The patient was referred Erastin for repeat attempt at endoscopic closure of the leak. An endoscopic suturing device was adjusted over the therapeutic endoscope and the needle was loaded outside the patient. The scope was advanced through an over-tube. The esophageal and gastric lumen were defined and the lower border of the defect was identified. This tissue was puctured with the needle to thread the suture. Once secure, the scope was rotated in order to approach the opposite border of the defect. The needle was reloaded and a second “bite” was taken inorder to complete
the stitch. Once both sides had been sutured, the defect borders were approximated by exerting significant tension on the sutures external to the endoscope. The suture was then cut and the end of the suture released with a tag attachement that secured it in place. Examination of the defect demonstrated closure. We then proceeded to place a covered metal esophageal stent, and this was sutured to the mucosa utilizing the suturing device. Stent migration is a common complication of intraluminal stents. Placing sutures is shown here to be a safe and effective strategy in the prevention of Ion Channel Ligand Library stent migration. Endoscopic suturing may also prove to be helpful in correcting transluminal defects. “
“During endoscopic submucosal dissection (ESD), bleeding is unavoidable and can be a major obstacle to successful resection.
The laser system would be able to perform precise tissue resection with simultaneous hemostasis.The
patient was 74-years old male. He was referred to our hospital for endoscopic resectipn of early gastric cancer. The lesion was 1.5 cm, 0-IIa, located at anterior wall of antrum. A laser system was used for all endoscopic procedures including marking, mucosal incision, submucosal dissection and hemostasis. Histone demethylase A flexible laser fiber, rather than electrosurgical endoknives, was inserted through the working channel of the endoscope. All procedures were completed without complications. The laser system is a safe and feasible method that minimizes immediate bleeding during ESD of gastric neoplasia. Our promising preliminary results warrant further clinical evaluation of this laser for therapeutic GI endoscopy. “
“Subepithelial tumors (SETs) are encountered in 1/200 upper endoscopies. They may represent neoplasms, most commonly GISTs. All GISTs are potentially malignant and, since risk stratification is dependent on size and mitotic rate, conventional evaluation of SETs includes endoscopic sampling via EUS guided FNA/core biopsy, “well” biopsies or removal of the overlying mucosa followed by deep tumor sampling. These conventional methods only provide sufficient tissue for definitive diagnosis in about 75% of cases and rarely if ever do they provide sufficient tissue for mitotic rate assessment. Therefore, NCCN and other guidelines recommend surgical resection of all SETs that are known or suspected GISTs ≥ 2 cm and lifelong endoscopic surveillance of those <2 cm.