Captivator™ EMR Device - EndoSuite Learning Center

Captivator EMR Device
™
Clinical Article and Abstract Summary
›
Endoscopic Mucosal Resection
• ASGE:
Barrett’s Early
Cancer Guidelines
• Bergman et al:
EMR Training Tips
• Bergman et al:
EMR Learning Curve
• ASGE:
EMR Guidelines
• ASGE:
EMR & ESD Guidelines
• Bergman et al:
Captivator EMR vs Cook Duette™
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• Bergman et al:
Captivator EMR vs
Multiband Mucosectomy
Use of EMR as a Diagnostic Tool
• Elsadek & Radwan: Biopsy vs. EMR for Diagnostics
• Lin: Limitations of EUS, Benefits of EMR for Diagnostics
• Wang: Background & Benefits of EMR
• Waxman: Captivator EMR for Staging
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Over-use of Esophagectomy
• Bosworth: EMR, Surgical Alternative
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Pathology
• Morales: Importance of Flattening Specimens
Captivator ™ EMR
Endoscopic Mucosal Resection Device
Endoscopic Mucosal Resection
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Learning Endoscopic Resection in the Esophagus
Tap Here
– J.J.G.H.M. Bergman et al.
This study summarizes the most important learning points for EMR
encountered during a structured endoscopic resection training
program using Cook Duette.
Included in tips are:
• Importance of lesion visualization
• Delineating lesion by marking
• Complication management
• Pathology handling
Learning to Perform Endoscopic Resection of Esophageal
Neoplasia is Associated with Significant Complications
Even within a Structured Training Program
– J.J.G.H.M. Bergman et al.
Tap Here
EMR should be performed by trained endoscopists in centers with
multidisciplinary experience of endoscopic resection to ensure
adequate treatment of complications.
• G
reater than 20 endoscopic resections are needed to overcoming
learning curve of EMR.
• EMR is associated with a 5% perforation rate.
Endoscopic Mucosal Resection and Endoscopic
Submucosal Dissection
– ASGE
Tap Here
EMR has emerged as an important therapeutic option for
premalignant and early stage GI malignancies.
• E
MR techniques aid in the diagnosis and therapy of subepithelial
lesions localized to the muscularis mucosa or submucosa. This
report focuses on instruments, injection solutions, and techniques
currently used during EMR and ESD.
Endoscopic Mucosal
Resection
Use of EMR as a
Diagnostic Tool
Over-use of
Esophagectomy
Pathology
Captivator ™ EMR
Endoscopic Mucosal Resection Device
Endoscopic Mucosal Resection
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In Vitro Assessment of the Performance of a New Multiband
Mucosectomy Device for Endoscopic Resection of Early
Upper Gastrointestinal Neoplasia
Tap Here
– J.J.G.H.M. Bergman et al.
Captivator EMR has many advantages over Cook Duette.
• C
ompared to the Cook Duette Device, the Captivator EMR Device
is associated with improved endoscopic visibility, smoother passage
of endoscopic devices, and marginally improved suction power.
The Role of Endoscopy in Barrett’s Esophagus and Other
Premalignant Conditions of the Esophagus
– ASGE
Tap Here
EMR as an eradication technique for high grade dysplasia and early
adenocarcinoma is successful in 91% to 98% of T1a cancers.
• T
his guideline discusses the role of endoscopy in the
management of premalignant conditions of the esophagus
including recommendations of when to use EMR.
Endoscopic Mucosal
Resection
Use of EMR as a
Diagnostic Tool
Over-use of
Esophagectomy
Pathology
Captivator ™ EMR
Endoscopic Mucosal Resection Device
Endoscopic Mucosal Resection
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Endoscopic Mucosal Resection
Tap Here
– ASGE
EMR was developed for minimally invasive, organ-sparing
endoscopic removal of benign and early malignant lesions in
the GI tract.
• T
his report focuses on instruments, injection solutions, and
techniques currently used for EMR.
Randomized Trial on Endoscopic Resection-cap vs.
Multiband Mucosectomy for Piecemeal Endoscopic Resection
of Early Barrett’s Neoplasia
Tap Here
– J.J.G.H.M. Bergman et al.
Multiband mucosectomy (MBM) is preferred over Cap EMR
(Olympus) for early Barrett’s neoplasia.
• Injection for submucosal lifting prior to MBM does not
decrease risk of bleeding or perforation.
• 40% of patients undergoing MDM had intraprocedural bleeds
that were successfully treated endoscopically. No delayed
bleeds were reported.
Endoscopic Mucosal
Resection
Use of EMR as a
Diagnostic Tool
Over-use of
Esophagectomy
Pathology
Captivator ™ EMR
Endoscopic Mucosal Resection Device
Use of EMR as a Diagnostic Tool
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Diagnostic Accuracy of Mucosal Biopsy vs
Endoscopic Mucosal Resection in Barrett’s Esophagus
and Related Superficial Lesions
– Hany M. Elsadek and Mamdouh M. Radwan
Tap Here
EMR is crucial before proceeding to endoscopic ablation therapy or
surgery. Standard biopsies are not sufficient for accurate diagnosis
and classification of dysplasia and neoplasia in the esophagus in
patients with BE and its related superficial esophageal lesions.
• A
n “upgrading” diagnosis was made by EMR (i.e., a higher
degree of dysplasia or neoplasia than that diagnosed with biopsy)
in 18 cases (37.5%)
• A “downgrading” diagnosis was made by EMR (i.e., a lower
degree of dysplasia or neoplasia than that diagnosed with biopsy)
in two cases (4.17%).
T1 esophageal Cancer, Request an Endoscopic Mucosal
Resection (EMR) for In-Depth Review
Tap Here
– James L. Lin
The role of EUS in clinical decision making of early stage esophageal
adenocarcinoma is questioned. EMR provides accurate staging data
and provided information for patient management.
• D
espite a normal EUS, after EMR 25 out of the 105 patients had
risk factors for lymph node metastasis that would have been
missed without corresponding histology resulting in “undertreatment”.
• Conversely in the 26 patients who had an EUS suggestive of
submucosal invasion or lymph node metastasis, EMR revealed
no risk factors for lymph node metastasis in 10 of these patients.
Referral to surgery based on the EUS findings would have
subjected these patients to “over-treatment”.
Endoscopic Mucosal
Resection
Use of EMR as a
Diagnostic Tool
Over-use of
Esophagectomy
Pathology
Captivator ™ EMR
Endoscopic Mucosal Resection Device
Use of EMR as a Diagnostic Tool
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Endoscopic Mucosal Resection in the Management of
Esophageal Neoplasia: Current Status and Future Directions
– Vikneswaran Namasivayam, MBBS, Kenneth K. Wang, MD,
and Ganapathy A Prasad, MD, MS
Tap Here
EMR is curative for lesions restricted to the mucosa and may be
considered in selected patients with submucosal disease and no
lymphovascular invasion.
• L
ong term outcomes of subjects treated with EMR alone or in
combination with ablative techniques appear to be comparable
to those treated with esophagectomy.
• EMR has 94-96% complete remission rates for HGD and
intramucosal adenocarcinoma.
• The findings on EMR changes the eventual management by
upstaging the grade of dysplasia originally seen on biopsy in as
much as 34%.
• Overall complication rate of EMR is 13-17%. The most common
complications are bleeding, strictures, and perforation. Serious
complications are rare.
Endoscopic Mucosal Resection
– Jennifer Chennat and Irving Waxman
Tap Here
EMR is the only endoscopic modality which serves the dual
function of curative potential and provision of more accurate
histo-logical staging.
• E
MR resulted in a 45% rate of upstaging or downstaging of
final BE neoplasia histology when comparing pre-EMR biopsies
with resection specimens
Endoscopic Mucosal
Resection
Use of EMR as a
Diagnostic Tool
Over-use of
Esophagectomy
Pathology
Captivator ™ EMR
Endoscopic Mucosal Resection Device
Over-use of Esophagectomy
Endoscopic Mucosal Resection Equivalent to Esophagectomy
for Patients with Early Esophageal Cancer
Tap Here
– Ted Bosworth
74% of patients who could have had an EMR got an
esophagectomy.
• 1
,098 patients meeting the definition of early esophageal
adenocarcinoma were treated between 1998 and 2009.
• Of these, 283 (26%) underwent endoscopic therapy, usually in
the form of EMR, as their first procedure.
• The remainder of the patients were initially treated with surgical
resection. Most of these patients received total esophagectomy
with partial gastrectomy.
Endoscopic Mucosal
Resection
Use of EMR as a
Diagnostic Tool
Over-use of
Esophagectomy
Pathology
Captivator ™ EMR
Endoscopic Mucosal Resection Device
Pathology
A Simple Tissue-Handling Technique Performed in the
Endoscopy Suite Improves Histologic Section Quality and
Diagnostic Accuracy for Serrated Polyps
– Shannon John Morales, Carol A. Bodian, Susan Kornacki, et al.
Tap Here
Flattening specimens leads to improved pathology reads compared
to only dropping in formalin.
• F
lattening specimen resulted in a decrease in requests from
pathologist for deeper tissue sections from 31.8% to 11.1 %.
• Flattening specimens increased the diagnosis rate from 40.3%
to 75.6 %.
• Flattening specimens increased inter-pathologist concordance
on diagnosis from 62.8% to 77.0 %
Endoscopic Mucosal
Resection
Use of EMR as a
Diagnostic Tool
Over-use of
Esophagectomy
Pathology
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ENDO-364305-AA January 2016