Figure 2 - available via license: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
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Schema showing double-scope endoscopic submucosal dissection using 2 scopes inserted from different entrances, the anus and ileal stoma.
Context in source publication
Context 1
... used glycerin solution (glycerol; 10% glycerin with 0.9% NaCl plus 5% fructose) for injection fluid. Mucosal incision and submucosal dissection of the anal side of the lesion were made to form a mucosal flap using a transanal main endoscope (PCF-Q260J; Olympus, Tokyo, Japan) ( Figure 2). After the circumferential mucosal incision, the flap was grasped and pulled with forceps using another scope inserted from the ileal stoma (GIF-Q260J; Olympus). ...
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Citations
... We proved the potential efficacy of DS-ESD, with approximately 40% reduction in procedure time. DS-ESD has been proposed as a feasible method for improving traction with the assistance of force provided from a second scope in the upper GI tract and distal colon, 9,13,14 and our study showed that it is feasible to apply DS-ESD even in the proximal colon. Our novel snare-based traction also offers adjustable strong traction with less tissue tearing compared to the previous foreign body forceps-based traction. ...
Background:
Colorectal endoscopic submucosal dissection is technically demanding, and the traction offered by gravity, cap, or clip-with-line during conventional endoscopic submucosal dissection remains unsatisfactory. Robotic systems are still under development and are expensive. We proposed double-scope endoscopic submucosal dissection with strong and adjustable traction offered by snaring the lesion with additional scope.
Objective:
This study aimed to test the novel double-scope endoscopic submucosal dissection with snare-based traction.
Design:
This was a retrospective study that reviewed double-scope endoscopic submucosal dissection compared with matched conventional endoscopic submucosal dissection, and size, location, morphology, and pathology between groups were compared.
Settings:
This study was conducted in a referral endoscopy center in a local hospital.
Patients:
This study included patients with colorectal lesions receiving double-scope endoscopic submucosal dissection and matched conventional endoscopic submucosal dissection.
Main outcome measures:
The pathological completeness, procedure time, and complications were analyzed.
Results:
Fifteen double-scope endoscopic submucosal dissection procedures, with 11 lesions located in the proximal colon with a median size of 40 mm, were performed. The median procedure time of double-scope endoscopic submucosal dissection was 32.45 (interquartile range, 16.03-38.20) minutes. The time required for second scope insertion was 2.57 (interquartile range, 0.95-6.75) minutes; for snaring, 3.03 (interquartile range, 2.12-6.62) minutes; and for actual endoscopic submucosal dissection, 28.23 (interquartile range, 7.90-37.00) minutes. All lesions were resected completely. No major complication was encountered. The procedure time was significantly shorter than that of 14 matched conventional endoscopic submucosal dissections (54.61 [interquartile range, 33.11-97.25] min; p = 0.021).
Limitations:
This was a single-center, single-operator, retrospective case-controlled study with limited cases.
Conclusions:
This study confirmed the feasibility of double-scope endoscopic submucosal dissection with snare-based traction to shorten procedure time and to simplify endoscopic submucosal dissection. Additional trials are required.
Parasitic infections rank amongst the most significant causes of morbidity and mortality worldwide, yet economic and other factors have contributed to a lack of innovation in treating these maladies. Thus, understanding all biological factors associated to susceptibility and resistance have become highly relevant. The existence of sexual dichotomy has been well described in several parasites of medical relevance. Intriguingly, regulation of specific immune responses against parasites have been associated with sex hormones, particularly estradiol. Moreover, sex hormones can directly affect parasites, which in turn have developed different trans-regulatory mechanisms to exploit the hormonal microenvironment of its host. This interaction occurs via expression of membranal components similar to the hormonal receptors present in mammals. Interaction of host hormones with the parasitic membranal components impacts directly on growth, reproduction, viability, and infectivity of different parasites. In this chapter we will discuss specifically the role of estradiol in the regulation of the immune response of the host during parasitic infections and how estradiol affects parasite physiology. The chapter will focus mainly on parasites medically relevant in human health.
