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Total neoadjuvant therapy: Less surgery?

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Total neoadjuvant therapy: Less surgery?

Quentin Denost 1

1 CHU de Bordeaux, Centre Medico-chirurgical Magellan, Pessac, France

Event

UEG Week Copenhagen 2023

Topics

Colorectal Digestive Oncology Endoscopy Mechanisms & Personalised Medicine Standards & Guidelines Surgery

Session

What's new in oncology in 2023?

Published

2023

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Summary: Into the depths! Guiding minimally-invasive management of small-bowel pathology

Andrea Laghi 1

1 Sapienza - University of Rome, Rome, Italy

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Endoscopy Radiology & Imaging Small Intestine & Nutrition

Session

Into the depths! Guiding minimally-invasive management of small-bowel pathology

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Evolution of acute necrotising pancreatitis: Imaging, clinical decision-making, and management of complications

Andrea Anderloni 1, Thomas L. Bollen 2

1 San Matteo Hospital, Pavia, Italy

2 St. Antonius Ziekenhuis, Nieuwegein, Netherlands

Event

UEG Postgraduate Teaching Programme Berlin 2025

Session

A 360-degree appraisal of acute pancreatitis

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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... for medical therapy in colorectal cancer

Sebastian Foersch 1

1 University Medical Center Mainz, Mainz, Germany

Event

UEG Week Berlin 2025

Topics

Colorectal IBD Surgery

Session

Predicting patient outcomes...

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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ENDOSCOPIC SELF-EXPANDABLE METAL STENT VERSUS ENDOSCOPY VACUUM THERAPY FOR TRAUMATIC OESOPHAGEAL PERFORATIONS: THE FORTAL RANDOMISED DOUBLE-BLIND CONTROLLED COMPARATIVE EFFECTIVENESS TRIAL

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Introduction

Oesophageal injuries and perforations are transmural ruptures of the oesophagus that subsequently lead to leakage of intraluminal contents into the surrounding mediastinum. This causes local inflammation, a systemic inflammatory response, and eventually the development of sepsis, resulting in significant morbidity and mortality.

Aims & Methods

This study aimed to compare oesophageal self-expandable metal stent (E-SEMS) with endoscopic vacuum therapy (EVT) in oesophageal perforations (EP) treatment. We randomly evaluated 30 patients with traumatic EP. The E-SEMS and EVT groups were assessed for treatment duration, duration of hospitalisation, LOS (length of stay), clinical outcomes, and treatment success.

Results

In both groups, the most common cause of injury was a foreign body 63.3% (19/30), followed by gunshot wounds 30.0% (9/30) and stab wounds 6.7% (2/30). The treatment duration for E-SEMS (45.8±12.9) was significantly longer than EVT (24.42±13.21), p<0.005. Evaluating the clinical results, E-SEMS demonstrated a 93.75% (15/16) discharge rate compared to EVT which showed 71.4% (10/14). Deaths occurred in the E-SEMS and EVT groups at rates of 6.3% (01/16) and 28.6% (04/14) respectively, p=0.1571. Treatment success showed no significant difference between E-SEMS 93.7% (15/16) and EVT 78.6% (11/14), p=0.3155. The costs were calculated at €19,266.08±10,925.00 for E-SEMS and €38,453.17±23,840.40 for EVT, respectively.

Conclusion

E-SEMS had a longer treatment duration compared to EVT. Both therapies showed no significant difference in clinical outcome and treatment success. The overall cost was lower for E-SEMS compared to EVT.

Disclosure

Alessandrino Terceiro de Oliveira, Amanda Cyntia Lima Fonseca Rodrigues, José Wilson da Cunha Parente Júnior, José Ruver Lima Herculano Junior, Jeany Borges e Silva Ribeiro, Orleancio Gomes Ripardo de Azevedo, and Paulo Roberto Cavalcante de Vasconcelos have no conflicts of interest.

ENDOSCOPIC SELF-EXPANDABLE METAL STENT VERSUS ENDOSCOPY VACUUM THERAPY FOR TRAUMATIC OESOPHAGEAL PERFORATIONS: THE FORTAL RANDOMISED DOUBLE-BLIND CONTROLLED COMPARATIVE EFFECTIVENESS TRIAL

Alessandrino Terceiro de Oliveira 1, Amanda Cyntia Lima Fonseca Rodrigues 2, Jose Wilson da Cunha Parente Júnior 3, Jose Ruver Lima Herculano Junior 1, Jeany Borges e Silva Ribeiro 4, Orleancio Gomes Ripardo de Azevedo 5, Paulo Roberto Cavalcante de Vasconcelos 5

1 General Hospital of Fortaleza, Fortaleza, Brazil

2 Positivo University, Curitiba, Brazil

3 Instituto Dr. Jose Frota, Fortaleza, Brazil

4 Federal University of Piaui, Teresina, Brazil

5 Federal University of Ceara, Fortaleza, Brazil

Event

UEG Week Copenhagen 2023

Topics

Endoscopy Oesophagus

Submission format

Late-Breaking Abstract

Session

Advances in endoscopy: Late-breaking abstracts

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Diagnosis and management of specific gestational liver disorders

Christophe Moreno 1

1 Hôpital Erasme (gastro) - Hôpital Erasme (gastro); Maransart/BE, Brussels, Belgium

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Hepatobiliary Paediatrics

Session

Liver and pregnancy: Beware of dangerous liaisons

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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DISTINCTIVE ASPECTS OF DEPRESSED TYPE OF COLORECTAL NEOPLASMS OBSERVED IN MAGNIFYING ENDOSCOPY AND ENDOCYTOSCOPY

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Introduction

At present, there are three developmental pathways for colorectal cancers, namely, the adenoma-carcinoma sequence, serrated pathway, and de novo pathway. The adenomatous route of colorectal cancer carcinogenesis has been extensively reviewed in the literature. Conversely, the de novo pathway, which leads depressed type polyps to colorectal cancer, lacking an adenomatous phase, recently has garnered increasing attention. Research has indicated that nonpolypoid lesions demonstrate a greater potential for malignancy, underscoring the need for their early detection. This study aims to explore the endoscopic characteristics of depressed type colorectal neoplasms by using magnifying endoscopy (pit pattern classification) and endocytoscopy (EC classification). Both the structural and cellular atypias can be observed in vivo, thus enabling more comprehensive evaluation of the disease.

Aims & Methods

A total of 40719 colorectal neoplasms resected endoscopically or surgically in our institution from April 2001 to June 2022 were subject of this study. Advanced cancers were excluded. Of these, 1463 lesions were submucosally invasive (T1) carcinomas, 6839 lesions were high-grade dysplasia and 32417 lesions were characterized as low-grade dysplasia. Morphologically, they were divided into 3 types: depressed, flat and protruded type comprising 1.2%, 42.9% and 55.9%, respectively. Specifically, the distinctive features of depressed type neoplasms concerning its pit pattern and EC classification were examined.

Results

Most of the flat (93.3%) and protruded type (94.7%) lesions showed type III _L or IV pit pattern, which are common findings in adenomas.On the other hand, most of the depressed type lesions(92.4%) classified by type III s, V_Ior V _N pit patterns, are typically seen in carcinomas. As for endocytoscopy, most of the flat and protruded type lesions were identified as EC2 corresponding to adenomas. In contrast, a relatively high rate of depressed type lesions was categorized as EC3a (40.0%) and EC3b (52.0%), consistent with invasive carcinomas. The proportion of T1 carcinomas in depressed type lesions was 61.3%, whereas in the flat and protruded type lesions it was 2.9% and 2.9%, respectively. Also, 10% of lesions less than 5mm in diameter were depressed, 0.01% were flat and 0% were protruded.

Conclusion

This investigation has revealed that depressed lesions can be classified in magnifying endoscopy as type III s, V I or V N pit patterns, and as types EC3a or EC3b in endocytoscopy. Lesions that have these features or these pit patterns also have a propensity to invade the submucosal layer even when they are small in size. Despite their elevated malignant potential, depressed type lesions are frequently disregarded, underscoring the critical importance of recognizing their distinctive features and accurately diagnosing lesions based on their morphology, pit pattern, and EC classification.