Endoscopic submucosal dissection (ESD) has emerged as a novel technique for achieving en bloc res... more Endoscopic submucosal dissection (ESD) has emerged as a novel technique for achieving en bloc resection for superficial neoplasms limited to the mucosa. ESD was originally developed in Japan as a method of endoscopic resection of superficial gastric cancers. In our hospital, ESD has been used concurrently in other parts of the gastrointestinal tract, including the esophagus and colorectum from the beginning of its development. However, ESD in the duodenum is considered more challenging than other parts. From August 2005 to March 2008, a total of 15 superficial duodenal neoplastic lesions in 14 patients were treated with endoscopic resection. Of these, nine underwent ESD. We report our experience with duodenal ESD with a combination of ST hood and hook knife.
Main RecommendationsPatients with chronic atrophic gastritis or intestinal metaplasia (IM) are at... more Main RecommendationsPatients with chronic atrophic gastritis or intestinal metaplasia (IM) are at risk for gastric adenocarcinoma. This underscores the importance of diagnosis and risk stratification for these patients. High definition endoscopy with chromoendoscopy (CE) is better than high definition white-light endoscopy alone for this purpose. Virtual CE can guide biopsies for staging atrophic and metaplastic changes and can target neoplastic lesions. Biopsies should be taken from at least two topographic sites (antrum and corpus) and labelled in two separate vials. For patients with mild to moderate atrophy restricted to the antrum there is no evidence to recommend surveillance. In patients with IM at a single location but with a family history of gastric cancer, incomplete IM, or persistent Helicobacter pylori gastritis, endoscopic surveillance with CE and guided biopsies may be considered in 3 years. Patients with advanced stages of atrophic gastritis should be followed up wit...
RESUMO IA doença de Whipple é uma doença rara, provocada por uma bactéria Gram-positiva intracelu... more RESUMO IA doença de Whipple é uma doença rara, provocada por uma bactéria Gram-positiva intracelular Tropheryma whipplei. É um diagnóstico difícil de fazer e, apesar de se poder apresentar com uma clínica muito variada, a sintomatologia gastrointestinal está ...
Abstract Introduction Endoscopic Submucosal Dissection (ESD)was introduced in the West later than... more Abstract Introduction Endoscopic Submucosal Dissection (ESD)was introduced in the West later than in the East. Our aim was to assess how Western endoscopists performing ESD have been trained and how they value animal models for training. Material and methods An online survey regarding training in ESD was sent to Western endoscopists who published articles on advanced resection techniques. Results From 279 endoscopists, 58 (21%) completed the questionnaire, of which 50 confirmed performance of clinical ESD. Endoscopists had a median of 15 years of endoscopic experience (IQR 9.75–20.25) and all of them were performing conventional EMR, before starting ESD. Prior to clinical ESD, 74% (n = 37) underwent training with ex vivo models, 84% (n = 42) with live animal models and 92% (n = 46) with at least, one of the two models. After starting clinical ESD, as trainers, 52% (n = 26) were involved with ex vivo and 60% (n = 30) with live animal models. Personal usefulness of ex vivo and live animal models was rated with a median of 9 (IQR 8–10) and 10 (IQR 8–10), out of 10, respectively. Courses with ex vivo and live animal models were considered a prerequisite before clinical practice by 84% (n = 42) and 78% (n = 39), respectively. Conclusions Western endoscopists have extensive endoscopic experience before starting ESD. The majority had pre-clinical training with ex vivo and live animal models and more than half are acting as trainers of other endoscopists with these models. Animal models are considered very useful and deemed a prerequisite before clinical practice by the majority of the endoscopists.
Background One of the aims of the European Society of Gastrointestinal Endoscopy (ESGE) is to enc... more Background One of the aims of the European Society of Gastrointestinal Endoscopy (ESGE) is to encourage high quality endoscopic research at a European level. In 2016, the ESGE research committee published a set of research priorities. As endoscopic research is flourishing, we aimed to review the literature and determine whether endoscopic research over the last 4 years had managed to address any of our previously published priorities. Methods As the previously published priorities were grouped under seven different domains, a working party with at least two European experts was created for each domain to review all the priorities under that domain. A structured review form was developed to standardize the review process. The group conducted an extensive literature search relevant to each of the priorities and then graded the priorities into three categories: (1) no longer a priority (well-designed trial, incorporated in national/international guidelines or adopted in routine clinica...
Abstract Background Gastric dysbiosis has been hinted as a potential cause of gastric cancer. How... more Abstract Background Gastric dysbiosis has been hinted as a potential cause of gastric cancer. However, changes in microbiome throughout the major stages of gastric carcinogenesis remain mostly unknown. Objective To describe gastric microbiome at different stages, analysing for the first time dysbiosis specifically in patients with early gastric cancer (EGC). Methods Cross-sectional study including patients (n = 77) with endoscopically and histologically confirmed normal stomachs (controls; n = 25), advanced atrophic gastritis with intestinal metaplasia (IM; n = 18) and EGC (n = 34). Endoscopic biopsies from antrum and corpus (n = 154) were analyzed. Next-generation sequencing was performed characterizing microbial communities down to the species level based on full-length 16SrRNA gene profiling. Results Significant differences were found in the microbiome profile between the groups. Firmicutes were more frequent (p = .012) and Proteobacteria were less frequent (p = .04) both in the IM and EGC when comparing to controls. Relative frequency of Helicobacter pylori, when present, was much higher in the controls (83%) when comparing to the other groups (IM 1%, EGC 27%; p = .006), being the dominant bacteria only in the controls. Dysbiosis was present already and more significantly at the IM stage, with two bacteria progressively increasing from controls to IM then to cancer: Gemella from 1.48 to 3.9% (p = .014); and Streptococcus from 19.3 to 33.7% (p = .04), being the EGC dominant bacteria. Conclusions Our results confirm Helicobacter pylori dominancy in non-atrophic stomachs and progressive dysbiosis throughout gastric carcinogenesis. Gemella but particularly Streptococcus is significantly increased in patients with EGC. Specific modulation of these bacteria may change gastric cancer risk.
Current Treatment Options in Gastroenterology, 2021
Chronic atrophic gastritis and intestinal metaplasia are associated with higher gastric cancer ri... more Chronic atrophic gastritis and intestinal metaplasia are associated with higher gastric cancer risk and guidelines recommend endoscopic surveillance, as diagnosis of early gastric neoplasia allows endoscopic resection. This review summarizes the current approach to the diagnosis and surveillance of pre-malignant gastric conditions and endoscopic treatment of early gastric cancer. Virtual chromoendoscopy can diagnose extensive gastric metaplasia with great accuracy compared with histopathology and higher endoscopic staging is a risk factor for gastric cancer. Poorly differentiated and superficially invasive cancers have higher (up to 3%) lymph node metastasis risk even after curative resection, which should influence post-resection management. After non-curative resection, a histopathological score (eCura system) can predict LNM and survival without gastrectomy. Extensive pre-malignant gastric conditions should be surveilled with high-definition chromoendoscopy, which allows intestinal metaplasia staging and improves dysplasia diagnosis. Endoscopic submucosal dissection is well-established as the first-line treatment of early gastric cancer.
Gastric cancer is the third leading cause of cancer mortality and the fifth for incidence worldwi... more Gastric cancer is the third leading cause of cancer mortality and the fifth for incidence worldwide. High-definition endoscopy with virtual chromoendoscopy allows to diagnose early stages of gastric cancers that can be removed by endoscopic resection. For advanced gastric cancers, surgery with or without chemotherapy may be necessary. Surveillance after gastric cancer treatment depends on the staging of the lesion and on the treatment. Aiming at detecting metachronous or local recurrence, endoscopic surveillance is necessary after endoscopic treatment or subtotal gastrectomy has been performed, whereas CT imaging is needed for distant metastasis according to baseline staging. After total gastrectomy, nutritional deficiencies evaluation and periodic CT for early detection of recurrence are essential.Gastric cancer is the third leading cause of cancer mortality worldwide and the fifth for incidence. In 2018, 1.033.701 new cases of gastric cancer were diagnosed and 782.665 people died for gastric cancer. Incidence rates are the highest in Eastern Asia and Eastern Europe, while the incidence rate is low in Northern Europe and Northern America with rates similar to Africa’s countries. If no interventions occur regarding screening strategies, incidence and mortality for gastric cancer are going to increase in the next years. Incidence will increase 36.2% in 2030 and 69.7% in 2040 with a total number of new cases of 1.758.810. The same will happen for deaths that will increase 37.7% in 2030 and 74.1% in 2040 with a total number of 1.366.121 of deaths. So, even though early recognition and treatment is possible in 2019 most cases are still being diagnosed at a late stage and most patients with gastric cancer will die of it (Bray et al., 2018)
Background: Gastric carcinogenesis progresses from normal mucosa, atrophic/metaplastic gastritis,... more Background: Gastric carcinogenesis progresses from normal mucosa, atrophic/metaplastic gastritis, and dysplasia to adenocarcinoma. MicroRNAs (miRNAs) regulate DNA expression and have been implicated; however, their role is not fully established. Aims: The aim of this study was to characterize plasma and tissue expression of several miRNAs in gastric carcinogenesis stages. Methods: Single-center cross-sectional study in 64 patients: 19 controls (normal mucosa); 15 with extensive atrophic/metaplastic gastritis; and 30 with early gastric neoplasia (EGN). Seven miRNAs (miR-21, miR-146a, miR-181b, miR-370, miR-375, miR 181b, and miR-490) were quantified by real time-qPCR in peripheral blood and endoscopic biopsy samples. Results: We found a significant upregulation of miR-181b, miR-490, and miR-21 in the EGN mucosa (overexpression 2–14-times higher than controls). We observed a significant underexpression of miR-146a and miR-370 in atrophic/metaplastic gastritis (86 and 66% decrease, p =...
European Journal of Gastroenterology & Hepatology, 2021
INTRODUCTION Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the main method for... more INTRODUCTION Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the main method for acquisition of tissue from gastrointestinal subepithelial lesions (SELs). Despite the development of new needles, diagnostic yield remains low. A new method of aspiration has been described, where the needle is filled with saline [wet-suction technique (WST)], with promising results in pancreatic lesions. This method has not been tested in SELs. AIMS AND METHODS Prospective single center study to assess the diagnostic yield of EUS-FNA+WST in the diagnosis of SELs, without the use of rapid on-site evaluation. In mesenchymal tumors, the diagnosis was considered positive only when immunohistochemistry could differentiate between gastrointestinal stromal tumor and leiomyoma. RESULTS Eighty-seven patients with SELs were included (55% male, mean age 66 years). Mean SEL size was 25 mm (min 10 mm, max 120 mm), mean number of passes was 3 (±0.8). A 22G needle was used in 72 patients (83%), 19G in 10 (12%) and 25G in 5 (6%). We obtained a conclusive cytopathological diagnosis in 74 cases (diagnostic yield of 85%) and immunohistochemistry was performed in 70 cases (81%). The most frequent diagnoses were gastrointestinal stromal tumor (n = 34, 37%), leiomyoma (n = 13, 15%) and metastases (n = 10, 11%). CONCLUSION Wet suction technique allowed an excellent diagnostic yield in the EUS-guided evaluation of SELs. We suggest that, after proper replication of these results, WST may become the first-line method in the management of these lesions.
Main RecommendationsThis manuscript represents an official Position Statement of the European Soc... more Main RecommendationsThis manuscript represents an official Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) aiming to guide general gastroenterologists to develop and maintain skills in optical diagnosis during endoscopy. In general, this requires additional training beyond the core curriculum currently provided in each country. In this context, ESGE have developed a European core curriculum for optical diagnosis practice across Europe for high quality optical diagnosis training.1 ESGE suggests that every endoscopist should have achieved general competence in upper and/or lower gastrointestinal (UGI/LGI) endoscopy before commencing training in optical diagnosis of the UGI/LGI tract, meaning personal experience of at least 300 UGI and/or 300 LGI endoscopies and meeting the ESGE quality measures for UGI/LGI endoscopy. ESGE suggests that every endoscopist should be able and competent to perform UGI/LGI endoscopy with high definition white light combined w...
Main RecommendationsThe European Society of Gastrointestinal Endoscopy (ESGE) has recognized the ... more Main RecommendationsThe European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize training in small-bowel endoscopy across European centers. The following criteria and framework for training in small-bowel capsule endoscopy (SBCE) and device-assisted enteroscopy (DAE), which aim to provide uniform and high quality training to ensure that small-bowel endoscopists are competent to operate independently, are based on the current literature and experience of experts in the field. Three main areas are covered: skills required prior to commencing training in small-bowel endoscopy; structured training for trainees to become independent endoscopists; and ways of ensuring competence is achieved. 1 Centers providing training in SBCE should perform a minimum of 75 – 100 SBCEs/year. 2 Experience in bidirectional endoscopies is desirable for structured training in SBCE. 3 SBCE courses should consist of at least 50 % hands-on training and cover information on tech...
Background Image-enhanced endoscopy (IEE) improves the accuracy of endoscopic diagnosis. We aimed... more Background Image-enhanced endoscopy (IEE) improves the accuracy of endoscopic diagnosis. We aimed to assess the value of IEE for gastric preneoplastic conditions and neoplastic lesions. Methods Medline and Embase were searched until December 2018. Studies allowing calculation of diagnostic measures were included. Risk of bias and applicability were assessed using QUADAS-2. Subgroup analysis was performed to explore heterogeneity. Results 44 studies met the inclusion criteria. For gastric intestinal metaplasia (GIM), narrow-band imaging (NBI) obtained a pooled sensitivity and specificity of 0.79 (95 %CI 0.72–0.85) and 0.91 (95 %CI 0.88–0.94) on per-patient basis; on per-biopsy basis, it was 0.84 (95 %CI 0.81–0.86) and 0.95 (95 %CI 0.94–0.96), respectively. Tubulovillous pattern was the most accurate marker to detect GIM and it was effectively assessed without high magnification. For dysplasia, NBI showed a pooled sensitivity and specificity of 0.87 (95 %CI 0.84–0.89) and 0.97 (95 %CI...
Background: Self-expanding metal stents (SEMS) have been used for the palliative treatment of mal... more Background: Self-expanding metal stents (SEMS) have been used for the palliative treatment of malignant gastrointestinal tract obstruction. However, restenosis or incomplete expansion of a first stent is a frequent complication, and the effectiveness of reintervention with placement of a second stent is still controversial. Objective: To evaluate the clinical outcomes of covered SEMS (cSEMS) placement after dysfunction of uncovered SEMS (uSEMS) by the stent-in-stent technique. Patients and Methods: We retrospectively studied a consecutive series of patients receiving palliative treatment for malignant gastrointestinal obstruction with cSEMS placement after uSEMS dysfunction in a tertiary center from January 2013 to August 2018. Technical and clinical success, time of patency, and adverse events were analyzed. Results: Twelve patients were included; their mean age was 60 ± 9 years. Eleven patients had gastric outlet obstruction, and 1 patient had compression of the transverse colon d...
Endoscopic submucosal dissection (ESD) has emerged as a novel technique for achieving en bloc res... more Endoscopic submucosal dissection (ESD) has emerged as a novel technique for achieving en bloc resection for superficial neoplasms limited to the mucosa. ESD was originally developed in Japan as a method of endoscopic resection of superficial gastric cancers. In our hospital, ESD has been used concurrently in other parts of the gastrointestinal tract, including the esophagus and colorectum from the beginning of its development. However, ESD in the duodenum is considered more challenging than other parts. From August 2005 to March 2008, a total of 15 superficial duodenal neoplastic lesions in 14 patients were treated with endoscopic resection. Of these, nine underwent ESD. We report our experience with duodenal ESD with a combination of ST hood and hook knife.
Main RecommendationsPatients with chronic atrophic gastritis or intestinal metaplasia (IM) are at... more Main RecommendationsPatients with chronic atrophic gastritis or intestinal metaplasia (IM) are at risk for gastric adenocarcinoma. This underscores the importance of diagnosis and risk stratification for these patients. High definition endoscopy with chromoendoscopy (CE) is better than high definition white-light endoscopy alone for this purpose. Virtual CE can guide biopsies for staging atrophic and metaplastic changes and can target neoplastic lesions. Biopsies should be taken from at least two topographic sites (antrum and corpus) and labelled in two separate vials. For patients with mild to moderate atrophy restricted to the antrum there is no evidence to recommend surveillance. In patients with IM at a single location but with a family history of gastric cancer, incomplete IM, or persistent Helicobacter pylori gastritis, endoscopic surveillance with CE and guided biopsies may be considered in 3 years. Patients with advanced stages of atrophic gastritis should be followed up wit...
RESUMO IA doença de Whipple é uma doença rara, provocada por uma bactéria Gram-positiva intracelu... more RESUMO IA doença de Whipple é uma doença rara, provocada por uma bactéria Gram-positiva intracelular Tropheryma whipplei. É um diagnóstico difícil de fazer e, apesar de se poder apresentar com uma clínica muito variada, a sintomatologia gastrointestinal está ...
Abstract Introduction Endoscopic Submucosal Dissection (ESD)was introduced in the West later than... more Abstract Introduction Endoscopic Submucosal Dissection (ESD)was introduced in the West later than in the East. Our aim was to assess how Western endoscopists performing ESD have been trained and how they value animal models for training. Material and methods An online survey regarding training in ESD was sent to Western endoscopists who published articles on advanced resection techniques. Results From 279 endoscopists, 58 (21%) completed the questionnaire, of which 50 confirmed performance of clinical ESD. Endoscopists had a median of 15 years of endoscopic experience (IQR 9.75–20.25) and all of them were performing conventional EMR, before starting ESD. Prior to clinical ESD, 74% (n = 37) underwent training with ex vivo models, 84% (n = 42) with live animal models and 92% (n = 46) with at least, one of the two models. After starting clinical ESD, as trainers, 52% (n = 26) were involved with ex vivo and 60% (n = 30) with live animal models. Personal usefulness of ex vivo and live animal models was rated with a median of 9 (IQR 8–10) and 10 (IQR 8–10), out of 10, respectively. Courses with ex vivo and live animal models were considered a prerequisite before clinical practice by 84% (n = 42) and 78% (n = 39), respectively. Conclusions Western endoscopists have extensive endoscopic experience before starting ESD. The majority had pre-clinical training with ex vivo and live animal models and more than half are acting as trainers of other endoscopists with these models. Animal models are considered very useful and deemed a prerequisite before clinical practice by the majority of the endoscopists.
Background One of the aims of the European Society of Gastrointestinal Endoscopy (ESGE) is to enc... more Background One of the aims of the European Society of Gastrointestinal Endoscopy (ESGE) is to encourage high quality endoscopic research at a European level. In 2016, the ESGE research committee published a set of research priorities. As endoscopic research is flourishing, we aimed to review the literature and determine whether endoscopic research over the last 4 years had managed to address any of our previously published priorities. Methods As the previously published priorities were grouped under seven different domains, a working party with at least two European experts was created for each domain to review all the priorities under that domain. A structured review form was developed to standardize the review process. The group conducted an extensive literature search relevant to each of the priorities and then graded the priorities into three categories: (1) no longer a priority (well-designed trial, incorporated in national/international guidelines or adopted in routine clinica...
Abstract Background Gastric dysbiosis has been hinted as a potential cause of gastric cancer. How... more Abstract Background Gastric dysbiosis has been hinted as a potential cause of gastric cancer. However, changes in microbiome throughout the major stages of gastric carcinogenesis remain mostly unknown. Objective To describe gastric microbiome at different stages, analysing for the first time dysbiosis specifically in patients with early gastric cancer (EGC). Methods Cross-sectional study including patients (n = 77) with endoscopically and histologically confirmed normal stomachs (controls; n = 25), advanced atrophic gastritis with intestinal metaplasia (IM; n = 18) and EGC (n = 34). Endoscopic biopsies from antrum and corpus (n = 154) were analyzed. Next-generation sequencing was performed characterizing microbial communities down to the species level based on full-length 16SrRNA gene profiling. Results Significant differences were found in the microbiome profile between the groups. Firmicutes were more frequent (p = .012) and Proteobacteria were less frequent (p = .04) both in the IM and EGC when comparing to controls. Relative frequency of Helicobacter pylori, when present, was much higher in the controls (83%) when comparing to the other groups (IM 1%, EGC 27%; p = .006), being the dominant bacteria only in the controls. Dysbiosis was present already and more significantly at the IM stage, with two bacteria progressively increasing from controls to IM then to cancer: Gemella from 1.48 to 3.9% (p = .014); and Streptococcus from 19.3 to 33.7% (p = .04), being the EGC dominant bacteria. Conclusions Our results confirm Helicobacter pylori dominancy in non-atrophic stomachs and progressive dysbiosis throughout gastric carcinogenesis. Gemella but particularly Streptococcus is significantly increased in patients with EGC. Specific modulation of these bacteria may change gastric cancer risk.
Current Treatment Options in Gastroenterology, 2021
Chronic atrophic gastritis and intestinal metaplasia are associated with higher gastric cancer ri... more Chronic atrophic gastritis and intestinal metaplasia are associated with higher gastric cancer risk and guidelines recommend endoscopic surveillance, as diagnosis of early gastric neoplasia allows endoscopic resection. This review summarizes the current approach to the diagnosis and surveillance of pre-malignant gastric conditions and endoscopic treatment of early gastric cancer. Virtual chromoendoscopy can diagnose extensive gastric metaplasia with great accuracy compared with histopathology and higher endoscopic staging is a risk factor for gastric cancer. Poorly differentiated and superficially invasive cancers have higher (up to 3%) lymph node metastasis risk even after curative resection, which should influence post-resection management. After non-curative resection, a histopathological score (eCura system) can predict LNM and survival without gastrectomy. Extensive pre-malignant gastric conditions should be surveilled with high-definition chromoendoscopy, which allows intestinal metaplasia staging and improves dysplasia diagnosis. Endoscopic submucosal dissection is well-established as the first-line treatment of early gastric cancer.
Gastric cancer is the third leading cause of cancer mortality and the fifth for incidence worldwi... more Gastric cancer is the third leading cause of cancer mortality and the fifth for incidence worldwide. High-definition endoscopy with virtual chromoendoscopy allows to diagnose early stages of gastric cancers that can be removed by endoscopic resection. For advanced gastric cancers, surgery with or without chemotherapy may be necessary. Surveillance after gastric cancer treatment depends on the staging of the lesion and on the treatment. Aiming at detecting metachronous or local recurrence, endoscopic surveillance is necessary after endoscopic treatment or subtotal gastrectomy has been performed, whereas CT imaging is needed for distant metastasis according to baseline staging. After total gastrectomy, nutritional deficiencies evaluation and periodic CT for early detection of recurrence are essential.Gastric cancer is the third leading cause of cancer mortality worldwide and the fifth for incidence. In 2018, 1.033.701 new cases of gastric cancer were diagnosed and 782.665 people died for gastric cancer. Incidence rates are the highest in Eastern Asia and Eastern Europe, while the incidence rate is low in Northern Europe and Northern America with rates similar to Africa’s countries. If no interventions occur regarding screening strategies, incidence and mortality for gastric cancer are going to increase in the next years. Incidence will increase 36.2% in 2030 and 69.7% in 2040 with a total number of new cases of 1.758.810. The same will happen for deaths that will increase 37.7% in 2030 and 74.1% in 2040 with a total number of 1.366.121 of deaths. So, even though early recognition and treatment is possible in 2019 most cases are still being diagnosed at a late stage and most patients with gastric cancer will die of it (Bray et al., 2018)
Background: Gastric carcinogenesis progresses from normal mucosa, atrophic/metaplastic gastritis,... more Background: Gastric carcinogenesis progresses from normal mucosa, atrophic/metaplastic gastritis, and dysplasia to adenocarcinoma. MicroRNAs (miRNAs) regulate DNA expression and have been implicated; however, their role is not fully established. Aims: The aim of this study was to characterize plasma and tissue expression of several miRNAs in gastric carcinogenesis stages. Methods: Single-center cross-sectional study in 64 patients: 19 controls (normal mucosa); 15 with extensive atrophic/metaplastic gastritis; and 30 with early gastric neoplasia (EGN). Seven miRNAs (miR-21, miR-146a, miR-181b, miR-370, miR-375, miR 181b, and miR-490) were quantified by real time-qPCR in peripheral blood and endoscopic biopsy samples. Results: We found a significant upregulation of miR-181b, miR-490, and miR-21 in the EGN mucosa (overexpression 2–14-times higher than controls). We observed a significant underexpression of miR-146a and miR-370 in atrophic/metaplastic gastritis (86 and 66% decrease, p =...
European Journal of Gastroenterology & Hepatology, 2021
INTRODUCTION Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the main method for... more INTRODUCTION Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the main method for acquisition of tissue from gastrointestinal subepithelial lesions (SELs). Despite the development of new needles, diagnostic yield remains low. A new method of aspiration has been described, where the needle is filled with saline [wet-suction technique (WST)], with promising results in pancreatic lesions. This method has not been tested in SELs. AIMS AND METHODS Prospective single center study to assess the diagnostic yield of EUS-FNA+WST in the diagnosis of SELs, without the use of rapid on-site evaluation. In mesenchymal tumors, the diagnosis was considered positive only when immunohistochemistry could differentiate between gastrointestinal stromal tumor and leiomyoma. RESULTS Eighty-seven patients with SELs were included (55% male, mean age 66 years). Mean SEL size was 25 mm (min 10 mm, max 120 mm), mean number of passes was 3 (±0.8). A 22G needle was used in 72 patients (83%), 19G in 10 (12%) and 25G in 5 (6%). We obtained a conclusive cytopathological diagnosis in 74 cases (diagnostic yield of 85%) and immunohistochemistry was performed in 70 cases (81%). The most frequent diagnoses were gastrointestinal stromal tumor (n = 34, 37%), leiomyoma (n = 13, 15%) and metastases (n = 10, 11%). CONCLUSION Wet suction technique allowed an excellent diagnostic yield in the EUS-guided evaluation of SELs. We suggest that, after proper replication of these results, WST may become the first-line method in the management of these lesions.
Main RecommendationsThis manuscript represents an official Position Statement of the European Soc... more Main RecommendationsThis manuscript represents an official Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) aiming to guide general gastroenterologists to develop and maintain skills in optical diagnosis during endoscopy. In general, this requires additional training beyond the core curriculum currently provided in each country. In this context, ESGE have developed a European core curriculum for optical diagnosis practice across Europe for high quality optical diagnosis training.1 ESGE suggests that every endoscopist should have achieved general competence in upper and/or lower gastrointestinal (UGI/LGI) endoscopy before commencing training in optical diagnosis of the UGI/LGI tract, meaning personal experience of at least 300 UGI and/or 300 LGI endoscopies and meeting the ESGE quality measures for UGI/LGI endoscopy. ESGE suggests that every endoscopist should be able and competent to perform UGI/LGI endoscopy with high definition white light combined w...
Main RecommendationsThe European Society of Gastrointestinal Endoscopy (ESGE) has recognized the ... more Main RecommendationsThe European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize training in small-bowel endoscopy across European centers. The following criteria and framework for training in small-bowel capsule endoscopy (SBCE) and device-assisted enteroscopy (DAE), which aim to provide uniform and high quality training to ensure that small-bowel endoscopists are competent to operate independently, are based on the current literature and experience of experts in the field. Three main areas are covered: skills required prior to commencing training in small-bowel endoscopy; structured training for trainees to become independent endoscopists; and ways of ensuring competence is achieved. 1 Centers providing training in SBCE should perform a minimum of 75 – 100 SBCEs/year. 2 Experience in bidirectional endoscopies is desirable for structured training in SBCE. 3 SBCE courses should consist of at least 50 % hands-on training and cover information on tech...
Background Image-enhanced endoscopy (IEE) improves the accuracy of endoscopic diagnosis. We aimed... more Background Image-enhanced endoscopy (IEE) improves the accuracy of endoscopic diagnosis. We aimed to assess the value of IEE for gastric preneoplastic conditions and neoplastic lesions. Methods Medline and Embase were searched until December 2018. Studies allowing calculation of diagnostic measures were included. Risk of bias and applicability were assessed using QUADAS-2. Subgroup analysis was performed to explore heterogeneity. Results 44 studies met the inclusion criteria. For gastric intestinal metaplasia (GIM), narrow-band imaging (NBI) obtained a pooled sensitivity and specificity of 0.79 (95 %CI 0.72–0.85) and 0.91 (95 %CI 0.88–0.94) on per-patient basis; on per-biopsy basis, it was 0.84 (95 %CI 0.81–0.86) and 0.95 (95 %CI 0.94–0.96), respectively. Tubulovillous pattern was the most accurate marker to detect GIM and it was effectively assessed without high magnification. For dysplasia, NBI showed a pooled sensitivity and specificity of 0.87 (95 %CI 0.84–0.89) and 0.97 (95 %CI...
Background: Self-expanding metal stents (SEMS) have been used for the palliative treatment of mal... more Background: Self-expanding metal stents (SEMS) have been used for the palliative treatment of malignant gastrointestinal tract obstruction. However, restenosis or incomplete expansion of a first stent is a frequent complication, and the effectiveness of reintervention with placement of a second stent is still controversial. Objective: To evaluate the clinical outcomes of covered SEMS (cSEMS) placement after dysfunction of uncovered SEMS (uSEMS) by the stent-in-stent technique. Patients and Methods: We retrospectively studied a consecutive series of patients receiving palliative treatment for malignant gastrointestinal obstruction with cSEMS placement after uSEMS dysfunction in a tertiary center from January 2013 to August 2018. Technical and clinical success, time of patency, and adverse events were analyzed. Results: Twelve patients were included; their mean age was 60 ± 9 years. Eleven patients had gastric outlet obstruction, and 1 patient had compression of the transverse colon d...
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