospective endoscopic mucosal resection database in a tertiary referral center. For each patient, we extracted the age, sex, lesion size, use of ablative therapy, and detection of esophageal strictures. The primary outcome was the presence of esophageal stricture at follow-up. Multivariate logistic regression was used to analyze the association between the primary outcome and predictors.

Results

Of 136 patients, 27% (n=37) had esophageal strictures. Thirty-two percent (n=44) needed endoscopic dilation to relieve dysphagia (median, 2; range, 1 to 8). Multivariate logistic regression analysis showed that the size of the lesion excised is associated with increased odds of having a stricture (odds ratio, 1.6; 95% confidence interval, 1.1 to 2.3; p=0.01), when controlling for age, sex, and ablative modalities. Similarly, the number of lesions removed in the index procedure was associated with increased odds of developing a stricture (odds ratio, 2.3; 95% confidence interval, 1.3 to 4.2; p=0.007).

Conclusions

Stricture formation after esophageal endoscopic mucosal resection is common. Risk factors for stricture formation include large mucosal resections and the resection of multiple lesions on the initial procedure.

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Focused Review Series: Endoscopic and Molecular Imagings of Premalignant GI Lesions, Part II
Recent Advances in Molecular Imaging of Premalignant Gastrointestinal Lesions and Future Application for Early Detection of Barrett Esophagus
Kwang Hyun Ko, Na Young Han, Chang Il Kwon, Hoo Keun Lee, Jong Min Park, Eun Hee Kim, Ki Baik Hahm
Clin Endosc 2014;47(1):7-14.   Published online January 24, 2014
DOI: https://doi.org/10.5946/ce.2014.47.1.7
AbstractAbstract PDFPubReaderePub

Recent advances in optical molecular imaging allow identification of morphologic and biochemical changes in tissues associated with gastrointestinal (GI) premalignant lesions earlier and in real-time. This focused review series introduces high-resolution imaging modalities that are being evaluated preclinically and clinically for the detection of early GI cancers, especially Barrett esophagus and esophageal adenocarcinoma. Although narrow band imaging, autofluorescence imaging, and chromoendoscopy are currently applied for this purpose in the clinic, further adoptions of probe-based confocal laser endomicroscopy, high-resolution microendoscopy, optical coherence tomography, and metabolomic imaging, as well as imaging mass spectrometry, will lead to detection at the earliest and will guide predictions of the clinical course in the near future in a manner that is beyond current advancements in optical imaging. In this review article, the readers will be introduced to sufficient information regarding this matter with which to enjoy this new era of high technology and to confront science in the field of molecular medical imaging.

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Treatment of Dysplasia in Barrett Esophagus
Javier Aranda-Hernandez, Maria Cirocco, Norman Marcon
Clin Endosc 2014;47(1):55-64.   Published online January 24, 2014
DOI: https://doi.org/10.5946/ce.2014.47.1.55
AbstractAbstract PDFPubReaderePub

Barrett esophagus is recognized as a risk factor for the development of dysplasia and adenocarcinoma of the esophagus. Cancer is usually diagnosed at an advanced stage with a 5-year survival rate of 15%. Most of these patients present de novo and are not part of a surveillance program. Endoscopic screening with improvement in recognition of early lesions may change this pattern. In the past, patients diagnosed with dysplasia and mucosal cancer were best managed by esophagectomy. Endoscopic techniques such as endoscopic mucosal resection and radiofrequency ablation have resulted in high curative rates and a shift away from esophagectomy. This pathway is supported by the literature review of esophagectomies performed for mucosal disease, as well as pathologists' interpretation of endoscopic mucosal specimens, which document the low risk of lymph node metastasis. The role of endoscopic therapy for superficial submucosal disease continues to be a challenge.

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