Difficult Polypectomy

Seitz, Uwe; Bohnacker, Sabine; Seewald, Stefan; Thonke, Frank; Soehendra, Nib; Waye, Jerome D.

doi:10.1002/9780470986943.ch36

Cited by 2 publications

(4 citation statements)

References 56 publications

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“…In our study, 58% of patients with sessile polyps had favorable histological criteria, all of them were treated by endoscopic polypectomy alone, and all are free of disease after a mean follow-up period of 7.3 years. In view of our results and those obtained in other series (16,24), an important number of patients with sessile polyps can be cured by endoscopic polypectomy alone if they meet favorable histological criteria. As a result we consider that Haggitt's levels of invasion cannot be applied to sessile adenomas with invasive carcinoma, as their application entails a significant number of surgical interventions that patient outcomes have proven unnecessary.…”

Section: Discussionsupporting

confidence: 71%

“…The results of the last series of patients with polyps with invasive carcinoma published in the literature (16), and those of the recent meta-analysis by Hassan and colleagues (15), confirm the validity of Morson's histological criteria. These results confirm that after endoscopic polypectomy we must evaluate all 3 histological risk criteria and classify patients into high-and low-risk categories in order to decide whether surgery is the most adequate option, as has been the case in our series.…”

Section: Discussionmentioning

confidence: 52%

“…The unfavorable histological criterion most commonly found in our patients was tumor involvement of resection margins. This is in many series the only factor with an independent predictive value of adverse outcome (1,8,16,19). Nevertheless, only 23.3% of our patients with lesions with involved resection margins had residual disease in the surgically resected specimen, and none of them showed lymph-node metastases or local or distant tumor recurrence.…”

Section: Discussionmentioning

confidence: 61%

“…Nowadays, endoscopic polypectomy is considered enough if excision is complete, the lesion is removed in a single piece, and certain histological criteria are met (14,(16)(17)(18). Piecemeal endoscopic resection hinders the accurate evaluation of such histological criteria and therefore is considered an indication for surgery.…”

Section: Discussionmentioning

confidence: 99%

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Malignant colonic adenomas. Therapeutic criteria: Long-term results of therapy in a series of 42 patients in our healthcare area

Pizarro-Moreno

Cordero-Fernández

Garzón-Benavides

et al. 2009

Rev. esp. enferm. dig.

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Objective: a) to evaluate the appropriateness of histological criteria as proposed by Morson as indicators for surgery; and b) to compare the adequacy of Morson's criteria with Haggitt's levels as indicators for surgery in the case of malignant sessile lesions. Material and methods: we carried out a prospective, protocolized study of 42 patients with polyps with invasive carcinoma (IC) who underwent colonoscopic polypectomy from 1979 through 2008. We applied the histological criteria proposed by Morson to all the patients included in the series. Results: we treated 24 polyps with IC and favorable histological criteria (FC) and 18 polyps showing unfavorable histological criteria (UC). All polyps with FC were treated by means of colonoscopic polypectomy. None of the patients showed signs of disease after a mean follow-up period o f 9.67 yrs. Patients with polyps with UC were recommended to undergo surgery. The presence of unfavorable histological criteria in the polypectomy sample was clearly associated with an unfavorable patient outcome and showed a 100% sensitivity level, a negative prognostic value (NPV) of 100%, and a false negative (FN) percentage of 0% for the prognosis of the disease. We found 12 sessile polyps (Haggitt's level 4). Colonoscopic polypectomy was the treatment employed in 9 out of 12 cases. All patients are free from disease (mean follow-up 7.3 yrs). If Haggitt's level criteria had been applied, all 12 patients would have undergone surgery. This means 58% more patients than following Morson's criteria. Conclusions: Morson's criteria are considered an adequate diagnostic tool for the indication of surgery in patients with malignant adenomas. Haggitt's invasion levels do not accurately discriminate the necessity for surgery in case of malignant sessile lesions.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

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Malignant colonic adenomas. Therapeutic criteria: Long-term results of therapy in a series of 42 patients in our healthcare area

Pizarro-Moreno

Cordero-Fernández

Garzón-Benavides

et al. 2009

Rev. esp. enferm. dig.

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Recent advances in natural orifice transluminal endoscopic surgery

Yip

Chiu

2015

Eur J Cardiothorac Surg

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Natural orifice transluminal endoscopic surgery (NOTES) has emerged as one of the most exciting areas in the field of minimally invasive surgery during the last decade. NOTES comprises a wide spectrum of procedures from various natural accesses such as transgastric or transvaginal routes, and different direct-target or distant-target organs. Since polypectomy was first performed in 1955, major advances in technology and refinement of endoscopic technique have allowed endoscopic surgeons to perform complex endoscopic interventions such as endoscopic submucosal dissection. Recognizing the safety and feasibility of submucosal tunnelling and mucosal closure, endoscopic resection beyond the level of mucosa has been increasingly reported. One of these procedures, peroral endoscopic myotomy for achalasia, has gained much popularity and excellent results have been published comparable with that of traditional Heller's cardiomyotomy. Submucosal tunnelling endoscopic resection has also been reported for tumours situated in the muscular layer of the gastrointestinal tract. To overcome the difficulty of intestinal closure after NOTES, researchers have collaborated with the industry in developing different endoscopic suturing devices such as the Eagle Claw (Olympus Medical Systems, Tokyo, Japan) and Overstitch™ (Apollo Endosurgery, Austin TX, USA). These devices allow precise and secure suture application with the ordinary flexible endoscope, achieving tissue approximation similar to open surgical suturing. To further expand the potential of NOTES, investigators had also developed multitasking platforms enabling the performance of surgical procedures of even higher complexity. Recently, a novel endoscopic robotic system 'Master and Slave Transluminal Endoscopic Robot' (MASTER) has been developed. Early results of endoscopic resection utilizing this system have been encouraging, allowing both experts and novices in endoscopy to perform difficult endoscopic resection with a high degree of flexibility.

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Difficult Polypectomy

Cited by 2 publications

References 56 publications

Malignant colonic adenomas. Therapeutic criteria: Long-term results of therapy in a series of 42 patients in our healthcare area

Malignant colonic adenomas. Therapeutic criteria: Long-term results of therapy in a series of 42 patients in our healthcare area

Recent advances in natural orifice transluminal endoscopic surgery

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