Dr. Falk Video report
Endoscopic resection of Barrett’s early carcinoma with a ligation device
Live endoscopy from the HSK Dr. Horst-Schmidt-Kliniken in Wiesbaden, Germany in collaboration with „Video Journal and Encyclopedia of GI Endoscopy“. Recording in the context of the Falk Symposium 185 „Interfaces and Controversies in Gastroenterology“ on October 3rd – 4th, 2012.
©2013 Elsevier. All rights reserved. Wirth the friendly assistance of Falk Foundation e.V., Freiburg.
Presented by: Hendrik Manner, HSK Dr. Horst-Schmidt-Kliniken Wiesbaden, Germany; Pradeep Bhandari, Queen Alexandra Hospital Cosham, Great Britain
This is a case of a 64-year-old patient with long standing reflux disease. At an upper endoscopy, a circumscribed early Barrett’s neoplasia was detected. Subsequent endosonography did not show any involvement of lymph nodes.
Here, an endoscopic resection of the Barrett’s neoplasia with a ligation device is performed. In this case, the final histological diagnosis of the specimen was a moderately differentiated neoplasia extending to the edge of the submucosa without any lymph vessel invasion. Therefore, the endoscopic resection is regarded to be curative in this case.
Take home messages:
- Indeed, endoscopic resection is the treatment of choice for most early Barrett’s neoplasias that do not invade deeper than the upper layer of the submucosa.
- Some neoplasias are very subtle and hard to demarcate and in these cases auxiliary techniques like chromoendoscopy are highly recommended, in particular chromoendoscopy with acetic acid as it highlights the mucosal details of both the non-neoplastic and the neoplastic mucosa.
- For prediction of local infiltration depth macroscopic evaluation is superior to endosonography.
- However, before proceeding to endoscopic resection a complete staging of the tumor is mandatory. This certainly includes endosonographic evaluation of a possible lymph node involvement.
Please switch on your loudspeakers!
Link to Falk Mediacenter
Latest research in brief:
Bowel
Text:
UKennedy NA et al, Lancet Gastroenterol Hepatol. 2019;4(5):341–53
Predicting anti-TNF treatment failure in patients with luminal Crohn’s disease: Results of a prospective trial confirm that primary and secondary treatment failure are common and can be predicted by drug concentrations at week 14.
Link to text
Text:
Bergman D et al, Aliment Pharmacol Ther. 2019;49(11):1395–400
Incidence of microscopic colitis in Sweden: Nationwide cohort study demonstrates that the incidence of microscopic colitis is still increasing, in particular in elder women ≥ 75 years of age. Across a lifetime, 1 in 115 females and 1 in 286 males are expected to be diagnosed with this disease, thus microscopic colitis is posing a considerable disease burden.
Link to text
Text:
Repici A et al, Gastroenterology. 2019;156(8):2198–207.e1
Efficacy of peroral methylene blue formulation for screening colonoscopy: Results of a phase 3 trial reveal that the adenoma detection rate can be increased by 8,5% by oral ingestion of methylene blue MMX tablets prior to the screening colonoscopy as compared to placebo.
Link to text
Liver Biliary Tracts
Text:
Lv Y et al, Gut. 2019;68(7):1297–310
Acute variceal bleeding in cirrhosis: In a current study, early transjugular intrahepatic portosystemic shunt (TIPS) was associated with improved survival in patients with Model for End-stage Liver Disease (MELD) ≥ 19 or Child-Pugh C cirrhosis but not in patients with MELD ≤ 11 or Child-Pugh A cirrhosis. For MELD 12–18 or Child-Pugh B patients, optimal selection criteria for early TIPS need to be defined in future studies.
Link to text
Text:
Fernández J et al, Gastroenterology. 2019;157(1):149–62
Albumin treatment in decompensated cirrhosis: In addition to previous findings, the recent ANSWER study indicated a survival benefit of long-term albumin treatment in patients with decompensated cirrhosis. The mechanisms of action of albumin treatment, however, remain elusive. A current study demonstrated that albumin treatment reduced systemic inflammation and cardiocirculatory dysfunction in patients with decompensated cirrhosis.
Link to text
Text:
van Dijk AH et al, Lancet. 2019;393(10188):2322–30
Cholecystectomy in patients with gallstones and abdominal pain: A current randomized trial demonstrates that a restrictive patient selection strategy for cholecystectomy using predefined criteria can reduce the number of cholecystectomies. However, pain reduction after 12 months was suboptimal using either the restrictive strategy or standard care (indication by surgeon in charge). In addition, pain reduction failed the criteria for non-inferiority when comparing the restrictive strategy to standard care.
Link to text
Oesophagus Stomach Duodenum
Text:
Harvey PR et al, Gut. 2019;68(5):790–5
Epidemiology of achalasia: Results of a nationwide study indicate that the incidence of achalasia is 1.99 of 100,000 in hospitalized patients and 1.53 of 100,000 in the general population. Achalasia patients have an approx. 5-fold increased incidence of esophageal carcinoma, increased risk for aspiration pneumonia, lower respiratory tract infections and higher mortality.
Link to text
Text:
Dydensborg Sander S et al, Gastroenterology. 2019;156(8):2217–29
Risk factor for celiac disease in early childhood: Results of a nationwide cohort study from Denmark and Norway indicate that exposure to systemic antibiotics during the first year of life is associated with an approx. 1.3-fold increased risk to develop celiac disease.
Link to text
Text:
Al-Batran SE et al, Lancet. 2019;393(10184):1948–57
Neoadjuvant chemotherapy for locally advanced resectable gastric and gastro-oesophageal junction adenocarcinoma: Results of a phase 2/3 trial indicate that overall survival is increased in patients receiving, 5-fluorouracil plus leucovorin, oxaliplatin and docetaxel (FLOT) as compared to epirubicin, cisplatin and 5-fluorouracil or capecitabine (ECF/ECX).
Link to text
Pancreas
Text:
Schepers NJ et al, Gut. 2019;68(6):1044–51
Impact of organ failure on mortality in patients with necrotizing pancreatitis: Post-hoc analysis of a prospective cohort of the Dutch Pancreatitis Study Group reveals that the time point of the manifestation and duration of persistent organ failure are not associated with increased mortality.
Link to text
International Symposia and Workshops
Symposium 216
Building Bridges in IBD
September 13–14, 2019, Brussels, Belgium
Square Brussels Convention Centre, Glass Entrance, Mont des Arts/Kunstberg, 1000 Brussels, Belgium
Registration
Online registration
Therapy algorithms
Crohn’s disease
Ulcerative colitis
Based upon the Guidelines of the
German Association for Digestive and Metabolic Disorders (DGVS) and the European Crohn’s and Colitis Organisation (ECCO)
Authors: K. Herrlinger, E.F. Stange
(4 pages)
S7e