Bitte benutzen Sie diese Referenz, um auf diese Ressource zu verweisen: doi:10.22028/D291-41472
Volltext verfügbar? / Dokumentlieferung
Titel: Direct Mucosal-Side Fibrosis Cutting for Salvage Endoscopic Submucosal Dissection of Secondary Barrett's Neoplasia Adjacent Multiband Resection Scars
Alternativtitel: Incisão mucosa directa de fibrose para ESD de resgate de neoplasia em Barrett adjacente a cicatrizes de resseção multibanda
VerfasserIn: Zimmer, Vincent
Bier, Bert
Sprache: Englisch
Titel: GE Portuguese Journal of Gastroenterology
Bandnummer: 30 (2023)
Heft: 3
Seiten: 249-251
Verlag/Plattform: Karger
Erscheinungsjahr: 2022
Freie Schlagwörter: Barrett´s esophagus
Early cancer
Endoscopic submucosal dissection
Perforation
Fibrosis
Multiband resection
Esófago de Barrett
Neoplasia precoce
Disseção endoscópica da submucosa
Perfuração
Fibrose
Ressecção multibandas
DDC-Sachgruppe: 610 Medizin, Gesundheit
Dokumenttyp: Journalartikel / Zeitschriftenartikel
Abstract: A 54-year-old male patient with long-standing Barrett’s esophagus underwent multiband ligation endoscopic mucosal resection (MBL-EMR) 1 year previously due to low-risk early cancer (pT1m2, L0, V0, G2, R0). Of note, a nodular-type small Barrett’s neoplasia was resected en bloc in one EMR specimen, while the remaining specimens contained areas of low-grade dysplasia without circumscribed lesions. Radiofrequency ablation of the remaining non-dysplastic Barrett’s mucosa with preserved acetic acid whitening was scheduled; however, the patient missed several follow-up appointments. At repeat EGD, a secondary Paris 0-IIa lesion estimated at 15 mm and representing a second Barrett’s neoplasia emerged adjacent to MBL-EMR scars at oral (towards the mouth) and anterior (towards the sternum) aspects (Fig. 1a, linked color imaging). Acetic acid staining was only abrogated within the lesion itself and endoscopic biopsies confirmed well-differentiated adenocarcinoma. The patient presented for endoscopic submucosal dissection (ESD) after adequate counselling, including alternative surgery. First, an uncomplicated C-shaped incision from the anal side around the posterior (towards the back, or towards 6 o’clock) parts was performed. Unlike the conventional ESD approach to high-grade fibrosis (distant mucosal incision, submucosal approach to fibrosis with or without tunnel technique), direct cutting into the scar area was tried using an articulating ESD knife (3.5-mm ClutchCutter, Fuji, Düsseldorf, Germany). An initial injection of indigo carmine-saline mixture likewise failed to reasonably lift the mucosa. Special attention was paid to first cut in an ultra-superficial fashion as indicated by a crepe paper-like appearance (electrosurgical settings as for mucosal incision: endo cut 1, effect 2, duration 4, interval 1; hemostasis: soft coagulation, effect 4, 100 W; Fig. 1b). Of note, a hard and longer Inoue-type cap was used to adequately grasp the tissue in a superficial fashion. With the incised mucosa continuously pushed aside by the opened scissors, deeper cuts through dense high-grade F2 fibrosis were performed, and this appeared to indicate the correct resection plane (Fig. 1c). The final histopathology confirmed en bloc resection: pT1m2, L0, V0, G1, R0 (Fig. 1d, e).
DOI der Erstveröffentlichung: 10.1159/000524269
URL der Erstveröffentlichung: https://doi.org/10.1159/000524269
Link zu diesem Datensatz: urn:nbn:de:bsz:291--ds-414726
hdl:20.500.11880/37154
http://dx.doi.org/10.22028/D291-41472
ISSN: 2341-4545
Datum des Eintrags: 22-Jan-2024
Fakultät: M - Medizinische Fakultät
Fachrichtung: M - Innere Medizin
Professur: M - Keiner Professur zugeordnet
Sammlung:SciDok - Der Wissenschaftsserver der Universität des Saarlandes

Dateien zu diesem Datensatz:
Es gibt keine Dateien zu dieser Ressource.


Alle Ressourcen in diesem Repository sind urheberrechtlich geschützt.