Use of modified multiband ligator facilitates circumferential EMR in Barrett's esophagus (with video)

Endoscopic mucosal resection in the upper gastrointestinal tract

“…In two separate studies from 2003 and 2006, no recurrent or metachronous lesions were reported. This is in stark contrast to an 11% recurrence rate with circumferential resections at a mean follow-up of 18 mo in a study by Giovannini et al [24,29,55] . In addition to EMR, multiple ablative techniques have been evaluated in the management of HGD and EC in BE.…”

“…The standard band ligator can be used, but a designated ligator that fits the single channel therapeutic upper scope is available (Duette, Cook Medical, Winston-Salem, NC). The main disadvantage of this technique with the standard ligator is that the endoscope must be withdrawn to remove the ligation cylinder before reinsertion for resection [29] . The Duette system, on the other hand, allows the passage of a snare via the therapeutic channel of the scope and multiple resections can be carried out sequentially without the need of removing the scope.…”

“…Upper GI tract perforation can be managed conservatively with the combination of clipping, nasogastric tube suction, and broad-spectrum antibiotics [43] . Patients are at an increased risk of developing strictures if circumferential resections of the esophagus or gastric pylorus are performed [29,44,45] . These strictures are often responsive to dilation.…”

Esophageal Preservation in Five Male Patients After Endoscopic Inner-Layer Circumferential Resection in the Setting of Superficial Cancer: A Regenerative Medicine Approach with a Biologic Scaffold

“…17,36,37 Circumferential, long segment inner layer resection as described in these patients would be expected to uniformly cause severe long segment stricture. Given the fact that only the portion of stripped esophagus that was not covered by ECM formed stricture and required dilation, the ECM placement clearly had a beneficial effect upon the host response such that intractable stricture was avoided and constructive remodeling was facilitated.…”

Barrett´s esophagus: a review

“…However, it is technically challenging and only indicated for BE segments with a length below 5 cm (112). It has a complication rate of 2% including hemorrhage and perforation, but the incidence of stenoses is high at 20-50% (107).…”