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Journals Best Practice & Research. Clin...

Best Practice & Research. Clinical Gastroenterology

https://read.qxmd.com/read/38749584/the-contribution-of-eus-to-the-management-of-endoscopic-and-surgical-complications
#1
REVIEW
N Tehami, K Kaushal, B Maher
Endoscopic Ultrasound (EUS) stands as a remarkable innovation in the realm of gastroenterology and its allied disciplines. EUS has evolved to such an extent that it now assumes a pivotal role in both diagnosis and therapeutics. In addition, it has developed as a tool which is also capable of addressing complications arising from endoscopic and surgical procedures. This minimally invasive technique combines endoscopy with high-frequency ultrasound, facilitating, high-resolution images of the gastrointestinal tract and adjacent structures...
March 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38749583/prevention-of-delayed-bleeding-after-resection-of-large-colonic-polyps
#2
REVIEW
Hein Htet, Gaius Longcroft-Wheaton
A significant problem encountered in the resection of large, complex colonic polyps is delayed bleeding. This can occur up to two weeks after the procedure and is a significant source of comorbidity. Untreated it can prove life threatening. It is therefore a priority of modern endoscopy to develop and employ techniques to minimaize this. In this article we will review and discuss the evidence base and controversies in this field, with cold EMR technique, Post-EMR clip closure, and topical haemostatic agents...
March 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38749582/prevention-of-post-ercp-complications
#3
REVIEW
Lotfi Triki, Andrea Tringali, Marianna Arvanitakis, Tommaso Schepis
Endoscopic retrograde cholangiopancreatography (ERCP) is a common endoscopic procedure which plays a key role in the management of diseases of the bile ducts and the pancreas. Despite ERCP being performed routinely since more than 4 decades, it is still related to a considerable rate of complications with post-ERCP pancreatitis being the most frequent one. Lately, endoscopic techniques have evolved, and numerous modalities have been developed to prevent or manage ERCP-related complications, especially PEP, such as the use of intra-rectal non-steroidal anti-inflammatory drugs (NSAIDs), insertion of prophylactic stents in the pancreatic duct (PD) or intravenous hyperhydration...
March 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38749581/management-of-perforations-during-endoscopic-resection
#4
REVIEW
Ludovico Alfarone, Marco Spadaccini, Alessandro Repici, Cesare Hassan, Roberta Maselli
Despite the evolution in tools and techniques, perforation is still one of the most pernicious adverse events of therapeutic endoscopy with potentially huge consequences. As advanced endoscopic resection techniques are worldwide spreading, endoscopists must be ready to manage intraprocedural perforations. In fact, immediate endoscopic closure through a prompt diagnosis represents the first-line option, saving patients from surgery, long hospitalizations and worse outcomes. Traditional and novel endoscopic closure modalities, including clips, suturing devices, stents and vacuum therapy, are increasingly expanding the therapeutic armamentarium for closing these defects...
March 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38749580/preface-to-special-edition-the-management-of-gi-endoscopy-complications
#5
EDITORIAL
Gaius Longcroft-Wheaton, Pradeep Bhandari
No abstract text is available yet for this article.
March 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38749579/endoscopic-management-of-intraprocedural-bleeding-during-endoscopic-interventions
#6
REVIEW
Ali A Alali, Asma A Alkandari
Endoscopic resection techniques have evolved over time, allowing effective and safe resection of the majority of pre-malignant and early cancerous lesions in the gastrointestinal tract. Bleeding is one of the most commonly encountered complications during endoscopic resection, which can interfere with the procedure and result in serious adverse events. Intraprocedural bleeding is relatively common during endoscopic resection and, in most cases, is a mild and self-limiting event. However, it can interfere with the completion of the resection and may result in negative patient-related outcomes in severe cases, including the need for hospitalization and blood transfusion as well as the requirement for radiological or surgical interventions...
March 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38749578/the-endoscopic-management-of-oesophageal-strictures
#7
REVIEW
Benjamin Charles Norton, Apostolis Papaefthymiou, Nasar Aslam, Andrea Telese, Charles Murray, Alberto Murino, Gavin Johnson, Rehan Haidry
An oesophageal stricture refers to a narrowing of the oesophageal lumen, which may be benign or malignant. The cardinal feature is dysphagia, and this may result from intrinsic oesophageal disease or extrinsic compression. Oesophageal strictures can be further classified as simple or complex depending on stricture length, location, diameter, and underlying aetiology. Many endoscopic options are now available for treating oesophageal strictures including dilatation, injectional therapy, stenting, stricturotomy, and ablation...
March 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38749577/endoscopic-management-of-surgical-complications
#8
REVIEW
Mayank Goyal, Anmol Bains, Yadwinder Singh, Fnu Deepali, Anmol Singh, Shubham Sood, Navtej S Buttar
While the endoscopic management of surgical complications like leaks, fistulas, and perforations is rapidly evolving, its core principles revolve around closure, drainage, and containment. Effectively managing these conditions relies on several factors, such as the underlying cause, chronicity of the lesion, tissue viability, co-morbidities, availability of devices, and expertise required to perform the endoscopy. In contrast to acute perforation, fistulas and leaks often demand a multimodal approach requiring more than one session to achieve the required results...
March 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38749576/management-of-ercp-complications
#9
REVIEW
Partha Pal, Mohan Ramchandani
Managing complications of ERCP poses a significant clinical challenge to endoscopists. ERCP complications can occur even after all preventive measures, which can lead to significant morbidity and even mortality. Major complications include pancreatitis, bleeding, perforation, cholangitis, and sedation-related adverse events. Early recognition of post-ERCP pancreatitis (PEP) is feasible by monitoring clinical parameters and specific cutoffs of serum amylase and lipase at 2-6 h post-ERCP. Pancreatic stenting for PEP is not recommended and can increase the incidence of infected necrosis in addition to being technically challenging...
March 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38749575/complications-and-management-of-interventional-endoscopic-ultrasound-a-critical-review
#10
REVIEW
Carlo Fabbri, Davide Scalvini, Giuffrida Paolo, Cecilia Binda, Aurelio Mauro, Chiara Coluccio, Stefano Mazza, Margherita Trebbi, Francesca Torello Viera, Andrea Anderloni
In the last decades, Endoscopic ultrasound (EUS) has rapidly grown and evolved from being mainly a diagnostic procedure, to being an interventional and therapeutic tool in several pathological clinical scenarios. With the progressive growth in technical expertise and dedicated devices, interventional endoscopic ultrasound procedures (IEUSP) have shown high rates of technical and clinical success, together with a relatively safe profile. However, the description and the standardization of different and specific types of adverse events (AEs) are still scarce in literature, and, consequently, even less the management of AEs...
March 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38522892/multimodal-cancer-treatment-with-endoscopy
#11
EDITORIAL
Michal F Kaminski, Nastazja Dagny Pilonis
No abstract text is available yet for this article.
February 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38522891/management-of-high-risk-t1-gastric-adenocarcinoma-following-endoscopic-resection
#12
REVIEW
Jéssica Chaves, Diogo Libânio, Pedro Pimentel-Nunes
Endoscopic submucosal dissection has revolutionized the treatment of early gastric cancer. However, cases that do not meet the curability criteria have a higher risk of lymph node metastasis and salvage surgery is still considered the next treatment approach to increase the chance of cure. Nevertheless, not all high-risk resections entail the same level of risk, emphasizing the utmost importance of individualized stratification for further treatment. In this review, we aim to examine the current evidence concerning the management following a high-risk non-curative resection, highlighting the existing approaches, while also presenting upcoming strategies that attempt to improve patient outcomes, minimize adverse events, and provide a tailored management...
February 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38522890/multimodal-treatment-with-endoscopic-ablation-and-systemic-therapy-for-cholangiocarcinoma
#13
REVIEW
Zaheer Nabi, Michał Żorniak, D Nageshwar Reddy
Cholangiocarcinoma (CCA) are primary malignancies of biliary system and usually unresectable at the time of diagnosis. As a consequence, majority of these cases are candidates for palliative care. With the advances in chemotherapeutic agents and multidisciplinary care, the survival rate has improved in cases with inoperable malignant biliary obstruction. As a consequence, there is a need to provide effective and durable palliative care in these patients. The main role of endoscopic palliation in the vast majority of CCA includes biliary stenting for obstructive jaundice...
February 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38522889/endoscopic-resection-of-residual-rectal-neoplasia-after-definitive-chemoradiotherapy-for-rectal-cancer
#14
REVIEW
Robert Klimkowski, Jakub Krzyzkowiak, Nastazja Dagny Pilonis, Krzysztof Bujko, Michal F Kaminski
The conventional approach to treating locally advanced rectal cancer, commonly defined as cT3 or cT4 primary tumors or with nodal metastases, involves chemoradiation (CRT) followed by surgical resection. There is a growing recognition of the potential for nonsurgical management following CRT or total neoadjuvant therapy (TNT), which allows for organ preservation. "Watch and wait" strategy may be considered if complete clinical response is achieved. In cases when adenoma or superficial cancer is present, a novel approach known as "salvage endoscopic resection of the residual disease" is emerging as a viable nonsurgical option for carefully selected patients...
February 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38522888/management-after-non-curative-endoscopic-resection-of-t1-rectal-cancer
#15
REVIEW
Hao Dang, Daan A Verhoeven, Jurjen J Boonstra, Monique E van Leerdam
Since the introduction of population-based screening, increasing numbers of T1 rectal cancers are detected and removed by local endoscopic resection. Patients can be cured with endoscopic resection alone, but there is a possibility of residual tumor cells remaining after the initial resection. These can be located intraluminally at the resection site or extraluminally in the form of (lymph node) metastases. To decrease the risk of residual cells progressing towards more advanced disease, additional treatment is usually needed...
February 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38522887/curative-criteria-for-endoscopic-treatment-of-oesophageal-squamous-cell-cancer
#16
REVIEW
Toshiro Iizuka
Endoscopic treatment of early oesophageal squamous cell carcinoma is widely accepted. ESD (Endoscopic Submucosal Dissection), which allows en bloc resection regardless of size, provides resected specimens that facilitate histological evaluation of curability. In the histological investigation, the determination of tumor depth, lymphovascular involvement, and lateral and vertical margins play a great role in the assessment of curability. The diagnosis of lymphovascular invasion, in particular, is enhanced by the addition of immunostaining...
February 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38522886/management-of-non-curative-endoscopic-resection-of-t1-colon-cancer
#17
REVIEW
Linn Bernklev, Jens Aksel Nilsen, Knut Magne Augestad, Øyvind Holme, Nastazja Dagny Pilonis
Endoscopic resection techniques enable en-bloc resection of T1 colon cancers. A complete removal of T1 colon cancer can be considered curative when histologic examination of the specimens shows none of the high-risk factors for lymph nodes metastases. Criteria predicting lymph nodes metastases include deep submucosal invasion, poor differentiation, lymphovascular invasion, and high-grade tumor budding. In these cases, complete (R0), local endoscopic resection is considered sufficient as negligible risk of lymph nodes metastases does not outweigh morbidity and mortality associated with surgical resection...
February 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38522885/multimodal-management-of-foregut-neuroendocrine-neoplasms
#18
REVIEW
Yichan Zhou, James Weiquan Li, Noriya Uedo
The foregut, which includes the esophagus, stomach and duodenum, represents one of the most common sites for neuroendocrine neoplasms. These are highly heterogenous with different risk of progression depending on location, cell-type of origin, size, grade and other factors. Various endoscopic and imaging modalities exist to inform therapeutic decision-making, which may be in the form of surgical or endoscopic resection and medical therapy depending on the extent of the disease after diagnostic evaluation. This narrative review aims to explore the literature on the multimodal management of such foregut neuroendocrine neoplasms...
February 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38522884/curative-criteria-for-endoscopic-treatment-of-oesophageal-adenocarcinoma
#19
REVIEW
Annemijn D I Maan, Prateek Sharma, Arjun D Koch
The incidence of oesophageal adenocarcinoma has been increasing rapidly in the Western world. A well-known risk factor for developing this type of tumour is reflux disease, which can cause metaplasia from the squamous cell mucosa to columnar epithelium (Barrett's Oesophagus) which can progress to dysplasia and eventually adenocarcinoma. With the rise of the incidence of oesophageal adenocarcinoma, research on the best way to manage this disease is of great importance and has changed treatment modalities over the last decades...
February 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38522883/endoscopic-resection-for-residual-oesophageal-neoplasia-after-definitive-chemoradiotherapy
#20
REVIEW
Judith Honing, Arjun D Koch, Peter D Siersema, Manon Spaander
Definitive chemoradiation is the recommended treatment for locally advanced, irresectable oesophageal cancer and a valid alternative to neoadjuvant chemoradiotherapy (CRT) with surgery in oesophageal squamous cell cancer (OSCC) patients. In case of locoregional recurrence, salvage treatment can be considered in fit and resectable patients. Salvage surgery is a valid option but associated with significant morbidity. Therefore, for tumors confined to the mucosa or submucosal layers endoscopic resection is a good and less-invasive alternative...
February 2024: Best Practice & Research. Clinical Gastroenterology
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