Citations 3
Endoscopic submucosal dissection for colorectal dysplasia in inflammatory bowel disease: a US multicenter study
Ngamruengphong, Saowanee , Aihara, Hiroyuki , Friedland, Shai , Benias, Petros C. , Draganov, Peter V. , Kumta, Nikhil A. , Borman, Zachary A. , Dixon, Rebekah E. , Marion, James F., Tomizawa, Yutaka , Mohapatra, Sonmoon , Charabaty, Aline , Lazarev, Mark , Figueroa, Esteban, Hanada, Yuri , Song, Louis M. Wong Kee , Wong Kee Song, Louis M, Nishimura, Makoto , Faleck, David M. , Yang, Dennis J. , D'Souza, Lionel S. , Jit, Simran, Parian, Alyssa M. , Wang, Andrew Y.
Endoscopy International Open | April 14, 2022 | Volume: 10 | Issue: 04 | Pages: E354-E360
Abstract Background and study aims In patients with inflammatory bowel disease (IBD), endoscopically visible lesions with distinct borders can be considered for endoscopic resection. The role of endoscopic submucosal dissection (ESD) for these lesions is not well defined because of a paucity of data. We aimed to evaluate the outcomes of colorectal ESD of dysplastic lesions in patients with IBD across centers in the United States. Patients and methods This was a retrospective analysis of consecutive patients with IBD who were referred for ESD of dysplastic colorectal lesions at nine centers. The primary endpoints were the rates of en bloc resection and complete (R0) resection. The secondary endpoints were the rates of adverse events and lesion recurrence. Results A total of 45 dysplastic lesions (median size 30mm, interquartile range [IQR] 23 to 42 mm) in 41 patients were included. Submucosal fibrosis was observed in 73 %. En bloc resection was achieved in 43 of 45 lesions (96 %) and R0 resection in 34 of 45 lesions (76 %). Intraprocedural perforation occurred in one patient (2.4 %) and was treated successfully with clip placement. Delayed bleeding occurred in four patients (9.8 %). No severe intraprocedural bleeding or delayed perforation occurred. During a median follow-up of 18 months (IQR 13 to 37 months), local recurrence occurred in one case (2.6 %). Metachronous lesions were identified in 11 patients (31 %). Conclusions ESD, when performed by experts, is safe and effective for large, dysplastic colorectal lesions in patients with IBD. Despite the high prevalence of submucosal fibrosis, en bloc resection was achieved in nearly all patients with IBD undergoing ESD. Careful endoscopic surveillance is necessary to monitor for local recurrence and metachronous lesions after ESD.
S1046 Predicting Histological Diagnosis After Endoscopic Submucosal Dissection With Demographic Characteristics and Endoscopic Lesion Characteristics: An Analysis of a Large Cohort in North America
Gudenkauf, Franciska J. , Aihara, Hiroyuki , Jue, Terry L., Munroe, Craig A., Bhatt, Amit , Kumta, Nikhil A. , Othman, Mohamed O. , Aadam, A. Aziz , Siegel, Amanda B. , Schlachterman, Alexander , Kowalski, Thomas E., Samarasena, Jason , Chang, Kenneth J. , Su, Bailey , Ujiki, Michael , Sharaiha, Reem Z. , Carr‐Locke, David L. , Facg, Tomizawa, Yutaka , Renteln, Daniel von , Karasik, Michael, Patel, Neej, Hanada, Yuri , Song, Louis Wong Kee, Friedland, Shai , Sethi, Amrita , Ngamruengphong, Saowanee , Group, Gastric ESD Study, Bhatt, Amit , Ferri, Lorenzo Edwin , Draganov, Peter V. , Yang, Dennis J. , Grimm, Ian S. , DeWitt, John M. , Bechara, Robert , Fukami, Norio , Nishimura, Makoto , Laszkowska, Monika , Wang, Andrew , Hwang, Joo Ha , Group, Gastric ESD Study
American Journal of Gastroenterology | October 24, 2021 | Volume: 116 | Issue: 1 | Pages: S496-S496
The Risk of Endoscopic Mucosal Resection in the Setting of Clopidogrel Use
Namasivayam, Vikneswaran , Prasad, Ganapathy A., Lutzke, Lori S., Dunagan, Kelly T., Borkenhagen, Lynn S., Okoro, Ngozi I., Tomizawa, Yutaka , Buttar, Navtej , Michel, Wongkeesong Louis, Wang, Kenneth K. , Buttar, Navtej S, Tomizawa, Yutaka
ISRN Gastroenterology | April 27, 2014 | Volume: 2014 | Issue: No issue available | Pages: 1-5
Objective. Guidelines on antiplatelet medication use during endoscopy are based on limited evidence. We investigate the risk of bleeding and ischemic events in patients undergoing endoscopic mucosal resection (EMR) of esophageal lesions in the setting of scheduled cessation and prompt resumption of clopidogrel. Design. Single centre retrospective review. Patients. Patients undergoing EMR of esophageal lesions. Interventions. Use of clopidogrel before EMR and resumption after EMR. Patients cease antiplatelets and anticoagulants 7 days before EMR and resume clopidogrel 2 days after EMR in average risk patients. Main Outcomes. Gastrointestinal bleeding (GIB) and ischemic events (IE) within 30 days of EMR. Results. 798 patients underwent 1716 EMR. 776 EMR were performed on patients on at least 1 antiplatelet/anticoagulant (APAC). 17 EMR were performed following clopidogrel cessation. There were 14 GIB and 2 IE. GIB risk in the setting of recent clopidogrel alone (0%) was comparable to those not on APAC (1.1%) (P=1.0). IE risk on clopidogrel (6.3%) was higher than those not on APAC (0.1%) (P=0.03). Limitations. Retrospective study. Conclusions. Temporary cessation of clopidogrel before EMR and prompt resumption is not associated with an increased risk of gastrointestinal bleeding but may be associated with increased ischemic events.