Endoscopic full-thickness resection using a clip non-exposed method for gastrointestinal tract lesions: a meta-analysis

Background and study aims Endoscopic full-thickness resection (EFTR) allows for treatment of epithelial and sub-epithelial lesions (SELs) unsuitable to conventional resection techniques. This meta-analysis aimed to assess the efficacy and safety of clip-assisted method for non-exposed EFTR using FTRD or over-the-scope clip of gastrointestinal tumors. Methods A comprehensive literature search was performed. The primary outcome of interest was the rate of histologic complete resection (R0). Secondary outcomes of interest were the rate of enbloc resection, FTR, adverse events, and post-EFTR surgery. Random-effects model was used to calculate pooled estimates and generate forest plots. Results Eighteen studies with 730 patients and 733 lesions were included in the analyses. Indications for EFTR were difficult/residual colorectal adenoma, adenoma at a diverticulum or appendiceal orifice and early cancer (n = 634), colorectal SELs (n = 42), and upper gastrointestinal lesions (n = 51), other colonic lesions (n = 6). Median size of lesions was 13.5 mm. There were 22 failed EFTR attempts. Pooled overall R0 resection rate was 82 % (95 % CI: 75, 89). The pooled overall FTR rate was 83 % (95 % CI: 77, 89). The pooled overall enbloc resection rate was 95 (95 % CI: 92, 96). The pooled estimates for perforation and bleeding were < 0.1 % and 2 %, respectively. Following EFTR, a total of 110 patients underwent surgery for any reason [pooled rate 7 % (95 % 2, 14). The pooled rates for post-EFTR surgery due to invasive cancer, for non-curative endoscopic resection and for adverse events were 4 %, < 0.1 % and < 0.1 %, respectively. No mortality related to EFTR was noted. Conclusions EFTR appears to be safe and effective for gastrointestinal lesions that are not amenable to conventional endoscopic resection. This technique should be considered as an alternative to surgery in selected cases.

Odontogenic Myxoma of Maxilla

ABSTRACT Odontogenic myxoma (OM) is a locally aggressive, benign, slowgrowing tumor arising from mesenchyme and/or odontogenic epithelium. It is the third most common odontogenic tumor predominantly affecting females and posterior mandible. Radiographically, OM demonstrates unilocular or multilocular, well or ill-defined radiolucency showing ‘honeycomb’, ‘soap-bubble’ or ‘tennis-racket’ pattern with cortical expansion and tooth displacement. Histologically, OM shows loosely arranged stellate or spindle-shaped cells interspersed in myxoid matrix. Various treatment modalities, such as wide excision, enucleation and curettage, curettage with/without electrical or chemical cautery, enbloc resection and wide resection with/without immediate grafting can be considered based on the extent of the lesion. Here, we present a case of a 17-year-old female, with OM in the left maxilla and the maxillary sinus. How to cite this article Hosalkar RM, Patel S, Pathak J, Swain N. Odontogenic Myxoma of Maxilla. J Contemp Dent 2015;5(1):27-30.

Microsurgical enbloc resection of myxopapillary cauda equina ependymoma

Benign myxopapillary filum terminale ependymomas are often poorly encapsulated and in apposition the cerebrospinal fluid (CSF). These characteristics present the potential surgical risk of CSF dissemination or injury to the delicate cauda equina nerve roots. This video details the techniques of en bloc surgical resection of a filum terminale ependymoma. Treatment strategies and techniques are illustrated to reduce the risk of CSF dissemination and cauda equina injury.The video can be found here: http://youtu.be/LK8AYg-5T7o.