New MethodUse of modified multiband ligator facilitates circumferential EMR in Barrett's esophagus (with video)
Section snippets
Patients and methods
The modification of the MBL (Wilson-Cook Medical Inc, Winston-Salem, NC) consists simply in widening the threading channel of the cranking device from 2 to 3.2 mm (Fig. 1). This allows for the insertion of a 7F catheter through the threading channel of the cranking device into the 3.7-mm working channel of the endoscope (GIF1T 140/160; Olympus Optical Co, Ltd, Tokyo, Japan). Band ligation can be performed with the polypectomy snare still within the working channel without any increased friction
Results
During a period of 6 months, a total of 10 consecutive patients were treated with the new MBL-EMR technique. All were men, with ages ranging from 43 to 82 years (median, 64 years). All patients had circumferential Barrett's segment with a length of 2 to 10 cm (median, 4 cm). In the initial biopsy before EMR, IMC was found in 8 cases and HGIN was found in two cases. No multifocal lesions were diagnosed.
In 5 of 10 patients, circumferential EMR was accomplished in one session by using 3 to 18
Discussion
In the last decade, various techniques of EMR have been introduced, mainly for early gastric cancer. The “strip biopsy,” initially performed as a biopsy in the stomach by Tada et al,23 was the first reported EMR method. This “lift and cut” technique with a double-channel endoscope was the most commonly used EMR method in Japan until 1998.24 The “suck and cut” technique with the transparent cap was popularized by Inoue et al.17 The en bloc resection method with an IT (insulation-tipped
References (29)
- et al.
Endoscopic mucosal resection of early cancer and high grade dysplasia in Barrett's esophagus
Gastroenterology
(2000) - et al.
Jumbo biopsy protocol still misses unsuspected cancer in Barrett's esophagus with high-grade dysplasia
Gastrointest Endosc
(1999) - et al.
Comparison of methylene blue-directed biopsies and conventional biopsies in the detection of intestinal metaplasia and dysplasia in Barrett's esophagus: a preliminary study
Gastrointest Endosc
(2001) - et al.
Prospective randomized controlled trial of argon plasma coagulation ablation vs. endoscopic surveillance of patients with Barrett's esophagus after antireflux surgery
Gastrointest Endosc
(2004) - et al.
Photodynamic therapy for Barrett's esophagus with dysplasia and/or early stage carcinoma: long-term results
Gastrointest Endosc
(2003) - et al.
Circumferential EMR and complete removal of Barrett's epithelium: a new approach to management of Barrett's esophagus containing high-grade intraepithelial neoplasia and intramucosal carcinoma
Gastrointest Endosc
(2003) - et al.
A new endoscopic technique for the resection of flat polypoid lesions
Gastrointest Endosc
(1994) - et al.
Tissue band ligation followed by snare resection (band and snare): a new technique for tissue acquisition in the esophagus
Gastrointest Endosc
(1996) - et al.
A prospective randomized trial of two different endoscopic resection techniques for early stage cancer of the esophagus
Gastrointest Endosc
(2003) - et al.
Endoscopic resection of early gastric cancer
Endoscopy
(1993)
Endoscopic resection of early gastric carcinoma: results of a retrospective analysis of 308 cases
Endoscopy
Endoscopic mucosal resection for early esophageal cancer: standard indications
Endoscopia Digestiva
Is endoscopic one-piece mucosal resection essential for early gastric cancer?
Dig Endosc
Local endoscopic therapy for intraepithelial high-grade neoplasia and early adenocarcinoma in Barrett's oesophagus: acute-phase and intermediate results of a new treatment approach
Eur J Gastroenterol Hepatol
Cited by (132)
Endoscopic Resection of Gastric Cancer
2021, Gastrointestinal Endoscopy Clinics of North AmericaRisk factors for serious adverse events associated with multiband mucosectomy in Barrett's esophagus: an international multicenter analysis of 3827 endoscopic resection procedures
2020, Gastrointestinal EndoscopyCitation Excerpt :MBM is the most commonly used technique for ER in BE, and most of these procedures are performed using the Duette device. A reliable estimation of potentially serious adverse events after MBM, such as perforation or postprocedural bleeding, is lacking because the incidence of these adverse events is low and only small studies describing the safety of MBM are available.2-7 Robust safety data of MBM in BE are, however, of great importance because the Duette device is part of the toolbox of most interventional endoscopists.
Management of Barrett's esophagus: From screening to newer treatments
2016, Revista de Gastroenterologia de Mexico
See CME section; p. 835.