ESD with double clips and rubber band traction of neoplastic lesions developed in the appendiceal orifice is effective and safe

Autor: Borathchakra Oung, Jérôme Rivory, Edouard Chabrun, Romain Legros, Julien Faller, Florence Léger-Nguyen, Florian Rostain, Charles-Eric Ber, Valérie Hervieu, Jean-Christophe Saurin, Thierry Ponchon, Jérémie Jacques, Mathieu Pioche
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: Endoscopy International Open, Vol 08, Iss 03, Pp E388-E395 (2020)
Druh dokumentu: article
ISSN: 2364-3722
2196-9736
DOI: 10.1055/a-1072-4830
Popis: Background and study aims Endoscopic submucosal dissection (ESD) of superficial colorectal lesions in close proximity to the appendiceal orifice (L-PAO) was shown to be feasible except in case of deep invasion into the appendix (type 3 of Toyonaga’s classification). This study aimed to determine the outcomes of ESD with double clip and rubber band traction (DCT-ESD) of L-PAO including a majority of type 3. Patients and methods We reviewed retrospectively all consecutive DCT-ESD of L-PAO performed in 3 French centers. Each lesion was described according to Toyonaga’s classification and type 0 lesions were excluded. The primary outcome was en bloc and R0 resection rates for L-PAO. Morbidity and salvage surgery were recorded. Results A total of 32 patients underwent DCT-ESD; 22 lesions (68.8 %) were type 3, including 11 with previous appendectomy (34.4 %). Median lesion size was 35 mm range (10–110 mm) and median duration of resection was 47 min range (10–230 min). We achieved 100 % of En bloc resection exclusively with DCT-ESD and 90.6 % of histological R0 resection rate. Per-procedure, 11 perforations occurred and were all immediately closed with clips. Overall, 3 patients (10.7 %) underwent surgery without stoma (2 complications related and 1 incomplete resection). No death occurred. Conclusion ESD of lesions deeply invading appendiceal orifice is feasible with the help of a traction system. Technical success by endoscopy avoiding surgery was achieved in 90.6 % of cases.
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