{"title":"Anorectal Endoscopic Hybrid Resection of an Uncommon Cause of Debilitating Diarrhoea: Polypoid Supra-Anal Mucosal Prolapse Syndrome.","authors":"Vincent Zimmer, Christoph Heinrich","doi":"10.1159/000522072","DOIUrl":"https://doi.org/10.1159/000522072","url":null,"abstract":"Endoscopic resection of supra-anal lesions is challenging due to marked fibrosis and generous venous plexus [1]. Furthermore, abundance of sensory nerve fibres in the anal canal calls for an adequate local anaesthesia otherwise not warranted in endoscopy [2]. This is the case of a 54-year-old male patient with a 2-year history of debilitating diarrhoea including inability to work (sic!), passing up to 25 watery stools with urgency. Prior gastroenterology consultations elsewhere including previous ileocolonoscopy did not indicate the cause of diarrhoea. Currently, the patient was scheduled for endoscopic resection of an estimated 15-mm, biopsy-confirmed mucosal prolapse polyp in the supra-anal rectum involving the dentate line. The retroflexed endoscopic visualization revealed a reddened polypoid lesion with an eroded surface, consistent with mucosal prolapse syndrome (Fig. 1a). For resection, a cap-fitted, antegrade endoscopic approach was chosen to first isolate the lesion from the squamous epithelium of the anal canal, which indeed was cut into in its proximal aspects after injection of an indigocarmine saline mixture without adrenaline and a local anaesthetic (Fig. 1b). To this end, limited endoscopic submucosal dissection using a Dual Knife J (Olympus, Hamburg, Germany) was performed under deep sedation using propofol and midazolam to ensure wide-margin resection at the anal side with diarrhoea most likely attributable to chronic sphincter irritation (Fig. 1c; note marked fibrosis and prominent vessels). Only after progression to the more oral rectum did the submucosal space begin to open up adequately (Fig. 1d). To accelerate the procedure and with a view to the benign histology, we subsequently opted for a hybrid approach ensnaring the lesion (30-mm snare; Medwork, Höchstadt, Germany) after adequate trimming of the anal parts of the lesion (Fig. 1e). The final resection bed was without bleeding;","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"30 2","pages":"159-161"},"PeriodicalIF":0.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bb/dd/pjg-0030-0159.PMC10050836.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9235467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pedro Pimentel-Nunes, Raquel Ortigão, Luís Pedro Afonso, Rui Pedro Bastos, Diogo Libânio, Mário Dinis-Ribeiro
{"title":"Endoscopic Resection of Gastrointestinal Neuroendocrine Tumors: Long-Term Outcomes and Comparison of Endoscopic Techniques.","authors":"Pedro Pimentel-Nunes, Raquel Ortigão, Luís Pedro Afonso, Rui Pedro Bastos, Diogo Libânio, Mário Dinis-Ribeiro","doi":"10.1159/000521654","DOIUrl":"https://doi.org/10.1159/000521654","url":null,"abstract":"<p><strong>Introduction: </strong>Gastrointestinal neuroendocrine tumors (GI-NETs) are being more frequently diagnosed and treated by endoscopic resection (ER) techniques. However, comparison studies of the different ER techniques or long-term outcomes are rarely reported.</p><p><strong>Methods: </strong>This was a single-center retrospective study analyzing short and long-term outcomes after ER of gastric, duodenum, and rectal GI-NETs. Comparison between standard EMR (sEMR), EMR with a cap (EMRc), and endoscopic submucosal dissection (ESD) was made.</p><p><strong>Results: </strong>Fifty-three patients with GI-NET (25 gastric, 15 duodenal, and 13 rectal; sEMR = 21; EMRc = 19; ESD = 13) were included in the analysis. Median tumor size was 11 mm (range 4-20), significantly larger in the ESD and EMRc groups compared to the sEMR group (<i>p</i> < 0.05). Complete ER was possible in all cases with 68% histological complete resection (no difference between the groups). Complication rate was significantly higher in the EMRc group (EMRc 32%, ESD 8%, and EMRs 0%, p = 0.01). Local recurrence occurred in only one patient, and systemic recurrence in 6%, with size ≥ 12 mm being a risk factor for systemic recurrence (p = 0.05). Specific disease-free survival after ER was 98%.</p><p><strong>Conclusion: </strong>ER is a safe and highly effective treatment particularly for less than 12 mm luminal GI-NETs. EMRc is associated with a high complication rate and should be avoided. sEMR is an easy and safe technique that is associated with long-term curability, and it is probably the best therapeutic option for most luminal GI-NETs. ESD appears to be the best option for lesions that cannot be resected en bloc with sEMR. Multicenter, prospective randomized trials should confirm these results.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"30 2","pages":"98-106"},"PeriodicalIF":0.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f4/e1/pjg-0030-0098.PMC10050860.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9235473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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